Raw Sum Research Articles

A measurement scale for material deprivation: A model‐based approach

The prevailing practice of defining classes of material deprivation based on the raw sum of a relatively small number of binary items has obvious advantages in terms of communication and ease of use. Do two people with the same raw score always have the same level of deprivation? This paper examines the methodological foundations of the raw score, comparing classical test theory with model‐based test theory such as Rasch measurement and item response theories. After discussing the merits and limitations of the different approaches, the paper legitimizes the raw score when the assumptions of the Rasch model are met. Based on the analytical procedure of the Rasch model and using the pre‐Covid data from the Survey on Income and Living Conditions, the paper also suggests how to develop a European scale for measuring material deprivation that ensures comparability across European countries.

Development & psychometrics of the SOLID-S – An inventory assessing software security culture in software development companies

Software security is a crucial requirement for most of the software used nowadays. Besides specialized knowledge of engineers and developers, organizational culture can contribute to software security to a great extent if specific cultural dimensions are in alignment with security. The purpose of this study is to develop and evaluate the SOLID-S, a six-dimensional inventory assessing this type of software security culture in software development companies. We present the iterative test development process of the inventory and examine its psychometric properties in an empirical study with N=327 participants by means of Item Response Theory. We identify the SOLID-S to have appropriate measurement qualities in terms of accuracy, fairness across subgroups, item fit and dimensionality. Results suggest that the inventory's subscales comply with the Partial Credit Model and, hence, raw sum scores of the subscales can be interpreted reliably. The SOLID-S can therefore be used for research, as a starting point for organizational change programs, or to evaluate the effectiveness of interventions aiming to improve security culture.

Common measures or common metrics? the value of IRT-based common metrics

There is a clear need to harmonize outcome measurement. Some authors propose to express scores as T scores to facilitate interpretation of PROM results in clinical practice. While this is a step in the right direction, there are important limitations to the acceptance of the T score metric as a common metric when T scores are based on raw sum scores of ordinal items: Such T scores of different instruments are not exactly comparable because they are not interval scaled; T scores of different measures are only on the same scale if exactly the same reference group is used; and the T sore metric cannot be maintained because it is reference population-dependent and needs to be updated regularly. These limitations can be overcome by using an item response theory (IRT)-based metric. Items from different measures can be placed on the same IRT metric to make scores comparable on an interval scale. The PROMIS initiative used IRT to develop item banks for measuring various health outcomes. Other PROMs have been linked to the PROMIS metric. Although PROMIS uses a T-score metric for practical reasons, the underlying PROMIS metric is actually an IRT metric. An IRT approach also enables further development of an item bank while preserving the underlying metric. Therefore, IRT-based metrics should be considered as common metrics for the future.

A Scale of Parent-to-Child Emotions (SPCE): Development and validation of a short form.

Parents' emotions towards a child are extremely important. The Scale of Parent-to-Child Emotions (SPCE) consists of five basic and four self-conscious emotion domains for assessment of parental emotional states. Abridgement of the SPCE is needed for research and clinical settings. Our previous investigational data for SPCE development were used in this study. The sample of 2336 fathers and 2264 mothers, whose eldest child's age was up to 12 years old, was analyzed. Total information for each pair (form) of items corresponding to a latent trait (θ) was calculated. The form with the greatest amount of total information was selected as the best for each domain. In addition, relative efficiency for each form and correlations of raw sum scores in classical test theory (CTT) for short forms with factor scores in item response theory (IRT) were calculated. The SPCE was shortened to 18 items by selecting two items each for nine domains. Correlations of raw sum scores in CTT for short forms with factor scores in IRT were correlated strongly and significantly. This abridged form of the scale, the SPCE-18, may be applicable in a busy clinical setting or research works to investigate the trajectory of parent-to-child emotions across a long span of time.

AN ESTIMATOR OF MOMENT OF INERTIA OF MAGIC SQUARE ARRAY OF MASSES

The classical definition of magic square of order is a square array of consecutive natural numbers from 1 to such that the raw, column and diagonal sum add up to the same number. When the magic square entries are considered as an array of masses of a rigid body, it is established that its moment of inertia is a function of This work consider a more general magic array of masses of a rigid body to establish its inertial moment as a function of the magic sum and the central entry of the array. The paper further discusses the advantage of this development.

Propriedades psicométricas da versão curta do Questionário das Cinco Facetas de Mindfulness em português

Abstract The aims of the current study were to evaluate the psychometric properties of a short version of the Five Facet Mindfulness Questionnaire (FFMQ-SF-BR) and verify if the addition of wording mechanisms (positive or negative) contributes to the fit of the shortened Brazilian Portuguese version of the FFMQ. Four hundred eight participants answered self-report measurements. Structural equation modelling was employed for both objectives. Adequate model fit was found for the 5-factor FFMQ-SF-BR model, with significant improvements arising from the addition of wording mechanism effects. No evidences of differential item functioning and population heterogeneity were found. Bifactor analysis showed that latent traces are preferred overusing raw sum scores. The FFMQ-SF-BR is suitable to measure mindfulness in the Brazilian population and has the benefits of decreasing data collection length without losing content coverage.

Satisfaction of Patients Who Received Breast-Conserving Surgery Using the Suture Scaffold Technique: A Single-Institution, Cross-Sectional Study.

Optimal cosmetic results after breast-conserving surgery (BCS) improve patient satisfaction. The suture scaffold technique (SST) is a breast reconstruction technique that all breast surgeons can perform without any extensive training in plastic surgery. We aimed to investigate patient satisfaction after BCS and compare blood loss and operative duration between the SST, breast glandular flap technique (BGFT), and no oncoplastic technique (NOT). This was a prospective, single-center, cross-sectional study. All patients who underwent BCS from August 2017 to September 2019 in our institution were included, with the exception of those with cT3 tumors or those who underwent nipple excision or bilateral breast surgery. The BREAST-Q™ was used to survey the patients, and the raw sum scale scores of the BREAST-Q™ were converted into BREAST-Q scores. Overall, we identified 421 eligible patients. The NOT was used in 47 (11.1%) patients, the BGFT was used in 231 (54.8%) patients, and the SST was used in 143 (33.9%) patients. In the univariable model, the BGFT and the SST had higher BREAST-Q scores than the NOT, while in the multivariable model, the SST had significantly higher BREAST-Q scores than the NOT (ß = +7.7, 95% confidence interval [CI] 0.9-13.7; p = 0.01). Blood loss was significantly less with the SST compared with the BGFT (ß = -4.4, 95% CI -7.3 to -1.4), and there was no difference in operative duration between the methods. Patient satisfaction with the SST was higher than with the NOT and was similar to the BGFT. The SST is an oncoplastic technique that all breast surgeons can perform and which requires comparable blood loss and operative duration in the NOT.

Abstract P3-18-13: A cross-sectional study to investigate association between oncoplastic techniques and patient satisfaction who received breast-conserving surgery

Abstract Background The suture scaffold technique (SST) is one of the oncoplastic techniques used for breast-conserving surgery (BCS), first reported in 2010. There is no report about the cosmetic outcome of SST, so we investigated SST patient satisfaction compared with other techniques. Method We started using the SST in August 2017. The SST requires the construction of scaffolds by using non-absorbable strings in the defect during BCS. The strings are pulled together and tied as close as possible without dimpling the skin from the superior to the inferior direction and medial to the defect's lateral direction. After approval by our institutional ethics committee in September 2020, we started a patient survey using the BREAST-QTM-BCT module (postoperative) version 2.0. We included the patients who received BCS from August 2017 to September 2019, except for cT3, patients who received nipple excision or bilateral breast surgery at our institution. The raw sum scale scores of BREAST-QTM were converted into one score that ranges from 0 (worst) to 100 (best). A score of 4 points is considered to be of minimal importance in breast reconstructive surgery. We utilized a multivariable linear regression model to identify the clinical factors associated with the score. The confounding variables included age, density of the breast, nipple-tumor distance, size of the tumor, location of the tumor, number of lymph nodes dissected, blood loss, and operative duration. Result We identified 437 eligible patients during the study period. Among them, 49 (11.7%) patients received no oncoplastic technique (NOT), 237 (56.8%) patients received mobilization technique of breast tissue (MTB), and 151 (36.2%) patients received SST. SST patients had a higher score than NOT and MTB patients in univariable analysis. In a multivariable model, SST patients had a significantly higher score than NOT (+7.1, 95%CI=0.5-13.0, p=0.03) and an equivalent score to MTB (+1.9, 95%CI=-1.9-5.8, p=0.32) patients. In addition, smaller tumors (+0.13; 95%CI=0.01-0.25) and cases with longer nipple-tumor distance (+1.1; 95%CI=0.24-1.9) showed significantly higher score. Conclusion Among patients who received BCS, the SST patients had higher satisfaction than NOT and equivalent satisfaction to MTB. Additional studies are needed to determine the indications and the limitations of this technique. Table. Multivariate logistic regression analyses for estimating the variables that may affect Rasch score who underwent BCS. Multivariate logistic regression analyses for estimating the variables that may affect Rasch score.Rasch score95% CIp-valueOncoplastic techniqueNOT (49)0 (Reference)BMT (237)5.1-0.7~11.10.08SST (151)7.10.88-13.40.02NTD (cm)1.10.2-1.90.01Size of the tumor (mm)-0.13-0.25~-0.010.02 Citation Format: Reiko Mitsueda, Anri Gen, Yoshitaka Fujiki, Naomi Gondo, Mutsumi Sato, Junko Kawano, Koichi Kuninaka, Shuichi Kanemitsu, Megumi Teraoka, Yoshito Matsuyama, Shinichi Baba, Sugako Nomoto, Robert Sloan, Yoshiaki Rai, Yoshiaki Sagara, Yasuaki Sagara. A cross-sectional study to investigate association between oncoplastic techniques and patient satisfaction who received breast-conserving surgery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-18-13.

Validation of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) adapted for the whole day repeated measures context

Our objective was to investigate the validity of four-item and six-item versions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX, or TLX for short) for measuring workload over a whole day in the repeated measures context. We analysed data on 51 people with type 1 diabetes from whom we collected ecological momentary assessment and daily diary data over 14 days. The TLX was administered at the last survey of every day. Confirmatory factor analysis fit statistics indicated that neither the TLX-6 nor TLX-4 were a unidimensional representation of whole day workload. In exploratory analyses, another set of TLX items we refer to as TLX-4v2 was sufficiently unidimensional. Raw sum scores from the TLX-6 and TLX-4v2 had plausible relationships with other measures, as evidenced by intra-person correlations and mixed-effects models. TLX-6 appears to capture multiple factors contributing to workload, while TLX-4v2 assesses the single factor of ‘mental strain’. Practitioner Summary: Using within-person longitudinal data, we found evidence supporting the validity of a measure evaluating whole-day workload (i.e. workload derived from all sources, not only paid employment) derived from the NASA-TLX. This measure may be useful to assess how day-to-day variations in workload impact quality of life among adults. Abbreviations: NASA-TLX or TLX: National Aeronautics and Space Administration Task Load Index; TLX-6: six item version of the NASA-TLX; TLX-4: four item version of the NASA-TLX, TLX-4v2: four item NASA-TLX version two; NIOSH: National Institute for Occupational Safety and Health; CFA: confirmatory factor analysis; T1D: type 1 diabetes; EMA: ecological momentary assessment; BG: blood glucose; SD: standard deviation; CV: coefficient of variation; RMSEA: root mean square error of approximation; CFI: comparative fit index; TLI: Tucker-Lewis Index; SRMR: standardized root mean square residual; AIC: Akaike information criterion; BIC: Bayesian information criterion; χ2: Chi-square statistic

Psychometric properties of the PHQ-9 measure of depression among Brazilian older adults

Objectives: To obtain evidence on the psychometric properties of the Patient Health Questionnaire − 9 (PHQ-9, one of the most extensively used tools for assessing depression) in the Brazilian older population. Method: Data on 3,356 Brazilian adults aged 60+ years living in Guarulhos, São Paulo state were used. The factor structure of the questionnaire was analysed using a factor analysis approach. The questionnaire’s measurement equivalence was tested across gender, age, personal income, and education level groups. The scores were compared across groups based on the highest level of equivalence achieved. The questionnaire’s internal consistency was analysed considering its factor structure. Results: A one-factor solution was identified as the most adequate factor structure, with the factor explaining 57.6% of the items’ variance. The correlation of the resulting latent score with the overall raw sum score in the PHQ-9 was r = 0.96. Measurement equivalence regarding thresholds and loadings was achieved for all tested groups. On average, women, older, less educated, and poorer people had higher latent scores on the depression factor. The measure showed a good internal consistency with Revelle’s omega total ω t =0.92. Conclusion: The results suggest that, among Brazilian older adults living in Guarulhos, São Paulo state, the PHQ-9 measures depressive symptomatology equivalently across different sociodemographic subgroups. Moreover, it can be scored using the raw sum of the item scores to adequately reflect different levels of depressive symptomatology.

Student Perceptions of Teaching Quality in Five Countries: A Partial Credit Model Approach to Assess Measurement Invariance

This study examines measurement invariance of student perceptions of teaching quality collected in five countries: Indonesia (n students = 6,331), the Netherlands (n students = 6,738), South Africa (n students = 3,422), South Korea (n students = 6,997) and Spain (n students = 4,676). The administered questionnaire was the My Teacher Questionnaire (MTQ). Student perceived teachers’ teaching quality was estimated using the partial credit model (PCM). Tests for differential item functioning (DIF) were used to assess measurement invariance. Furthermore, if DIF was found, it was explored whether an application of a quasi-international calibration, which estimates country-unique parameters for DIF items, can provide more valid estimates for between-country comparisons. Results indicate the absence of non-uniform DIF, but presence of uniform DIF among most items. This suggests that direct comparisons of raw mean or sum scores between countries is not advisable. Details of the set of invariant items are provided. Furthermore, results suggest that the quasi-international calibration is promising, but also that this approach needs further exploration in the context of student perceptions of teaching quality.

Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence

Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking. To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course. This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019). Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State. Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale-Revised. A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale-Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = -0.206, P = .05) and in social relationships (β = -0.221, P = .03) were associated with a reduction in PTSD symptoms. These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.

Psychological status of lung cancer patients and the effects of online intervention during the coronavirus disease 2019 pandemic

The aim of the present study was to evaluate the anxiety and depression status of lung cancer patients during the coronavirus disease 2019 (COVID‑19) pandemic and the effects of psychological counseling online. For this purpose, following enrollment. patients were divided into an intervention group (group I) and a control group (group C). Participants in the two groups were scored using the Self‑Rating Anxiety Scale (SAS) and Self‑Rating Depression Scale (SDS) before and one week after the intervention. The depression and anxiety status of the lung cancer patients during the COVID‑19 pandemic was evaluated based on SAS and SDS, and the effects of intervention online were also evaluated. The results revealed that the rate of anxiety in patients with lung cancer reached 35.71%, while the rate of depression reached 51.43%. After one week of intervention, the standard total score of SAS (S‑SAS) and the raw sum score of the SDS (R‑SDS) in group I were lower than those in group C (P<0.05). The S‑SAS and R‑SDS in group I after one week of intervention were lower than those before intervention (P<0.05). However, the SAS and SDS scores in group C after one week of intervention did not differ significantly from those before intervention (P>0.05). On the whole, the present study demonstrates that psychological counseling online for lung cancer patients during the COVID‑19 pandemic can effectively reduce their anxiety and depression scores. In addition, this type of counseling may be an effective psychological counseling method that is worthy of promotion during the pandemic.

Parent SNAP‐IV rating of attention‐deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD, validity, and reliability in a Brazilian sample

ObjectiveTo investigate the psychometric properties of the short or multimodal treatment study version of the Swanson, Nolan, and Pelham, Version IV (SNAP‐IV) scale, which measures attention‐deficit/hyperactivity disorder and oppositional defiant disorder symptoms. MethodsParticipants were 765 parents of children from 4 to 16 years old (641 non‐attention‐deficit/hyperactivity disorder and 124 attention‐deficit/hyperactivity disorder children) from Belo Horizonte, Brazil, who reported sociodemographic characteristics and answered the SNAP‐IV. Parents of the clinical sample also underwent the K‐SADS‐PL interview. ResultsAge was significantly associated with SNAP‐IV hyperactivity‐impulsivity problems (r = −0.14), but not with inattention or oppositional defiant disorder. Sex was a significant influence on attention‐deficit/hyperactivity disorder and oppositional defiant disorder severity (all p <0.001), with boys showing higher scores in the full sample, but not within the attention‐deficit/hyperactivity disorder group. Exploratory and confirmatory factor analysis supports a three‐factor structure of the SNAP‐IV scale. Moderate‐to‐strong correlations were found between SNAP‐IV and K‐SADS‐PL measures. All SNAP‐IV scales showed very high internal consistency coefficients (all above 0.91). SNAP‐IV inattention scores were the most predictive of attention‐deficit/hyperactivity disorder diagnosis (AUC: 0.877 for the averaging rating method and the raw sum method, and 0.874 for the symptom presence/absence method). ConclusionThe parent SNAP‐IV showed good psychometric properties in a Brazilian school and clinical sample.

130 The National Emergency Department Overcrowding Scale and Perceived Staff Workload: Evidence for Construct Validity in a Pediatric Setting

Our objective was to determine if there is a correlation between perceived staff workload and the National Emergency Department Overcrowding Scale (NEDOCS) in a pediatric ED (PED). Our primary outcome was the R squared, on univariate linear regression, between perceived workload measured by the raw sum of NASA Task Load Index (TLX) subscales and most recent hourly NEDOCS. Secondary outcomes included correlation between each TLX subscale and NEDOCS, correlation among specific staff roles, correlation between mean TLX responses for all staff in a given hour and most recent hourly NEDOCS, and the ROC AUC for the raw sum TLX categorical prediction of NEDOCS as “severely overcrowded” or not.

Parent SNAP-IV rating of attention-deficit/hyperactivity disorder: accuracy in a clinical sample of ADHD, validity, and reliability in a Brazilian sample

ObjectiveTo investigate the psychometric properties of the short or multimodal treatment study version of the Swanson, Nolan, and Pelham, Version IV (SNAP-IV) scale, which measures attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms. MethodsParticipants were 765 parents of children from 4 to 16 years old (641 non-attention-deficit/hyperactivity disorder and 124 attention-deficit/hyperactivity disorder children) from Belo Horizonte, Brazil, who reported sociodemographic characteristics and answered the SNAP-IV. Parents of the clinical sample also underwent the K-SADS-PL interview. ResultsAge was significantly associated with SNAP-IV hyperactivity-impulsivity problems (r=−0.14), but not with inattention or oppositional defiant disorder. Sex was a significant influence on attention-deficit/hyperactivity disorder and oppositional defiant disorder severity (all p<0.001), with boys showing higher scores in the full sample, but not within the attention-deficit/hyperactivity disorder group. Exploratory and confirmatory factor analysis supports a three-factor structure of the SNAP-IV scale. Moderate-to-strong correlations were found between SNAP-IV and K-SADS-PL measures. All SNAP-IV scales showed very high internal consistency coefficients (all above 0.91). SNAP-IV inattention scores were the most predictive of attention-deficit/hyperactivity disorder diagnosis (AUC: 0.877 for the averaging rating method and the raw sum method, and 0.874 for the symptom presence/absence method). ConclusionThe parent SNAP-IV showed good psychometric properties in a Brazilian school and clinical sample.

Sparse multiple factor analysis to integrate genetic data, neuroimaging features, and attention-deficit/hyperactivity disorder domains.

We proposed the application of a multivariate cross-sectional framework based on a combination of a variable selection method and a multiple factor analysis (MFA) in order to identify complex meaningful biological signals related to attention-deficit/hyperactivity disorder (ADHD) symptoms and hyperactivity/inattention domains. The study included 135 children from the general population with genomic and neuroimaging data. ADHD symptoms were assessed using a questionnaire based on ADHD-DSM-IV criteria. In all analyses, the raw sum scores of the hyperactivity and inattention domains and total ADHD were used. The analytical framework comprised two steps. First, zero-inflated negative binomial linear model via penalized maximum likelihood (LASSO-ZINB) was performed. Second, the most predictive features obtained with LASSO-ZINB were used as input for the MFA. We observed significant relationships between ADHD symptoms and hyperactivity and inattention domains with white matter, gray matter regions, and cerebellum, as well as with loci within chromosome 1. Multivariate methods can be used to advance the neurobiological characterization of complex diseases, improving the statistical power with respect to univariate methods, allowing the identification of meaningful biological signals in Imaging Genetic studies.

Pre- and post-intervention factor structure of functional independence measure (Fim®) in patients with spinal cord injury

The usefulness of Functional Independence Measure (FIM ® ) scores was questioned by several previous research due to its multidimensional factor structure. The FIM ® has been widely used amongst people with spinal cord injury (SCI). Previous evidence on FIM ® validity amongst people with SCI is scarce. A few studies have reported that FIM ® has substantial ceiling effect in a cognitive area, a possible item redundancy in a motor area, and poor psychometrics assessed by the Rasch analysis. Based on the Rasch analysis, the FIM ® motor score was not recommended for use, at least as a raw sum of items’ scores. The cognitive scale was found to work well except for considerable ceiling effect. The aim was to evaluate the factor structure of FIM ® scale amongst people with SCI. The 155 people with SCI participated in multidisciplinary inpatient rehabilitation. FIM ® was assessed at the beginning and at the end of intervention. Retrospective register-based study. Cronbach's alpha and exploratory factor analysis. The internal consistency demonstrated a high Cronbach's alpha of 0.95 to 0.96. For both pre- and post-intervention assessments, the exploratory factor analysis resulted in 3-factor structures. Except for two items (‘walking or using a wheelchair’ and ‘expression’), the structures of the identified three factors remained the same at the beginning and at the end of rehabilitation. The loadings of all the items were sufficient exceeding 0.3. Both pre- and post-intervention chi-square tests showed significant P -values < 0.0001. Within the sample of people with SCI, FIM ® failed to demonstrate unidimensionality. Instead, it showed a 3-factor structure that was unstable depending on the timing of measurement. Using a total or subscale FIM ® scores seem to be unjustified in the studied population.

Beware of the origin of numbers: Standard scoring of the SF‐12 and SF‐36 summary measures distorts measurement and score interpretations

The 12-item Short Form Health Survey (SF-12) is a generic health rating scale developed to reproduce the Physical and Mental Component Summary scores (PCS and MCS, respectively) of a longer survey, the SF-36. The standard PCS/MCS scoring algorithm has been criticized because its expected dimensionality often lacks empirical support, scoring is based on the assumption that physical and mental health are uncorrelated, and because scores on physical health items influence MCS scores, and vice versa. In this paper, we review the standard PCS/MCS scoring algorithm for the SF-12 and consider alternative scoring procedures: the RAND-12 Health Status Inventory (HSI) and raw sum scores. We corroborate that the SF-12 reproduces SF-36 scores but also inherits its problems. In simulations, good physical health scores reduce mental health scores, and vice versa. This may explain results of clinical studies in which, for example, poor physical health scores result in good MCS scores despite compromised mental health. When applied to empirical data from people with Parkinson's disease (PD) and stroke, standard SF-12 scores suggest a weak correlation between physical and mental health (rs .16), whereas RAND-12 HSI and raw sum scores show a much stronger correlation (rs .67-.68). Furthermore, standard PCS scores yield a different statistical conclusion regarding the association between physical health and age than do RAND-12 HSI and raw sum scores. We recommend that the standard SF-12 scoring algorithm be abandoned in favor of alternatives that provide more valid representations of physical and mental health, of which raw sum scores appear the simplest.

Categorizing the Magnitude and Frequency of Exposure to Uncivil Behaviors: A New Approach for More Meaningful Interventions.

To examine turnover intentions, as well as the prevalence and frequency of uncivil behaviors, from the perspective of registered nurses, respiratory therapists, and imaging professionals, using a new method to categorize exposure magnitude. Data were collected using the 22-item Negative Acts Questionnaire-Revised (NAQ-R). Additional items, informed by Price and Mueller's causal model of turnover, were included, as were select demographic variables. The final sample included 170 healthcare professionals. Descriptive statistics were used to describe the sample, a chi-square test was constructed to test for significant differences in exposure to uncivil behavior based on demographics, and Cochran-Mantel-Haenszel statistics were used to test associations between variables and calculation of raw sum scores to implement a new method of analysis for the NAQ-R, allowing for categorization of exposure magnitude. Exposure to uncivil behavior was reported more often among nursing staff than other healthcare professionals. Lack of exposure to uncivil behavior was a significant predictor of intention to stay. Perceptual differences were found between nurses prepared at the baccalaureate and associate degree levels. Lastly, no significant correlations between exposure to uncivil behavior and selected demographic variables were found, suggesting that exposure is not dependent upon age, race, unit type, or educational level. Findings support prior research associating negative organizational climate with higher turnover intentions. Uncivil behavior was reported across the organization, most predominantly among units staffed with nurses. Finally, use of newly defined cutoff points for the NAQ-R provide organizations with the ability to use both subjective and objective data to identify targets of uncivil behaviors to construct meaningful interventions. There is a need to develop more meaningful interventions to support targets of uncivil behaviors. Use of the NAQ-R, coupled with the proposed cutoff scores, allows for the identification of targets, the magnitude of exposure, and the construction of meaningful primary, secondary, and tertiary intervention programs that may improve turnover and quality of care.