Sample records for adjusted models conclusions

  1. Use of Prolonged Travel to Improve Pediatric Risk-Adjustment Models

    PubMed Central

    Lorch, Scott A; Silber, Jeffrey H; Even-Shoshan, Orit; Millman, Andrea

    2009-01-01

    Objective To determine whether travel variables could explain previously reported differences in lengths of stay (LOS), readmission, or death at children's hospitals versus other hospital types. Data Source Hospital discharge data from Pennsylvania between 1996 and 1998. Study Design A population cohort of children aged 1–17 years with one of 19 common pediatric conditions was created (N=51,855). Regression models were constructed to determine difference for LOS, readmission, or death between children's hospitals and other types of hospitals after including five types of additional illness severity variables to a traditional risk-adjustment model. Principal Findings With the traditional risk-adjustment model, children traveling longer to children's or rural hospitals had longer adjusted LOS and higher readmission rates. Inclusion of either a geocoded travel time variable or a nongeocoded travel distance variable provided the largest reduction in adjusted LOS, adjusted readmission rates, and adjusted mortality rates for children's hospitals and rural hospitals compared with other types of hospitals. Conclusions Adding a travel variable to traditional severity adjustment models may improve the assessment of an individual hospital's pediatric care by reducing systematic differences between different types of hospitals. PMID:19207591

  2. Data, Model, Conclusions, Doing It Again.

    ERIC Educational Resources Information Center

    Molenaar, Ivo W.

    1998-01-01

    Explores the robustness of conclusions from a statistical model against variations in model choice with an illustration from G. Box and G. Tiao (1973). Suggests that simultaneous consideration of a class of models for the same data is sometimes superior to analyzing the data under one model and demonstrates advantages to Adaptive Bayesian…

  3. Kuk's Model Adjusted for Protection and Efficiency

    ERIC Educational Resources Information Center

    Su, Shu-Ching; Sedory, Stephen A.; Singh, Sarjinder

    2015-01-01

    In this article, we adjust the Kuk randomized response model for collecting information on a sensitive characteristic for increased protection and efficiency by making use of forced "yes" and forced "no" responses. We first describe Kuk's model and then the proposed adjustment to Kuk's model. Next, by means of a simulation…

  4. Evaluation of the DAVROS (Development And Validation of Risk-adjusted Outcomes for Systems of emergency care) risk-adjustment model as a quality indicator for healthcare

    PubMed Central

    Wilson, Richard; Goodacre, Steve W; Klingbajl, Marcin; Kelly, Anne-Maree; Rainer, Tim; Coats, Tim; Holloway, Vikki; Townend, Will; Crane, Steve

    2014-01-01

    Background and objective Risk-adjusted mortality rates can be used as a quality indicator if it is assumed that the discrepancy between predicted and actual mortality can be attributed to the quality of healthcare (ie, the model has attributional validity). The Development And Validation of Risk-adjusted Outcomes for Systems of emergency care (DAVROS) model predicts 7-day mortality in emergency medical admissions. We aimed to test this assumption by evaluating the attributional validity of the DAVROS risk-adjustment model. Methods We selected cases that had the greatest discrepancy between observed mortality and predicted probability of mortality from seven hospitals involved in validation of the DAVROS risk-adjustment model. Reviewers at each hospital assessed hospital records to determine whether the discrepancy between predicted and actual mortality could be explained by the healthcare provided. Results We received 232/280 (83%) completed review forms relating to 179 unexpected deaths and 53 unexpected survivors. The healthcare system was judged to have potentially contributed to 10/179 (8%) of the unexpected deaths and 26/53 (49%) of the unexpected survivors. Failure of the model to appropriately predict risk was judged to be responsible for 135/179 (75%) of the unexpected deaths and 2/53 (4%) of the unexpected survivors. Some 10/53 (19%) of the unexpected survivors died within a few months of the 7-day period of model prediction. Conclusions We found little evidence that deaths occurring in patients with a low predicted mortality from risk-adjustment could be attributed to the quality of healthcare provided. PMID:23605036

  5. Adjusting STEMS growth model for Wisconsin forests.

    Treesearch

    Margaret R. Holdaway

    1985-01-01

    Describes a simple procedure for adjusting growth in the STEMS regional tree growth model to compensate for subregional differences. Coefficients are reported to adjust Lake States STEMS to the forests of Northern and Central Wisconsin--an area of essentially uniform climate and similar broad physiographic features. Errors are presented for various combinations of...

  6. Light-adjustable lens.

    PubMed Central

    Schwartz, Daniel M

    2003-01-01

    PURPOSE: First, to determine whether a silicone light-adjustable intraocular lens (IOL) can be fabricated and adjusted precisely with a light delivery device (LDD). Second, to determine the biocompatibility of an adjustable IOL and whether the lens can be adjusted precisely in vivo. METHODS: After fabrication of a light-adjustable silicone formulation, IOLs were made and tested in vitro for cytotoxicity, leaching, precision of adjustment, optical quality after adjustment, and mechanical properties. Light-adjustable IOLs were then tested in vivo for biocompatibility and precision of adjustment in a rabbit model. In collaboration with Zeiss-Meditec, a digital LDD was developed and tested to correct for higher-order aberrations in light-adjustable IOLs. RESULTS: The results establish that a biocompatible silicone IOL can be fabricated and adjusted using safe levels of light. There was no evidence of cytotoxicity or leaching. Testing of mechanical properties revealed no significant differences from commercial controls. Implantation of light-adjustable lenses in rabbits demonstrated- excellent biocompatibility after 6 months, comparable to a commercially available IOL. In vivo spherical (hyperopic and myopic) adjustment in rabbits was achieved using an analog light delivery system. The digital light delivery system was tested and achieved correction of higher-order aberrations. CONCLUSION: A silicone light-adjustable IOL and LDD have been developed to enable postoperative, noninvasive adjustment of lens power. The ability to correct higher-order aberrations in these materials has broad potential applicability for optimization of vision in patients undergoing cataract and refractive surgery. PMID:14971588

  7. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus.

    PubMed

    Cohen, Mark E; Ko, Clifford Y; Bilimoria, Karl Y; Zhou, Lynn; Huffman, Kristopher; Wang, Xue; Liu, Yaoming; Kraemer, Kari; Meng, Xiangju; Merkow, Ryan; Chow, Warren; Matel, Brian; Richards, Karen; Hart, Amy J; Dimick, Justin B; Hall, Bruce L

    2013-08-01

    The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) collects detailed clinical data from participating hospitals using standardized data definitions, analyzes these data, and provides participating hospitals with reports that permit risk-adjusted comparisons with a surgical quality standard. Since its inception, the ACS NSQIP has worked to refine surgical outcomes measurements and enhance statistical methods to improve the reliability and validity of this hospital profiling. From an original focus on controlling for between-hospital differences in patient risk factors with logistic regression, ACS NSQIP has added a variable to better adjust for the complexity and risk profile of surgical procedures (procedure mix adjustment) and stabilized estimates derived from small samples by using a hierarchical model with shrinkage adjustment. New models have been developed focusing on specific surgical procedures (eg, "Procedure Targeted" models), which provide opportunities to incorporate indication and other procedure-specific variables and outcomes to improve risk adjustment. In addition, comparative benchmark reports given to participating hospitals have been expanded considerably to allow more detailed evaluations of performance. Finally, procedures have been developed to estimate surgical risk for individual patients. This article describes the development of, and justification for, these new statistical methods and reporting strategies in ACS NSQIP. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  8. A Developmental Sequence Model to University Adjustment of International Undergraduate Students

    ERIC Educational Resources Information Center

    Chavoshi, Saeid; Wintre, Maxine Gallander; Dentakos, Stella; Wright, Lorna

    2017-01-01

    The current study proposes a Developmental Sequence Model to University Adjustment and uses a multifaceted measure, including academic, social and psychological adjustment, to examine factors predictive of undergraduate international student adjustment. A hierarchic regression model is carried out on the Student Adaptation to College Questionnaire…

  9. Adjusted variable plots for Cox's proportional hazards regression model.

    PubMed

    Hall, C B; Zeger, S L; Bandeen-Roche, K J

    1996-01-01

    Adjusted variable plots are useful in linear regression for outlier detection and for qualitative evaluation of the fit of a model. In this paper, we extend adjusted variable plots to Cox's proportional hazards model for possibly censored survival data. We propose three different plots: a risk level adjusted variable (RLAV) plot in which each observation in each risk set appears, a subject level adjusted variable (SLAV) plot in which each subject is represented by one point, and an event level adjusted variable (ELAV) plot in which the entire risk set at each failure event is represented by a single point. The latter two plots are derived from the RLAV by combining multiple points. In each point, the regression coefficient and standard error from a Cox proportional hazards regression is obtained by a simple linear regression through the origin fit to the coordinates of the pictured points. The plots are illustrated with a reanalysis of a dataset of 65 patients with multiple myeloma.

  10. Modeling wind adjustment factor and midflame wind speed for Rothermel's surface fire spread model

    Treesearch

    Patricia L. Andrews

    2012-01-01

    Rothermel's surface fire spread model was developed to use a value for the wind speed that affects surface fire, called midflame wind speed. Models have been developed to adjust 20-ft wind speed to midflame wind speed for sheltered and unsheltered surface fuel. In this report, Wind Adjustment Factor (WAF) model equations are given, and the BehavePlus fire modeling...

  11. Contact angle adjustment in equation-of-state-based pseudopotential model

    NASA Astrophysics Data System (ADS)

    Hu, Anjie; Li, Longjian; Uddin, Rizwan; Liu, Dong

    2016-05-01

    The single component pseudopotential lattice Boltzmann model has been widely applied in multiphase simulation due to its simplicity and stability. In many studies, it has been claimed that this model can be stable for density ratios larger than 1000. However, the application of the model is still limited to small density ratios when the contact angle is considered. The reason is that the original contact angle adjustment method influences the stability of the model. Moreover, simulation results in the present work show that, by applying the original contact angle adjustment method, the density distribution near the wall is artificially changed, and the contact angle is dependent on the surface tension. Hence, it is very inconvenient to apply this method with a fixed contact angle, and the accuracy of the model cannot be guaranteed. To solve these problems, a contact angle adjustment method based on the geometry analysis is proposed and numerically compared with the original method. Simulation results show that, with our contact angle adjustment method, the stability of the model is highly improved when the density ratio is relatively large, and it is independent of the surface tension.

  12. Contact angle adjustment in equation-of-state-based pseudopotential model.

    PubMed

    Hu, Anjie; Li, Longjian; Uddin, Rizwan; Liu, Dong

    2016-05-01

    The single component pseudopotential lattice Boltzmann model has been widely applied in multiphase simulation due to its simplicity and stability. In many studies, it has been claimed that this model can be stable for density ratios larger than 1000. However, the application of the model is still limited to small density ratios when the contact angle is considered. The reason is that the original contact angle adjustment method influences the stability of the model. Moreover, simulation results in the present work show that, by applying the original contact angle adjustment method, the density distribution near the wall is artificially changed, and the contact angle is dependent on the surface tension. Hence, it is very inconvenient to apply this method with a fixed contact angle, and the accuracy of the model cannot be guaranteed. To solve these problems, a contact angle adjustment method based on the geometry analysis is proposed and numerically compared with the original method. Simulation results show that, with our contact angle adjustment method, the stability of the model is highly improved when the density ratio is relatively large, and it is independent of the surface tension.

  13. The Concept of Adjustment: A Structural Model.

    ERIC Educational Resources Information Center

    Dodds, A.; And Others

    1994-01-01

    This study analyzed scores of 469 British adult clients with recent loss of sight on the Nottingham Adjustment Scale using LISREL structural modeling techniques. Results supported a theoretical model of the self in terms of two latent factors--internal self-worth and self as agent. Implications for rehabilitation and intervention with cognitive…

  14. Risk-adjusted models for adverse obstetric outcomes and variation in risk-adjusted outcomes across hospitals.

    PubMed

    Bailit, Jennifer L; Grobman, William A; Rice, Madeline Murguia; Spong, Catherine Y; Wapner, Ronald J; Varner, Michael W; Thorp, John M; Leveno, Kenneth J; Caritis, Steve N; Shubert, Phillip J; Tita, Alan T; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Blackwell, Sean C; Tolosa, Jorge E; Van Dorsten, J Peter

    2013-11-01

    Regulatory bodies and insurers evaluate hospital quality using obstetrical outcomes, however meaningful comparisons should take preexisting patient characteristics into account. Furthermore, if risk-adjusted outcomes are consistent within a hospital, fewer measures and resources would be needed to assess obstetrical quality. Our objective was to establish risk-adjusted models for 5 obstetric outcomes and assess hospital performance across these outcomes. We studied a cohort of 115,502 women and their neonates born in 25 hospitals in the United States from March 2008 through February 2011. Hospitals were ranked according to their unadjusted and risk-adjusted frequency of venous thromboembolism, postpartum hemorrhage, peripartum infection, severe perineal laceration, and a composite neonatal adverse outcome. Correlations between hospital risk-adjusted outcome frequencies were assessed. Venous thromboembolism occurred too infrequently (0.03%; 95% confidence interval [CI], 0.02-0.04%) for meaningful assessment. Other outcomes occurred frequently enough for assessment (postpartum hemorrhage, 2.29%; 95% CI, 2.20-2.38, peripartum infection, 5.06%; 95% CI, 4.93-5.19, severe perineal laceration at spontaneous vaginal delivery, 2.16%; 95% CI, 2.06-2.27, neonatal composite, 2.73%; 95% CI, 2.63-2.84). Although there was high concordance between unadjusted and adjusted hospital rankings, several individual hospitals had an adjusted rank that was substantially different (as much as 12 rank tiers) than their unadjusted rank. None of the correlations between hospital-adjusted outcome frequencies was significant. For example, the hospital with the lowest adjusted frequency of peripartum infection had the highest adjusted frequency of severe perineal laceration. Evaluations based on a single risk-adjusted outcome cannot be generalized to overall hospital obstetric performance. Copyright © 2013 Mosby, Inc. All rights reserved.

  15. Disaster Hits Home: A Model of Displaced Family Adjustment after Hurricane Katrina

    ERIC Educational Resources Information Center

    Peek, Lori; Morrissey, Bridget; Marlatt, Holly

    2011-01-01

    The authors explored individual and family adjustment processes among parents (n = 30) and children (n = 55) who were displaced to Colorado after Hurricane Katrina. Drawing on in-depth interviews with 23 families, this article offers an inductive model of displaced family adjustment. Four stages of family adjustment are presented in the model: (a)…

  16. An evaluation of bias in propensity score-adjusted non-linear regression models.

    PubMed

    Wan, Fei; Mitra, Nandita

    2018-03-01

    Propensity score methods are commonly used to adjust for observed confounding when estimating the conditional treatment effect in observational studies. One popular method, covariate adjustment of the propensity score in a regression model, has been empirically shown to be biased in non-linear models. However, no compelling underlying theoretical reason has been presented. We propose a new framework to investigate bias and consistency of propensity score-adjusted treatment effects in non-linear models that uses a simple geometric approach to forge a link between the consistency of the propensity score estimator and the collapsibility of non-linear models. Under this framework, we demonstrate that adjustment of the propensity score in an outcome model results in the decomposition of observed covariates into the propensity score and a remainder term. Omission of this remainder term from a non-collapsible regression model leads to biased estimates of the conditional odds ratio and conditional hazard ratio, but not for the conditional rate ratio. We further show, via simulation studies, that the bias in these propensity score-adjusted estimators increases with larger treatment effect size, larger covariate effects, and increasing dissimilarity between the coefficients of the covariates in the treatment model versus the outcome model.

  17. Adjustment in Mothers of Children with Asperger Syndrome: An Application of the Double ABCX Model of Family Adjustment

    ERIC Educational Resources Information Center

    Pakenham, Kenneth I.; Samios, Christina; Sofronoff, Kate

    2005-01-01

    The present study examined the applicability of the double ABCX model of family adjustment in explaining maternal adjustment to caring for a child diagnosed with Asperger syndrome. Forty-seven mothers completed questionnaires at a university clinic while their children were participating in an anxiety intervention. The children were aged between…

  18. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China

    PubMed Central

    Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

    2016-01-01

    Background and Purpose A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. Methods The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson’s correlation coefficient. Results The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79–0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81–0.84). Excellent calibration was reported in the two models with Pearson’s correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). Conclusions The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke. PMID:27846282

  19. Lower extremity EMG-driven modeling of walking with automated adjustment of musculoskeletal geometry

    PubMed Central

    Meyer, Andrew J.; Patten, Carolynn

    2017-01-01

    Neuromusculoskeletal disorders affecting walking ability are often difficult to manage, in part due to limited understanding of how a patient’s lower extremity muscle excitations contribute to the patient’s lower extremity joint moments. To assist in the study of these disorders, researchers have developed electromyography (EMG) driven neuromusculoskeletal models utilizing scaled generic musculoskeletal geometry. While these models can predict individual muscle contributions to lower extremity joint moments during walking, the accuracy of the predictions can be hindered by errors in the scaled geometry. This study presents a novel EMG-driven modeling method that automatically adjusts surrogate representations of the patient’s musculoskeletal geometry to improve prediction of lower extremity joint moments during walking. In addition to commonly adjusted neuromusculoskeletal model parameters, the proposed method adjusts model parameters defining muscle-tendon lengths, velocities, and moment arms. We evaluated our EMG-driven modeling method using data collected from a high-functioning hemiparetic subject walking on an instrumented treadmill at speeds ranging from 0.4 to 0.8 m/s. EMG-driven model parameter values were calibrated to match inverse dynamic moments for five degrees of freedom in each leg while keeping musculoskeletal geometry close to that of an initial scaled musculoskeletal model. We found that our EMG-driven modeling method incorporating automated adjustment of musculoskeletal geometry predicted net joint moments during walking more accurately than did the same method without geometric adjustments. Geometric adjustments improved moment prediction errors by 25% on average and up to 52%, with the largest improvements occurring at the hip. Predicted adjustments to musculoskeletal geometry were comparable to errors reported in the literature between scaled generic geometric models and measurements made from imaging data. Our results demonstrate that

  20. Husbands' perceptions of their wives' breast cancer coping efficacy: testing congruence models of adjustment.

    PubMed

    Merluzzi, Thomas V; Martinez Sanchez, MaryAnn

    2018-01-01

    Recent reviews have reinforced the notion that having a supportive spouse can help with the process of coping with and adjusting to cancer. Congruence between spouses' perspectives has been proposed as one mechanism in that process, yet alternative models of congruence have not been examined closely. This study assessed alternative models of congruence in perceptions of coping and their mediating effects on adjustment to breast cancer. Seventy-two women in treatment for breast cancer and their husbands completed measures of marital adjustment, self-efficacy for coping, and adjustment to cancer. Karnofsky Performance Status was obtained from medical records. Wives completed a measure of self-efficacy for coping (wives' ratings of self-efficacy for coping [WSEC]) and husbands completed a measure of self-efficacy for coping (husbands' ratings of wives' self-efficacy for coping [HSEC]) based on their perceptions of their wives' coping efficacy. Interestingly, the correlation between WSEC and HSEC was only 0.207; thus, they are relatively independent perspectives. The following three models were tested to determine the nature of the relationship between WSEC and HSEC: discrepancy model (WSEC - HSEC), additive model (WSEC + HSEC), and multiplicative model (WSEC × HSEC). The discrepancy model was not related to wives' adjustment; however, the additive ( B =0.205, P <0.001) and multiplicative ( B =0.001, P <0.001) models were significantly related to wives' adjustment. Also, the additive model mediated the relationship between performance status and adjustment. Husbands' perception of their wives' coping efficacy contributed marginally to their wives' adjustment, and the combination of WSEC and HSEC mediated the relationship between functional status and wives' adjustment, thus positively impacting wives' adjustment to cancer. Future research is needed to determine the quality of the differences between HSEC and WSEC in order to develop interventions to optimize the

  1. The relationship between the c-statistic of a risk-adjustment model and the accuracy of hospital report cards: A Monte Carlo study

    PubMed Central

    Austin, Peter C.; Reeves, Mathew J.

    2015-01-01

    Background Hospital report cards, in which outcomes following the provision of medical or surgical care are compared across health care providers, are being published with increasing frequency. Essential to the production of these reports is risk-adjustment, which allows investigators to account for differences in the distribution of patient illness severity across different hospitals. Logistic regression models are frequently used for risk-adjustment in hospital report cards. Many applied researchers use the c-statistic (equivalent to the area under the receiver operating characteristic curve) of the logistic regression model as a measure of the credibility and accuracy of hospital report cards. Objectives To determine the relationship between the c-statistic of a risk-adjustment model and the accuracy of hospital report cards. Research Design Monte Carlo simulations were used to examine this issue. We examined the influence of three factors on the accuracy of hospital report cards: the c-statistic of the logistic regression model used for risk-adjustment, the number of hospitals, and the number of patients treated at each hospital. The parameters used to generate the simulated datasets came from analyses of patients hospitalized with a diagnosis of acute myocardial infarction in Ontario, Canada. Results The c-statistic of the risk-adjustment model had, at most, a very modest impact on the accuracy of hospital report cards, whereas the number of patients treated at each hospital had a much greater impact. Conclusions The c-statistic of a risk-adjustment model should not be used to assess the accuracy of a hospital report card. PMID:23295579

  2. Storm Water Management Model Climate Adjustment Tool (SWMM-CAT)

    EPA Science Inventory

    The US EPA’s newest tool, the Stormwater Management Model (SWMM) – Climate Adjustment Tool (CAT) is meant to help municipal stormwater utilities better address potential climate change impacts affecting their operations. SWMM, first released in 1971, models hydrology and hydrauli...

  3. Using risk-adjustment models to identify high-cost risks.

    PubMed

    Meenan, Richard T; Goodman, Michael J; Fishman, Paul A; Hornbrook, Mark C; O'Keeffe-Rosetti, Maureen C; Bachman, Donald J

    2003-11-01

    We examine the ability of various publicly available risk models to identify high-cost individuals and enrollee groups using multi-HMO administrative data. Five risk-adjustment models (the Global Risk-Adjustment Model [GRAM], Diagnostic Cost Groups [DCGs], Adjusted Clinical Groups [ACGs], RxRisk, and Prior-expense) were estimated on a multi-HMO administrative data set of 1.5 million individual-level observations for 1995-1996. Models produced distributions of individual-level annual expense forecasts for comparison to actual values. Prespecified "high-cost" thresholds were set within each distribution. The area under the receiver operating characteristic curve (AUC) for "high-cost" prevalences of 1% and 0.5% was calculated, as was the proportion of "high-cost" dollars correctly identified. Results are based on a separate 106,000-observation validation dataset. For "high-cost" prevalence targets of 1% and 0.5%, ACGs, DCGs, GRAM, and Prior-expense are very comparable in overall discrimination (AUCs, 0.83-0.86). Given a 0.5% prevalence target and a 0.5% prediction threshold, DCGs, GRAM, and Prior-expense captured $963,000 (approximately 3%) more "high-cost" sample dollars than other models. DCGs captured the most "high-cost" dollars among enrollees with asthma, diabetes, and depression; predictive performance among demographic groups (Medicaid members, members over 64, and children under 13) varied across models. Risk models can efficiently identify enrollees who are likely to generate future high costs and who could benefit from case management. The dollar value of improved prediction performance of the most accurate risk models should be meaningful to decision-makers and encourage their broader use for identifying high costs.

  4. Husbands’ perceptions of their wives’ breast cancer coping efficacy: testing congruence models of adjustment

    PubMed Central

    Martinez Sanchez, MaryAnn

    2018-01-01

    Introduction Recent reviews have reinforced the notion that having a supportive spouse can help with the process of coping with and adjusting to cancer. Congruence between spouses’ perspectives has been proposed as one mechanism in that process, yet alternative models of congruence have not been examined closely. This study assessed alternative models of congruence in perceptions of coping and their mediating effects on adjustment to breast cancer. Methods Seventy-two women in treatment for breast cancer and their husbands completed measures of marital adjustment, self-efficacy for coping, and adjustment to cancer. Karnofsky Performance Status was obtained from medical records. Wives completed a measure of self-efficacy for coping (wives’ ratings of self-efficacy for coping [WSEC]) and husbands completed a measure of self-efficacy for coping (husbands’ ratings of wives’ self-efficacy for coping [HSEC]) based on their perceptions of their wives’ coping efficacy. Results Interestingly, the correlation between WSEC and HSEC was only 0.207; thus, they are relatively independent perspectives. The following three models were tested to determine the nature of the relationship between WSEC and HSEC: discrepancy model (WSEC − HSEC), additive model (WSEC + HSEC), and multiplicative model (WSEC × HSEC). The discrepancy model was not related to wives’ adjustment; however, the additive (B=0.205, P<0.001) and multiplicative (B=0.001, P<0.001) models were significantly related to wives’ adjustment. Also, the additive model mediated the relationship between performance status and adjustment. Discussion Husbands’ perception of their wives’ coping efficacy contributed marginally to their wives’ adjustment, and the combination of WSEC and HSEC mediated the relationship between functional status and wives’ adjustment, thus positively impacting wives’ adjustment to cancer. Future research is needed to determine the quality of the differences between HSEC and

  5. Relevance of the c-statistic when evaluating risk-adjustment models in surgery.

    PubMed

    Merkow, Ryan P; Hall, Bruce L; Cohen, Mark E; Dimick, Justin B; Wang, Edward; Chow, Warren B; Ko, Clifford Y; Bilimoria, Karl Y

    2012-05-01

    The measurement of hospital quality based on outcomes requires risk adjustment. The c-statistic is a popular tool used to judge model performance, but can be limited, particularly when evaluating specific operations in focused populations. Our objectives were to examine the interpretation and relevance of the c-statistic when used in models with increasingly similar case mix and to consider an alternative perspective on model calibration based on a graphical depiction of model fit. From the American College of Surgeons National Surgical Quality Improvement Program (2008-2009), patients were identified who underwent a general surgery procedure, and procedure groups were increasingly restricted: colorectal-all, colorectal-elective cases only, and colorectal-elective cancer cases only. Mortality and serious morbidity outcomes were evaluated using logistic regression-based risk adjustment, and model c-statistics and calibration curves were used to compare model performance. During the study period, 323,427 general, 47,605 colorectal-all, 39,860 colorectal-elective, and 21,680 colorectal cancer patients were studied. Mortality ranged from 1.0% in general surgery to 4.1% in the colorectal-all group, and serious morbidity ranged from 3.9% in general surgery to 12.4% in the colorectal-all procedural group. As case mix was restricted, c-statistics progressively declined from the general to the colorectal cancer surgery cohorts for both mortality and serious morbidity (mortality: 0.949 to 0.866; serious morbidity: 0.861 to 0.668). Calibration was evaluated graphically by examining predicted vs observed number of events over risk deciles. For both mortality and serious morbidity, there was no qualitative difference in calibration identified between the procedure groups. In the present study, we demonstrate how the c-statistic can become less informative and, in certain circumstances, can lead to incorrect model-based conclusions, as case mix is restricted and patients become

  6. An approach to adjustment of relativistic mean field model parameters

    NASA Astrophysics Data System (ADS)

    Bayram, Tuncay; Akkoyun, Serkan

    2017-09-01

    The Relativistic Mean Field (RMF) model with a small number of adjusted parameters is powerful tool for correct predictions of various ground-state nuclear properties of nuclei. Its success for describing nuclear properties of nuclei is directly related with adjustment of its parameters by using experimental data. In the present study, the Artificial Neural Network (ANN) method which mimics brain functionality has been employed for improvement of the RMF model parameters. In particular, the understanding capability of the ANN method for relations between the RMF model parameters and their predictions for binding energies (BEs) of 58Ni and 208Pb have been found in agreement with the literature values.

  7. A comparison of administrative and physiologic predictive models in determining risk adjusted mortality rates in critically ill patients.

    PubMed

    Enfield, Kyle B; Schafer, Katherine; Zlupko, Mike; Herasevich, Vitaly; Novicoff, Wendy M; Gajic, Ognjen; Hoke, Tracey R; Truwit, Jonathon D

    2012-01-01

    Hospitals are increasingly compared based on clinical outcomes adjusted for severity of illness. Multiple methods exist to adjust for differences between patients. The challenge for consumers of this information, both the public and healthcare providers, is interpreting differences in risk adjustment models particularly when models differ in their use of administrative and physiologic data. We set to examine how administrative and physiologic models compare to each when applied to critically ill patients. We prospectively abstracted variables for a physiologic and administrative model of mortality from two intensive care units in the United States. Predicted mortality was compared through the Pearsons Product coefficient and Bland-Altman analysis. A subgroup of patients admitted directly from the emergency department was analyzed to remove potential confounding changes in condition prior to ICU admission. We included 556 patients from two academic medical centers in this analysis. The administrative model and physiologic models predicted mortalities for the combined cohort were 15.3% (95% CI 13.7%, 16.8%) and 24.6% (95% CI 22.7%, 26.5%) (t-test p-value<0.001). The r(2) for these models was 0.297. The Bland-Atlman plot suggests that at low predicted mortality there was good agreement; however, as mortality increased the models diverged. Similar results were found when analyzing a subgroup of patients admitted directly from the emergency department. When comparing the two hospitals, there was a statistical difference when using the administrative model but not the physiologic model. Unexplained mortality, defined as those patients who died who had a predicted mortality less than 10%, was a rare event by either model. In conclusion, while it has been shown that administrative models provide estimates of mortality that are similar to physiologic models in non-critically ill patients with pneumonia, our results suggest this finding can not be applied globally to

  8. Unified Model for Academic Competence, Social Adjustment, and Psychopathology.

    ERIC Educational Resources Information Center

    Schaefer, Earl S.; And Others

    A unified conceptual model is needed to integrate the extensive research on (1) social competence and adaptive behavior, (2) converging conceptualizations of social adjustment and psychopathology, and (3) emerging concepts and measures of academic competence. To develop such a model, a study was conducted in which teacher ratings were collected on…

  9. Sample Size and Statistical Conclusions from Tests of Fit to the Rasch Model According to the Rasch Unidimensional Measurement Model (Rumm) Program in Health Outcome Measurement.

    PubMed

    Hagell, Peter; Westergren, Albert

    Sample size is a major factor in statistical null hypothesis testing, which is the basis for many approaches to testing Rasch model fit. Few sample size recommendations for testing fit to the Rasch model concern the Rasch Unidimensional Measurement Models (RUMM) software, which features chi-square and ANOVA/F-ratio based fit statistics, including Bonferroni and algebraic sample size adjustments. This paper explores the occurrence of Type I errors with RUMM fit statistics, and the effects of algebraic sample size adjustments. Data with simulated Rasch model fitting 25-item dichotomous scales and sample sizes ranging from N = 50 to N = 2500 were analysed with and without algebraically adjusted sample sizes. Results suggest the occurrence of Type I errors with N less then or equal to 500, and that Bonferroni correction as well as downward algebraic sample size adjustment are useful to avoid such errors, whereas upward adjustment of smaller samples falsely signal misfit. Our observations suggest that sample sizes around N = 250 to N = 500 may provide a good balance for the statistical interpretation of the RUMM fit statistics studied here with respect to Type I errors and under the assumption of Rasch model fit within the examined frame of reference (i.e., about 25 item parameters well targeted to the sample).

  10. Risk adjustment alternatives in paying for behavioral health care under Medicaid.

    PubMed Central

    Ettner, S L; Frank, R G; McGuire, T G; Hermann, R C

    2001-01-01

    OBJECTIVE: To compare the performance of various risk adjustment models in behavioral health applications such as setting mental health and substance abuse (MH/SA) capitation payments or overall capitation payments for populations including MH/SA users. DATA SOURCES/STUDY DESIGN: The 1991-93 administrative data from the Michigan Medicaid program were used. We compared mean absolute prediction error for several risk adjustment models and simulated the profits and losses that behavioral health care carve outs and integrated health plans would experience under risk adjustment if they enrolled beneficiaries with a history of MH/SA problems. Models included basic demographic adjustment, Adjusted Diagnostic Groups, Hierarchical Condition Categories, and specifications designed for behavioral health. PRINCIPAL FINDINGS: Differences in predictive ability among risk adjustment models were small and generally insignificant. Specifications based on relatively few MH/SA diagnostic categories did as well as or better than models controlling for additional variables such as medical diagnoses at predicting MH/SA expenditures among adults. Simulation analyses revealed that among both adults and minors considerable scope remained for behavioral health care carve outs to make profits or losses after risk adjustment based on differential enrollment of severely ill patients. Similarly, integrated health plans have strong financial incentives to avoid MH/SA users even after adjustment. CONCLUSIONS: Current risk adjustment methodologies do not eliminate the financial incentives for integrated health plans and behavioral health care carve-out plans to avoid high-utilizing patients with psychiatric disorders. PMID:11508640

  11. On the hydrologic adjustment of climate-model projections: The potential pitfall of potential evapotranspiration

    USGS Publications Warehouse

    Milly, P.C.D.; Dunne, K.A.

    2011-01-01

    Hydrologic models often are applied to adjust projections of hydroclimatic change that come from climate models. Such adjustment includes climate-bias correction, spatial refinement ("downscaling"), and consideration of the roles of hydrologic processes that were neglected in the climate model. Described herein is a quantitative analysis of the effects of hydrologic adjustment on the projections of runoff change associated with projected twenty-first-century climate change. In a case study including three climate models and 10 river basins in the contiguous United States, the authors find that relative (i.e., fractional or percentage) runoff change computed with hydrologic adjustment more often than not was less positive (or, equivalently, more negative) than what was projected by the climate models. The dominant contributor to this decrease in runoff was a ubiquitous change in runoff (median 211%) caused by the hydrologic model's apparent amplification of the climate-model-implied growth in potential evapotranspiration. Analysis suggests that the hydrologic model, on the basis of the empirical, temperature-based modified Jensen-Haise formula, calculates a change in potential evapotranspiration that is typically 3 times the change implied by the climate models, which explicitly track surface energy budgets. In comparison with the amplification of potential evapotranspiration, central tendencies of other contributions from hydrologic adjustment (spatial refinement, climate-bias adjustment, and process refinement) were relatively small. The authors' findings highlight the need for caution when projecting changes in potential evapotranspiration for use in hydrologic models or drought indices to evaluate climatechange impacts on water. Copyright ?? 2011, Paper 15-001; 35,952 words, 3 Figures, 0 Animations, 1 Tables.

  12. Physically Modeling Stream Channel Adjustment to Woody Riparian Vegetation

    NASA Astrophysics Data System (ADS)

    Bennett, S. J.; Alonso, C. V.

    2003-12-01

    Stream restoration designs often use vegetation to promote bank and channel stability, to facilitate point-bar development, and to encourage natural colonization of riparian species. Here we examine the adjustment of an alluvial channel to in-stream and riparian vegetation using a distorted Froude-scale flume model with a movable boundary. A decimeter-scale trapezoidal channel comprised of 0.8-mm diameter sand was systematically vegetated with emergent, rigid dowels (3-mm in diameter) in rectangular and hemispherical patterns with varying vegetation densities while conserving the shape of the zone and the geometry of the vegetal patterns. Alternate sides of the channel were vegetated at the prescribed spacing of equilibrium alternate bars, ca. 5 to 7 times the channel width. Using flow conditions just below the threshold of sediment motion, flow obstruction, deflection, and acceleration caused bed erosion, bank failure, and morphologic channel adjustments that were wholly attributable to the managed plantings. As vegetation density increased, the magnitude and rate of scaled channel adjustment increased, which included increased channel widths, bankline steepening and meandering, and thalweg meandering. As the modeled channel began to meander, the stream bed aggraded and flow depth decreased markedly, creating a continuously connected, inter-reach complex of mid-channel bars. This study demonstrates the utility of using managed vegetations in stream corridor design and meander development, and it provides the practitioner with guidance on the magnitude of channel adjustment as it relates to vegetation density, shape, and spacing.

  13. On the Hydrologic Adjustment of Climate-Model Projections: The Potential Pitfall of Potential Evapotranspiration

    USGS Publications Warehouse

    Milly, Paul C.D.; Dunne, Krista A.

    2011-01-01

    Hydrologic models often are applied to adjust projections of hydroclimatic change that come from climate models. Such adjustment includes climate-bias correction, spatial refinement ("downscaling"), and consideration of the roles of hydrologic processes that were neglected in the climate model. Described herein is a quantitative analysis of the effects of hydrologic adjustment on the projections of runoff change associated with projected twenty-first-century climate change. In a case study including three climate models and 10 river basins in the contiguous United States, the authors find that relative (i.e., fractional or percentage) runoff change computed with hydrologic adjustment more often than not was less positive (or, equivalently, more negative) than what was projected by the climate models. The dominant contributor to this decrease in runoff was a ubiquitous change in runoff (median -11%) caused by the hydrologic model’s apparent amplification of the climate-model-implied growth in potential evapotranspiration. Analysis suggests that the hydrologic model, on the basis of the empirical, temperature-based modified Jensen–Haise formula, calculates a change in potential evapotranspiration that is typically 3 times the change implied by the climate models, which explicitly track surface energy budgets. In comparison with the amplification of potential evapotranspiration, central tendencies of other contributions from hydrologic adjustment (spatial refinement, climate-bias adjustment, and process refinement) were relatively small. The authors’ findings highlight the need for caution when projecting changes in potential evapotranspiration for use in hydrologic models or drought indices to evaluate climate-change impacts on water.

  14. A simple approach to adjust tidal forcing in fjord models

    NASA Astrophysics Data System (ADS)

    Hjelmervik, Karina; Kristensen, Nils Melsom; Staalstrøm, André; Røed, Lars Petter

    2017-07-01

    To model currents in a fjord accurate tidal forcing is of extreme importance. Due to complex topography with narrow and shallow straits, the tides in the innermost parts of a fjord are both shifted in phase and altered in amplitude compared to the tides in the open water outside the fjord. Commonly, coastal tide information extracted from global or regional models is used on the boundary of the fjord model. Since tides vary over short distances in shallower waters close to the coast, the global and regional tidal forcings are usually too coarse to achieve sufficiently accurate tides in fjords. We present a straightforward method to remedy this problem by simply adjusting the tides to fit the observed tides at the entrance of the fjord. To evaluate the method, we present results from the Oslofjord, Norway. A model for the fjord is first run using raw tidal forcing on its open boundary. By comparing modelled and observed time series of water level at a tidal gauge station close to the open boundary of the model, a factor for the amplitude and a shift in phase are computed. The amplitude factor and the phase shift are then applied to produce adjusted tidal forcing at the open boundary. Next, we rerun the fjord model using the adjusted tidal forcing. The results from the two runs are then compared to independent observations inside the fjord in terms of amplitude and phases of the various tidal components, the total tidal water level, and the depth integrated tidal currents. The results show improvements in the modelled tides in both the outer, and more importantly, the inner parts of the fjord.

  15. Women's Work Conditions and Marital Adjustment in Two-Earner Couples: A Structural Model.

    ERIC Educational Resources Information Center

    Sears, Heather A.; Galambos, Nancy L.

    1992-01-01

    Evaluated structural model of women's work conditions, women's stress, and marital adjustment using path analysis. Findings from 86 2-earner couples with adolescents indicated support for spillover model in which women's work stress and global stress mediated link between their work conditions and their perceptions of marital adjustment.…

  16. The effect of accuracy motivation on anchoring and adjustment: do people adjust from provided anchors?

    PubMed

    Simmons, Joseph P; LeBoeuf, Robyn A; Nelson, Leif D

    2010-12-01

    Increasing accuracy motivation (e.g., by providing monetary incentives for accuracy) often fails to increase adjustment away from provided anchors, a result that has led researchers to conclude that people do not effortfully adjust away from such anchors. We challenge this conclusion. First, we show that people are typically uncertain about which way to adjust from provided anchors and that this uncertainty often causes people to believe that they have initially adjusted too far away from such anchors (Studies 1a and 1b). Then, we show that although accuracy motivation fails to increase the gap between anchors and final estimates when people are uncertain about the direction of adjustment, accuracy motivation does increase anchor-estimate gaps when people are certain about the direction of adjustment, and that this is true regardless of whether the anchors are provided or self-generated (Studies 2, 3a, 3b, and 5). These results suggest that people do effortfully adjust away from provided anchors but that uncertainty about the direction of adjustment makes that adjustment harder to detect than previously assumed. This conclusion has important theoretical implications, suggesting that currently emphasized distinctions between anchor types (self-generated vs. provided) are not fundamental and that ostensibly competing theories of anchoring (selective accessibility and anchoring-and-adjustment) are complementary. PsycINFO Database Record (c) 2010 APA, all rights reserved.

  17. Aqua/Aura Updated Inclination Adjust Maneuver Performance Prediction Model

    NASA Technical Reports Server (NTRS)

    Boone, Spencer

    2017-01-01

    This presentation will discuss the updated Inclination Adjust Maneuver (IAM) performance prediction model that was developed for Aqua and Aura following the 2017 IAM series. This updated model uses statistical regression methods to identify potential long-term trends in maneuver parameters, yielding improved predictions when re-planning past maneuvers. The presentation has been reviewed and approved by Eric Moyer, ESMO Deputy Project Manager.

  18. The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act

    PubMed Central

    Kautter, John; Pope, Gregory C; Ingber, Melvin; Freeman, Sara; Patterson, Lindsey; Cohen, Michael; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge. The risk adjustment methodology includes the risk adjustment model and the risk transfer formula. This article is the second of three in this issue of the Review that describe the Department of Health and Human Services (HHS) risk adjustment methodology and focuses on the risk adjustment model. In our first companion article, we discuss the key issues and choices in developing the methodology. In this article, we present the risk adjustment model, which is named the HHS-Hierarchical Condition Categories (HHS-HCC) risk adjustment model. We first summarize the HHS-HCC diagnostic classification, which is the key element of the risk adjustment model. Then the data and methods, results, and evaluation of the risk adjustment model are presented. Fifteen separate models are developed. For each age group (adult, child, and infant), a model is developed for each cost sharing level (platinum, gold, silver, and bronze metal levels, as well as catastrophic plans). Evaluation of the risk adjustment models shows good predictive accuracy, both for individuals and for groups. Lastly, this article provides examples of how the model output is used to calculate risk scores, which are an input into the risk transfer formula. Our third companion paper describes the risk transfer formula. PMID:25360387

  19. Risk adjustment models for short-term outcomes after surgical resection for oesophagogastric cancer.

    PubMed

    Fischer, C; Lingsma, H; Hardwick, R; Cromwell, D A; Steyerberg, E; Groene, O

    2016-01-01

    Outcomes for oesophagogastric cancer surgery are compared with the aim of benchmarking quality of care. Adjusting for patient characteristics is crucial to avoid biased comparisons between providers. The study objective was to develop a case-mix adjustment model for comparing 30- and 90-day mortality and anastomotic leakage rates after oesophagogastric cancer resections. The study reviewed existing models, considered expert opinion and examined audit data in order to select predictors that were consequently used to develop a case-mix adjustment model for the National Oesophago-Gastric Cancer Audit, covering England and Wales. Models were developed on patients undergoing surgical resection between April 2011 and March 2013 using logistic regression. Model calibration and discrimination was quantified using a bootstrap procedure. Most existing risk models for oesophagogastric resections were methodologically weak, outdated or based on detailed laboratory data that are not generally available. In 4882 patients with oesophagogastric cancer used for model development, 30- and 90-day mortality rates were 2·3 and 4·4 per cent respectively, and 6·2 per cent of patients developed an anastomotic leak. The internally validated models, based on predictors selected from the literature, showed moderate discrimination (area under the receiver operating characteristic (ROC) curve 0·646 for 30-day mortality, 0·664 for 90-day mortality and 0·587 for anastomotic leakage) and good calibration. Based on available data, three case-mix adjustment models for postoperative outcomes in patients undergoing curative surgery for oesophagogastric cancer were developed. These models should be used for risk adjustment when assessing hospital performance in the National Health Service, and tested in other large health systems. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  20. Finite element fatigue analysis of rectangular clutch spring of automatic slack adjuster

    NASA Astrophysics Data System (ADS)

    Xu, Chen-jie; Luo, Zai; Hu, Xiao-feng; Jiang, Wen-song

    2015-02-01

    The failure of rectangular clutch spring of automatic slack adjuster directly affects the work of automatic slack adjuster. We establish the structural mechanics model of automatic slack adjuster rectangular clutch spring based on its working principle and mechanical structure. In addition, we upload such structural mechanics model to ANSYS Workbench FEA system to predict the fatigue life of rectangular clutch spring. FEA results show that the fatigue life of rectangular clutch spring is 2.0403×105 cycle under the effect of braking loads. In the meantime, fatigue tests of 20 automatic slack adjusters are carried out on the fatigue test bench to verify the conclusion of the structural mechanics model. The experimental results show that the mean fatigue life of rectangular clutch spring is 1.9101×105, which meets the results based on the finite element analysis using ANSYS Workbench FEA system.

  1. Adjusting the Stems Regional Forest Growth Model to Improve Local Predictions

    Treesearch

    W. Brad Smith

    1983-01-01

    A simple procedure using double sampling is described for adjusting growth in the STEMS regional forest growth model to compensate for subregional variations. Predictive accuracy of the STEMS model (a distance-independent, individual tree growth model for Lake States forests) was improved by using this procedure

  2. Application of Artificial Neural Networks in the Heart Electrical Axis Position Conclusion Modeling

    NASA Astrophysics Data System (ADS)

    Bakanovskaya, L. N.

    2016-08-01

    The article touches upon building of a heart electrical axis position conclusion model using an artificial neural network. The input signals of the neural network are the values of deflections Q, R and S; and the output signal is the value of the heart electrical axis position. Training of the network is carried out by the error propagation method. The test results allow concluding that the created neural network makes a conclusion with a high degree of accuracy.

  3. Risk Adjustment and Primary Health Care in Chile

    PubMed Central

    Vargas, Veronica; Wasem, Juergen

    2006-01-01

    Aim To offer a capitation formula with greater capacity for guiding resource spending on population with poorer health and lower socioeconomic status in the context of financing and equity in primary health care. Methods We collected two years of data on a sample of 10 000 individuals from a region in Chile, Valdivia and Temuco and evaluated three models to estimate utilization and expenditures per capita. The first model included age and sex; the second one included age, sex, and the presence of two key diagnoses; and the third model included age, sex, and the presence of seven key diagnoses. Regression results were evaluated by R2 and predictive ratios to select the best specifications. Results Per-capita expenditures by age and sex confirmed international trends, where children under five, women, and the elderly were the main users of primary health care services. Women sought health advice twice as much as men. Clear differences by socioeconomic status were observed for the indigent population aged ≥65 years who under-utilized primary health care services. From the three models, major improvement in the predictive power occurred from the demographic (adjusted R2, 9%) to the demographic plus two diagnoses model (adjusted R2, 27%). Improvements were modest when five other diagnoses were added (adjusted R2, 28%). Conclusion The current formula that uses municipality’s financial power and geographic location of health centers to adjust capitation payments provides little incentive to appropriate care for the indigent and people with chronic conditions. A capitation payment that adjusts for age, sex, and the presence of diabetes and hypertension will better guide resource allocation to those with poorer health and lower socioeconomic status. PMID:16758525

  4. Biologically Inspired Visual Model With Preliminary Cognition and Active Attention Adjustment.

    PubMed

    Qiao, Hong; Xi, Xuanyang; Li, Yinlin; Wu, Wei; Li, Fengfu

    2015-11-01

    Recently, many computational models have been proposed to simulate visual cognition process. For example, the hierarchical Max-Pooling (HMAX) model was proposed according to the hierarchical and bottom-up structure of V1 to V4 in the ventral pathway of primate visual cortex, which could achieve position- and scale-tolerant recognition. In our previous work, we have introduced memory and association into the HMAX model to simulate visual cognition process. In this paper, we improve our theoretical framework by mimicking a more elaborate structure and function of the primate visual cortex. We will mainly focus on the new formation of memory and association in visual processing under different circumstances as well as preliminary cognition and active adjustment in the inferior temporal cortex, which are absent in the HMAX model. The main contributions of this paper are: 1) in the memory and association part, we apply deep convolutional neural networks to extract various episodic features of the objects since people use different features for object recognition. Moreover, to achieve a fast and robust recognition in the retrieval and association process, different types of features are stored in separated clusters and the feature binding of the same object is stimulated in a loop discharge manner and 2) in the preliminary cognition and active adjustment part, we introduce preliminary cognition to classify different types of objects since distinct neural circuits in a human brain are used for identification of various types of objects. Furthermore, active cognition adjustment of occlusion and orientation is implemented to the model to mimic the top-down effect in human cognition process. Finally, our model is evaluated on two face databases CAS-PEAL-R1 and AR. The results demonstrate that our model exhibits its efficiency on visual recognition process with much lower memory storage requirement and a better performance compared with the traditional purely computational

  5. Variational assimilation of streamflow into operational distributed hydrologic models: effect of spatiotemporal adjustment scale

    NASA Astrophysics Data System (ADS)

    Lee, H.; Seo, D.-J.; Liu, Y.; Koren, V.; McKee, P.; Corby, R.

    2012-01-01

    State updating of distributed rainfall-runoff models via streamflow assimilation is subject to overfitting because large dimensionality of the state space of the model may render the assimilation problem seriously under-determined. To examine the issue in the context of operational hydrology, we carry out a set of real-world experiments in which streamflow data is assimilated into gridded Sacramento Soil Moisture Accounting (SAC-SMA) and kinematic-wave routing models of the US National Weather Service (NWS) Research Distributed Hydrologic Model (RDHM) with the variational data assimilation technique. Study basins include four basins in Oklahoma and five basins in Texas. To assess the sensitivity of data assimilation performance to dimensionality reduction in the control vector, we used nine different spatiotemporal adjustment scales, where state variables are adjusted in a lumped, semi-distributed, or distributed fashion and biases in precipitation and potential evaporation (PE) are adjusted hourly, 6-hourly, or kept time-invariant. For each adjustment scale, three different streamflow assimilation scenarios are explored, where streamflow observations at basin interior points, at the basin outlet, or at both interior points and the outlet are assimilated. The streamflow assimilation experiments with nine different basins show that the optimum spatiotemporal adjustment scale varies from one basin to another and may be different for streamflow analysis and prediction in all of the three streamflow assimilation scenarios. The most preferred adjustment scale for seven out of nine basins is found to be the distributed, hourly scale, despite the fact that several independent validation results at this adjustment scale indicated the occurrence of overfitting. Basins with highly correlated interior and outlet flows tend to be less sensitive to the adjustment scale and could benefit more from streamflow assimilation. In comparison to outlet flow assimilation, interior flow

  6. Emotional closeness to parents and grandparents: A moderated mediation model predicting adolescent adjustment.

    PubMed

    Attar-Schwartz, Shalhevet

    2015-09-01

    Warm and emotionally close relationships with parents and grandparents have been found in previous studies to be linked with better adolescent adjustment. The present study, informed by Family Systems Theory and Intergenerational Solidarity Theory, uses a moderated mediation model analyzing the contribution of the dynamics of these intergenerational relationships to adolescent adjustment. Specifically, it examines the mediating role of emotional closeness to the closest grandparent in the relationship between emotional closeness to a parent (the offspring of the closest grandparent) and adolescent adjustment difficulties. The model also examines the moderating role of emotional closeness to parents in the relationship between emotional closeness to grandparents and adjustment difficulties. The study was based on a sample of 1,405 Jewish Israeli secondary school students (ages 12-18) who completed a structured questionnaire. It was found that emotional closeness to the closest grandparent was more strongly associated with reduced adjustment difficulties among adolescents with higher levels of emotional closeness to their parents. In addition, adolescent adjustment and emotional closeness to parents was partially mediated by emotional closeness to grandparents. Examining the family conditions under which adolescents' relationships with grandparents is stronger and more beneficial for them can help elucidate variations in grandparent-grandchild ties and expand our understanding of the mechanisms that shape child outcomes. (c) 2015 APA, all rights reserved).

  7. PACE and the Medicare+Choice risk-adjusted payment model.

    PubMed

    Temkin-Greener, H; Meiners, M R; Gruenberg, L

    2001-01-01

    This paper investigates the impact of the Medicare principal inpatient diagnostic cost group (PIP-DCG) payment model on the Program of All-Inclusive Care for the Elderly (PACE). Currently, more than 6,000 Medicare beneficiaries who are nursing home certifiable receive care from PACE, a program poised for expansion under the Balanced Budget Act of 1997. Overall, our analysis suggests that the application of the PIP-DCG model to the PACE program would reduce Medicare payments to PACE, on average, by 38%. The PIP-DCG payment model bases its risk adjustment on inpatient diagnoses and does not capture adequately the risk of caring for a population with functional impairments.

  8. Modeling and Control of the Redundant Parallel Adjustment Mechanism on a Deployable Antenna Panel

    PubMed Central

    Tian, Lili; Bao, Hong; Wang, Meng; Duan, Xuechao

    2016-01-01

    With the aim of developing multiple input and multiple output (MIMO) coupling systems with a redundant parallel adjustment mechanism on the deployable antenna panel, a structural control integrated design methodology is proposed in this paper. Firstly, the modal information from the finite element model of the structure of the antenna panel is extracted, and then the mathematical model is established with the Hamilton principle; Secondly, the discrete Linear Quadratic Regulator (LQR) controller is added to the model in order to control the actuators and adjust the shape of the panel. Finally, the engineering practicality of the modeling and control method based on finite element analysis simulation is verified. PMID:27706076

  9. Model Minority Stereotyping, Perceived Discrimination, and Adjustment Among Adolescents from Asian American Backgrounds.

    PubMed

    Kiang, Lisa; Witkow, Melissa R; Thompson, Taylor L

    2016-07-01

    The model minority image is a common and pervasive stereotype that Asian American adolescents must navigate. Using multiwave data from 159 adolescents from Asian American backgrounds (mean age at initial recruitment = 15.03, SD = .92; 60 % female; 74 % US-born), the current study targeted unexplored aspects of the model minority experience in conjunction with more traditionally measured experiences of negative discrimination. When examining normative changes, perceptions of model minority stereotyping increased over the high school years while perceptions of discrimination decreased. Both experiences were not associated with each other, suggesting independent forms of social interactions. Model minority stereotyping generally promoted academic and socioemotional adjustment, whereas discrimination hindered outcomes. Moreover, in terms of academic adjustment, the model minority stereotype appears to protect against the detrimental effect of discrimination. Implications of the complex duality of adolescents' social interactions are discussed.

  10. An in-depth assessment of a diagnosis-based risk adjustment model based on national health insurance claims: the application of the Johns Hopkins Adjusted Clinical Group case-mix system in Taiwan.

    PubMed

    Chang, Hsien-Yen; Weiner, Jonathan P

    2010-01-18

    Diagnosis-based risk adjustment is becoming an important issue globally as a result of its implications for payment, high-risk predictive modelling and provider performance assessment. The Taiwanese National Health Insurance (NHI) programme provides universal coverage and maintains a single national computerized claims database, which enables the application of diagnosis-based risk adjustment. However, research regarding risk adjustment is limited. This study aims to examine the performance of the Adjusted Clinical Group (ACG) case-mix system using claims-based diagnosis information from the Taiwanese NHI programme. A random sample of NHI enrollees was selected. Those continuously enrolled in 2002 were included for concurrent analyses (n = 173,234), while those in both 2002 and 2003 were included for prospective analyses (n = 164,562). Health status measures derived from 2002 diagnoses were used to explain the 2002 and 2003 health expenditure. A multivariate linear regression model was adopted after comparing the performance of seven different statistical models. Split-validation was performed in order to avoid overfitting. The performance measures were adjusted R2 and mean absolute prediction error of five types of expenditure at individual level, and predictive ratio of total expenditure at group level. The more comprehensive models performed better when used for explaining resource utilization. Adjusted R2 of total expenditure in concurrent/prospective analyses were 4.2%/4.4% in the demographic model, 15%/10% in the ACGs or ADGs (Aggregated Diagnosis Group) model, and 40%/22% in the models containing EDCs (Expanded Diagnosis Cluster). When predicting expenditure for groups based on expenditure quintiles, all models underpredicted the highest expenditure group and overpredicted the four other groups. For groups based on morbidity burden, the ACGs model had the best performance overall. Given the widespread availability of claims data and the superior explanatory

  11. Suitability of a three-dimensional model to measure empathy and its relationship with social and normative adjustment in Spanish adolescents: a cross-sectional study

    PubMed Central

    Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario; Jolliffe, Darrick; Romera, Eva M.

    2017-01-01

    Objectives (1) To examine the psychometric properties of the Basic Empathy Scale (BES) with Spanish adolescents, comparing a two and a three-dimensional structure;(2) To analyse the relationship between the three-dimensional empathy and social and normative adjustment in school. Design Transversal and ex post facto retrospective study. Confirmatory factorial analysis, multifactorial invariance analysis and structural equations models were used. Participants 747 students (51.3% girls) from Cordoba, Spain, aged 12–17 years (M=13.8; SD=1.21). Results The original two-dimensional structure was confirmed (cognitive empathy, affective empathy), but a three-dimensional structure showed better psychometric properties, highlighting the good fit found in confirmatory factorial analysis and adequate internal consistent valued, measured with Cronbach’s alpha and McDonald’s omega. Composite reliability and average variance extracted showed better indices for a three-factor model. The research also showed evidence of measurement invariance across gender. All the factors of the final three-dimensional BES model were direct and significantly associated with social and normative adjustment, being most strongly related to cognitive empathy. Conclusions This research supports the advances in neuroscience, developmental psychology and psychopathology through a three-dimensional version of the BES, which represents an improvement in the original two-factorial model. The organisation of empathy in three factors benefits the understanding of social and normative adjustment in adolescents, in which emotional disengagement favours adjusted peer relationships. Psychoeducational interventions aimed at improving the quality of social life in schools should target these components of empathy. PMID:28951400

  12. Suggestion of a Numerical Model for the Blood Glucose Adjustment with Ingesting a Food

    NASA Astrophysics Data System (ADS)

    Yamamoto, Naokatsu; Takai, Hiroshi

    In this study, we present a numerical model of the time dependence of blood glucose value after ingesting a meal. Two numerical models are proposed in this paper to explain a digestion mechanism and an adjustment mechanism of blood glucose in the body, respectively. It is considered that models are exhibited by using simple equations with a transfer function and a block diagram. Additionally, the time dependence of blood glucose was measured, when subjects ingested a sucrose or a starch. As a result, it is clear that the calculated result of models using a computer can be fitted very well to the measured result of the time dependence of blood glucose. Therefore, it is considered that the digestion model and the adjustment model are useful models in order to estimate a blood glucose value after ingesting meals.

  13. Glacial isostatic adjustment using GNSS permanent stations and GIA modelling tools

    NASA Astrophysics Data System (ADS)

    Kollo, Karin; Spada, Giorgio; Vermeer, Martin

    2013-04-01

    Glacial Isostatic Adjustment (GIA) affects the Earth's mantle in areas which were once ice covered and the process is still ongoing. In this contribution we focus on GIA processes in Fennoscandian and North American uplift regions. In this contribution we use horizontal and vertical uplift rates from Global Navigation Satellite System (GNSS) permanent stations. For Fennoscandia the BIFROST dataset (Lidberg, 2010) and North America the dataset from Sella, 2007 were used respectively. We perform GIA modelling with the SELEN program (Spada and Stocchi, 2007) and we vary ice model parameters in space in order to find ice model which suits best with uplift values obtained from GNSS time series analysis. In the GIA modelling, the ice models ICE-5G (Peltier, 2004) and the ice model denoted as ANU05 ((Fleming and Lambeck, 2004) and references therein) were used. As reference, the velocity field from GNSS permanent station time series was used for both target areas. Firstly the sensitivity to the harmonic degree was tested in order to reduce the computation time. In the test, nominal viscosity values and pre-defined lithosphere thicknesses models were used, varying maximum harmonic degree values. Main criteria for choosing the suitable harmonic degree was chi-square fit - if the error measure does not differ more than 10%, then one might use as well lower harmonic degree value. From this test, maximum harmonic degree of 72 was chosen to perform calculations, as the larger value did not significantly modify the results obtained, as well the computational time for observations was kept reasonable. Secondly the GIA computations were performed to find the model, which could fit with highest probability to the GNSS-based velocity field in the target areas. In order to find best fitting Earth viscosity parameters, different viscosity profiles for the Earth models were tested and their impact on horizontal and vertical velocity rates from GIA modelling was studied. For every

  14. Lithium-ion Open Circuit Voltage (OCV) curve modelling and its ageing adjustment

    NASA Astrophysics Data System (ADS)

    Lavigne, L.; Sabatier, J.; Francisco, J. Mbala; Guillemard, F.; Noury, A.

    2016-08-01

    This paper is a contribution to lithium-ion batteries modelling taking into account aging effects. It first analyses the impact of aging on electrode stoichiometry and then on lithium-ion cell Open Circuit Voltage (OCV) curve. Through some hypotheses and an appropriate definition of the cell state of charge, it shows that each electrode equilibrium potential, but also the whole cell equilibrium potential can be modelled by a polynomial that requires only one adjustment parameter during aging. An adjustment algorithm, based on the idea that for two fixed OCVs, the state of charge between these two equilibrium states is unique for a given aging level, is then proposed. Its efficiency is evaluated on a battery pack constituted of four cells.

  15. Simplification and its consequences in biological modelling: conclusions from a study of calcium oscillations in hepatocytes.

    PubMed

    Hetherington, James P J; Warner, Anne; Seymour, Robert M

    2006-04-22

    Systems Biology requires that biological modelling is scaled up from small components to system level. This can produce exceedingly complex models, which obscure understanding rather than facilitate it. The successful use of highly simplified models would resolve many of the current problems faced in Systems Biology. This paper questions whether the conclusions of simple mathematical models of biological systems are trustworthy. The simplification of a specific model of calcium oscillations in hepatocytes is examined in detail, and the conclusions drawn from this scrutiny generalized. We formalize our choice of simplification approach through the use of functional 'building blocks'. A collection of models is constructed, each a progressively more simplified version of a well-understood model. The limiting model is a piecewise linear model that can be solved analytically. We find that, as expected, in many cases the simpler models produce incorrect results. However, when we make a sensitivity analysis, examining which aspects of the behaviour of the system are controlled by which parameters, the conclusions of the simple model often agree with those of the richer model. The hypothesis that the simplified model retains no information about the real sensitivities of the unsimplified model can be very strongly ruled out by treating the simplification process as a pseudo-random perturbation on the true sensitivity data. We conclude that sensitivity analysis is, therefore, of great importance to the analysis of simple mathematical models in biology. Our comparisons reveal which results of the sensitivity analysis regarding calcium oscillations in hepatocytes are robust to the simplifications necessarily involved in mathematical modelling. For example, we find that if a treatment is observed to strongly decrease the period of the oscillations while increasing the proportion of the cycle during which cellular calcium concentrations are rising, without affecting the inter

  16. Projecting School Psychology Staffing Needs Using a Risk-Adjusted Model.

    ERIC Educational Resources Information Center

    Stellwagen, Kurt

    A model is proposed to project optimal school psychology service ratios based upon the percentages of at risk students enrolled within a given school population. Using the standard 1:1,000 service ratio advocated by The National Association of School Psychologists (NASP) as a starting point, ratios are then adjusted based upon the size of three…

  17. Adjusting the Adjusted X[superscript 2]/df Ratio Statistic for Dichotomous Item Response Theory Analyses: Does the Model Fit?

    ERIC Educational Resources Information Center

    Tay, Louis; Drasgow, Fritz

    2012-01-01

    Two Monte Carlo simulation studies investigated the effectiveness of the mean adjusted X[superscript 2]/df statistic proposed by Drasgow and colleagues and, because of problems with the method, a new approach for assessing the goodness of fit of an item response theory model was developed. It has been previously recommended that mean adjusted…

  18. Parental bonding in males with adjustment disorder and hyperventilation syndrome

    PubMed Central

    2012-01-01

    Background The purpose of the study was to identify the style of parental bonding and the personality characteristics that might increase the risk of hyperventilation and adjustment disorder. Methods A total of 917 males were recruited, 156 with adjustment disorder and hyperventilation syndrome (AD + HY), 273 with adjustment disorder without hyperventilation syndrome (AD–HY), and 488 healthy controls. All participants completed the Parental Bonding Instrument, Eysenck Personality Questionnaire, and Chinese Health Questionnaire. Results Analysis using structural equation models identified a pathway relationship in which parental bonding affected personality characteristics, personality characteristics affected mental health condition, and mental health condition affected the development of hyperventilation or adjustment disorder. Males with AD–HY perceived less paternal care, and those with AD + HY perceived more maternal protection than those with adjustment disorder and those in the control group. Participants with AD–HY were more neurotic and less extroverted than those with AD + HY. Both groups showed poorer mental health than the controls. Conclusions Although some patients with hyperventilation syndrome demonstrated symptoms of adjustment disorder, there were different predisposing factors between the two groups in terms of parental bonding and personality characteristics. This finding is important for the early intervention and prevention of hyperventilation and adjustment disorder. PMID:22672223

  19. Adjustment for reporting bias in network meta-analysis of antidepressant trials

    PubMed Central

    2012-01-01

    Background Network meta-analysis (NMA), a generalization of conventional MA, allows for assessing the relative effectiveness of multiple interventions. Reporting bias is a major threat to the validity of MA and NMA. Numerous methods are available to assess the robustness of MA results to reporting bias. We aimed to extend such methods to NMA. Methods We introduced 2 adjustment models for Bayesian NMA. First, we extended a meta-regression model that allows the effect size to depend on its standard error. Second, we used a selection model that estimates the propensity of trial results being published and in which trials with lower propensity are weighted up in the NMA model. Both models rely on the assumption that biases are exchangeable across the network. We applied the models to 2 networks of placebo-controlled trials of 12 antidepressants, with 74 trials in the US Food and Drug Administration (FDA) database but only 51 with published results. NMA and adjustment models were used to estimate the effects of the 12 drugs relative to placebo, the 66 effect sizes for all possible pair-wise comparisons between drugs, probabilities of being the best drug and ranking of drugs. We compared the results from the 2 adjustment models applied to published data and NMAs of published data and NMAs of FDA data, considered as representing the totality of the data. Results Both adjustment models showed reduced estimated effects for the 12 drugs relative to the placebo as compared with NMA of published data. Pair-wise effect sizes between drugs, probabilities of being the best drug and ranking of drugs were modified. Estimated drug effects relative to the placebo from both adjustment models were corrected (i.e., similar to those from NMA of FDA data) for some drugs but not others, which resulted in differences in pair-wise effect sizes between drugs and ranking. Conclusions In this case study, adjustment models showed that NMA of published data was not robust to reporting bias and

  20. Spiritual Well-Being and Dyadic Adjustment: Mediator Effects for Family Strengths

    PubMed Central

    Ghaffari, Majid

    2016-01-01

    Objectives The aim of the present study was to test a structural model of hypothesized relationships between spiritual well-being, intervening variables of personal worth of self and others, commitment to relationship stability, commitment to relationship growth, positive interaction/appreciation, communication/conflict resolution, time spent together, and, the dependent variable, dyadic adjustment. Materials and Methods Two hundred and sixty eight (171 females and 97 males) married parent subjects were selected by convenience sampling from three universities in Mazandaran, Iran, to take part in this study. They were all volunteers and were not paid and their age range was 23 to 47 (31.07 ± 4.37 years). All participants were asked to complete the spiritual well-being scale (SWBS), family strengths scale (FSS) and revised dyadic adjustment scale (RDAS). Results The results from structural equation modeling confirmed a hierarchy for the development of family strengths, and indicated that spiritual well-being and strength in most characteristics affected dyadic adjustment, positively (P <0.05). Conclusions Couples’ level of dyadic adjustment is increased when they have higher spiritual well-being, value each other, have commitment to each other, communicate well, enjoy being with each other, and spend time together. PMID:27822273

  1. Player Modeling for Intelligent Difficulty Adjustment

    NASA Astrophysics Data System (ADS)

    Missura, Olana; Gärtner, Thomas

    In this paper we aim at automatically adjusting the difficulty of computer games by clustering players into different types and supervised prediction of the type from short traces of gameplay. An important ingredient of video games is to challenge players by providing them with tasks of appropriate and increasing difficulty. How this difficulty should be chosen and increase over time strongly depends on the ability, experience, perception and learning curve of each individual player. It is a subjective parameter that is very difficult to set. Wrong choices can easily lead to players stopping to play the game as they get bored (if underburdened) or frustrated (if overburdened). An ideal game should be able to adjust its difficulty dynamically governed by the player’s performance. Modern video games utilise a game-testing process to investigate among other factors the perceived difficulty for a multitude of players. In this paper, we investigate how machine learning techniques can be used for automatic difficulty adjustment. Our experiments confirm the potential of machine learning in this application.

  2. Adjustable Autonomy Testbed

    NASA Technical Reports Server (NTRS)

    Malin, Jane T.; Schrenkenghost, Debra K.

    2001-01-01

    The Adjustable Autonomy Testbed (AAT) is a simulation-based testbed located in the Intelligent Systems Laboratory in the Automation, Robotics and Simulation Division at NASA Johnson Space Center. The purpose of the testbed is to support evaluation and validation of prototypes of adjustable autonomous agent software for control and fault management for complex systems. The AA T project has developed prototype adjustable autonomous agent software and human interfaces for cooperative fault management. This software builds on current autonomous agent technology by altering the architecture, components and interfaces for effective teamwork between autonomous systems and human experts. Autonomous agents include a planner, flexible executive, low level control and deductive model-based fault isolation. Adjustable autonomy is intended to increase the flexibility and effectiveness of fault management with an autonomous system. The test domain for this work is control of advanced life support systems for habitats for planetary exploration. The CONFIG hybrid discrete event simulation environment provides flexible and dynamically reconfigurable models of the behavior of components and fluids in the life support systems. Both discrete event and continuous (discrete time) simulation are supported, and flows and pressures are computed globally. This provides fast dynamic simulations of interacting hardware systems in closed loops that can be reconfigured during operations scenarios, producing complex cascading effects of operations and failures. Current object-oriented model libraries support modeling of fluid systems, and models have been developed of physico-chemical and biological subsystems for processing advanced life support gases. In FY01, water recovery system models will be developed.

  3. Testing an Attachment Model of Latina/o College Students' Psychological Adjustment

    ERIC Educational Resources Information Center

    Garriott, Patton O.; Love, Keisha M.; Tyler, Kenneth M.; Thomas, Deneia M.; Roan-Belle, Clarissa R.; Brown, Carrie L.

    2010-01-01

    The present study examined the influence of attachment relationships on the psychological adjustment of Latina/o university students (N = 80) attending predominantly White institutions of higher education. A path analysis conducted to test a hypothesized model of parent and peer attachment, self-esteem, and psychological distress indicated that…

  4. Towards an Integrated Conceptual Model of International Student Adjustment and Adaptation

    ERIC Educational Resources Information Center

    Schartner, Alina; Young, Tony Johnstone

    2016-01-01

    Despite a burgeoning body of empirical research on "the international student experience", the area remains under-theorized. The literature to date lacks a guiding conceptual model that captures the adjustment and adaptation trajectories of this unique, growing, and important sojourner group. In this paper, we therefore put forward a…

  5. Stress and Personal Resource as Predictors of the Adjustment of Parents to Autistic Children: A Multivariate Model

    ERIC Educational Resources Information Center

    Siman-Tov, Ayelet; Kaniel, Shlomo

    2011-01-01

    The research validates a multivariate model that predicts parental adjustment to coping successfully with an autistic child. The model comprises four elements: parental stress, parental resources, parental adjustment and the child's autism symptoms. 176 parents of children aged between 6 to 16 diagnosed with PDD answered several questionnaires…

  6. SIM_ADJUST -- A computer code that adjusts simulated equivalents for observations or predictions

    USGS Publications Warehouse

    Poeter, Eileen P.; Hill, Mary C.

    2008-01-01

    This report documents the SIM_ADJUST computer code. SIM_ADJUST surmounts an obstacle that is sometimes encountered when using universal model analysis computer codes such as UCODE_2005 (Poeter and others, 2005), PEST (Doherty, 2004), and OSTRICH (Matott, 2005; Fredrick and others (2007). These codes often read simulated equivalents from a list in a file produced by a process model such as MODFLOW that represents a system of interest. At times values needed by the universal code are missing or assigned default values because the process model could not produce a useful solution. SIM_ADJUST can be used to (1) read a file that lists expected observation or prediction names and possible alternatives for the simulated values; (2) read a file produced by a process model that contains space or tab delimited columns, including a column of simulated values and a column of related observation or prediction names; (3) identify observations or predictions that have been omitted or assigned a default value by the process model; and (4) produce an adjusted file that contains a column of simulated values and a column of associated observation or prediction names. The user may provide alternatives that are constant values or that are alternative simulated values. The user may also provide a sequence of alternatives. For example, the heads from a series of cells may be specified to ensure that a meaningful value is available to compare with an observation located in a cell that may become dry. SIM_ADJUST is constructed using modules from the JUPITER API, and is intended for use on any computer operating system. SIM_ADJUST consists of algorithms programmed in Fortran90, which efficiently performs numerical calculations.

  7. Internal working models and adjustment of physically abused children: the mediating role of self-regulatory abilities.

    PubMed

    Hawkins, Amy L; Haskett, Mary E

    2014-01-01

    Abused children's internal working models (IWM) of relationships are known to relate to their socioemotional adjustment, but mechanisms through which negative representations increase vulnerability to maladjustment have not been explored. We sought to expand the understanding of individual differences in IWM of abused children and investigate the mediating role of self-regulation in links between IWM and adjustment. Cluster analysis was used to subgroup 74 physically abused children based on their IWM. Internal working models were identified by children's representations, as measured by a narrative story stem task. Self-regulation was assessed by teacher report and a behavioral task, and adjustment was measured by teacher report. Cluster analyses indicated two subgroups of abused children with distinct patterns of IWMs. Cluster membership predicted internalizing and externalizing problems. Associations between cluster membership and adjustment were mediated by children's regulation, as measured by teacher reports of many aspects of regulation. There was no support for mediation when regulation was measured by a behavioral task that tapped more narrow facets of regulation. Abused children exhibit clinically relevant individual differences in their IWMs; these models are linked to adjustment in the school setting, possibly through children's self-regulation. © 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.

  8. Phasic valence and arousal do not influence post-conflict adjustments in the Simon task.

    PubMed

    Dignath, David; Janczyk, Markus; Eder, Andreas B

    2017-03-01

    According to theoretical accounts of cognitive control, conflict between competing responses is monitored and triggers post conflict behavioural adjustments. Some models proposed that conflict is detected as an affective signal. While the conflict monitoring theory assumed that conflict is registered as a negative valence signal, the adaptation by binding model hypothesized that conflict provides a high arousal signal. The present research induced phasic affect in a Simon task with presentations of pleasant and unpleasant pictures that were high or low in arousal. If conflict is registered as an affective signal, the presentation of a corresponding affective signal should potentiate post conflict adjustments. Results did not support the hypothesis, and Bayesian analyses corroborated the conclusion that phasic affects do not influence post conflict behavioural adjustments in the Simon task. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Evaluation of the Stress Adjustment and Adaptation Model among Families Reporting Economic Pressure

    ERIC Educational Resources Information Center

    Vandsburger, Etty; Biggerstaff, Marilyn A.

    2004-01-01

    This research evaluates the Stress Adjustment and Adaptation Model (double ABCX model) examining the effects resiliency resources on family functioning when families experience economic pressure. Families (N = 128) with incomes at or below the poverty line from a rural area of a southern state completed measures of perceived economic pressure,…

  10. Testing a Social Ecological Model for Relations between Political Violence and Child Adjustment in Northern Ireland

    PubMed Central

    Cummings, E. Mark; Merrilees, Christine E.; Schermerhorn, Alice C.; Goeke-Morey, Marcie C.; Shirlow, Peter; Cairns, Ed

    2013-01-01

    Relations between political violence and child adjustment are matters of international concern. Past research demonstrates the significance of community, family and child psychological processes in child adjustment, supporting study of inter-relations between multiple social ecological factors and child adjustment in contexts of political violence. Testing a social ecological model, 300 mothers and their children (M= 12.28 years, SD = 1.77) from Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland completed measures of community discord, family relations, and children’s regulatory processes (i.e., emotional security) and outcomes. Historical political violence in neighborhoods based on objective records (i.e., politically motivated deaths) were related to family members’ reports of current sectarian and non-sectarian antisocial behavior. Interparental conflict and parental monitoring and children’s emotional security about both the community and family contributed to explanatory pathways for relations between sectarian antisocial behavior in communities and children’s adjustment problems. The discussion evaluates support for social ecological models for relations between political violence and child adjustment and its implications for understanding relations in other parts of the world. PMID:20423550

  11. Testing a social ecological model for relations between political violence and child adjustment in Northern Ireland.

    PubMed

    Cummings, E Mark; Merrilees, Christine E; Schermerhorn, Alice C; Goeke-Morey, Marcie C; Shirlow, Peter; Cairns, Ed

    2010-05-01

    Relations between political violence and child adjustment are matters of international concern. Past research demonstrates the significance of community, family, and child psychological processes in child adjustment, supporting study of interrelations between multiple social ecological factors and child adjustment in contexts of political violence. Testing a social ecological model, 300 mothers and their children (M = 12.28 years, SD = 1.77) from Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures of community discord, family relations, and children's regulatory processes (i.e., emotional security) and outcomes. Historical political violence in neighborhoods based on objective records (i.e., politically motivated deaths) were related to family members' reports of current sectarian antisocial behavior and nonsectarian antisocial behavior. Interparental conflict and parental monitoring and children's emotional security about both the community and family contributed to explanatory pathways for relations between sectarian antisocial behavior in communities and children's adjustment problems. The discussion evaluates support for social ecological models for relations between political violence and child adjustment and its implications for understanding relations in other parts of the world.

  12. Utilizing Visual Effects Software for Efficient and Flexible Isostatic Adjustment Modelling

    NASA Astrophysics Data System (ADS)

    Meldgaard, A.; Nielsen, L.; Iaffaldano, G.

    2017-12-01

    The isostatic adjustment signal generated by transient ice sheet loading is an important indicator of past ice sheet extent and the rheological constitution of the interior of the Earth. Finite element modelling has proved to be a very useful tool in these studies. We present a simple numerical model for 3D visco elastic Earth deformation and a new approach to the design of such models utilizing visual effects software designed for the film and game industry. The software package Houdini offers an assortment of optimized tools and libraries which greatly facilitate the creation of efficient numerical algorithms. In particular, we make use of Houdini's procedural work flow, the SIMD programming language VEX, Houdini's sparse matrix creation and inversion libraries, an inbuilt tetrahedralizer for grid creation, and the user interface, which facilitates effortless manipulation of 3D geometry. We mitigate many of the time consuming steps associated with the authoring of efficient algorithms from scratch while still keeping the flexibility that may be lost with the use of commercial dedicated finite element programs. We test the efficiency of the algorithm by comparing simulation times with off-the-shelf solutions from the Abaqus software package. The algorithm is tailored for the study of local isostatic adjustment patterns, in close vicinity to present ice sheet margins. In particular, we wish to examine possible causes for the considerable spatial differences in the uplift magnitude which are apparent from field observations in these areas. Such features, with spatial scales of tens of kilometres, are not resolvable with current global isostatic adjustment models, and may require the inclusion of local topographic features. We use the presented algorithm to study a near field area where field observations are abundant, namely, Disko Bay in West Greenland with the intention of constraining Earth parameters and ice thickness. In addition, we assess how local

  13. An Efficient Bundle Adjustment Model Based on Parallax Parametrization for Environmental Monitoring

    NASA Astrophysics Data System (ADS)

    Chen, R.; Sun, Y. Y.; Lei, Y.

    2017-12-01

    With the rapid development of Unmanned Aircraft Systems (UAS), more and more research fields have been successfully equipped with this mature technology, among which is environmental monitoring. One difficult task is how to acquire accurate position of ground object in order to reconstruct the scene more accurate. To handle this problem, we combine bundle adjustment method from Photogrammetry with parallax parametrization from Computer Vision to create a new method call APCP (aerial polar-coordinate photogrammetry). One impressive advantage of this method compared with traditional method is that the 3-dimensional point in space is represented using three angles (elevation angle, azimuth angle and parallax angle) rather than the XYZ value. As the basis for APCP, bundle adjustment could be used to optimize the UAS sensors' pose accurately, reconstruct the 3D models of environment, thus serving as the criterion of accurate position for monitoring. To verity the effectiveness of the proposed method, we test on several UAV dataset obtained by non-metric digital cameras with large attitude angles, and we find that our methods could achieve 1 or 2 times better efficiency with no loss of accuracy than traditional ones. For the classical nonlinear optimization of bundle adjustment model based on the rectangular coordinate, it suffers the problem of being seriously dependent on the initial values, making it unable to converge fast or converge to a stable state. On the contrary, APCP method could deal with quite complex condition of UAS when conducting monitoring as it represent the points in space with angles, including the condition that the sequential images focusing on one object have zero parallax angle. In brief, this paper presents the parameterization of 3D feature points based on APCP, and derives a full bundle adjustment model and the corresponding nonlinear optimization problems based on this method. In addition, we analyze the influence of convergence and

  14. Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?

    PubMed

    Tsang, Victor T; Brown, Katherine L; Synnergren, Mats Johanssen; Kang, Nicholas; de Leval, Marc R; Gallivan, Steve; Utley, Martin

    2009-02-01

    Risk adjustment of outcomes in pediatric congenital heart surgery is challenging due to the great diversity in diagnoses and procedures. We have previously shown that variable life-adjusted display (VLAD) charts provide an effective graphic display of risk-adjusted outcomes in this specialty. A question arises as to whether the risk model used remains appropriate over time. We used a recently developed graphic technique to evaluate the performance of an existing risk model among those patients at a single center during 2000 to 2003 originally used in model development. We then compared the distribution of predicted risk among these patients with that among patients in 2004 to 2006. Finally, we constructed a VLAD chart of risk-adjusted outcomes for the latter period. Among 1083 patients between April 2000 and March 2003, the risk model performed well at predicted risks above 3%, underestimated mortality at 2% to 3% predicted risk, and overestimated mortality below 2% predicted risk. There was little difference in the distribution of predicted risk among these patients and among 903 patients between June 2004 and October 2006. Outcomes for the more recent period were appreciably better than those expected according to the risk model. This finding cannot be explained by any apparent bias in the risk model combined with changes in case-mix. Risk models can, and hopefully do, become out of date. There is scope for complacency in the risk-adjusted audit if the risk model used is not regularly recalibrated to reflect changing standards and expectations.

  15. A Unified Model of Geostrophic Adjustment and Frontogenesis

    NASA Astrophysics Data System (ADS)

    Taylor, John; Shakespeare, Callum

    2013-11-01

    Fronts, or regions with strong horizontal density gradients, are ubiquitous and dynamically important features of the ocean and atmosphere. In the ocean, fronts are associated with enhanced air-sea fluxes, turbulence, and biological productivity, while atmospheric fronts are associated with some of the most extreme weather events. Here, we describe a new mathematical framework for describing the formation of fronts, or frontogenesis. This framework unifies two classical problems in geophysical fluid dynamics, geostrophic adjustment and strain-driven frontogenesis, and provides a number of important extensions beyond previous efforts. The model solutions closely match numerical simulations during the early stages of frontogenesis, and provide a means to describe the development of turbulence at mature fronts.

  16. A Model to Predict Psychological- and Health-Related Adjustment in Men with Prostate Cancer: The Role of Post Traumatic Growth, Physical Post Traumatic Growth, Resilience and Mindfulness.

    PubMed

    Walsh, Deirdre M J; Morrison, Todd G; Conway, Ronan J; Rogers, Eamonn; Sullivan, Francis J; Groarke, AnnMarie

    2018-01-01

    Background: Post traumatic growth (PTG) can be defined as positive change following a traumatic event. The current conceptualization of PTG encompasses five main dimensions, however, there is no dimension which accounts for the distinct effect of a physical trauma on PTG. The purpose of the present research was to test the role of PTG, physical post traumatic growth (PPTG), resilience and mindfulness in predicting psychological and health related adjustment. Method: Ethical approval was obtained from relevant institutional ethics committees. Participants ( N = 241), who were at least 1 year post prostate cancer treatment, were invited to complete a battery of questionnaires either through an online survey or a paper and pencil package received in the post The sample ranged in age from 44 to 88 years ( M = 64.02, SD = 7.76). Data were analysis using confirmatory factor analysis and structural equation modeling. Results: The physical post traumatic growth inventory (P-PTGI) was used to evaluate the role of PPTG in predicting adjustment using structural equation modeling. P-PTGI predicted lower distress and improvement of quality of life, whereas conversely, the traditional PTG measure was linked with poor adjustment. The relationship between resilience and adjustment was found to be mediated by P-PTGI. Conclusion: Findings suggest the central role of PTG in the prostate cancer survivorship experience is enhanced by the inclusion of PPTG. Adjusting to a physical trauma such as illness (internal transgressor) is unlike a trauma with an external transgressor as the physical trauma creates an entirely different framework for adjustment. The current study demonstrates the impact of PPTG on adjustment. This significantly adds to the theory of the development of PTG by highlighting the interplay of resilience with PTG, PPTG, and adjustment.

  17. Two Models of Caregiver Strain and Bereavement Adjustment: A Comparison of Husband and Daughter Caregivers of Breast Cancer Hospice Patients

    ERIC Educational Resources Information Center

    Bernard, Lori L.; Guarnaccia, Charles A.

    2003-01-01

    Purpose: Caregiver bereavement adjustment literature suggests opposite models of impact of role strain on bereavement adjustment after care-recipient death--a Complicated Grief Model and a Relief Model. This study tests these competing models for husband and adult-daughter caregivers of breast cancer hospice patients. Design and Methods: This…

  18. Price adjustment for traditional Chinese medicine procedures: Based on a standardized value parity model.

    PubMed

    Wang, Haiyin; Jin, Chunlin; Jiang, Qingwu

    2017-11-20

    Traditional Chinese medicine (TCM) is an important part of China's medical system. Due to the prolonged low price of TCM procedures and the lack of an effective mechanism for dynamic price adjustment, the development of TCM has markedly lagged behind Western medicine. The World Health Organization (WHO) has emphasized the need to enhance the development of alternative and traditional medicine when creating national health care systems. The establishment of scientific and appropriate mechanisms to adjust the price of medical procedures in TCM is crucial to promoting the development of TCM. This study has examined incorporating value indicators and data on basic manpower expended, time spent, technical difficulty, and the degree of risk in the latest standards for the price of medical procedures in China, and this study also offers a price adjustment model with the relative price ratio as a key index. This study examined 144 TCM procedures and found that prices of TCM procedures were mainly based on the value of medical care provided; on average, medical care provided accounted for 89% of the price. Current price levels were generally low and the current price accounted for 56% of the standardized value of a procedure, on average. Current price levels accounted for a markedly lower standardized value of acupuncture, moxibustion, special treatment with TCM, and comprehensive TCM procedures. This study selected a total of 79 procedures and adjusted them by priority. The relationship between the price of TCM procedures and the suggested price was significantly optimized (p < 0.01). This study suggests that adjustment of the price of medical procedures based on a standardized value parity model is a scientific and suitable method of price adjustment that can serve as a reference for other provinces and municipalities in China and other countries and regions that mainly have fee-for-service (FFS) medical care.

  19. Adjustments of the TaD electron density reconstruction model with GNSS-TEC parameters for operational application purposes

    NASA Astrophysics Data System (ADS)

    Kutiev, Ivan; Marinov, Pencho; Fidanova, Stefka; Belehaki, Anna; Tsagouri, Ioanna

    2012-12-01

    Validation results on the latest version of TaD model (TaDv2) show realistic reconstruction of the electron density profiles (EDPs) with an average error of 3 TECU, similar to the error obtained from GNSS-TEC calculated paremeters. The work presented here has the aim to further improve the accuracy of the TaD topside reconstruction, adjusting the TEC parameter calculated from TaD model with the TEC parameter calculated by GNSS transmitting RINEX files provided by receivers co-located with the Digisondes. The performance of the new version is tested during a storm period demonstrating further improvements in respect to the previous version. Statistical comparison of modeled and observed TEC confirms the validity of the proposed adjustment. A significant benefit of the proposed upgrade is that it facilitates the real-time implementation of TaD. The model needs a reliable measure of the scale height at the peak height, which is supposed to be provided by Digisondes. Oftenly, the automatic scaling software fails to correctly calculate the scale height at the peak, Hm, due to interferences in the receiving signal. Consequently the model estimated topside scale height is wrongly calculated leading to unrealistic results for the modeled EDP. The proposed TEC adjustment forces the model to correctly reproduce the topside scale height, despite the inaccurate values of Hm. This adjustment is very important for the application of TaD in an operational environment.

  20. Health-based risk adjustment: improving the pharmacy-based cost group model by adding diagnostic cost groups.

    PubMed

    Prinsze, Femmeke J; van Vliet, René C J A

    Since 1991, risk-adjusted premium subsidies have existed in the Dutch social health insurance sector, which covered about two-thirds of the population until 2006. In 2002, pharmacy-based cost groups (PCGs) were included in the demographic risk adjustment model, which improved the goodness-of-fit, as measured by the R2, to 11.5%. The model's R2 reached 22.8% in 2004, when inpatient diagnostic information was added in the form of diagnostic cost groups (DCGs). PCGs and DCGs appear to be complementary in their ability to predict future costs. PCGs particularly improve the R2 for outpatient expenses, whereas DCGs improve the R2 for inpatient expenses. In 2006, this system of risk-adjusted premium subsidies was extended to cover the entire population.

  1. On the multiple imputation variance estimator for control-based and delta-adjusted pattern mixture models.

    PubMed

    Tang, Yongqiang

    2017-12-01

    Control-based pattern mixture models (PMM) and delta-adjusted PMMs are commonly used as sensitivity analyses in clinical trials with non-ignorable dropout. These PMMs assume that the statistical behavior of outcomes varies by pattern in the experimental arm in the imputation procedure, but the imputed data are typically analyzed by a standard method such as the primary analysis model. In the multiple imputation (MI) inference, Rubin's variance estimator is generally biased when the imputation and analysis models are uncongenial. One objective of the article is to quantify the bias of Rubin's variance estimator in the control-based and delta-adjusted PMMs for longitudinal continuous outcomes. These PMMs assume the same observed data distribution as the mixed effects model for repeated measures (MMRM). We derive analytic expressions for the MI treatment effect estimator and the associated Rubin's variance in these PMMs and MMRM as functions of the maximum likelihood estimator from the MMRM analysis and the observed proportion of subjects in each dropout pattern when the number of imputations is infinite. The asymptotic bias is generally small or negligible in the delta-adjusted PMM, but can be sizable in the control-based PMM. This indicates that the inference based on Rubin's rule is approximately valid in the delta-adjusted PMM. A simple variance estimator is proposed to ensure asymptotically valid MI inferences in these PMMs, and compared with the bootstrap variance. The proposed method is illustrated by the analysis of an antidepressant trial, and its performance is further evaluated via a simulation study. © 2017, The International Biometric Society.

  2. Nonlinear relative-proportion-based route adjustment process for day-to-day traffic dynamics: modeling, equilibrium and stability analysis

    NASA Astrophysics Data System (ADS)

    Zhu, Wenlong; Ma, Shoufeng; Tian, Junfang; Li, Geng

    2016-11-01

    Travelers' route adjustment behaviors in a congested road traffic network are acknowledged as a dynamic game process between them. Existing Proportional-Switch Adjustment Process (PSAP) models have been extensively investigated to characterize travelers' route choice behaviors; PSAP has concise structure and intuitive behavior rule. Unfortunately most of which have some limitations, i.e., the flow over adjustment problem for the discrete PSAP model, the absolute cost differences route adjustment problem, etc. This paper proposes a relative-Proportion-based Route Adjustment Process (rePRAP) maintains the advantages of PSAP and overcomes these limitations. The rePRAP describes the situation that travelers on higher cost route switch to those with lower cost at the rate that is unilaterally depended on the relative cost differences between higher cost route and its alternatives. It is verified to be consistent with the principle of the rational behavior adjustment process. The equivalence among user equilibrium, stationary path flow pattern and stationary link flow pattern is established, which can be applied to judge whether a given network traffic flow has reached UE or not by detecting the stationary or non-stationary state of link flow pattern. The stability theorem is proved by the Lyapunov function approach. A simple example is tested to demonstrate the effectiveness of the rePRAP model.

  3. A system dynamics model of China's electric power structure adjustment with constraints of PM10 emission reduction.

    PubMed

    Guo, Xiaopeng; Ren, Dongfang; Guo, Xiaodan

    2018-06-01

    Recently, Chinese state environmental protection administration has brought out several PM10 reduction policies to control the coal consumption strictly and promote the adjustment of power structure. Under this new policy environment, a suitable analysis method is required to simulate the upcoming major shift of China's electric power structure. Firstly, a complete system dynamics model is built to simulate China's evolution path of power structure with constraints of PM10 reduction considering both technical and economical factors. Secondly, scenario analyses are conducted under different clean-power capacity growth rates to seek applicable policy guidance for PM10 reduction. The results suggest the following conclusions. (1) The proportion of thermal power installed capacity will decrease to 67% in 2018 with a dropping speed, and there will be an accelerated decline in 2023-2032. (2) The system dynamics model can effectively simulate the implementation of the policy, for example, the proportion of coal consumption in the forecast model is 63.3% (the accuracy rate is 95.2%), below policy target 65% in 2017. (3) China should promote clean power generation such as nuclear power to meet PM10 reduction target.

  4. Adjustment of regional regression models of urban-runoff quality using data for Chattanooga, Knoxville, and Nashville, Tennessee

    USGS Publications Warehouse

    Hoos, Anne B.; Patel, Anant R.

    1996-01-01

    Model-adjustment procedures were applied to the combined data bases of storm-runoff quality for Chattanooga, Knoxville, and Nashville, Tennessee, to improve predictive accuracy for storm-runoff quality for urban watersheds in these three cities and throughout Middle and East Tennessee. Data for 45 storms at 15 different sites (five sites in each city) constitute the data base. Comparison of observed values of storm-runoff load and event-mean concentration to the predicted values from the regional regression models for 10 constituents shows prediction errors, as large as 806,000 percent. Model-adjustment procedures, which combine the regional model predictions with local data, are applied to improve predictive accuracy. Standard error of estimate after model adjustment ranges from 67 to 322 percent. Calibration results may be biased due to sampling error in the Tennessee data base. The relatively large values of standard error of estimate for some of the constituent models, although representing significant reduction (at least 50 percent) in prediction error compared to estimation with unadjusted regional models, may be unacceptable for some applications. The user may wish to collect additional local data for these constituents and repeat the analysis, or calibrate an independent local regression model.

  5. Models of traumatic experiences and children's psychological adjustment: the roles of perceived parenting and the children's own resources and activity.

    PubMed

    Punamäki, R L; Qouta, S; el Sarraj, E

    1997-08-01

    The relations between traumatic events, perceived parenting styles, children's resources, political activity, and psychological adjustment were examined among 108 Palestinian boys and girls of 11-12 years of age. The results showed that exposure to traumatic events increased psychological adjustment problems directly and via 2 mediating paths. First, the more traumatic events children had experienced, the more negative parenting they experienced. And, the poorer they perceived parenting, the more they suffered from high neuroticism and low self-esteem. Second, the more traumatic events children had experienced, the more political activity they showed, and the more active they were, the more they suffered from psychological adjustment problems. Good perceived parenting protected children's psychological adjustment by making them less vulnerable in two ways. First, traumatic events decreased their intellectual, creative, and cognitive resources, and a lack of resources predicted many psychological adjustment problems in a model excluding perceived parenting. Second, political activity increased psychological adjustment problems in the same model, but not in the model including good parenting.

  6. Adjusting lidar-derived digital terrain models in coastal marshes based on estimated aboveground biomass density

    DOE PAGES

    Medeiros, Stephen; Hagen, Scott; Weishampel, John; ...

    2015-03-25

    Digital elevation models (DEMs) derived from airborne lidar are traditionally unreliable in coastal salt marshes due to the inability of the laser to penetrate the dense grasses and reach the underlying soil. To that end, we present a novel processing methodology that uses ASTER Band 2 (visible red), an interferometric SAR (IfSAR) digital surface model, and lidar-derived canopy height to classify biomass density using both a three-class scheme (high, medium and low) and a two-class scheme (high and low). Elevation adjustments associated with these classes using both median and quartile approaches were applied to adjust lidar-derived elevation values closer tomore » true bare earth elevation. The performance of the method was tested on 229 elevation points in the lower Apalachicola River Marsh. The two-class quartile-based adjusted DEM produced the best results, reducing the RMS error in elevation from 0.65 m to 0.40 m, a 38% improvement. The raw mean errors for the lidar DEM and the adjusted DEM were 0.61 ± 0.24 m and 0.32 ± 0.24 m, respectively, thereby reducing the high bias by approximately 49%.« less

  7. A Four-Part Model of Autonomy during Emerging Adulthood: Associations with Adjustment

    ERIC Educational Resources Information Center

    Lamborn, Susie D.; Groh, Kelly

    2009-01-01

    We found support for a four-part model of autonomy that links connectedness, separation, detachment, and agency to adjustment during emerging adulthood. Based on self-report surveys of 285 American college students, expected associations among the autonomy variables were found. In addition, agency, as measured by self-reliance, predicted lower…

  8. Sweet Conclusion

    ERIC Educational Resources Information Center

    Shirley, Britt M.; Wooldridge, Barbara Ross; Camp, Kerri M.

    2012-01-01

    Jen Harrington is the owner and pastry chef of Sweet Conclusion, a bakery in Tampa, Florida. Most of Harrington's business comes from baking wedding cakes, but she has been attempting to attract customers to her retail bakery, where she sells cupcakes, pies, ice cream, and coffee. Nearly four years she opened Sweet Conclusion, the retail part of…

  9. Evaluation of Rapid Adjustments to Radiative Forcing for Five Climate Forcing Agents in the Precipitation Driver Response Model Intercomparison Project (PDRMIP)

    NASA Astrophysics Data System (ADS)

    Smith, C. J.; Forster, P.; Richardson, T.; Myhre, G.

    2016-12-01

    Effective radiative forcing (ERF), rather than "traditional" radiative forcing (RF), has become an increasingly popular metric in recent years, as it more closely links the difference in the earth's top-of-atmosphere (TOA) energy budget to equilibrium near-surface temperature rise. One method to diagnose ERF is to take the difference of TOA radiative fluxes from two climate model runs (a perturbation and a control) with prescribed sea-surface temperatures and sea-ice coverage. ERF can be thought of as the sum of a direct forcing, which is the pure radiative effect of a forcing agent, plus rapid adjustments, which are changes in climate state triggered by the forcing agent that themselves affect the TOA energy budget and are unrelated to surface temperature changes.In addition to the classic experiment of doubling of CO2 (2xCO2), we analyse rapid adjustments to a tripling of methane (3xCH4), a quintupling of sulphate aerosol (5xSul), a ten times increase in black carbon (10xBC) and a 2% increase in the solar constant (2%Sol). We use CMIP-style climate model diagnostics from six participating models of the Precipitation Driver Response Model Intercomparison Project (PDRMIP).Assuming approximately linear contributions to the TOA flux differences, the rapid adjustments from changes in atmospheric temperature, surface temperature, surface albedo and water vapour can be cleanly and simply separated from the direct forcing by radiative kernels. The rapid adjustments are in turn decomposed into stratospheric and tropospheric components. We introduce kernels based on the HadGEM2 climate model and find similar results to those based on other models. Cloud adjustments are evaluated as a residual of the TOA radiative fluxes between all-sky and clear-sky runs once direct forcing and rapid adjustments have been subtracted. The cloud adjustments are also calculated online within the HadGEM2 model using the ISCCP simulator. For aerosol forcing experiments, rapid adjustments vary

  10. Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

    PubMed Central

    Oza, Ajay; Donohue, Fionnuala; Johnson, Howard; Cunney, Robert

    2016-01-01

    As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed. PMID:27541730

  11. Characterizing and Addressing the Need for Statistical Adjustment of Global Climate Model Data

    NASA Astrophysics Data System (ADS)

    White, K. D.; Baker, B.; Mueller, C.; Villarini, G.; Foley, P.; Friedman, D.

    2017-12-01

    As part of its mission to research and measure the effects of the changing climate, the U. S. Army Corps of Engineers (USACE) regularly uses the World Climate Research Programme's Coupled Model Intercomparison Project Phase 5 (CMIP5) multi-model dataset. However, these data are generated at a global level and are not fine-tuned for specific watersheds. This often causes CMIP5 output to vary from locally observed patterns in the climate. Several downscaling methods have been developed to increase the resolution of the CMIP5 data and decrease systemic differences to support decision-makers as they evaluate results at the watershed scale. Evaluating preliminary comparisons of observed and projected flow frequency curves over the US revealed a simple framework for water resources decision makers to plan and design water resources management measures under changing conditions using standard tools. Using this framework as a basis, USACE has begun to explore to use of statistical adjustment to alter global climate model data to better match the locally observed patterns while preserving the general structure and behavior of the model data. When paired with careful measurement and hypothesis testing, statistical adjustment can be particularly effective at navigating the compromise between the locally observed patterns and the global climate model structures for decision makers.

  12. A spatial model of bird abundance as adjusted for detection probability

    USGS Publications Warehouse

    Gorresen, P.M.; Mcmillan, G.P.; Camp, R.J.; Pratt, T.K.

    2009-01-01

    Modeling the spatial distribution of animals can be complicated by spatial and temporal effects (i.e. spatial autocorrelation and trends in abundance over time) and other factors such as imperfect detection probabilities and observation-related nuisance variables. Recent advances in modeling have demonstrated various approaches that handle most of these factors but which require a degree of sampling effort (e.g. replication) not available to many field studies. We present a two-step approach that addresses these challenges to spatially model species abundance. Habitat, spatial and temporal variables were handled with a Bayesian approach which facilitated modeling hierarchically structured data. Predicted abundance was subsequently adjusted to account for imperfect detection and the area effectively sampled for each species. We provide examples of our modeling approach for two endemic Hawaiian nectarivorous honeycreepers: 'i'iwi Vestiaria coccinea and 'apapane Himatione sanguinea. ?? 2009 Ecography.

  13. A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

    PubMed Central

    Juhnke, Christin; Bethge, Susanne

    2016-01-01

    Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

  14. A comparative evaluation of risk-adjustment models for benchmarking amputation-free survival after lower extremity bypass.

    PubMed

    Simons, Jessica P; Goodney, Philip P; Flahive, Julie; Hoel, Andrew W; Hallett, John W; Kraiss, Larry W; Schanzer, Andres

    2016-04-01

    Providing patients and payers with publicly reported risk-adjusted quality metrics for the purpose of benchmarking physicians and institutions has become a national priority. Several prediction models have been developed to estimate outcomes after lower extremity revascularization for critical limb ischemia, but the optimal model to use in contemporary practice has not been defined. We sought to identify the highest-performing risk-adjustment model for amputation-free survival (AFS) at 1 year after lower extremity bypass (LEB). We used the national Society for Vascular Surgery Vascular Quality Initiative (VQI) database (2003-2012) to assess the performance of three previously validated risk-adjustment models for AFS. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL), Finland National Vascular (FINNVASC) registry, and the modified Project of Ex-vivo vein graft Engineering via Transfection III (PREVENT III [mPIII]) risk scores were applied to the VQI cohort. A novel model for 1-year AFS was also derived using the VQI data set and externally validated using the PIII data set. The relative discrimination (Harrell c-index) and calibration (Hosmer-May goodness-of-fit test) of each model were compared. Among 7754 patients in the VQI who underwent LEB for critical limb ischemia, the AFS was 74% at 1 year. Each of the previously published models for AFS demonstrated similar discriminative performance: c-indices for BASIL, FINNVASC, mPIII were 0.66, 0.60, and 0.64, respectively. The novel VQI-derived model had improved discriminative ability with a c-index of 0.71 and appropriate generalizability on external validation with a c-index of 0.68. The model was well calibrated in both the VQI and PIII data sets (goodness of fit P = not significant). Currently available prediction models for AFS after LEB perform modestly when applied to national contemporary VQI data. Moreover, the performance of each model was inferior to that of the novel VQI-derived model

  15. A New Climate Adjustment Tool: An update to EPA’s Storm Water Management Model

    EPA Science Inventory

    The US EPA’s newest tool, the Stormwater Management Model (SWMM) – Climate Adjustment Tool (CAT) is meant to help municipal stormwater utilities better address potential climate change impacts affecting their operations.

  16. Positive Adjustment Among American Repatriated Prisoners of the Vietnam War: Modeling the Long-Term Effects of Captivity.

    PubMed

    King, Daniel W; King, Lynda A; Park, Crystal L; Lee, Lewina O; Kaiser, Anica Pless; Spiro, Avron; Moore, Jeffrey L; Kaloupek, Danny G; Keane, Terence M

    2015-11-01

    A longitudinal lifespan model of factors contributing to later-life positive adjustment was tested on 567 American repatriated prisoners from the Vietnam War. This model encompassed demographics at time of capture and attributes assessed after return to the U.S. (reports of torture and mental distress) and approximately 3 decades later (later-life stressors, perceived social support, positive appraisal of military experiences, and positive adjustment). Age and education at time of capture and physical torture were associated with repatriation mental distress, which directly predicted poorer adjustment 30 years later. Physical torture also had a salutary effect, enhancing later-life positive appraisals of military experiences. Later-life events were directly and indirectly (through concerns about retirement) associated with positive adjustment. Results suggest that the personal resources of older age and more education and early-life adverse experiences can have cascading effects over the lifespan to impact well-being in both positive and negative ways.

  17. Positive Adjustment Among American Repatriated Prisoners of the Vietnam War: Modeling the Long-Term Effects of Captivity

    PubMed Central

    King, Daniel W.; King, Lynda A.; Park, Crystal L.; Lee, Lewina O.; Kaiser, Anica Pless; Spiro, Avron; Moore, Jeffrey L.; Kaloupek, Danny G.; Keane, Terence M.

    2015-01-01

    A longitudinal lifespan model of factors contributing to later-life positive adjustment was tested on 567 American repatriated prisoners from the Vietnam War. This model encompassed demographics at time of capture and attributes assessed after return to the U.S. (reports of torture and mental distress) and approximately 3 decades later (later-life stressors, perceived social support, positive appraisal of military experiences, and positive adjustment). Age and education at time of capture and physical torture were associated with repatriation mental distress, which directly predicted poorer adjustment 30 years later. Physical torture also had a salutary effect, enhancing later-life positive appraisals of military experiences. Later-life events were directly and indirectly (through concerns about retirement) associated with positive adjustment. Results suggest that the personal resources of older age and more education and early-life adverse experiences can have cascading effects over the lifespan to impact well-being in both positive and negative ways. PMID:26693100

  18. Statistics, Adjusted Statistics, and Maladjusted Statistics.

    PubMed

    Kaufman, Jay S

    2017-05-01

    Statistical adjustment is a ubiquitous practice in all quantitative fields that is meant to correct for improprieties or limitations in observed data, to remove the influence of nuisance variables or to turn observed correlations into causal inferences. These adjustments proceed by reporting not what was observed in the real world, but instead modeling what would have been observed in an imaginary world in which specific nuisances and improprieties are absent. These techniques are powerful and useful inferential tools, but their application can be hazardous or deleterious if consumers of the adjusted results mistake the imaginary world of models for the real world of data. Adjustments require decisions about which factors are of primary interest and which are imagined away, and yet many adjusted results are presented without any explanation or justification for these decisions. Adjustments can be harmful if poorly motivated, and are frequently misinterpreted in the media's reporting of scientific studies. Adjustment procedures have become so routinized that many scientists and readers lose the habit of relating the reported findings back to the real world in which we live.

  19. Modelling the impact of new patient visits on risk adjusted access at 2 clinics.

    PubMed

    Kolber, Michael A; Rueda, Germán; Sory, John B

    2018-06-01

    To evaluate the effect new outpatient clinic visits has on the availability of follow-up visits for established patients when patient visit frequency is risk adjusted. Diagnosis codes for patients from 2 Internal Medicine Clinics were extracted through billing data. The HHS-HCC risk adjusted scores for each clinic were determined based upon the average of all clinic practitioners' profiles. These scores were then used to project encounter frequencies for established patients, and for new patients entering the clinic based on risk and time of entry into the clinics. A distinct mean risk frequency distribution for physicians in each clinic could be defined providing model parameters. Within the model, follow-up visit utilization at the highest risk adjusted visit frequencies would require more follow-up slots than currently available when new patient no-show rates and annual patient loss are included. Patients seen at an intermediate or lower visit risk adjusted frequency could be accommodated when new patient no-show rates and annual patient clinic loss are considered. Value-based care is driven by control of cost while maintaining quality of care. In order to control cost, there has been a drive to increase visit frequency in primary care for those patients at increased risk. Adding new patients to primary care clinics limits the availability of follow-up slots that accrue over time for those at highest risk, thereby limiting disease and, potentially, cost control. If frequency of established care visits can be reduced by improved disease control, closing the practice to new patients, hiring health care extenders, or providing non-face to face care models then quality and cost of care may be improved. © 2018 John Wiley & Sons, Ltd.

  20. Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment.

    PubMed

    Kanerva, Mari; Ollgren, Jukka; Lyytikäinen, Outi

    2011-11-01

    It is difficult to draw conclusions about the prudence of antibiotic use in different hospitals by directly comparing usage figures. We present a patient case-mix adjustment model of antibiotic use to rank hospitals while taking patient characteristics into account. Data on antibiotic use were collected during the national healthcare-associated infection (HAI) prevalence survey in 2005 in Finland in all 5 tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals. The use of antibiotics was measured using use-days/100 patient-days during a 7day period and the prevalence of patients receiving at least two antimicrobials during the study day. Case-mix-adjusted antibiotic use was calculated by using multivariate models and an indirect standardization method. Parameters in the model included age, sex, severity of underlying diseases, intensive care, haematology, preceding surgery, respirator, central venous and urinary catheters, community-associated infection, HAI and contact isolation due to methicillin-resistant Staphylococcus aureus. The ranking order changed one position in 12 (40%) hospitals and more than two positions in 13 (43%) hospitals when the case-mix-adjusted figures were compared with those observed. In 24 hospitals (80%), the antibiotic use density observed was lower than expected by the case-mix-adjusted use density. The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined.

  1. Modeling Quality-Adjusted Life Expectancy Loss Resulting from Tobacco Use in the United States

    ERIC Educational Resources Information Center

    Kaplan, Robert M.; Anderson, John P.; Kaplan, Cameron M.

    2007-01-01

    Purpose: To describe the development of a model for estimating the effects of tobacco use upon Quality Adjusted Life Years (QALYs) and to estimate the impact of tobacco use on health outcomes for the United States (US) population using the model. Method: We obtained estimates of tobacco consumption from 6 years of the National Health Interview…

  2. Development and Validation of Perioperative Risk-Adjustment Models for Hip Fracture Repair, Total Hip Arthroplasty, and Total Knee Arthroplasty.

    PubMed

    Schilling, Peter L; Bozic, Kevin J

    2016-01-06

    Comparing outcomes across providers requires risk-adjustment models that account for differences in case mix. The burden of data collection from the clinical record can make risk-adjusted outcomes difficult to measure. The purpose of this study was to develop risk-adjustment models for hip fracture repair (HFR), total hip arthroplasty (THA), and total knee arthroplasty (TKA) that weigh adequacy of risk adjustment against data-collection burden. We used data from the American College of Surgeons National Surgical Quality Improvement Program to create derivation cohorts for HFR (n = 7000), THA (n = 17,336), and TKA (n = 28,661). We developed logistic regression models for each procedure using age, sex, American Society of Anesthesiologists (ASA) physical status classification, comorbidities, laboratory values, and vital signs-based comorbidities as covariates, and validated the models with use of data from 2012. The derivation models' C-statistics for mortality were 80%, 81%, 75%, and 92% and for adverse events were 68%, 68%, 60%, and 70% for HFR, THA, TKA, and combined procedure cohorts. Age, sex, and ASA classification accounted for a large share of the explained variation in mortality (50%, 58%, 70%, and 67%) and adverse events (43%, 45%, 46%, and 68%). For THA and TKA, these three variables were nearly as predictive as models utilizing all covariates. HFR model discrimination improved with the addition of comorbidities and laboratory values; among the important covariates were functional status, low albumin, high creatinine, disseminated cancer, dyspnea, and body mass index. Model performance was similar in validation cohorts. Risk-adjustment models using data from health records demonstrated good discrimination and calibration for HFR, THA, and TKA. It is possible to provide adequate risk adjustment using only the most predictive variables commonly available within the clinical record. This finding helps to inform the trade-off between model performance and data

  3. Improving the Process of Adjusting the Parameters of Finite Element Models of Healthy Human Intervertebral Discs by the Multi-Response Surface Method.

    PubMed

    Gómez, Fátima Somovilla; Lorza, Rubén Lostado; Bobadilla, Marina Corral; García, Rubén Escribano

    2017-09-21

    The kinematic behavior of models that are based on the finite element method (FEM) for modeling the human body depends greatly on an accurate estimate of the parameters that define such models. This task is complex, and any small difference between the actual biomaterial model and the simulation model based on FEM can be amplified enormously in the presence of nonlinearities. The current paper attempts to demonstrate how a combination of the FEM and the MRS methods with desirability functions can be used to obtain the material parameters that are most appropriate for use in defining the behavior of Finite Element (FE) models of the healthy human lumbar intervertebral disc (IVD). The FE model parameters were adjusted on the basis of experimental data from selected standard tests (compression, flexion, extension, shear, lateral bending, and torsion) and were developed as follows: First, three-dimensional parameterized FE models were generated on the basis of the mentioned standard tests. Then, 11 parameters were selected to define the proposed parameterized FE models. For each of the standard tests, regression models were generated using MRS to model the six stiffness and nine bulges of the healthy IVD models that were created by changing the parameters of the FE models. The optimal combination of the 11 parameters was based on three different adjustment criteria. The latter, in turn, were based on the combination of stiffness and bulges that were obtained from the standard test FE simulations. The first adjustment criteria considered stiffness and bulges to be equally important in the adjustment of FE model parameters. The second adjustment criteria considered stiffness as most important, whereas the third considered the bulges to be most important. The proposed adjustment methods were applied to a medium-sized human IVD that corresponded to the L3-L4 lumbar level with standard dimensions of width = 50 mm, depth = 35 mm, and height = 10 mm. Agreement between the

  4. Improving the Process of Adjusting the Parameters of Finite Element Models of Healthy Human Intervertebral Discs by the Multi-Response Surface Method

    PubMed Central

    Somovilla Gómez, Fátima

    2017-01-01

    The kinematic behavior of models that are based on the finite element method (FEM) for modeling the human body depends greatly on an accurate estimate of the parameters that define such models. This task is complex, and any small difference between the actual biomaterial model and the simulation model based on FEM can be amplified enormously in the presence of nonlinearities. The current paper attempts to demonstrate how a combination of the FEM and the MRS methods with desirability functions can be used to obtain the material parameters that are most appropriate for use in defining the behavior of Finite Element (FE) models of the healthy human lumbar intervertebral disc (IVD). The FE model parameters were adjusted on the basis of experimental data from selected standard tests (compression, flexion, extension, shear, lateral bending, and torsion) and were developed as follows: First, three-dimensional parameterized FE models were generated on the basis of the mentioned standard tests. Then, 11 parameters were selected to define the proposed parameterized FE models. For each of the standard tests, regression models were generated using MRS to model the six stiffness and nine bulges of the healthy IVD models that were created by changing the parameters of the FE models. The optimal combination of the 11 parameters was based on three different adjustment criteria. The latter, in turn, were based on the combination of stiffness and bulges that were obtained from the standard test FE simulations. The first adjustment criteria considered stiffness and bulges to be equally important in the adjustment of FE model parameters. The second adjustment criteria considered stiffness as most important, whereas the third considered the bulges to be most important. The proposed adjustment methods were applied to a medium-sized human IVD that corresponded to the L3–L4 lumbar level with standard dimensions of width = 50 mm, depth = 35 mm, and height = 10 mm. Agreement between the

  5. The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program

    PubMed Central

    WIEBE, DOUGLAS J.; HOLENA, DANIEL N.; DELGADO, M. KIT; McWILLIAMS, NATHAN; ALTENBURG, JULIET; CARR, BRENDAN G.

    2018-01-01

    Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance. PMID:28541852

  6. The Pennsylvania Trauma Outcomes Study Risk-Adjusted Mortality Model: Results of a Statewide Benchmarking Program.

    PubMed

    Wiebe, Douglas J; Holena, Daniel N; Delgado, M Kit; McWilliams, Nathan; Altenburg, Juliet; Carr, Brendan G

    2017-05-01

    Trauma centers need objective feedback on performance to inform quality improvement efforts. The Trauma Quality Improvement Program recently published recommended methodology for case mix adjustment and benchmarking performance. We tested the feasibility of applying this methodology to develop risk-adjusted mortality models for a statewide trauma system. We performed a retrospective cohort study of patients ≥16 years old at Pennsylvania trauma centers from 2011 to 2013 (n = 100,278). Our main outcome measure was observed-to-expected mortality ratios (overall and within blunt, penetrating, multisystem, isolated head, and geriatric subgroups). Patient demographic variables, physiology, mechanism of injury, transfer status, injury severity, and pre-existing conditions were included as predictor variables. The statistical model had excellent discrimination (area under the curve = 0.94). Funnel plots of observed-to-expected identified five centers with lower than expected mortality and two centers with higher than expected mortality. No centers were outliers for management of penetrating trauma, but five centers had lower and three had higher than expected mortality for blunt trauma. It is feasible to use Trauma Quality Improvement Program methodology to develop risk-adjusted models for statewide trauma systems. Even with smaller numbers of trauma centers that are available in national datasets, it is possible to identify high and low outliers in performance.

  7. Quality-of-life-adjusted hazard of death: a formulation of the quality-adjusted life-years model of use in benefit-risk assessment.

    PubMed

    Garcia-Hernandez, Alberto

    2014-03-01

    Although the quality-adjusted life-years (QALY) model is standard in health technology assessment, quantitative methods are less frequent but increasingly used for benefit-risk assessment (BRA) at earlier stages of drug development. A frequent challenge when implementing metrics for BRA is to weigh the importance of effects on a chronic condition against the risk of severe events during the trial. The lifetime component of the QALY model has a counterpart in the BRA context, namely, the risk of dying during the study. A new concept is presented, the hazard of death function that a subject is willing to accept instead of the baseline hazard to improve his or her chronic health status, which we have called the quality-of-life-adjusted hazard of death. It has been proven that if assumptions of the linear QALY model hold, the excess mortality rate tolerated by a subject for a chronic health improvement is inversely proportional to the mean residual life. This result leads to a new representation of the linear QALY model in terms of hazard rate functions and allows utilities obtained by using standard methods involving trade-offs of life duration to be translated into thresholds of tolerated mortality risk during a short period of time, thereby avoiding direct trade-offs using small probabilities of events during the study, which is known to lead to bias and variability. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  8. [Applying temporally-adjusted land use regression models to estimate ambient air pollution exposure during pregnancy].

    PubMed

    Zhang, Y J; Xue, F X; Bai, Z P

    2017-03-06

    The impact of maternal air pollution exposure on offspring health has received much attention. Precise and feasible exposure estimation is particularly important for clarifying exposure-response relationships and reducing heterogeneity among studies. Temporally-adjusted land use regression (LUR) models are exposure assessment methods developed in recent years that have the advantage of having high spatial-temporal resolution. Studies on the health effects of outdoor air pollution exposure during pregnancy have been increasingly carried out using this model. In China, research applying LUR models was done mostly at the model construction stage, and findings from related epidemiological studies were rarely reported. In this paper, the sources of heterogeneity and research progress of meta-analysis research on the associations between air pollution and adverse pregnancy outcomes were analyzed. The methods of the characteristics of temporally-adjusted LUR models were introduced. The current epidemiological studies on adverse pregnancy outcomes that applied this model were systematically summarized. Recommendations for the development and application of LUR models in China are presented. This will encourage the implementation of more valid exposure predictions during pregnancy in large-scale epidemiological studies on the health effects of air pollution in China.

  9. Dynamic gauge adjustment of high-resolution X-band radar data for convective rain storms: Model-based evaluation against measured combined sewer overflow

    NASA Astrophysics Data System (ADS)

    Borup, Morten; Grum, Morten; Linde, Jens Jørgen; Mikkelsen, Peter Steen

    2016-08-01

    Numerous studies have shown that radar rainfall estimates need to be adjusted against rain gauge measurements in order to be useful for hydrological modelling. In the current study we investigate if adjustment can improve radar rainfall estimates to the point where they can be used for modelling overflows from urban drainage systems, and we furthermore investigate the importance of the aggregation period of the adjustment scheme. This is done by continuously adjusting X-band radar data based on the previous 5-30 min of rain data recorded by multiple rain gauges and propagating the rainfall estimates through a hydraulic urban drainage model. The model is built entirely from physical data, without any calibration, to avoid bias towards any specific type of rainfall estimate. The performance is assessed by comparing measured and modelled water levels at a weir downstream of a highly impermeable, well defined, 64 ha urban catchment, for nine overflow generating rain events. The dynamically adjusted radar data perform best when the aggregation period is as small as 10-20 min, in which case it performs much better than static adjusted radar data and data from rain gauges situated 2-3 km away.

  10. Functional form and risk adjustment of hospital costs: Bayesian analysis of a Box-Cox random coefficients model.

    PubMed

    Hollenbeak, Christopher S

    2005-10-15

    While risk-adjusted outcomes are often used to compare the performance of hospitals and physicians, the most appropriate functional form for the risk adjustment process is not always obvious for continuous outcomes such as costs. Semi-log models are used most often to correct skewness in cost data, but there has been limited research to determine whether the log transformation is sufficient or whether another transformation is more appropriate. This study explores the most appropriate functional form for risk-adjusting the cost of coronary artery bypass graft (CABG) surgery. Data included patients undergoing CABG surgery at four hospitals in the midwest and were fit to a Box-Cox model with random coefficients (BCRC) using Markov chain Monte Carlo methods. Marginal likelihoods and Bayes factors were computed to perform model comparison of alternative model specifications. Rankings of hospital performance were created from the simulation output and the rankings produced by Bayesian estimates were compared to rankings produced by standard models fit using classical methods. Results suggest that, for these data, the most appropriate functional form is not logarithmic, but corresponds to a Box-Cox transformation of -1. Furthermore, Bayes factors overwhelmingly rejected the natural log transformation. However, the hospital ranking induced by the BCRC model was not different from the ranking produced by maximum likelihood estimates of either the linear or semi-log model. Copyright (c) 2005 John Wiley & Sons, Ltd.

  11. A Threshold Model of Social Support, Adjustment, and Distress after Breast Cancer Treatment

    ERIC Educational Resources Information Center

    Mallinckrodt, Brent; Armer, Jane M.; Heppner, P. Paul

    2012-01-01

    This study examined a threshold model that proposes that social support exhibits a curvilinear association with adjustment and distress, such that support in excess of a critical threshold level has decreasing incremental benefits. Women diagnosed with a first occurrence of breast cancer (N = 154) completed survey measures of perceived support…

  12. Zero adjusted models with applications to analysing helminths count data.

    PubMed

    Chipeta, Michael G; Ngwira, Bagrey M; Simoonga, Christopher; Kazembe, Lawrence N

    2014-11-27

    It is common in public health and epidemiology that the outcome of interest is counts of events occurrence. Analysing these data using classical linear models is mostly inappropriate, even after transformation of outcome variables due to overdispersion. Zero-adjusted mixture count models such as zero-inflated and hurdle count models are applied to count data when over-dispersion and excess zeros exist. Main objective of the current paper is to apply such models to analyse risk factors associated with human helminths (S. haematobium) particularly in a case where there's a high proportion of zero counts. The data were collected during a community-based randomised control trial assessing the impact of mass drug administration (MDA) with praziquantel in Malawi, and a school-based cross sectional epidemiology survey in Zambia. Count data models including traditional (Poisson and negative binomial) models, zero modified models (zero inflated Poisson and zero inflated negative binomial) and hurdle models (Poisson logit hurdle and negative binomial logit hurdle) were fitted and compared. Using Akaike information criteria (AIC), the negative binomial logit hurdle (NBLH) and zero inflated negative binomial (ZINB) showed best performance in both datasets. With regards to zero count capturing, these models performed better than other models. This paper showed that zero modified NBLH and ZINB models are more appropriate methods for the analysis of data with excess zeros. The choice between the hurdle and zero-inflated models should be based on the aim and endpoints of the study.

  13. DaMoScope and its internet graphics for the visual control of adjusting mathematical models describing experimental data

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Belousov, V. I.; Ezhela, V. V.; Kuyanov, Yu. V., E-mail: Yu.Kuyanov@gmail.com

    The experience of using the dynamic atlas of the experimental data and mathematical models of their description in the problems of adjusting parametric models of observable values depending on kinematic variables is presented. The functional possibilities of an image of a large number of experimental data and the models describing them are shown by examples of data and models of observable values determined by the amplitudes of elastic scattering of hadrons. The Internet implementation of an interactive tool DaMoScope and its interface with the experimental data and codes of adjusted parametric models with the parameters of the best description ofmore » data are schematically shown. The DaMoScope codes are freely available.« less

  14. Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres

    PubMed Central

    Pagel, Christina; Utley, Martin; Crowe, Sonya; Witter, Thomas; Anderson, David; Samson, Ray; McLean, Andrew; Banks, Victoria; Tsang, Victor; Brown, Katherine

    2013-01-01

    Objective To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery. Design Collaborative monitoring software development and implementation in three specialist centres. Patients and methods Analyses incorporated 2 years of data routinely audited by the National Institute of Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac or only catheter procedures. We applied the partial risk adjustment in surgery (PRAiS) risk model for death within 30 days following surgery and generated variable life-adjusted display (VLAD) charts for each centre. These were shared with each clinical team and feedback was sought. Results Participating centres were Great Ormond Street Hospital, Evelina Children's Hospital and The Royal Hospital for Sick Children in Glasgow. Data captured all procedures performed between 1 January 2010 and 31 December 2011. This incorporated 2490 30-day episodes of care, 66 of which were associated with a death within 30 days.The VLAD charts generated for each centre displayed trends in outcomes benchmarked to recent national outcomes. All centres ended the 2-year period within four deaths from what would be expected. The VLAD charts were shared in multidisciplinary meetings and clinical teams reported that they were a useful addition to existing quality assurance initiatives. Each centre is continuing to use the prototype software to monitor their in-house surgical outcomes. Conclusions Timely and routine monitoring of risk-adjusted mortality following paediatric cardiac surgery is feasible. Close liaison with hospital data managers as well as clinicians was crucial to the success of the project. PMID:23564473

  15. The effects of coping on adjustment: Re-examining the goodness of fit model of coping effectiveness.

    PubMed

    Masel, C N; Terry, D J; Gribble, M

    1996-01-01

    Abstract The primary aim of the present study was to examine the extent to which the effects of coping on adjustment are moderated by levels of event controllability. Specifically, the research tested two revisions to the goodness of fit model of coping effectiveness. First, it was hypothesized that the effects of problem management coping (but not problem appraisal coping) would be moderated by levels of event controllability. Second, it was hypothesized that the effects of emotion-focused coping would be moderated by event controllability, but only in the acute phase of a stressful encounter. To test these predictions, a longitudinal study was undertaken (185 undergraduate students participated in all three stages of the research). Measures of initial adjustment (low depression and coping efficacy) were obtained at Time 1. Four weeks later (Time 2), coping responses to a current or a recent stressor were assessed. Based on subjects' descriptions of the event, objective and subjective measures of event controllability were also obtained. Measures of concurrent and subsequent adjustment were obtained at Times 2 and 3 (two weeks later), respectively. There was only weak support for the goodness of fit model of coping effectiveness. The beneficial effects of a high proportion of problem management coping (relative to total coping efforts) on Time 3 perceptions of coping efficacy were more evident in high control than in low control situations. Other results of the research revealed that, irrespective of the controllability of the event, problem appraisal coping strategies and emotion-focused strategies (escapism and self-denigration) were associated with high and low levels of concurrent adjustment, respectively. The effects of these coping responses on subsequent adjustment were mediated through concurrent levels of adjustment.

  16. Adjustment modes in the trajectory of progressive multiple sclerosis: a qualitative study and conceptual model.

    PubMed

    Bogosian, Angeliki; Morgan, Myfanwy; Bishop, Felicity L; Day, Fern; Moss-Morris, Rona

    2017-03-01

    We examined cognitive and behavioural challenges and adaptations for people with progressive multiple sclerosis (MS) and developed a preliminary conceptual model of changes in adjustment over time. Using theoretical sampling, 34 semi-structured interviews were conducted with people with MS. Participants were between 41 and 77 years of age. Thirteen were diagnosed with primary progressive MS and 21 with secondary progressive MS. Data were analysed using a grounded theory approach. Participants described initially bracketing the illness off and carrying on their usual activities but this became problematic as the condition progressed and they employed different adjustment modes to cope with increased disabilities. Some scaled back their activities to live a more comfortable life, others identified new activities or adapted old ones, whereas at times, people disengaged from the adjustment process altogether and resigned to their condition. Relationships with partners, emotional reactions, environment and perception of the environment influenced adjustment, while people were often flexible and shifted among modes. Adjusting to a progressive condition is a fluid process. Future interventions can be tailored to address modifiable factors at different stages of the condition and may involve addressing emotional reactions concealing/revealing the condition and perceptions of the environment.

  17. The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line-Associated Bloodstream Infection Risk-Adjustment Methodology.

    PubMed

    Jackson, Sarah S; Leekha, Surbhi; Magder, Laurence S; Pineles, Lisa; Anderson, Deverick J; Trick, William E; Woeltje, Keith F; Kaye, Keith S; Stafford, Kristen; Thom, Kerri; Lowe, Timothy J; Harris, Anthony D

    2017-09-01

    BACKGROUND Risk adjustment is needed to fairly compare central-line-associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes. METHODS Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank. RESULTS Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51-0.59) for the ICU-type model and 0.64 (95% CI, 0.60-0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model. CONCLUSIONS Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals. Infect Control Hosp Epidemiol 2017;38:1019-1024.

  18. Using multilevel modeling to assess case-mix adjusters in consumer experience surveys in health care.

    PubMed

    Damman, Olga C; Stubbe, Janine H; Hendriks, Michelle; Arah, Onyebuchi A; Spreeuwenberg, Peter; Delnoij, Diana M J; Groenewegen, Peter P

    2009-04-01

    Ratings on the quality of healthcare from the consumer's perspective need to be adjusted for consumer characteristics to ensure fair and accurate comparisons between healthcare providers or health plans. Although multilevel analysis is already considered an appropriate method for analyzing healthcare performance data, it has rarely been used to assess case-mix adjustment of such data. The purpose of this article is to investigate whether multilevel regression analysis is a useful tool to detect case-mix adjusters in consumer assessment of healthcare. We used data on 11,539 consumers from 27 Dutch health plans, which were collected using the Dutch Consumer Quality Index health plan instrument. We conducted multilevel regression analyses of consumers' responses nested within health plans to assess the effects of consumer characteristics on consumer experience. We compared our findings to the results of another methodology: the impact factor approach, which combines the predictive effect of each case-mix variable with its heterogeneity across health plans. Both multilevel regression and impact factor analyses showed that age and education were the most important case-mix adjusters for consumer experience and ratings of health plans. With the exception of age, case-mix adjustment had little impact on the ranking of health plans. On both theoretical and practical grounds, multilevel modeling is useful for adequate case-mix adjustment and analysis of performance ratings.

  19. Peer Victimization and Rejection: Investigation of an Integrative Model of Effects on Emotional, Behavioral, and Academic Adjustment in Early Adolescence

    ERIC Educational Resources Information Center

    Lopez, Cristy; DuBois, David L.

    2005-01-01

    This study investigated an integrative model of the effects of peer victimization (PV) and peer rejection (PR) on youth adjustment using data from 508 middle-school students. In the proposed model, PV and PR each contribute independently to problems in emotional, behavioral, and academic adjustment. The adverse consequences of PV and PR are each…

  20. Estimation of group means when adjusting for covariates in generalized linear models.

    PubMed

    Qu, Yongming; Luo, Junxiang

    2015-01-01

    Generalized linear models are commonly used to analyze categorical data such as binary, count, and ordinal outcomes. Adjusting for important prognostic factors or baseline covariates in generalized linear models may improve the estimation efficiency. The model-based mean for a treatment group produced by most software packages estimates the response at the mean covariate, not the mean response for this treatment group for the studied population. Although this is not an issue for linear models, the model-based group mean estimates in generalized linear models could be seriously biased for the true group means. We propose a new method to estimate the group mean consistently with the corresponding variance estimation. Simulation showed the proposed method produces an unbiased estimator for the group means and provided the correct coverage probability. The proposed method was applied to analyze hypoglycemia data from clinical trials in diabetes. Copyright © 2014 John Wiley & Sons, Ltd.

  1. Severity-Adjusted Mortality in Trauma Patients Transported by Police

    PubMed Central

    Band, Roger A.; Salhi, Rama A.; Holena, Daniel N.; Powell, Elizabeth; Branas, Charles C.; Carr, Brendan G.

    2018-01-01

    Study objective Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. Methods This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index. Results Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police. Conclusion We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care. PMID:24387925

  2. The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence

    PubMed Central

    Romera, Eva M.; Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario

    2016-01-01

    There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy) could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34). The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire, the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment. PMID:27891108

  3. The Mediating Role of Psychological Adjustment between Peer Victimization and Social Adjustment in Adolescence.

    PubMed

    Romera, Eva M; Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario

    2016-01-01

    There is extensive scientific evidence of the serious psychological and social effects that peer victimization may have on students, among them internalizing problems such as anxiety or negative self-esteem, difficulties related to low self-efficacy and lower levels of social adjustment. Although a direct relationship has been observed between victimization and these effects, it has not yet been analyzed whether there is a relationship of interdependence between all these measures of psychosocial adjustment. The aim of this study was to examine the relationship between victimization and difficulties related to social adjustment among high school students. To do so, various explanatory models were tested to determine whether psychological adjustment (negative self-esteem, social anxiety and social self-efficacy) could play a mediating role in this relationship, as suggested by other studies on academic adjustment. The sample comprised 2060 Spanish high school students (47.9% girls; mean age = 14.34). The instruments used were the scale of victimization from European Bullying Intervention Project Questionnaire , the negative scale from Rosenberg Self-Esteem Scale, Social Anxiety Scale for Adolescents and a general item about social self-efficacy, all of them self-reports. Structural equation modeling was used to analyze the data. The results confirmed the partial mediating role of negative self-esteem, social anxiety and social self-efficacy between peer victimization and social adjustment and highlight the importance of empowering victimized students to improve their self-esteem and self-efficacy and prevent social anxiety. Such problems lead to the avoidance of social interactions and social reinforcement, thus making it difficult for these students to achieve adequate social adjustment.

  4. Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models

    PubMed Central

    2013-01-01

    Background Comparison of outcomes between populations or centres may be confounded by any casemix differences and standardisation is carried out to avoid this. However, when the casemix adjustment models are large and complex, direct standardisation has been described as “practically impossible”, and indirect standardisation may lead to unfair comparisons. We propose a new method of directly standardising for risk rather than standardising for casemix which overcomes these problems. Methods Using a casemix model which is the same model as would be used in indirect standardisation, the risk in individuals is estimated. Risk categories are defined, and event rates in each category for each centre to be compared are calculated. A weighted sum of the risk category specific event rates is then calculated. We have illustrated this method using data on 6 million admissions to 146 hospitals in England in 2007/8 and an existing model with over 5000 casemix combinations, and a second dataset of 18,668 adult emergency admissions to 9 centres in the UK and overseas and a published model with over 20,000 casemix combinations and a continuous covariate. Results Substantial differences between conventional directly casemix standardised rates and rates from direct risk standardisation (DRS) were found. Results based on DRS were very similar to Standardised Mortality Ratios (SMRs) obtained from indirect standardisation, with similar standard errors. Conclusions Direct risk standardisation using our proposed method is as straightforward as using conventional direct or indirect standardisation, always enables fair comparisons of performance to be made, can use continuous casemix covariates, and was found in our examples to have similar standard errors to the SMR. It should be preferred when there is a risk that conventional direct or indirect standardisation will lead to unfair comparisons. PMID:24168424

  5. Parental Psychological Control and Adolescent Adjustment: The Role of Adolescent Emotion Regulation

    PubMed Central

    Cui, Lixian; Morris, Amanda Sheffield; Criss, Michael M.; Houltberg, Benjamin J.; Silk, Jennifer S.

    2014-01-01

    SYNOPSIS Objective This study investigated associations between parental psychological control and aggressive behavior and depressive symptoms among adolescents from predominantly disadvantaged backgrounds. The indirect effects of psychological control on adolescent adjustment through adolescent emotion regulation (anger and sadness regulation) were examined as well as the moderating effects of adolescent emotion regulation. Design 206 adolescents (ages 10–18) reported on parental psychological control and their own depressive symptoms, and parents and adolescents reported on adolescent emotion regulation and aggressive behavior. Indirect effect models were tested using structural equation modeling; moderating effects were tested using hierarchical multiple regression. Results The associations between parental psychological control and adolescent aggressive behavior and depressive symptoms were indirect through adolescents’ anger regulation. Moderation analyses indicated that the association between parental psychological control and adolescent depressive symptoms was stronger among adolescents with poor sadness regulation and the association between psychological control and aggressive behavior was stronger among older adolescents with poor anger regulation. Conclusions Psychological control is negatively associated with adolescent adjustment, particularly among adolescents who have difficulty regulating emotions. Emotion regulation is one mechanism through which psychological control is linked to adolescent adjustment, particularly anger dysregulation, and this pattern holds for both younger and older adolescents and for both boys and girls. PMID:25057264

  6. International Workshop on Educational Infrastructure: Conclusions (Summary of Proceedings, Guadalajara, Jalisco, Mexico, February 24-27, 2002).

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France). Programme on Educational Building.

    This document summarizes themes developed and conclusions from the International Workshop on Educational Infrastructure. The opening topic was "Delivering Education and Training in the Knowledge Society." It was clear to participants that educational infrastructure must go hand-in-hand with reengineering processes to adjust to the needs…

  7. Filling Gaps in the Acculturation Gap-Distress Model: Heritage Cultural Maintenance and Adjustment in Mexican-American Families.

    PubMed

    Telzer, Eva H; Yuen, Cynthia; Gonzales, Nancy; Fuligni, Andrew J

    2016-07-01

    The acculturation gap-distress model purports that immigrant children acculturate faster than do their parents, resulting in an acculturation gap that leads to family and youth maladjustment. However, empirical support for the acculturation gap-distress model has been inconclusive. In the current study, 428 Mexican-American adolescents (50.2 % female) and their primary caregivers independently completed questionnaires assessing their levels of American and Mexican cultural orientation, family functioning, and youth adjustment. Contrary to the acculturation gap-distress model, acculturation gaps were not associated with poorer family or youth functioning. Rather, adolescents with higher levels of Mexican cultural orientations showed positive outcomes, regardless of their parents' orientations to either American or Mexican cultures. Findings suggest that youths' heritage cultural maintenance may be most important for their adjustment.

  8. Development of bovine serum albumin-water partition coefficients predictive models for ionogenic organic chemicals based on chemical form adjusted descriptors.

    PubMed

    Ding, Feng; Yang, Xianhai; Chen, Guosong; Liu, Jining; Shi, Lili; Chen, Jingwen

    2017-10-01

    The partition coefficients between bovine serum albumin (BSA) and water (K BSA/w ) for ionogenic organic chemicals (IOCs) were different greatly from those of neutral organic chemicals (NOCs). For NOCs, several excellent models were developed to predict their logK BSA/w . However, it was found that the conventional descriptors are inappropriate for modeling logK BSA/w of IOCs. Thus, alternative approaches are urgently needed to develop predictive models for K BSA/w of IOCs. In this study, molecular descriptors that can be used to characterize the ionization effects (e.g. chemical form adjusted descriptors) were calculated and used to develop predictive models for logK BSA/w of IOCs. The models developed had high goodness-of-fit, robustness, and predictive ability. The predictor variables selected to construct the models included the chemical form adjusted averages of the negative potentials on the molecular surface (V s-adj - ), the chemical form adjusted molecular dipole moment (dipolemoment adj ), the logarithm of the n-octanol/water distribution coefficient (logD). As these molecular descriptors can be calculated from their molecular structures directly, the developed model can be easily used to fill the logK BSA/w data gap for other IOCs within the applicability domain. Furthermore, the chemical form adjusted descriptors calculated in this study also could be used to construct predictive models on other endpoints of IOCs. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Influence of adult attachment insecurities on parenting self-esteem: the mediating role of dyadic adjustment

    PubMed Central

    Calvo, Vincenzo; Bianco, Francesca

    2015-01-01

    Background: Parenting self-esteem includes two global components, parents’ self-efficacy and satisfaction with their parental role, and has a crucial role in parent–child interactions. The purpose of this study was to develop an integrative model linking adult attachment insecurities, dyadic adjustment, and parenting self-esteem. Methods: The study involved 118 pairs (236 subjects) of heterosexual parents of a firstborn child aged 0–6 years. They were administered the Experiences in Close Relationships-Revised (ECR-R) questionnaire, the Dyadic Adjustment Scale, and the Parenting Sense of Competence Scale. Results: Path analysis was used to design and test a theoretical integrative model, achieving a good fit with the data. Findings showed that dyadic adjustment mediates the negative influence on parenting self-efficacy of both attachment anxiety and attachment avoidance. Parenting satisfaction is positively influenced by parenting self-efficacy and negatively affected by child’s age. Attachment anxiety negatively influences parenting satisfaction. Conclusion: Our findings are in line with the theoretical expectations and have promising implications for future research and intervention programs designed to improve parenting self-esteem. PMID:26441811

  10. Bayes linear covariance matrix adjustment

    NASA Astrophysics Data System (ADS)

    Wilkinson, Darren J.

    1995-12-01

    In this thesis, a Bayes linear methodology for the adjustment of covariance matrices is presented and discussed. A geometric framework for quantifying uncertainties about covariance matrices is set up, and an inner-product for spaces of random matrices is motivated and constructed. The inner-product on this space captures aspects of our beliefs about the relationship between covariance matrices of interest to us, providing a structure rich enough for us to adjust beliefs about unknown matrices in the light of data such as sample covariance matrices, exploiting second-order exchangeability and related specifications to obtain representations allowing analysis. Adjustment is associated with orthogonal projection, and illustrated with examples of adjustments for some common problems. The problem of adjusting the covariance matrices underlying exchangeable random vectors is tackled and discussed. Learning about the covariance matrices associated with multivariate time series dynamic linear models is shown to be amenable to a similar approach. Diagnostics for matrix adjustments are also discussed.

  11. Case-Mix Adjusting Performance Measures in a Veteran Population: Pharmacy- and Diagnosis-Based Approaches

    PubMed Central

    Liu, Chuan-Fen; Sales, Anne E; Sharp, Nancy D; Fishman, Paul; Sloan, Kevin L; Todd-Stenberg, Jeff; Nichol, W Paul; Rosen, Amy K; Loveland, Susan

    2003-01-01

    Objective To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures. Data Sources/Study Setting The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N=126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse. Study Design We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care. Principal Findings Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models. Conclusions Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility. PMID:14596393

  12. SU-E-T-247: Multi-Leaf Collimator Model Adjustments Improve Small Field Dosimetry in VMAT Plans

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Young, L; Yang, F

    2014-06-01

    Purpose: The Elekta beam modulator linac employs a 4-mm micro multileaf collimator (MLC) backed by a fixed jaw. Out-of-field dose discrepancies between treatment planning system (TPS) calculations and output water phantom measurements are caused by the 1-mm leaf gap required for all moving MLCs in a VMAT arc. In this study, MLC parameters are optimized to improve TPS out-of-field dose approximations. Methods: Static 2.4 cm square fields were created with a 1-mm leaf gap for MLCs that would normally park behind the jaw. Doses in the open field and leaf gap were measured with an A16 micro ion chamber andmore » EDR2 film for comparison with corresponding point doses in the Pinnacle TPS. The MLC offset table and tip radius were adjusted until TPS point doses agreed with photon measurements. Improvements to the beam models were tested using static arcs consisting of square fields ranging from 1.6 to 14.0 cm, with 45° collimator rotation, and 1-mm leaf gap to replicate VMAT conditions. Gamma values for the 3-mm distance, 3% dose difference criteria were evaluated using standard QA procedures with a cylindrical detector array. Results: The best agreement in point doses within the leaf gap and open field was achieved by offsetting the default rounded leaf end table by 0.1 cm and adjusting the leaf tip radius to 13 cm. Improvements in TPS models for 6 and 10 MV photon beams were more significant for smaller field sizes 3.6 cm or less where the initial gamma factors progressively increased as field size decreased, i.e. for a 1.6cm field size, the Gamma increased from 56.1% to 98.8%. Conclusion: The MLC optimization techniques developed will achieve greater dosimetric accuracy in small field VMAT treatment plans for fixed jaw linear accelerators. Accurate predictions of dose to organs at risk may reduce adverse effects of radiotherapy.« less

  13. A new multivariate zero-adjusted Poisson model with applications to biomedicine.

    PubMed

    Liu, Yin; Tian, Guo-Liang; Tang, Man-Lai; Yuen, Kam Chuen

    2018-05-25

    Recently, although advances were made on modeling multivariate count data, existing models really has several limitations: (i) The multivariate Poisson log-normal model (Aitchison and Ho, ) cannot be used to fit multivariate count data with excess zero-vectors; (ii) The multivariate zero-inflated Poisson (ZIP) distribution (Li et al., 1999) cannot be used to model zero-truncated/deflated count data and it is difficult to apply to high-dimensional cases; (iii) The Type I multivariate zero-adjusted Poisson (ZAP) distribution (Tian et al., 2017) could only model multivariate count data with a special correlation structure for random components that are all positive or negative. In this paper, we first introduce a new multivariate ZAP distribution, based on a multivariate Poisson distribution, which allows the correlations between components with a more flexible dependency structure, that is some of the correlation coefficients could be positive while others could be negative. We then develop its important distributional properties, and provide efficient statistical inference methods for multivariate ZAP model with or without covariates. Two real data examples in biomedicine are used to illustrate the proposed methods. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. The relationship between the C-statistic of a risk-adjustment model and the accuracy of hospital report cards: a Monte Carlo Study.

    PubMed

    Austin, Peter C; Reeves, Mathew J

    2013-03-01

    Hospital report cards, in which outcomes following the provision of medical or surgical care are compared across health care providers, are being published with increasing frequency. Essential to the production of these reports is risk-adjustment, which allows investigators to account for differences in the distribution of patient illness severity across different hospitals. Logistic regression models are frequently used for risk adjustment in hospital report cards. Many applied researchers use the c-statistic (equivalent to the area under the receiver operating characteristic curve) of the logistic regression model as a measure of the credibility and accuracy of hospital report cards. To determine the relationship between the c-statistic of a risk-adjustment model and the accuracy of hospital report cards. Monte Carlo simulations were used to examine this issue. We examined the influence of 3 factors on the accuracy of hospital report cards: the c-statistic of the logistic regression model used for risk adjustment, the number of hospitals, and the number of patients treated at each hospital. The parameters used to generate the simulated datasets came from analyses of patients hospitalized with a diagnosis of acute myocardial infarction in Ontario, Canada. The c-statistic of the risk-adjustment model had, at most, a very modest impact on the accuracy of hospital report cards, whereas the number of patients treated at each hospital had a much greater impact. The c-statistic of a risk-adjustment model should not be used to assess the accuracy of a hospital report card.

  15. Adjusting Satellite Rainfall Error in Mountainous Areas for Flood Modeling Applications

    NASA Astrophysics Data System (ADS)

    Zhang, X.; Anagnostou, E. N.; Astitha, M.; Vergara, H. J.; Gourley, J. J.; Hong, Y.

    2014-12-01

    This study aims to investigate the use of high-resolution Numerical Weather Prediction (NWP) for evaluating biases of satellite rainfall estimates of flood-inducing storms in mountainous areas and associated improvements in flood modeling. Satellite-retrieved precipitation has been considered as a feasible data source for global-scale flood modeling, given that satellite has the spatial coverage advantage over in situ (rain gauges and radar) observations particularly over mountainous areas. However, orographically induced heavy precipitation events tend to be underestimated and spatially smoothed by satellite products, which error propagates non-linearly in flood simulations.We apply a recently developed retrieval error and resolution effect correction method (Zhang et al. 2013*) on the NOAA Climate Prediction Center morphing technique (CMORPH) product based on NWP analysis (or forecasting in the case of real-time satellite products). The NWP rainfall is derived from the Weather Research and Forecasting Model (WRF) set up with high spatial resolution (1-2 km) and explicit treatment of precipitation microphysics.In this study we will show results on NWP-adjusted CMORPH rain rates based on tropical cyclones and a convective precipitation event measured during NASA's IPHEX experiment in the South Appalachian region. We will use hydrologic simulations over different basins in the region to evaluate propagation of bias correction in flood simulations. We show that the adjustment reduced the underestimation of high rain rates thus moderating the strong rainfall magnitude dependence of CMORPH rainfall bias, which results in significant improvement in flood peak simulations. Further study over Blue Nile Basin (western Ethiopia) will be investigated and included in the presentation. *Zhang, X. et al. 2013: Using NWP Simulations in Satellite Rainfall Estimation of Heavy Precipitation Events over Mountainous Areas. J. Hydrometeor, 14, 1844-1858.

  16. Three methods to construct predictive models using logistic regression and likelihood ratios to facilitate adjustment for pretest probability give similar results.

    PubMed

    Chan, Siew Foong; Deeks, Jonathan J; Macaskill, Petra; Irwig, Les

    2008-01-01

    To compare three predictive models based on logistic regression to estimate adjusted likelihood ratios allowing for interdependency between diagnostic variables (tests). This study was a review of the theoretical basis, assumptions, and limitations of published models; and a statistical extension of methods and application to a case study of the diagnosis of obstructive airways disease based on history and clinical examination. Albert's method includes an offset term to estimate an adjusted likelihood ratio for combinations of tests. Spiegelhalter and Knill-Jones method uses the unadjusted likelihood ratio for each test as a predictor and computes shrinkage factors to allow for interdependence. Knottnerus' method differs from the other methods because it requires sequencing of tests, which limits its application to situations where there are few tests and substantial data. Although parameter estimates differed between the models, predicted "posttest" probabilities were generally similar. Construction of predictive models using logistic regression is preferred to the independence Bayes' approach when it is important to adjust for dependency of tests errors. Methods to estimate adjusted likelihood ratios from predictive models should be considered in preference to a standard logistic regression model to facilitate ease of interpretation and application. Albert's method provides the most straightforward approach.

  17. A four-culture study of self-enhancement and adjustment using the social relations model: do alternative conceptualizations and indices make a difference?

    PubMed

    Church, A Timothy; Katigbak, Marcia S; Mazuera Arias, Rina; Rincon, Brigida Carolina; Vargas-Flores, José de Jesús; Ibáñez-Reyes, Joselina; Wang, Lei; Alvarez, Juan M; Wang, Congcong; Ortiz, Fernando A

    2014-06-01

    In the self-enhancement literature, 2 major controversies remain--whether self-enhancement is a cultural universal and whether it is healthy or maladaptive. Use of the social relations model (SRM; Kenny, 1994) might facilitate resolution of these controversies. We applied the SRM with a round-robin design in both friend and family contexts in 4 diverse cultures: the United States (n = 399), Mexico (n = 413), Venezuela (n = 290), and China (n = 222). Results obtained with social comparison, self-insight, and SRM conceptualizations and indices of self-enhancement were compared for both agentic traits (i.e., egoistic bias) and communal traits (i.e., moralistic bias). Conclusions regarding cultural differences in the prevalence of self-enhancement vs. self-effacement tendencies, and the relationship between self-enhancement and adjustment, varied depending on the index of self-enhancement used. For example, consistent with cultural psychology perspectives, Chinese showed a greater tendency to self-efface than self-enhance using social comparison and self-insight indices, particularly on communal traits in the friend context. However, no cultural differences were observed when perceiver and target effects were controlled using the SRM indices. In all cultures, self-enhancement indices were moderately consistent across friend and family contexts, suggesting traitlike tendencies. To a similar extent in all 4 cultures, self-enhancement tendencies, as measured by the SRM indices, were moderately related to self-rated adjustment, but unrelated, or less so, to observer-rated adjustment.

  18. External Validation of a Case-Mix Adjustment Model for the Standardized Reporting of 30-Day Stroke Mortality Rates in China.

    PubMed

    Yu, Ping; Pan, Yuesong; Wang, Yongjun; Wang, Xianwei; Liu, Liping; Ji, Ruijun; Meng, Xia; Jing, Jing; Tong, Xu; Guo, Li; Wang, Yilong

    2016-01-01

    A case-mix adjustment model has been developed and externally validated, demonstrating promise. However, the model has not been thoroughly tested among populations in China. In our study, we evaluated the performance of the model in Chinese patients with acute stroke. The case-mix adjustment model A includes items on age, presence of atrial fibrillation on admission, National Institutes of Health Stroke Severity Scale (NIHSS) score on admission, and stroke type. Model B is similar to Model A but includes only the consciousness component of the NIHSS score. Both model A and B were evaluated to predict 30-day mortality rates in 13,948 patients with acute stroke from the China National Stroke Registry. The discrimination of the models was quantified by c-statistic. Calibration was assessed using Pearson's correlation coefficient. The c-statistic of model A in our external validation cohort was 0.80 (95% confidence interval, 0.79-0.82), and the c-statistic of model B was 0.82 (95% confidence interval, 0.81-0.84). Excellent calibration was reported in the two models with Pearson's correlation coefficient (0.892 for model A, p<0.001; 0.927 for model B, p = 0.008). The case-mix adjustment model could be used to effectively predict 30-day mortality rates in Chinese patients with acute stroke.

  19. Combined expectancies: electrophysiological evidence for the adjustment of expectancy effects

    PubMed Central

    Mattler, Uwe; van der Lugt, Arie; Münte, Thomas F

    2006-01-01

    Background When subjects use cues to prepare for a likely stimulus or a likely response, reaction times are facilitated by valid cues but prolonged by invalid cues. In studies on combined expectancy effects, two cues can independently give information regarding two dimensions of the forthcoming task. In certain situations, cueing effects on one dimension are reduced when the cue on the other dimension is invalid. According to the Adjusted Expectancy Model, cues affect different processing levels and a mechanism is presumed which is sensitive to the validity of early level cues and leads to online adjustment of expectancy effects at later levels. To examine the predictions of this model cueing of stimulus modality was combined with response cueing. Results Behavioral measures showed the interaction of cueing effects. Electrophysiological measures of the lateralized readiness potential (LRP) and the N200 amplitude confirmed the predictions of the model. The LRP showed larger effects of response cues on response activation when modality cues were valid rather than invalid. N200 amplitude was largest with valid modality cues and invalid response cues, medium with invalid modality cues, and smallest with two valid cues. Conclusion Findings support the view that the validity of early level expectancies modulates the effects of late level expectancies, which included response activation and response conflict in the present study. PMID:16674805

  20. Adjusting for multiple prognostic factors in the analysis of randomised trials

    PubMed Central

    2013-01-01

    Background When multiple prognostic factors are adjusted for in the analysis of a randomised trial, it is unclear (1) whether it is necessary to account for each of the strata, formed by all combinations of the prognostic factors (stratified analysis), when randomisation has been balanced within each stratum (stratified randomisation), or whether adjusting for the main effects alone will suffice, and (2) the best method of adjustment in terms of type I error rate and power, irrespective of the randomisation method. Methods We used simulation to (1) determine if a stratified analysis is necessary after stratified randomisation, and (2) to compare different methods of adjustment in terms of power and type I error rate. We considered the following methods of analysis: adjusting for covariates in a regression model, adjusting for each stratum using either fixed or random effects, and Mantel-Haenszel or a stratified Cox model depending on outcome. Results Stratified analysis is required after stratified randomisation to maintain correct type I error rates when (a) there are strong interactions between prognostic factors, and (b) there are approximately equal number of patients in each stratum. However, simulations based on real trial data found that type I error rates were unaffected by the method of analysis (stratified vs unstratified), indicating these conditions were not met in real datasets. Comparison of different analysis methods found that with small sample sizes and a binary or time-to-event outcome, most analysis methods lead to either inflated type I error rates or a reduction in power; the lone exception was a stratified analysis using random effects for strata, which gave nominal type I error rates and adequate power. Conclusions It is unlikely that a stratified analysis is necessary after stratified randomisation except in extreme scenarios. Therefore, the method of analysis (accounting for the strata, or adjusting only for the covariates) will not

  1. Political Violence and Child Adjustment: Longitudinal Tests of Sectarian Antisocial Behavior, Family Conflict and Insecurity as Explanatory Pathways

    PubMed Central

    Cummings, E. Mark; Merrilees, Christine E.; Schermerhorn, Alice C.; Goeke-Morey, Marcie C.; Shirlow, Peter; Cairns, Ed

    2011-01-01

    Understanding the impact of political violence on child maladjustment is a matter of international concern. Recent research has advanced a social ecological explanation for relations between political violence and child adjustment. However, conclusions are qualified by the lack of longitudinal tests. Towards examining pathways longitudinally, mothers and their adolescents (M = 12.33, SD =1.78, at time 1) from two-parent families in Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures assessing multiple levels of a social ecological model. Utilizing autoregressive controls, a three-wave longitudinal model test (T1, n = 299; T2, n = 248; T3, n = 197) supported a specific pathway linking sectarian community violence, family conflict, children’s insecurity about family relationships, and adjustment problems. PMID:22313052

  2. Ice loading model for Glacial Isostatic Adjustment in the Barents Sea constrained by GRACE gravity observations

    NASA Astrophysics Data System (ADS)

    Root, Bart; Tarasov, Lev; van der Wal, Wouter

    2014-05-01

    The global ice budget is still under discussion because the observed 120-130 m eustatic sea level equivalent since the Last Glacial Maximum (LGM) can not be explained by the current knowledge of land-ice melt after the LGM. One possible location for the missing ice is the Barents Sea Region, which was completely covered with ice during the LGM. This is deduced from relative sea level observations on Svalbard, Novaya Zemlya and the North coast of Scandinavia. However, there are no observations in the middle of the Barents Sea that capture the post-glacial uplift. With increased precision and longer time series of monthly gravity observations of the GRACE satellite mission it is possible to constrain Glacial Isostatic Adjustment in the center of the Barents Sea. This study investigates the extra constraint provided by GRACE data for modeling the past ice geometry in the Barents Sea. We use CSR release 5 data from February 2003 to July 2013. The GRACE data is corrected for the past 10 years of secular decline of glacier ice on Svalbard, Novaya Zemlya and Frans Joseph Land. With numerical GIA models for a radially symmetric Earth, we model the expected gravity changes and compare these with the GRACE observations after smoothing with a 250 km Gaussian filter. The comparisons show that for the viscosity profile VM5a, ICE-5G has too strong a gravity signal compared to GRACE. The regional calibrated ice sheet model (GLAC) of Tarasov appears to fit the amplitude of the GRACE signal. However, the GRACE data are very sensitive to the ice-melt correction, especially for Novaya Zemlya. Furthermore, the ice mass should be more concentrated to the middle of the Barents Sea. Alternative viscosity models confirm these conclusions.

  3. Modeling of Turbulent Boundary Layer Surface Pressure Fluctuation Auto and Cross Spectra - Verification and Adjustments Based on TU-144LL Data

    NASA Technical Reports Server (NTRS)

    Rackl, Robert; Weston, Adam

    2005-01-01

    The literature on turbulent boundary layer pressure fluctuations provides several empirical models which were compared to the measured TU-144 data. The Efimtsov model showed the best agreement. Adjustments were made to improve its agreement further, consisting of the addition of a broad band peak in the mid frequencies, and a minor modification to the high frequency rolloff. The adjusted Efimtsov predicted and measured results are compared for both subsonic and supersonic flight conditions. Measurements in the forward and middle portions of the fuselage have better agreement with the model than those from the aft portion. For High Speed Civil Transport supersonic cruise, interior levels predicted by use of this model are expected to increase by 1-3 dB due to the adjustments to the Efimtsov model. The space-time cross-correlations and cross-spectra of the fluctuating surface pressure were also investigated. This analysis is an important ingredient in structural acoustic models of aircraft interior noise. Once again the measured data were compared to the predicted levels from the Efimtsov model.

  4. Lipid Adjustment for Chemical Exposures: Accounting for Concomitant Variables

    PubMed Central

    Li, Daniel; Longnecker, Matthew P.; Dunson, David B.

    2013-01-01

    Background Some environmental chemical exposures are lipophilic and need to be adjusted by serum lipid levels before data analyses. There are currently various strategies that attempt to account for this problem, but all have their drawbacks. To address such concerns, we propose a new method that uses Box-Cox transformations and a simple Bayesian hierarchical model to adjust for lipophilic chemical exposures. Methods We compared our Box-Cox method to existing methods. We ran simulation studies in which increasing levels of lipid-adjusted chemical exposure did and did not increase the odds of having a disease, and we looked at both single-exposure and multiple-exposures cases. We also analyzed an epidemiology dataset that examined the effects of various chemical exposures on the risk of birth defects. Results Compared with existing methods, our Box-Cox method produced unbiased estimates, good coverage, similar power, and lower type-I error rates. This was the case in both single- and multiple-exposure simulation studies. Results from analysis of the birth-defect data differed from results using existing methods. Conclusion Our Box-Cox method is a novel and intuitive way to account for the lipophilic nature of certain chemical exposures. It addresses some of the problems with existing methods, is easily extendable to multiple exposures, and can be used in any analyses that involve concomitant variables. PMID:24051893

  5. Parametric Adjustments to the Rankine Vortex Wind Model for Gulf of Mexico Hurricanes

    DTIC Science & Technology

    2012-11-01

    2012 4. TITLE AND SUBTITLE Parametric Adjustments to the Rankine Vortex Wind Model for Gulf of Mexico Hurricanes 5a. CONTRACT NUMBER 5b. GRANT ...may be used to construct spatially varying wind fields for the GOM region (e.g., Thompson and Cardone [12]), but this requires using a complicated...Storm Damage Reduc- tion, and Dredging Operations and Environmental Research (DOER). The USACE Headquarters granted permission to publish this paper

  6. Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

    PubMed

    McMillan, Matthew T; Soi, Sameer; Asbun, Horacio J; Ball, Chad G; Bassi, Claudio; Beane, Joal D; Behrman, Stephen W; Berger, Adam C; Bloomston, Mark; Callery, Mark P; Christein, John D; Dixon, Elijah; Drebin, Jeffrey A; Castillo, Carlos Fernandez-Del; Fisher, William E; Fong, Zhi Ven; House, Michael G; Hughes, Steven J; Kent, Tara S; Kunstman, John W; Malleo, Giuseppe; Miller, Benjamin C; Salem, Ronald R; Soares, Kevin; Valero, Vicente; Wolfgang, Christopher L; Vollmer, Charles M

    2016-08-01

    To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P < 0.00001) and octreotide (odds ratio 3.30, P < 0.00001). When adjusting for risk, performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.

  7. Understanding New Jersey's School Funding Formula: The Role of Adjustment Aid

    ERIC Educational Resources Information Center

    Farrie, Danielle; Luhm, Theresa; Johnson, Monete

    2015-01-01

    The objective of this policy brief is to explain the purpose of adjustment aid in New Jersey's school funding formula and to correct several misconceptions about the level of aid and how it is distributed. The main conclusions include: (1) The amount of adjustment aid in the funding formula is currently overstated in the "informational"…

  8. Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

    PubMed Central

    Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

    1996-01-01

    Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

  9. Geostrophic adjustment in a shallow-water numerical model as it relates to thermospheric dynamics

    NASA Technical Reports Server (NTRS)

    Larsen, M. F.; Mikkelsen, I. S.

    1986-01-01

    The theory of geostrophic adjustment and its application to the dynamics of the high latitude thermosphere have been discussed in previous papers based on a linearized treatment of the fluid dynamical equations. However, a linearized treatment is only valid for small Rossby numbers given by Ro = V/fL, where V is the wind speed, f is the local value of the Coriolis parameter, and L is a characteristic horizontal scale for the flow. For typical values in the auroral zone, the approximation is not reasonable for wind speeds greater than 25 m/s or so. A shallow-water (one layer) model was developed that includes the spherical geometry and full nonlinear dynamics in the momentum equations in order to isolate the effects of the nonlinearities on the adjustment process. A belt of accelerated winds between 60 deg and 70 deg latitude was used as the initial condition. The adjustment process was found to proceed as expected from the linear formulation, but that an asymmetry between the response for an eastward and westward flow results from the nonlineawr curvature (centrifugal) terms. In general, the amplitude of an eastward flowing wind will be less after adjustment than a westward wind. For instance, if the initial wind velocity is 300 m/s, the linearized theory predicts a final wind speed of 240 m/s, regardless of the flow direction. However, the nonlinear curvature terms modify the response and produce a final wind speed of only 200 m/s for an initial eastward wind and a final wind speed of almost 300 m/s for an initial westward flow direction. Also, less gravity wave energy is produced by the adjustment of the westward flow than by the adjustment of the eastward flow. The implications are that the response of the thermosphere should be significantly different on the dawn and dusk sides of the auroral oval. Larger flow velocities would be expected on the dusk side since the plasma will accelerate the flow in a westward direction in that sector.

  10. Family support and acceptance, gay male identity formation, and psychological adjustment: a path model.

    PubMed

    Elizur, Y; Ziv, M

    2001-01-01

    While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N = 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure (Elizur & Mintzer, 2001). The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.

  11. NGA-West2 Empirical Fourier Model for Active Crustal Regions to Generate Regionally Adjustable Response Spectra

    NASA Astrophysics Data System (ADS)

    Bora, S. S.; Cotton, F.; Scherbaum, F.; Kuehn, N. M.

    2016-12-01

    Adjustment of median ground motion prediction equations (GMPEs) from data-rich (host) regions to data-poor regions (target) is one of major challenges that remains with the current practice of engineering seismology and seismic hazard analysis. Fourier spectral representation of ground motion provides a solution to address the problem of adjustment that is physically transparent and consistent with the concepts of linear system theory. Also, it provides a direct interface to appreciate the physically expected behavior of seismological parameters on ground motion. In the present study, we derive an empirical Fourier model for computing regionally adjustable response spectral ordinates based on random vibration theory (RVT) from shallow crustal earthquakes in active tectonic regions, following the approach of Bora et al. (2014, 2015). , For this purpose, we use an expanded NGA-West2 database with M 3.2—7.9 earthquakes at distances ranging from 0 to 300 km. A mixed-effects regression technique is employed to further explore various components of variability. The NGA-West2 database expanded over a wide magnitude range provides a better understanding (and constraint) of source scaling of ground motion. The large global volume of the database also allows investigating regional patterns in distance-dependent attenuation (i.e., geometrical spreading and inelastic attenuation) of ground motion as well as in the source parameters (e.g., magnitude and stress drop). Furthermore, event-wise variability and its correlation with stress parameter are investigated. Finally, application of the derived Fourier model in generating adjustable response spectra will be shown.

  12. Conclusiveness of natural languages and recognition of images

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wojcik, Z.M.

    1983-01-01

    The conclusiveness is investigated using recognition processes and one-one correspondence between expressions of a natural language and graphs representing events. The graphs, as conceived in psycholinguistics, are obtained as a result of perception processes. It is possible to generate and process the graphs automatically, using computers and then to convert the resulting graphs into expressions of a natural language. Correctness and conclusiveness of the graphs and sentences are investigated using the fundamental condition for events representation processes. Some consequences of the conclusiveness are discussed, e.g. undecidability of arithmetic, human brain assymetry, correctness of statistical calculations and operations research. It ismore » suggested that the group theory should be imposed on mathematical models of any real system. Proof of the fundamental condition is also presented. 14 references.« less

  13. Procedures for adjusting regional regression models of urban-runoff quality using local data

    USGS Publications Warehouse

    Hoos, A.B.; Sisolak, J.K.

    1993-01-01

    Statistical operations termed model-adjustment procedures (MAP?s) can be used to incorporate local data into existing regression models to improve the prediction of urban-runoff quality. Each MAP is a form of regression analysis in which the local data base is used as a calibration data set. Regression coefficients are determined from the local data base, and the resulting `adjusted? regression models can then be used to predict storm-runoff quality at unmonitored sites. The response variable in the regression analyses is the observed load or mean concentration of a constituent in storm runoff for a single storm. The set of explanatory variables used in the regression analyses is different for each MAP, but always includes the predicted value of load or mean concentration from a regional regression model. The four MAP?s examined in this study were: single-factor regression against the regional model prediction, P, (termed MAP-lF-P), regression against P,, (termed MAP-R-P), regression against P, and additional local variables (termed MAP-R-P+nV), and a weighted combination of P, and a local-regression prediction (termed MAP-W). The procedures were tested by means of split-sample analysis, using data from three cities included in the Nationwide Urban Runoff Program: Denver, Colorado; Bellevue, Washington; and Knoxville, Tennessee. The MAP that provided the greatest predictive accuracy for the verification data set differed among the three test data bases and among model types (MAP-W for Denver and Knoxville, MAP-lF-P and MAP-R-P for Bellevue load models, and MAP-R-P+nV for Bellevue concentration models) and, in many cases, was not clearly indicated by the values of standard error of estimate for the calibration data set. A scheme to guide MAP selection, based on exploratory data analysis of the calibration data set, is presented and tested. The MAP?s were tested for sensitivity to the size of a calibration data set. As expected, predictive accuracy of all MAP?s for

  14. Case-Mix Adjustment of the Bereaved Family Survey.

    PubMed

    Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

    2018-01-01

    Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

  15. Adjusted adaptive Lasso for covariate model-building in nonlinear mixed-effect pharmacokinetic models.

    PubMed

    Haem, Elham; Harling, Kajsa; Ayatollahi, Seyyed Mohammad Taghi; Zare, Najaf; Karlsson, Mats O

    2017-02-01

    One important aim in population pharmacokinetics (PK) and pharmacodynamics is identification and quantification of the relationships between the parameters and covariates. Lasso has been suggested as a technique for simultaneous estimation and covariate selection. In linear regression, it has been shown that Lasso possesses no oracle properties, which means it asymptotically performs as though the true underlying model was given in advance. Adaptive Lasso (ALasso) with appropriate initial weights is claimed to possess oracle properties; however, it can lead to poor predictive performance when there is multicollinearity between covariates. This simulation study implemented a new version of ALasso, called adjusted ALasso (AALasso), to take into account the ratio of the standard error of the maximum likelihood (ML) estimator to the ML coefficient as the initial weight in ALasso to deal with multicollinearity in non-linear mixed-effect models. The performance of AALasso was compared with that of ALasso and Lasso. PK data was simulated in four set-ups from a one-compartment bolus input model. Covariates were created by sampling from a multivariate standard normal distribution with no, low (0.2), moderate (0.5) or high (0.7) correlation. The true covariates influenced only clearance at different magnitudes. AALasso, ALasso and Lasso were compared in terms of mean absolute prediction error and error of the estimated covariate coefficient. The results show that AALasso performed better in small data sets, even in those in which a high correlation existed between covariates. This makes AALasso a promising method for covariate selection in nonlinear mixed-effect models.

  16. Glacial isostatic adjustment model with composite 3-D Earth rheology for Fennoscandia

    NASA Astrophysics Data System (ADS)

    van der Wal, Wouter; Barnhoorn, Auke; Stocchi, Paolo; Gradmann, Sofie; Wu, Patrick; Drury, Martyn; Vermeersen, Bert

    2013-07-01

    Models for glacial isostatic adjustment (GIA) can provide constraints on rheology of the mantle if past ice thickness variations are assumed to be known. The Pleistocene ice loading histories that are used to obtain such constraints are based on an a priori 1-D mantle viscosity profile that assumes a single deformation mechanism for mantle rocks. Such a simplified viscosity profile makes it hard to compare the inferred mantle rheology to inferences from seismology and laboratory experiments. It is unknown what constraints GIA observations can provide on more realistic mantle rheology with an ice history that is not based on an a priori mantle viscosity profile. This paper investigates a model for GIA with a new ice history for Fennoscandia that is constrained by palaeoclimate proxies and glacial sediments. Diffusion and dislocation creep flow law data are taken from a compilation of laboratory measurements on olivine. Upper-mantle temperature data sets down to 400 km depth are derived from surface heatflow measurements, a petrochemical model for Fennoscandia and seismic velocity anomalies. Creep parameters below 400 km are taken from an earlier study and are only varying with depth. The olivine grain size and water content (a wet state, or a dry state) are used as free parameters. The solid Earth response is computed with a global spherical 3-D finite-element model for an incompressible, self-gravitating Earth. We compare predictions to sea level data and GPS uplift rates in Fennoscandia. The objective is to see if the mantle rheology and the ice model is consistent with GIA observations. We also test if the inclusion of dislocation creep gives any improvements over predictions with diffusion creep only, and whether the laterally varying temperatures result in an improved fit compared to a widely used 1-D viscosity profile (VM2). We find that sea level data can be explained with our ice model and with information on mantle rheology from laboratory experiments

  17. Girls’ childhood trajectories of disruptive behavior predict adjustment problems in early adolescence

    PubMed Central

    van der Molen, Elsa; Blokland, Arjan A. J.; Hipwell, Alison E.; Vermeiren, Robert R.J.M.; Doreleijers, Theo A.H.; Loeber, Rolf

    2014-01-01

    Background It is widely recognized that early onset of disruptive behavior is linked to a variety of detrimental outcomes in males later in life. In contrast, little is known about the association between girls’ childhood trajectories of disruptive behavior and adjustment problems in early adolescence. Methods The current study used 9 waves of data from the ongoing Pittsburgh Girls Study. A semi-parametric group based model was used to identify trajectories of disruptive behavior in 1,513 girls from age 6 to 12 years. Adjustment problems were characterized by depression, self-harm, PTSD, substance use, interpersonal aggression, sexual behavior, affiliation with delinquent peers, and academic achievement at ages 13 and 14. Results Three trajectories of childhood disruptive behavior were identified: low, medium, and high. Girls in the high group were at increased risk for depression, self-harm, PTSD, illegal substance use, interpersonal aggression, early and risky sexual behavior, and lower academic achievement. The likelihood of multiple adjustment problems increased with trajectories reflecting higher levels of disruptive behavior. Conclusion Girls following the high childhood trajectory of disruptive behavior require early intervention programs to prevent multiple, adverse outcomes in adolescence and further escalation in adulthood. PMID:25302849

  18. Custodial grandmothers' psychological distress, dysfunctional parenting, and grandchildren's adjustment.

    PubMed

    Smith, Gregory C; Palmieri, Patrick A; Hancock, Gregory R; Richardson, Rhonda A

    2008-01-01

    An adaptation of the Family Stress Model (FSM) with hypothesized linkages between family contextual factors, custodial grandmothers' psychological distress, parenting practices, and grandchildren's adjustment was tested with structural equation modeling. Interview data from 733 custodial grandmothers of grandchildren between ages 4-17 revealed that the effect of grandmothers' distress on grandchildren's adjustment was mediated by dysfunctional parenting, especially regarding externalizing problems. The effects of contextual factors on grandchildren's adjustment were also indirect. The model's measurement and structural components were largely invariant across grandmothers' race and age, as well as grandchildren's gender and age. Group differences were more prevalent regarding the magnitude of latent means for model constructs. We conclude that parenting models like the FSM are useful for investigating custodial grandfamilies.

  19. Evaluation of average daily gain prediction by level one of the 1996 National Research Council beef model and development of net energy adjusters.

    PubMed

    Block, H C; Klopfenstein, T J; Erickson, G E

    2006-04-01

    Two data sets were developed to evaluate and refine feed energy predictions with the beef National Research Council (NRC, 1996) model level 1. The first data set included pen means of group-fed cattle from 31 growing trials (201 observations) and 17 finishing trials (154 observations) representing over 7,700 animals fed outside in dirt lots. The second data set consisted of 15 studies with individually fed cattle (916 observations) fed in a barn. In each data set, actual ADG was compared with ADG predicted with the NRC model level 1, assuming thermoneutral environmental conditions. Next, the observed ADG (kg), TDN intake (kg/d), and TDN concentration (kg/kg of DM) were used to develop equations to adjust the level 1 predicted diet NEm and NEg (diet NE adjusters) to be applied to more accurately predict ADG. In both data sets, the NRC (1996) model level 1 inaccurately predicted ADG (P < 0.001 for slope = 1; intercept = 0 when observed ADG was regressed on predicted ADG). The following nonlinear relationships to adjust NE based on observed ADG, TDN intake, and TDN concentration were all significant (P < 0.001): NE adjuster = 0.7011 x 10(-0.8562 x ADG) + 0.8042, R2 = 0.325, s(y.x) = 0.136 kg; NE adjuster = 4.795 10(-0.3689 x TDN intake) + 0.8233, R2 x = 0.714, s(y.x) = 0.157 kg; and NE adjuster = 357 x 10(-5.449 x TDN concentration) + 0.8138, R2 = 0.754, s(y.x) = 0.127 kg. An NE adjuster < 1 indicates overprediction of ADG. The average NE adjustment required for the pen-fed finishing trials was 0.820, whereas the (P < 0.001) adjustment of 0.906 for individually fed cattle indicates that the pen-fed environment increased NE requirements. The use of these equations should improve ADG prediction by the NRC (1996) model level 1, although the equations reflect limitations of the data from which they were developed and are appropriate only over the range of the developmental data set. There is a need for independent evaluation of the ability of the equations to improve ADG

  20. Dynamically adjustable foot-ground contact model to estimate ground reaction force during walking and running.

    PubMed

    Jung, Yihwan; Jung, Moonki; Ryu, Jiseon; Yoon, Sukhoon; Park, Sang-Kyoon; Koo, Seungbum

    2016-03-01

    Human dynamic models have been used to estimate joint kinetics during various activities. Kinetics estimation is in demand in sports and clinical applications where data on external forces, such as the ground reaction force (GRF), are not available. The purpose of this study was to estimate the GRF during gait by utilizing distance- and velocity-dependent force models between the foot and ground in an inverse-dynamics-based optimization. Ten males were tested as they walked at four different speeds on a force plate-embedded treadmill system. The full-GRF model whose foot-ground reaction elements were dynamically adjusted according to vertical displacement and anterior-posterior speed between the foot and ground was implemented in a full-body skeletal model. The model estimated the vertical and shear forces of the GRF from body kinematics. The shear-GRF model with dynamically adjustable shear reaction elements according to the input vertical force was also implemented in the foot of a full-body skeletal model. Shear forces of the GRF were estimated from body kinematics, vertical GRF, and center of pressure. The estimated full GRF had the lowest root mean square (RMS) errors at the slow walking speed (1.0m/s) with 4.2, 1.3, and 5.7% BW for anterior-posterior, medial-lateral, and vertical forces, respectively. The estimated shear forces were not significantly different between the full-GRF and shear-GRF models, but the RMS errors of the estimated knee joint kinetics were significantly lower for the shear-GRF model. Providing COP and vertical GRF with sensors, such as an insole-type pressure mat, can help estimate shear forces of the GRF and increase accuracy for estimation of joint kinetics. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. The Effectiveness of the Strength-Centered Career Adjustment Model for Dual-Career Women in Taiwan

    ERIC Educational Resources Information Center

    Wang, Yu-Chen; Tien, Hsiu-Lan Shelley

    2011-01-01

    The authors investigated the effectiveness of a Strength-Centered Career Adjustment Model for dual-career women (N = 28). Fourteen women in the experimental group received strength-centered career counseling for 6 to 8 sessions; the 14 women in the control group received test services in 1 to 2 sessions. All participants completed the Personal…

  2. Environmental Chemicals in Urine and Blood: Improving Methods for Creatinine and Lipid Adjustment

    PubMed Central

    O’Brien, Katie M.; Upson, Kristen; Cook, Nancy R.; Weinberg, Clarice R.

    2015-01-01

    Background Investigators measuring exposure biomarkers in urine typically adjust for creatinine to account for dilution-dependent sample variation in urine concentrations. Similarly, it is standard to adjust for serum lipids when measuring lipophilic chemicals in serum. However, there is controversy regarding the best approach, and existing methods may not effectively correct for measurement error. Objectives We compared adjustment methods, including novel approaches, using simulated case–control data. Methods Using a directed acyclic graph framework, we defined six causal scenarios for epidemiologic studies of environmental chemicals measured in urine or serum. The scenarios include variables known to influence creatinine (e.g., age and hydration) or serum lipid levels (e.g., body mass index and recent fat intake). Over a range of true effect sizes, we analyzed each scenario using seven adjustment approaches and estimated the corresponding bias and confidence interval coverage across 1,000 simulated studies. Results For urinary biomarker measurements, our novel method, which incorporates both covariate-adjusted standardization and the inclusion of creatinine as a covariate in the regression model, had low bias and possessed 95% confidence interval coverage of nearly 95% for most simulated scenarios. For serum biomarker measurements, a similar approach involving standardization plus serum lipid level adjustment generally performed well. Conclusions To control measurement error bias caused by variations in serum lipids or by urinary diluteness, we recommend improved methods for standardizing exposure concentrations across individuals. Citation O’Brien KM, Upson K, Cook NR, Weinberg CR. 2016. Environmental chemicals in urine and blood: improving methods for creatinine and lipid adjustment. Environ Health Perspect 124:220–227; http://dx.doi.org/10.1289/ehp.1509693 PMID:26219104

  3. Adjustment of automatic control systems of production facilities at coal processing plants using multivariant physico- mathematical models

    NASA Astrophysics Data System (ADS)

    Evtushenko, V. F.; Myshlyaev, L. P.; Makarov, G. V.; Ivushkin, K. A.; Burkova, E. V.

    2016-10-01

    The structure of multi-variant physical and mathematical models of control system is offered as well as its application for adjustment of automatic control system (ACS) of production facilities on the example of coal processing plant.

  4. Modeling fluvial incision and transient landscape evolution: Influence of dynamic channel adjustment

    NASA Astrophysics Data System (ADS)

    Attal, M.; Tucker, G. E.; Whittaker, A. C.; Cowie, P. A.; Roberts, G. P.

    2008-09-01

    Channel geometry exerts a fundamental control on fluvial processes. Recent work has shown that bedrock channel width depends on a number of parameters, including channel slope, and is not solely a function of drainage area as is commonly assumed. The present work represents the first attempt to investigate the consequences of dynamic, gradient-sensitive channel adjustment for drainage-basin evolution. We use the Channel-Hillslope Integrated Landscape Development (CHILD) model to analyze the response of a catchment to a given tectonic perturbation, using, as a template, the topography of a well-documented catchment in the footwall of an active normal fault in the Apennines (Italy) that is known to be undergoing a transient response to tectonic forcing. We show that the observed transient response can be reproduced to first order with a simple detachment-limited fluvial incision law. Transient landscape is characterized by gentler gradients and a shorter response time when dynamic channel adjustment is allowed. The differences in predicted channel geometry between the static case (width dependent solely on upstream area) and dynamic case (width dependent on both drainage area and channel slope) lead to contrasting landscape morphologies when integrated at the scale of a whole catchment, particularly in presence of strong tilting and/or pronounced slip-rate acceleration. Our results emphasize the importance of channel width in controlling fluvial processes and landscape evolution. They stress the need for using a dynamic hydraulic scaling law when modeling landscape evolution, particularly when the relative uplift field is nonuniform.

  5. Association of funding and conclusions in randomized drug trials: a reflection of treatment effect or adverse events?

    PubMed

    Als-Nielsen, Bodil; Chen, Wendong; Gluud, Christian; Kjaergard, Lise L

    2003-08-20

    Previous studies indicate that industry-sponsored trials tend to draw proindustry conclusions. To explore whether the association between funding and conclusions in randomized drug trials reflects treatment effects or adverse events. Observational study of 370 randomized drug trials included in meta-analyses from Cochrane reviews selected from the Cochrane Library, May 2001. From a random sample of 167 Cochrane reviews, 25 contained eligible meta-analyses (assessed a binary outcome; pooled at least 5 full-paper trials of which at least 1 reported adequate and 1 reported inadequate allocation concealment). The primary binary outcome from each meta-analysis was considered the primary outcome for all trials included in each meta-analysis. The association between funding and conclusions was analyzed by logistic regression with adjustment for treatment effect, adverse events, and additional confounding factors (methodological quality, control intervention, sample size, publication year, and place of publication). Conclusions in trials, classified into whether the experimental drug was recommended as the treatment of choice or not. The experimental drug was recommended as treatment of choice in 16% of trials funded by nonprofit organizations, 30% of trials not reporting funding, 35% of trials funded by both nonprofit and for-profit organizations, and 51% of trials funded by for-profit organizations (P<.001; chi2 test). Logistic regression analyses indicated that funding, treatment effect, and double blinding were the only significant predictors of conclusions. Adjusted analyses showed that trials funded by for-profit organizations were significantly more likely to recommend the experimental drug as treatment of choice (odds ratio, 5.3; 95% confidence interval, 2.0-14.4) compared with trials funded by nonprofit organizations. This association did not appear to reflect treatment effect or adverse events. Conclusions in trials funded by for-profit organizations may be more

  6. The Importance of Isomorphism for Conclusions about Homology: A Bayesian Multilevel Structural Equation Modeling Approach with Ordinal Indicators.

    PubMed

    Guenole, Nigel

    2016-01-01

    We describe a Monte Carlo study examining the impact of assuming item isomorphism (i.e., equivalent construct meaning across levels of analysis) on conclusions about homology (i.e., equivalent structural relations across levels of analysis) under varying degrees of non-isomorphism in the context of ordinal indicator multilevel structural equation models (MSEMs). We focus on the condition where one or more loadings are higher on the between level than on the within level to show that while much past research on homology has ignored the issue of psychometric isomorphism, psychometric isomorphism is in fact critical to valid conclusions about homology. More specifically, when a measurement model with non-isomorphic items occupies an exogenous position in a multilevel structural model and the non-isomorphism of these items is not modeled, the within level exogenous latent variance is under-estimated leading to over-estimation of the within level structural coefficient, while the between level exogenous latent variance is overestimated leading to underestimation of the between structural coefficient. When a measurement model with non-isomorphic items occupies an endogenous position in a multilevel structural model and the non-isomorphism of these items is not modeled, the endogenous within level latent variance is under-estimated leading to under-estimation of the within level structural coefficient while the endogenous between level latent variance is over-estimated leading to over-estimation of the between level structural coefficient. The innovative aspect of this article is demonstrating that even minor violations of psychometric isomorphism render claims of homology untenable. We also show that posterior predictive p-values for ordinal indicator Bayesian MSEMs are insensitive to violations of isomorphism even when they lead to severely biased within and between level structural parameters. We highlight conditions where poor estimation of even correctly specified

  7. The Importance of Isomorphism for Conclusions about Homology: A Bayesian Multilevel Structural Equation Modeling Approach with Ordinal Indicators

    PubMed Central

    Guenole, Nigel

    2016-01-01

    We describe a Monte Carlo study examining the impact of assuming item isomorphism (i.e., equivalent construct meaning across levels of analysis) on conclusions about homology (i.e., equivalent structural relations across levels of analysis) under varying degrees of non-isomorphism in the context of ordinal indicator multilevel structural equation models (MSEMs). We focus on the condition where one or more loadings are higher on the between level than on the within level to show that while much past research on homology has ignored the issue of psychometric isomorphism, psychometric isomorphism is in fact critical to valid conclusions about homology. More specifically, when a measurement model with non-isomorphic items occupies an exogenous position in a multilevel structural model and the non-isomorphism of these items is not modeled, the within level exogenous latent variance is under-estimated leading to over-estimation of the within level structural coefficient, while the between level exogenous latent variance is overestimated leading to underestimation of the between structural coefficient. When a measurement model with non-isomorphic items occupies an endogenous position in a multilevel structural model and the non-isomorphism of these items is not modeled, the endogenous within level latent variance is under-estimated leading to under-estimation of the within level structural coefficient while the endogenous between level latent variance is over-estimated leading to over-estimation of the between level structural coefficient. The innovative aspect of this article is demonstrating that even minor violations of psychometric isomorphism render claims of homology untenable. We also show that posterior predictive p-values for ordinal indicator Bayesian MSEMs are insensitive to violations of isomorphism even when they lead to severely biased within and between level structural parameters. We highlight conditions where poor estimation of even correctly specified

  8. Burden of Disease Measured by Disability-Adjusted Life Years and a Disease Forecasting Time Series Model of Scrub Typhus in Laiwu, China

    PubMed Central

    Yang, Li-Ping; Liang, Si-Yuan; Wang, Xian-Jun; Li, Xiu-Jun; Wu, Yan-Ling; Ma, Wei

    2015-01-01

    Background Laiwu District is recognized as a hyper-endemic region for scrub typhus in Shandong Province, but the seriousness of this problem has been neglected in public health circles. Methodology/Principal Findings A disability-adjusted life years (DALYs) approach was adopted to measure the burden of scrub typhus in Laiwu, China during the period 2006 to 2012. A multiple seasonal autoregressive integrated moving average model (SARIMA) was used to identify the most suitable forecasting model for scrub typhus in Laiwu. Results showed that the disease burden of scrub typhus is increasing yearly in Laiwu, and which is higher in females than males. For both females and males, DALY rates were highest for the 60–69 age group. Of all the SARIMA models tested, the SARIMA(2,1,0)(0,1,0)12 model was the best fit for scrub typhus cases in Laiwu. Human infections occurred mainly in autumn with peaks in October. Conclusions/Significance Females, especially those of 60 to 69 years of age, were at highest risk of developing scrub typhus in Laiwu, China. The SARIMA (2,1,0)(0,1,0)12 model was the best fit forecasting model for scrub typhus in Laiwu, China. These data are useful for developing public health education and intervention programs to reduce disease. PMID:25569248

  9. ESTIMATION OF EMISSION ADJUSTMENTS FROM THE APPLICATION OF FOUR-DIMENSIONAL DATA ASSIMILATION TO PHOTOCHEMICAL AIR QUALITY MODELING. (R826372)

    EPA Science Inventory

    Four-dimensional data assimilation applied to photochemical air quality modeling is used to suggest adjustments to the emissions inventory of the Atlanta, Georgia metropolitan area. In this approach, a three-dimensional air quality model, coupled with direct sensitivity analys...

  10. Predictors of adjustment and growth in women with recurrent ovarian cancer.

    PubMed

    Ponto, Julie Ann; Ellington, Lee; Mellon, Suzanne; Beck, Susan L

    2010-05-01

    To analyze predictors of adjustment and growth in women who had experienced recurrent ovarian cancer using components of the Resiliency Model of Family Stress, Adjustment, and Adaptation as a conceptual framework. Cross-sectional. Participants were recruited from national cancer advocacy groups. 60 married or partnered women with recurrent ovarian cancer. Participants completed an online or paper survey. Independent variables included demographic and illness variables and meaning of illness. Outcome variables were psychological adjustment and post-traumatic growth. A model of five predictor variables (younger age, fewer years in the relationship, poorer performance status, greater symptom distress, and more negative meaning) accounted for 64% of the variance in adjustment but did not predict post-traumatic growth. This study supports the use of a model of adjustment that includes demographic, illness, and appraisal variables for women with recurrent ovarian cancer. Symptom distress and poorer performance status were the most significant predictors of adjustment. Younger age and fewer years in the relationship also predicted poorer adjustment. Nurses have the knowledge and skills to influence the predictors of adjustment to recurrent ovarian cancer, particularly symptom distress and poor performance status. Nurses who recognize the predictors of poorer adjustment can anticipate problems and intervene to improve adjustment for women.

  11. NKG201xGIA - first results for a new model of glacial isostatic adjustment in Fennoscandia

    NASA Astrophysics Data System (ADS)

    Steffen, Holger; Barletta, Valentina; Kollo, Karin; Milne, Glenn A.; Nordman, Maaria; Olsson, Per-Anders; Simpson, Matthew J. R.; Tarasov, Lev; Ågren, Jonas

    2016-04-01

    Glacial isostatic adjustment (GIA) is a dominant process in northern Europe, which is observed with several geodetic and geophysical methods. The observed land uplift due to this process amounts to about 1 cm/year in the northern Gulf of Bothnia. GIA affects the establishment and maintenance of reliable geodetic and gravimetric reference networks in the Nordic countries. To support a high level of accuracy in the determination of position, adequate corrections have to be applied with dedicated models. Currently, there are efforts within a Nordic Geodetic Commission (NKG) activity towards a model of glacial isostatic adjustment for Fennoscandia. The new model, NKG201xGIA, to be developed in the near future will complement the forthcoming empirical NKG land uplift model, which will substitute the currently used empirical land uplift model NKG2005LU (Ågren & Svensson, 2007). Together, the models will be a reference for vertical and horizontal motion, gravity and geoid change and more. NKG201xGIA will also provide uncertainty estimates for each field. Following former investigations, the GIA model is based on a combination of an ice and an earth model. The selected reference ice model, GLAC, for Fennoscandia, the Barents/Kara seas and the British Isles is provided by Lev Tarasov and co-workers. Tests of different ice and earth models will be performed based on the expertise of each involved modeler. This includes studies on high resolution ice sheets, different rheologies, lateral variations in lithosphere and mantle viscosity and more. This will also be done in co-operation with scientists outside NKG who help in the development and testing of the model. References Ågren, J., Svensson, R. (2007): Postglacial Land Uplift Model and System Definition for the New Swedish Height System RH 2000. Reports in Geodesy and Geographical Information Systems Rapportserie, LMV-Rapport 4, Lantmäteriet, Gävle.

  12. Risk adjustment in the American College of Surgeons National Surgical Quality Improvement Program: a comparison of logistic versus hierarchical modeling.

    PubMed

    Cohen, Mark E; Dimick, Justin B; Bilimoria, Karl Y; Ko, Clifford Y; Richards, Karen; Hall, Bruce Lee

    2009-12-01

    Although logistic regression has commonly been used to adjust for risk differences in patient and case mix to permit quality comparisons across hospitals, hierarchical modeling has been advocated as the preferred methodology, because it accounts for clustering of patients within hospitals. It is unclear whether hierarchical models would yield important differences in quality assessments compared with logistic models when applied to American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) data. Our objective was to evaluate differences in logistic versus hierarchical modeling for identifying hospitals with outlying outcomes in the ACS-NSQIP. Data from ACS-NSQIP patients who underwent colorectal operations in 2008 at hospitals that reported at least 100 operations were used to generate logistic and hierarchical prediction models for 30-day morbidity and mortality. Differences in risk-adjusted performance (ratio of observed-to-expected events) and outlier detections from the two models were compared. Logistic and hierarchical models identified the same 25 hospitals as morbidity outliers (14 low and 11 high outliers), but the hierarchical model identified 2 additional high outliers. Both models identified the same eight hospitals as mortality outliers (five low and three high outliers). The values of observed-to-expected events ratios and p values from the two models were highly correlated. Results were similar when data were permitted from hospitals providing < 100 patients. When applied to ACS-NSQIP data, logistic and hierarchical models provided nearly identical results with respect to identification of hospitals' observed-to-expected events ratio outliers. As hierarchical models are prone to implementation problems, logistic regression will remain an accurate and efficient method for performing risk adjustment of hospital quality comparisons.

  13. Political violence and child adjustment: longitudinal tests of sectarian antisocial behavior, family conflict, and insecurity as explanatory pathways.

    PubMed

    Cummings, Edward M; Merrilees, Christine E; Schermerhorn, Alice C; Goeke-Morey, Marcie C; Shirlow, Peter; Cairns, Ed

    2012-01-01

    Understanding the impact of political violence on child maladjustment is a matter of international concern. Recent research has advanced a social ecological explanation for relations between political violence and child adjustment. However, conclusions are qualified by the lack of longitudinal tests. Toward examining pathways longitudinally, mothers and their adolescents (M = 12.33, SD = 1.78, at Time 1) from 2-parent families in Catholic and Protestant working class neighborhoods in Belfast, Northern Ireland, completed measures assessing multiple levels of a social ecological model. Utilizing autoregressive controls, a 3-wave longitudinal model test (T1, n = 299; T2, n = 248; T3, n = 197) supported a specific pathway linking sectarian community violence, family conflict, children's insecurity about family relationships, and adjustment problems. © 2012 The Authors. Child Development © 2012 Society for Research in Child Development, Inc.

  14. Internal Working Models and Adjustment of Physically Abused Children: The Mediating Role of Self-Regulatory Abilities

    ERIC Educational Resources Information Center

    Hawkins, Amy L.; Haskett, Mary E.

    2014-01-01

    Background: Abused children's internal working models (IWM) of relationships are known to relate to their socioemotional adjustment, but mechanisms through which negative representations increase vulnerability to maladjustment have not been explored. We sought to expand the understanding of individual differences in IWM of abused children and…

  15. Alternatives for using multivariate regression to adjust prospective payment rates

    PubMed Central

    Sheingold, Steven H.

    1990-01-01

    Multivariate regression analysis has been used in structuring three of the adjustments to Medicare's prospective payment rates. Because the indirect-teaching adjustment, the disproportionate-share adjustment, and the adjustment for large cities are responsible for distributing approximately $3 billion in payments each year, the specification of regression models for these adjustments is of critical importance. In this article, the application of regression for adjusting Medicare's prospective rates is discussed, and the implications that differing specifications could have for these adjustments are demonstrated. PMID:10113271

  16. A comparative study of adjustable and non-adjustable sutures in primary horizontal muscle surgery in children

    PubMed Central

    Kamal, A M; Abozeid, D; Seif, Y; Hassan, M

    2016-01-01

    Purpose To compare the results of using adjustable and non-adjustable sutures in primary horizontal strabismus surgeries in children. Methods This randomized control trial included 60 cases of primary horizontal deviation. The adjustable suture (AS) group included 30 patients, and the non-adjustable suture (NAS) group included 30 patients. The follow-up period was at least 6 months. A successful motor outcome was defined as orthophoria or a horizontal tropia of 8 PD or less at both near and far distances. The success rate and ocular drift were recorded and analysed. Results The mean age in the AS group was 3.48±2.37 years at the time of surgery. The mean age in the NAS group was 3.55±2.64 years at the time of surgery. The success rate at the end of 6 months was 86.67% in the AS group and 73.33% in the NAS group (P=0.197). In exotropic patients, there was a mean undercorrection drift of 2.86 PD in the AS group and a mean undercorrection drift of 2.17 PD in the NAS group. In esotropic patients, there was a mean undercorrection drift of 0.26 PD in the AS group and a mean undercorrection drift of 1.83 PD in the NAS group. Conclusion There was no significant difference between the groups. However, the success rate was clinically higher in the AS group than in the NAS group. PMID:27419838

  17. Custodial Grandmothers' Psychological Distress, Dysfunctional Parenting, and Grandchildren's Adjustment

    PubMed Central

    Smith, Gregory C.; Palmieri, Patrick A.; Hancock, Gregory R.; Richardson, Rhonda A.

    2009-01-01

    An adaptation of the Family Stress Model (FSM) with hypothesized linkages between family contextual factors, custodial grandmothers' psychological distress, parenting practices, and grandchildren's adjustment was tested with structural equation modeling. Interview data from 733 custodial grandmothers of grandchildren between ages 4-17 revealed that the effect of grandmothers' distress on grandchildren's adjustment was mediated by dysfunctional parenting, especially regarding externalizing problems. The effects of contextual factors on grandchildren's adjustment were also indirect. The model's measurement and structural components were largely invariant across grandmothers' race and age, as well as grandchildren's gender and age. Group differences were more prevalent regarding the magnitude of latent means for model constructs. We conclude that parenting models like the FSM are useful for investigating custodial grandfamilies. PMID:19266869

  18. Poor adjustment to college life mediates the relationship between drinking motives and alcohol consequences: a look at college adjustment, drinking motives, and drinking outcomes.

    PubMed

    LaBrie, Joseph W; Ehret, Phillip J; Hummer, Justin F; Prenovost, Katherine

    2012-04-01

    The current study examined whether the relationship between drinking motives and alcohol-related outcomes was mediated by college adjustment. Participants (N=253) completed an online survey that assessed drinking motives, degree of both positive and negative college adjustment, typical weekly drinking, and past month negative alcohol-related consequences. Structural equation modeling examined negative alcohol consequences as a function of college adjustment, drinking motives, and weekly drinking behavior in college students. Negative college adjustment mediated the relationship between coping drinking motives and drinking consequences. Positive college adjustment was not related to alcohol consumption or consequences. Positive reinforcement drinking motives (i.e. social and enhancement) not only directly predicted consequences, but were partially mediated by weekly drinking and degree of negative college adjustment. Gender specific models revealed that males exhibited more variability in drinking and their positive reinforcement drinking motives were more strongly associated with weekly drinking. Uniquely for females, coping motives were directly and indirectly (via negative adjustment) related to consequences. These findings suggest that interventions which seek to decrease alcohol-related risk may wish to incorporate discussions about strategies for decreasing stress and increasing other factors associated with better college adjustment. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Modular Bundle Adjustment for Photogrammetric Computations

    NASA Astrophysics Data System (ADS)

    Börlin, N.; Murtiyoso, A.; Grussenmeyer, P.; Menna, F.; Nocerino, E.

    2018-05-01

    In this paper we investigate how the residuals in bundle adjustment can be split into a composition of simple functions. According to the chain rule, the Jacobian (linearisation) of the residual can be formed as a product of the Jacobians of the individual steps. When implemented, this enables a modularisation of the computation of the bundle adjustment residuals and Jacobians where each component has limited responsibility. This enables simple replacement of components to e.g. implement different projection or rotation models by exchanging a module. The technique has previously been used to implement bundle adjustment in the open-source package DBAT (Börlin and Grussenmeyer, 2013) based on the Photogrammetric and Computer Vision interpretations of Brown (1971) lens distortion model. In this paper, we applied the technique to investigate how affine distortions can be used to model the projection of a tilt-shift lens. Two extended distortion models were implemented to test the hypothesis that the ordering of the affine and lens distortion steps can be changed to reduce the size of the residuals of a tilt-shift lens calibration. Results on synthetic data confirm that the ordering of the affine and lens distortion steps matter and is detectable by DBAT. However, when applied to a real camera calibration data set of a tilt-shift lens, no difference between the extended models was seen. This suggests that the tested hypothesis is false and that other effects need to be modelled to better explain the projection. The relatively low implementation effort that was needed to generate the models suggest that the technique can be used to investigate other novel projection models in photogrammetry, including modelling changes in the 3D geometry to better understand the tilt-shift lens.

  20. A data-driven model for constraint of present-day glacial isostatic adjustment in North America

    NASA Astrophysics Data System (ADS)

    Simon, K. M.; Riva, R. E. M.; Kleinherenbrink, M.; Tangdamrongsub, N.

    2017-09-01

    Geodetic measurements of vertical land motion and gravity change are incorporated into an a priori model of present-day glacial isostatic adjustment (GIA) in North America via least-squares adjustment. The result is an updated GIA model wherein the final predicted signal is informed by both observational data, and prior knowledge (or intuition) of GIA inferred from models. The data-driven method allows calculation of the uncertainties of predicted GIA fields, and thus offers a significant advantage over predictions from purely forward GIA models. In order to assess the influence each dataset has on the final GIA prediction, the vertical land motion and GRACE-measured gravity data are incorporated into the model first independently (i.e., one dataset only), then simultaneously. The relative weighting of the datasets and the prior input is iteratively determined by variance component estimation in order to achieve the most statistically appropriate fit to the data. The best-fit model is obtained when both datasets are inverted and gives respective RMS misfits to the GPS and GRACE data of 1.3 mm/yr and 0.8 mm/yr equivalent water layer change. Non-GIA signals (e.g., hydrology) are removed from the datasets prior to inversion. The post-fit residuals between the model predictions and the vertical motion and gravity datasets, however, suggest particular regions where significant non-GIA signals may still be present in the data, including unmodeled hydrological changes in the central Prairies west of Lake Winnipeg. Outside of these regions of misfit, the posterior uncertainty of the predicted model provides a measure of the formal uncertainty associated with the GIA process; results indicate that this quantity is sensitive to the uncertainty and spatial distribution of the input data as well as that of the prior model information. In the study area, the predicted uncertainty of the present-day GIA signal ranges from ∼0.2-1.2 mm/yr for rates of vertical land motion, and

  1. Risk-adjusted performance evaluation in three academic thoracic surgery units using the Eurolung risk models.

    PubMed

    Pompili, Cecilia; Shargall, Yaron; Decaluwe, Herbert; Moons, Johnny; Chari, Madhu; Brunelli, Alessandro

    2018-01-03

    The objective of this study was to evaluate the performance of 3 thoracic surgery centres using the Eurolung risk models for morbidity and mortality. This was a retrospective analysis performed on data collected from 3 academic centres (2014-2016). Seven hundred and twenty-one patients in Centre 1, 857 patients in Centre 2 and 433 patients in Centre 3 who underwent anatomical lung resections were analysed. The Eurolung1 and Eurolung2 models were used to predict risk-adjusted cardiopulmonary morbidity and 30-day mortality rates. Observed and risk-adjusted outcomes were compared within each centre. The observed morbidity of Centre 1 was in line with the predicted morbidity (observed 21.1% vs predicted 22.7%, P = 0.31). Centre 2 performed better than expected (observed morbidity 20.2% vs predicted 26.7%, P < 0.001), whereas the observed morbidity of Centre 3 was higher than the predicted morbidity (observed 41.1% vs predicted 24.3%, P < 0.001). Centre 1 had higher observed mortality when compared with the predicted mortality (3.6% vs 2.1%, P = 0.005), whereas Centre 2 had an observed mortality rate significantly lower than the predicted mortality rate (1.2% vs 2.5%, P = 0.013). Centre 3 had an observed mortality rate in line with the predicted mortality rate (observed 1.4% vs predicted 2.4%, P = 0.17). The observed mortality rates in the patients with major complications were 30.8% in Centre 1 (versus predicted mortality rate 3.8%, P < 0.001), 8.2% in Centre 2 (versus predicted mortality rate 4.1%, P = 0.030) and 9.0% in Centre 3 (versus predicted mortality rate 3.5%, P = 0.014). The Eurolung models were successfully used as risk-adjusting instruments to internally audit the outcomes of 3 different centres, showing their applicability for future quality improvement initiatives. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

    PubMed

    Antioch, K M; Walsh, M K

    2002-01-01

    Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Prob<0.0001. Regression coefficients represent the additional per patient costs summed to the base payment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost

  3. Parenting Styles and Adjustment Outcomes among College Students

    ERIC Educational Resources Information Center

    Love, Keisha M.; Thomas, Deneia M.

    2014-01-01

    Research has demonstrated that parenting styles partially explain college students' academic adjustment. However, to account for academic adjustment more fully, additional contributors should be identified and tested. We examined the fit of a hypothesized model consisting of parenting styles, indicators of well-being, and academic adjustment…

  4. Improving Risk Adjustment for Mortality After Pediatric Cardiac Surgery: The UK PRAiS2 Model.

    PubMed

    Rogers, Libby; Brown, Katherine L; Franklin, Rodney C; Ambler, Gareth; Anderson, David; Barron, David J; Crowe, Sonya; English, Kate; Stickley, John; Tibby, Shane; Tsang, Victor; Utley, Martin; Witter, Thomas; Pagel, Christina

    2017-07-01

    Partial Risk Adjustment in Surgery (PRAiS), a risk model for 30-day mortality after children's heart surgery, has been used by the UK National Congenital Heart Disease Audit to report expected risk-adjusted survival since 2013. This study aimed to improve the model by incorporating additional comorbidity and diagnostic information. The model development dataset was all procedures performed between 2009 and 2014 in all UK and Ireland congenital cardiac centers. The outcome measure was death within each 30-day surgical episode. Model development followed an iterative process of clinical discussion and development and assessment of models using logistic regression under 25 × 5 cross-validation. Performance was measured using Akaike information criterion, the area under the receiver-operating characteristic curve (AUC), and calibration. The final model was assessed in an external 2014 to 2015 validation dataset. The development dataset comprised 21,838 30-day surgical episodes, with 539 deaths (mortality, 2.5%). The validation dataset comprised 4,207 episodes, with 97 deaths (mortality, 2.3%). The updated risk model included 15 procedural, 11 diagnostic, and 4 comorbidity groupings, and nonlinear functions of age and weight. Performance under cross-validation was: median AUC of 0.83 (range, 0.82 to 0.83), median calibration slope and intercept of 0.92 (range, 0.64 to 1.25) and -0.23 (range, -1.08 to 0.85) respectively. In the validation dataset, the AUC was 0.86 (95% confidence interval [CI], 0.82 to 0.89), and the calibration slope and intercept were 1.01 (95% CI, 0.83 to 1.18) and 0.11 (95% CI, -0.45 to 0.67), respectively, showing excellent performance. A more sophisticated PRAiS2 risk model for UK use was developed with additional comorbidity and diagnostic information, alongside age and weight as nonlinear variables. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  5. New Parents’ Psychological Adjustment and Trajectories of Early Parental Involvement

    PubMed Central

    Jia, Rongfang; Kotila, Letitia E.; Schoppe-Sullivan, Sarah J.; Kamp Dush, Claire M.

    2016-01-01

    Trajectories of parental involvement time (engagement and child care) across 3, 6, and 9 months postpartum and associations with parents’ own and their partners’ psychological adjustment (dysphoria, anxiety, and empathic personal distress) were examined using a sample of dual-earner couples experiencing first-time parenthood (N = 182 couples). Using time diary measures that captured intensive parenting moments, hierarchical linear modeling analyses revealed that patterns of associations between psychological adjustment and parental involvement time depended on the parenting domain, aspect of psychological adjustment, and parent gender. Psychological adjustment difficulties tended to bias the 2-parent system toward a gendered pattern of “mother step in” and “father step out,” as father involvement tended to decrease, and mother involvement either remained unchanged or increased, in response to their own and their partners’ psychological adjustment difficulties. In contrast, few significant effects were found in models using parental involvement to predict psychological adjustment. PMID:27397935

  6. Family caregiver adjustment and stroke survivor impairment: A path analytic model.

    PubMed

    Pendergrass, Anna; Hautzinger, Martin; Elliott, Timothy R; Schilling, Oliver; Becker, Clemens; Pfeiffer, Klaus

    2017-05-01

    Depressive symptoms are a common problem among family caregivers of stroke survivors. The purpose of this study was to examine the association between care recipient's impairment and caregiver depression, and determine the possible mediating effects of caregiver negative problem-orientation, mastery, and leisure time satisfaction. The evaluated model was derived from Pearlin's stress process model of caregiver adjustment. We analyzed baseline data from 122 strained family members who were assisting stroke survivors in Germany for a minimum of 6 months and who consented to participate in a randomized clinical trial. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale. The cross-sectional data were analyzed using path analysis. The results show an adequate fit of the model to the data, χ2(1, N = 122) = 0.17, p = .68; comparative fit index = 1.00; root mean square error of approximation: p < .01; standardized root mean square residual = 0.01. The model explained 49% of the variance in the caregiver depressive symptoms. Results indicate that caregivers at risk for depression reported a negative problem orientation, low caregiving mastery, and low leisure time satisfaction. The situation is particularly affected by the frequency of stroke survivor problematic behavior, and by the degree of their impairments in activities of daily living. The findings provide empirical support for the Pearlin's stress model and emphasize how important it is to target these mediators in health promotion interventions for family caregivers of stroke survivors. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  7. Rapid Adjustments Cause Weak Surface Temperature Response to Increased Black Carbon Concentrations

    NASA Astrophysics Data System (ADS)

    Stjern, Camilla Weum; Samset, Bjørn Hallvard; Myhre, Gunnar; Forster, Piers M.; Hodnebrog, Øivind; Andrews, Timothy; Boucher, Olivier; Faluvegi, Gregory; Iversen, Trond; Kasoar, Matthew; Kharin, Viatcheslav; Kirkevâg, Alf; Lamarque, Jean-François; Olivié, Dirk; Richardson, Thomas; Shawki, Dilshad; Shindell, Drew; Smith, Christopher J.; Takemura, Toshihiko; Voulgarakis, Apostolos

    2017-11-01

    We investigate the climate response to increased concentrations of black carbon (BC), as part of the Precipitation Driver Response Model Intercomparison Project (PDRMIP). A tenfold increase in BC is simulated by nine global coupled-climate models, producing a model median effective radiative forcing of 0.82 (ranging from 0.41 to 2.91) W m-2, and a warming of 0.67 (0.16 to 1.66) K globally and 1.24 (0.26 to 4.31) K in the Arctic. A strong positive instantaneous radiative forcing (median of 2.10 W m-2 based on five of the models) is countered by negative rapid adjustments (-0.64 W m-2 for the same five models), which dampen the total surface temperature signal. Unlike other drivers of climate change, the response of temperature and cloud profiles to the BC forcing is dominated by rapid adjustments. Low-level cloud amounts increase for all models, while higher-level clouds are diminished. The rapid temperature response is particularly strong above 400 hPa, where increased atmospheric stabilization and reduced cloud cover contrast the response pattern of the other drivers. In conclusion, we find that this substantial increase in BC concentrations does have considerable impacts on important aspects of the climate system. However, some of these effects tend to offset one another, leaving a relatively small median global warming of 0.47 K per W m-2—about 20% lower than the response to a doubling of CO2. Translating the tenfold increase in BC to the present-day impact of anthropogenic BC (given the emissions used in this work) would leave a warming of merely 0.07 K.

  8. Direct comparison of risk-adjusted and non-risk-adjusted CUSUM analyses of coronary artery bypass surgery outcomes.

    PubMed

    Novick, Richard J; Fox, Stephanie A; Stitt, Larry W; Forbes, Thomas L; Steiner, Stefan

    2006-08-01

    We previously applied non-risk-adjusted cumulative sum methods to analyze coronary bypass outcomes. The objective of this study was to assess the incremental advantage of risk-adjusted cumulative sum methods in this setting. Prospective data were collected in 793 consecutive patients who underwent coronary bypass grafting performed by a single surgeon during a period of 5 years. The composite occurrence of an "adverse outcome" included mortality or any of 10 major complications. An institutional logistic regression model for adverse outcome was developed by using 2608 contemporaneous patients undergoing coronary bypass. The predicted risk of adverse outcome in each of the surgeon's 793 patients was then calculated. A risk-adjusted cumulative sum curve was then generated after specifying control limits and odds ratio. This risk-adjusted curve was compared with the non-risk-adjusted cumulative sum curve, and the clinical significance of this difference was assessed. The surgeon's adverse outcome rate was 96 of 793 (12.1%) versus 270 of 1815 (14.9%) for all the other institution's surgeons combined (P = .06). The non-risk-adjusted curve reached below the lower control limit, signifying excellent outcomes between cases 164 and 313, 323 and 407, and 667 and 793, but transgressed the upper limit between cases 461 and 478. The risk-adjusted cumulative sum curve never transgressed the upper control limit, signifying that cases preceding and including 461 to 478 were at an increased predicted risk. Furthermore, if the risk-adjusted cumulative sum curve was reset to zero whenever a control limit was reached, it still signaled a decrease in adverse outcome at 166, 653, and 782 cases. Risk-adjusted cumulative sum techniques provide incremental advantages over non-risk-adjusted methods by not signaling a decrement in performance when preoperative patient risk is high.

  9. Adjustment Disorders as a Stress-Related Disorder: A Longitudinal Study of the Associations among Stress, Resources, and Mental Health

    PubMed Central

    Kocalevent, Rüya-Daniela; Mierke, Annett; Danzer, Gerhard; Klapp, Burghard F.

    2014-01-01

    Objective Adjustment disorders are re-conceptualized in the DSM-5 as a stress-related disorder; however, besides the impact of an identifiable stressor, the specification of a stress concept, remains unclear. This study is the first to examine an existing stress-model from the general population, in patients diagnosed with adjustment disorders, using a longitudinal design. Methods The study sample consisted of 108 patients consecutively admitted for adjustment disorders. Associations of stress perception, emotional distress, resources, and mental health were measured at three time points: the outpatients’ presentation, admission for inpatient treatment, and discharge from the hospital. To evaluate a longitudinal stress model of ADs, we examined whether stress at admission predicted mental health at each of the three time points using multiple linear regressions and structural equation modeling. A series of repeated-measures one-way analyses of variance (rANOVAs) was performed to assess change over time. Results Significant within-participant changes from baseline were observed between hospital admission and discharge with regard to mental health, stress perception, and emotional distress (p<0.001). Stress perception explained nearly half of the total variance (44%) of mental health at baseline; the adjusted R2 increased (0.48), taking emotional distress (i.e., depressive symptoms) into account. The best predictor of mental health at discharge was the level of emotional distress (i.e., anxiety level) at baseline (β = −0.23, R2 corr = 0.56, p<0.001). With a CFI of 0.86 and an NFI of 0.86, the fit indices did not allow for acceptance of the stress-model (Cmin/df = 15.26; RMSEA = 0.21). Conclusions Stress perception is an important predictor in adjustment disorders, and mental health-related treatment goals are dependent on and significantly impacted by stress perception and emotional distress. PMID:24825165

  10. Conversations with God: Prayer and Bargaining in Adjustment to Disability

    ERIC Educational Resources Information Center

    Rodriguez, Valerie J.; Glover-Graf, Noreen M.; Blanco, E. Lisette

    2013-01-01

    The role of religiosity and spirituality in the process of adjustment to disability is of increasing interest to rehabilitation professionals. Beginning with the Kubler-Ross models of grief and adjustment to disability and terminal illness, a number of stage models have included spiritual and religious interactions as a part of the adjustment…

  11. Risk-adjusted monitoring of survival times

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Sego, Landon H.; Reynolds, Marion R.; Woodall, William H.

    2009-02-26

    We consider the monitoring of clinical outcomes, where each patient has a di®erent risk of death prior to undergoing a health care procedure.We propose a risk-adjusted survival time CUSUM chart (RAST CUSUM) for monitoring clinical outcomes where the primary endpoint is a continuous, time-to-event variable that may be right censored. Risk adjustment is accomplished using accelerated failure time regression models. We compare the average run length performance of the RAST CUSUM chart to the risk-adjusted Bernoulli CUSUM chart, using data from cardiac surgeries to motivate the details of the comparison. The comparisons show that the RAST CUSUM chart is moremore » efficient at detecting a sudden decrease in the odds of death than the risk-adjusted Bernoulli CUSUM chart, especially when the fraction of censored observations is not too high. We also discuss the implementation of a prospective monitoring scheme using the RAST CUSUM chart.« less

  12. Emotional insecurity about the community: A dynamic, within-person mediator of child adjustment in contexts of political violence.

    PubMed

    Cummings, E Mark; Merrilees, Christine; Taylor, Laura K; Goeke-Morey, Marcie; Shirlow, Peter

    2017-02-01

    Over 1 billion children worldwide are exposed to political violence and armed conflict. The current conclusions are qualified by limited longitudinal research testing sophisticated process-oriented explanatory models for child adjustment outcomes. In this study, consistent with a developmental psychopathology perspective emphasizing the value of process-oriented longitudinal study of child adjustment in developmental and social-ecological contexts, we tested emotional insecurity about the community as a dynamic, within-person mediating process for relations between sectarian community violence and child adjustment. Specifically, this study explored children's emotional insecurity at a person-oriented level of analysis assessed over 5 consecutive years, with child gender examined as a moderator of indirect effects between sectarian community violence and child adjustment. In the context of a five-wave longitudinal research design, participants included 928 mother-child dyads in Belfast (453 boys, 475 girls) drawn from socially deprived, ethnically homogenous areas that had experienced political violence. Youth ranged in age from 10 to 20 years and were 13.24 (SD = 1.83) years old on average at the initial time point. Greater insecurity about the community measured over multiple time points mediated relations between sectarian community violence and youth's total adjustment problems. The pathway from sectarian community violence to emotional insecurity about the community was moderated by child gender, with relations to emotional insecurity about the community stronger for girls than for boys. The results suggest that ameliorating children's insecurity about community in contexts of political violence is an important goal toward improving adolescents' well-being and adjustment. These results are discussed in terms of their translational research implications, consistent with a developmental psychopathology model for the interface between basic and intervention

  13. Patterns of Children's Adrenocortical Reactivity to Interparental Conflict and Associations with Child Adjustment: A Growth Mixture Modeling Approach

    ERIC Educational Resources Information Center

    Koss, Kalsea J.; George, Melissa R. W.; Davies, Patrick T.; Cicchetti, Dante; Cummings, E. Mark; Sturge-Apple, Melissa L.

    2013-01-01

    Examining children's physiological functioning is an important direction for understanding the links between interparental conflict and child adjustment. Utilizing growth mixture modeling, the present study examined children's cortisol reactivity patterns in response to a marital dispute. Analyses revealed three different patterns of cortisol…

  14. Optimized ventricular restraint therapy: adjustable restraint is superior to standard restraint in an ovine model of ischemic cardiomyopathy.

    PubMed

    Lee, Lawrence S; Ghanta, Ravi K; Mokashi, Suyog A; Coelho-Filho, Otavio; Kwong, Raymond Y; Kwon, Michael; Guan, Jian; Liao, Ronglih; Chen, Frederick Y

    2013-03-01

    The effects of ventricular restraint level on left ventricular reverse remodeling are not known. We hypothesized that restraint level affects the degree of reverse remodeling and that restraint applied in an adjustable manner is superior to standard, nonadjustable restraint. This study was performed in 2 parts using a model of chronic heart failure in the sheep. In part I, restraint was applied at control (0 mm Hg, n = 3), low (1.5 mm Hg, n = 3), and high (3.0 mm Hg, n = 3) levels with an adjustable and measurable ventricular restraint (AMVR) device. Restraint level was not altered throughout the 2-month treatment period. Serial restraint level measurements and transthoracic echocardiography were performed. In part II, restraint was applied with the AMVR device set at 3.0 mm Hg (n = 6) and adjusted periodically to maintain that level. This was compared with restraint applied in a standard, nonadjustable manner using a mesh wrap (n = 6). All subjects were followed up for 2 months with serial magnetic resonance imaging. In part I, there was greater and earlier reverse remodeling in the high restraint group. In both groups, the rate of reverse remodeling peaked and then declined as the measured restraint level decreased with progression of reverse remodeling. In part II, adjustable restraint resulted in greater reverse remodeling than standard restraint. Left ventricular end diastolic volume decreased by 12.7% (P = .005) with adjustable restraint and by 5.7% (P = .032) with standard restraint. Left ventricular ejection fraction increased by 18.9% (P = .014) and 14.4% (P < .001) with adjustable and standard restraint, respectively. Restraint level affects the rate and degree of reverse remodeling and is an important determinant of therapy efficacy. Adjustable restraint is more effective than nonadjustable restraint in promoting reverse remodeling. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  15. Investigating the prostate specific antigen, body mass index and age relationship: is an age-BMI-adjusted PSA model clinically useful?

    PubMed

    Harrison, Sean; Tilling, Kate; Turner, Emma L; Lane, J Athene; Simpkin, Andrew; Davis, Michael; Donovan, Jenny; Hamdy, Freddie C; Neal, David E; Martin, Richard M

    2016-12-01

    Previous studies indicate a possible inverse relationship between prostate-specific antigen (PSA) and body mass index (BMI), and a positive relationship between PSA and age. We investigated the associations between age, BMI, PSA, and screen-detected prostate cancer to determine whether an age-BMI-adjusted PSA model would be clinically useful for detecting prostate cancer. Cross-sectional analysis nested within the UK ProtecT trial of treatments for localized cancer. Of 18,238 men aged 50-69 years, 9,457 men without screen-detected prostate cancer (controls) and 1,836 men with prostate cancer (cases) met inclusion criteria: no history of prostate cancer or diabetes; PSA < 10 ng/ml; BMI between 15 and 50 kg/m 2 . Multivariable linear regression models were used to investigate the relationship between log-PSA, age, and BMI in all men, controlling for prostate cancer status. In the 11,293 included men, the median PSA was 1.2 ng/ml (IQR: 0.7-2.6); mean age 61.7 years (SD 4.9); and mean BMI 26.8 kg/m 2 (SD 3.7). There were a 5.1% decrease in PSA per 5 kg/m 2 increase in BMI (95% CI 3.4-6.8) and a 13.6% increase in PSA per 5-year increase in age (95% CI 12.0-15.1). Interaction tests showed no evidence for different associations between age, BMI, and PSA in men above and below 3.0 ng/ml (all p for interaction >0.2). The age-BMI-adjusted PSA model performed as well as an age-adjusted model based on National Institute for Health and Care Excellence (NICE) guidelines at detecting prostate cancer. Age and BMI were associated with small changes in PSA. An age-BMI-adjusted PSA model is no more clinically useful for detecting prostate cancer than current NICE guidelines. Future studies looking at the effect of different variables on PSA, independent of their effect on prostate cancer, may improve the discrimination of PSA for prostate cancer.

  16. The impact of training problem-solving skills on self-esteem and behavioral adjustment in teenage girls who have irresponsible parents or no parents.

    PubMed

    Shahgholy Ghahfarokhi, F; Moradi, N; Alborzkouh, P; Radmehr, S; Zainali, M

    2015-01-01

    Proper psychological interventions are of great importance because they help enhancing psychological and public health in adolescents with irresponsible parents or no parents. The current research aimed to examine the impact of training problem-solving experiment on self-esteem and behavioral adjustment in teenage girls with irresponsible parents or no parents. Methodology: The approach of the present research was a semi-test via a post-test-pre-test model and a check team. Hence, in Tehran, 40 girls with irresponsible parents or no parents were chosen by using the Convenience modeling, and they were classified into 2 teams: control and experiment. Both groups were pre-tested by using a demography questionnaire, Rosenberg's self-esteem scale, and a behavioral adjustment questionnaire. Afterwards, both groups were post-tested, and the obtained data were examined by using inferential and descriptive methods through SPSS 21. Findings: Findings indicated that the training problem-solving skills significantly increased the self-esteem and the behavioral adjustment in teenage girls with irresponsible parents or no parents (P < 0/ 001). Conclusion: The conclusion of this research was that training problem-solving methods greatly helps endangered people such as teenage girls with irresponsible parents or no parents, because these methods are highly efficient especially when they are performed in groups, as they are cheap and accepted by different people.

  17. The impact of training problem-solving skills on self-esteem and behavioral adjustment in teenage girls who have irresponsible parents or no parents

    PubMed Central

    Shahgholy Ghahfarokhi, F; Moradi, N; Alborzkouh, P; Radmehr, S; Zainali, M

    2015-01-01

    Proper psychological interventions are of great importance because they help enhancing psychological and public health in adolescents with irresponsible parents or no parents. The current research aimed to examine the impact of training problem-solving experiment on self-esteem and behavioral adjustment in teenage girls with irresponsible parents or no parents. Methodology: The approach of the present research was a semi-test via a post-test-pre-test model and a check team. Hence, in Tehran, 40 girls with irresponsible parents or no parents were chosen by using the Convenience modeling, and they were classified into 2 teams: control and experiment. Both groups were pre-tested by using a demography questionnaire, Rosenberg’s self-esteem scale, and a behavioral adjustment questionnaire. Afterwards, both groups were post-tested, and the obtained data were examined by using inferential and descriptive methods through SPSS 21. Findings: Findings indicated that the training problem-solving skills significantly increased the self-esteem and the behavioral adjustment in teenage girls with irresponsible parents or no parents (P < 0/ 001). Conclusion: The conclusion of this research was that training problem-solving methods greatly helps endangered people such as teenage girls with irresponsible parents or no parents, because these methods are highly efficient especially when they are performed in groups, as they are cheap and accepted by different people. PMID:28316718

  18. [Domestic elder abuse and neglect--conclusions from the evaluation of a model project].

    PubMed

    Görgen, T; Nägele, B

    2005-02-01

    The main task of a federally funded model project in the German city of Hannover was to develop approaches for prevention and intervention in the field of domestic elder abuse. Over a three year period (1998-2001), different approaches--like a telephone helpline for senior citizens, and social workers operating as counsellors for elderly people and their relatives--were tested at a local level. The paper presents results from the evaluation of the project and draws conclusions for future prevention and intervention in the field. The authors argue that the explicit use of the conceptual framework of "violence"/"abuse" creates potentials for scandalizing the issue and is therefore supportive for media appearance, whereas it can impede the approach to the main target groups (elderly people and their relatives) and reduce accessibility of counselling services for potential clients. In the light of evaluation results the focus of the project ("domestic elder abuse" or "violence against elderly people in close relationships") was too narrow for a local project. Counselling services were used in a relatively small number of cases; analyses of cases show that incidents of domestic elder abuse are often embedded in complex problem constellations. Cases brought to the attention of the model project were multifaceted and not limited to incidents of neglect and abuse of elderly care recipients caused by caregiver overload. Cases of intimate violence in partnerships and of intergenerational violence without any of the participants being dependent on care show the need to develop a broader concept of domestic elder abuse. Integration of the concepts of domestic violence, violence against women, elder abuse/neglect and abuse/neglect in caregiving relationships is necessary on a conceptual level as well as on the level of interagency cooperation of institutions dealing with cases of "elder abuse".

  19. Waist Circumference Adjusted for Body Mass Index and Intra-Abdominal Fat Mass

    PubMed Central

    Berentzen, Tina Landsvig; Ängquist, Lars; Kotronen, Anna; Borra, Ronald; Yki-Järvinen, Hannele; Iozzo, Patricia; Parkkola, Riitta; Nuutila, Pirjo; Ross, Robert; Allison, David B.; Heymsfield, Steven B.; Overvad, Kim; Sørensen, Thorkild I. A.; Jakobsen, Marianne Uhre

    2012-01-01

    Background The association between waist circumference (WC) and mortality is particularly strong and direct when adjusted for body mass index (BMI). One conceivable explanation for this association is that WC adjusted for BMI is a better predictor of the presumably most harmful intra-abdominal fat mass (IAFM) than WC alone. We studied the prediction of abdominal subcutaneous fat mass (ASFM) and IAFM by WC alone and by addition of BMI as an explanatory factor. Methodology/Principal Findings WC, BMI and magnetic resonance imaging data from 742 men and women who participated in clinical studies in Canada and Finland were pooled. Total adjusted squared multiple correlation coefficients (R2) of ASFM and IAFM were calculated from multiple linear regression models with WC and BMI as explanatory variables. Mean BMI and WC of the participants in the pooled sample were 30 kg/m2 and 102 cm, respectively. WC explained 29% of the variance in ASFM and 51% of the variance in IAFM. Addition of BMI to WC added 28% to the variance explained in ASFM, but only 1% to the variance explained in IAFM. Results in subgroups stratified by study center, sex, age, obesity level and type 2 diabetes status were not systematically different. Conclusion/Significance The prediction of IAFM by WC is not improved by addition of BMI. PMID:22384179

  20. Acculturation, Psychological Adjustment, and Parenting Styles of Chinese Immigrant Mothers in the U.S.

    PubMed Central

    Yu, Jing; Cheah, Charissa S. L.; Calvin, Grace

    2016-01-01

    Objectives This study examined whether acculturation to American culture, maintenance of Chinese culture, and their interaction predicted Chinese immigrant parents’ psychological adjustment and parenting styles. We hypothesized that American orientation would be associated with more positive psychological well-being and fewer depressive symptoms in immigrant mothers, which in turn would be associated with more authoritative parenting and less authoritarian parenting. The examination of the roles of Chinese orientation and the interaction of the two cultural orientations in relation to psychological adjustment and parenting were exploratory. Methods Participants were 164 first-generation Chinese immigrant mothers in the U.S. (Mage = 37.80). Structural equation modeling was used to examine the direct and indirect effects of acculturation on psychological adjustment and parenting. Bootstrapping technique was used to explore the conditional indirect effects of acculturation on parenting as appropriate. Results American orientation was strongly associated with positive psychological well-being, which was in turn related to more authoritative parenting and less authoritarian parenting. Moreover, American and Chinese orientations interacted to predict depressive symptoms, which were in turn associated with more authoritarian parenting. Specifically, American orientation was negatively associated with depressive symptoms only at mean or high levels of Chinese orientation. Conclusions Results suggest acculturation as a distal contextual factor and psychological adjustment as one critical mechanism that transmits the effects of acculturation to parenting. Promoting immigrant parents’ ability and comfort in the new culture independently or in conjunction with encouraging biculturalism through policy intervention efforts appear crucial for the positive adjustment of Chinese immigrant parents and children. PMID:27077796

  1. Medications for Sleep Schedule Adjustments in Athletes.

    PubMed

    Baird, Matthew B; Asif, Irfan M

    Sleep schedule adjustments are common requirements of modern-day athletes. Many nonpharmacologic and pharmacologic strategies exist to facilitate circadian rhythm shifts to maximize alertness and performance during competition. This review summarizes the evidence for commonly used pharmacologic agents and presents recommendations for the sports medicine provider. MEDLINE searches were performed using the following keywords: sleep aids, circadian rhythm adjustment, athletes and sleep, caffeine and sports, melatonin and athletes, and sleep aids and sports. Pertinent articles were extracted and discussed. Clinical review. Level 2. There are very few available studies investigating pharmacologic sleep aids in athletes. Data from studies involving shift workers and airline personnel are more abundant and were used to formulate recommendations and conclusions. Melatonin, caffeine, and nonbenzodiazepine sleep aids have a role in facilitating sleep schedule changes in athletes and maximizing sports performance through sleep enhancement.

  2. Adjustment to Spinal Cord Injury: A Comprehensive Follow-Up Study.

    ERIC Educational Resources Information Center

    Cook, Daniel; And Others

    This document reports a comprehensive followup study to describe postservice life status of former vocational rehabilitation clients and to develop an empirical index of postservice adjustment to spinal cord injury. Significant findings, conclusions, and implications are found at the beginning. The introduction section summarizes followup studies…

  3. Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs

    PubMed Central

    Gifford, Gregory A.; Edwards, Kevan R.; Knutson, David J.

    2004-01-01

    This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model. PMID:25372356

  4. Adjustment patterns of the Arab internal refugees in Israel.

    PubMed

    Al-haj, M

    1986-09-01

    This analysis is pursued in the framework of an interrelated multidimensional model which includes 5 main components: 1) dimensions of adjustment, 2) range of adjustment, 3) levels of adjustment, 4) typology of aggregate adjustment, and 5) indicators of mobility and variation in the refugee adjustment. Arab internal refugees in Israel, including their characteristics and patterns of adjustment in the host communities as well as in Israeli society, are studied. Social, psychological, and socioeconomic adjustments are separated out and show the importance of the linkage between adjustment patterns at both the communal and the societal levels. The findings indicate that processes of adjustment at the communal and the societal levels are not necessarily conjunctive and symmetric. At the societal level, socioeconomic adjustment occurs relatively more rapidly than social adjustment. At the communal level, inter-marriage with locals lags behind friendship relationships and mutual visits. Psychological adjustment rates in between these 2. Cultural and linguistic compatibility with the host community are crucial positive factors for refugee adjustment. Cultural, linguistic, and national compatibility with the host community may have paradoxically indirect negative effects on the refugee psychological adjustment. High background compatibility generates high expectations among the refugees, which may be easily transferred into alienation, when faced with a different situation than expected; the greater the gap between the expected and the actual, the more the alienation.

  5. A unified model exploring parenting practices as mediators of marital conflict and children's adjustment.

    PubMed

    Coln, Kristen L; Jordan, Sara S; Mercer, Sterett H

    2013-06-01

    We examined positive and negative parenting practices and psychological control as mediators of the relations between constructive and destructive marital conflict and children's internalizing and externalizing problems in a unified model. Married mothers of 121 children between the ages of 6 and 12 completed questionnaires measuring marital conflict, parenting practices, and child adjustment. Analyses revealed significant direct paths from destructive marital conflict to negative parenting practices, psychological control, and both children's internalizing and externalizing behavior. In addition, psychological control was found to partially mediate relations between destructive marital conflict and children's internalizing and externalizing behavior.

  6. Fathers of children with cancer: involvement, coping, and adjustment.

    PubMed

    Bennett Murphy, Laura M; Flowers, Stacy; McNamara, Kelly A; Young-Saleme, Tammi

    2008-01-01

    This study examined the role of fathers caring for children with cancer. Psychological adjustment, coping, and work patterns of mothers and fathers were described. Twenty fathers of children with cancer were compared with 20 mothers of children with cancer and 20 control fathers of healthy children. Questionnaire data were collected regarding coping, parental adjustment, child adjustment, and family involvement. Fathers did not differ from mothers or control fathers in terms of psychological adjustment or coping. However, fathers of children with cancer spent more hours at work and more hours caring for children than did control fathers. Paternal adjustment was significantly related to child adjustment only when the child had cancer. Coping was related to work outside the home for fathers and adjustment for mothers. Models of family adaptation may be different for fathers and mothers. Treatment teams must attend to the unique needs of fathers.

  7. Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study.

    PubMed

    McLawhorn, Alexander S; Schairer, William W; Schwarzkopf, Ran; Halsey, David A; Iorio, Richard; Padgett, Douglas E

    2017-12-06

    For Medicare beneficiaries, hospital reimbursement for nonrevision hip arthroplasty is anchored to either diagnosis-related group code 469 or 470. Under alternative payment models, reimbursement for care episodes is not further risk-adjusted. This study's purpose was to compare outcomes of primary total hip arthroplasty (THA) vs conversion THA to explore the rationale for risk adjustment for conversion procedures. All primary and conversion THAs from 2007 to 2014, excluding acute hip fractures and cancer patients, were identified in the National Surgical Quality Improvement Program database. Conversion and primary THA patients were matched 1:1 using propensity scores, based on preoperative covariates. Multivariable logistic regressions evaluated associations between conversion THA and 30-day outcomes. A total of 2018 conversions were matched to 2018 primaries. There were no differences in preoperative covariates. Conversions had longer operative times (148 vs 95 minutes, P < .001), more transfusions (37% vs 17%, P < .001), and longer length of stay (4.4 vs 3.1 days, P < .001). Conversion THA had increased odds of complications (odds ratio [OR] 1.75; 95% confidence interval [CI] 1.37-2.24), deep infection (OR 4.21; 95% CI 1.72-10.28), discharge to inpatient care (OR 1.52; 95% CI 1.34-1.72), and death (OR 2.39; 95% CI 1.04-5.47). Readmission odds were similar. Compared with primary THA, conversion THA is associated with more complications, longer length of stay, and increased discharge to continued inpatient care, implying greater resource utilization for conversion patients. As reimbursement models shift toward bundled payment paradigms, conversion THA appears to be a procedure for which risk adjustment is appropriate. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Posttraumatic Stress Symptoms Among National Guard Soldiers Deployed to Iraq: Associations with Parenting Behaviors and Couple Adjustment

    PubMed Central

    Gewirtz, Abigail H.; Polusny, Melissa A.; DeGarmo, David S.; Khaylis, Anna; Erbes, Christopher R.

    2011-01-01

    Objective This article reports findings from a one-year longitudinal study examining the impact of change in PTSD symptoms following combat deployment on National Guard soldiers’ perceived parenting, and couple adjustment one year following return from Iraq. Method Participants were 468 Army National Guard fathers from a Brigade Combat Team (mean age 36 years; median deployment length 16 months; 89% European American, 5% African American, 6% Hispanic American). Participants completed an in-theater survey one month before returning home from OIF deployment (Time 1), and again, one year post-deployment (Time 2). The PTSD Checklist-Military Version (PCL-M; Weathers, Litz, Herman, Huska, & Keane, 1993) was gathered at both times, and two items assessing social support were gathered at baseline only. At Time 2, participants also completed self-report measures of parenting (Alabama Parenting Questionnaire—Short Form; Elgar, Waschbusch, Dadds, & Sigvaldason, 2007), couple adjustment (Dyadic Adjustment Scale-7; Sharpley & Rogers, 1984; Spanier, 1976), parent-child relationship quality (4 items from the Social Adjustment Scale-Self Report; Weissman & Bothwell, 1976), alcohol use (Alcohol Use Disorders Identification Test; Babor, Higgins-Biddle, Saunders, & Monteiro, 2001), and items assessing injuries sustained while deployed. Results Structural equation modeling analyses showed that increases in PTSD symptoms were associated with poorer couple adjustment and greater perceived parenting challenges at Time 2 (both at p<.001). Furthermore, PTSD symptoms predicted parenting challenges independent of their impact on couple adjustment. Conclusions Findings highlight the importance of investigating and intervening to support parenting and couple adjustment among combat-affected National Guard families. PMID:20873896

  9. Implied adjusted volatility functions: Empirical evidence from Australian index option market

    NASA Astrophysics Data System (ADS)

    Harun, Hanani Farhah; Hafizah, Mimi

    2015-02-01

    This study aims to investigate the implied adjusted volatility functions using the different Leland option pricing models and to assess whether the use of the specified implied adjusted volatility function can lead to an improvement in option valuation accuracy. The implied adjusted volatility is investigated in the context of Standard and Poor/Australian Stock Exchange (S&P/ASX) 200 index options over the course of 2001-2010, which covers the global financial crisis in the mid-2007 until the end of 2008. Both in- and out-of-sample resulted in approximately similar pricing error along the different Leland models. Results indicate that symmetric and asymmetric models of both moneyness ratio and logarithmic transformation of moneyness provide the overall best result in both during and post-crisis periods. We find that in the different period of interval (pre-, during and post-crisis) is subject to a different implied adjusted volatility function which best explains the index options. Hence, it is tremendously important to identify the intervals beforehand in investigating the implied adjusted volatility function.

  10. Development of a risk-adjustment model for antimicrobial utilization data in 21 public hospitals in Queensland, Australia (2006-11).

    PubMed

    Rajmokan, M; Morton, A; Marquess, J; Playford, E G; Jones, M

    2013-10-01

    Making valid comparisons of antimicrobial utilization between hospitals requires risk adjustment for each hospital's case mix. Data on individual patients may be unavailable or difficult to process. Therefore, risk adjustment for antimicrobial usage frequently needs to be based on a hospital's services. This study evaluated such a strategy for hospital antimicrobial utilization. Data were obtained on five broad subclasses of antibiotics [carbapenems, β-lactam/β-lactamase inhibitor combinations (BLBLIs), fluoroquinolones, glycopeptides and third-generation cephalosporins] from the Queensland pharmacy database (MedTrx) for 21 acute public hospitals (2006-11). Eleven clinical services and a variable for hospitals from the tropical region were employed for risk adjustment. Multivariable regression models were used to identify risk and protective services for these antibiotics. Funnel plots were used to display hospitals' antimicrobial utilization. Total inpatient antibiotic utilization for these antibiotics increased from 130.6 defined daily doses (DDDs)/1000 patient-days in 2006 to 155.8 DDDs/1000 patient-days in 2011 (P < 0.0001). Except for third-generation cephalosporins, the average utilization rate was higher for intensive care, renal/nephrology, cardiac, burns/plastic surgery, neurosurgery, transplant and acute spinal services than for the respective reference group (no service). In addition, oncology, high-activity infectious disease and coronary care services were associated with higher utilization of carbapenems, BLBLIs and glycopeptides. Our model predicted antimicrobial utilization rates by hospital services. The funnel plots displayed hospital utilization data after adjustment for variation among the hospitals. However, the methodology needs to be validated in other populations, ideally using a larger group of hospitals.

  11. The self as a mediator between personality and adjustment.

    PubMed

    Graziano, W G; Jensen-Campbell, L A; Finch, J F

    1997-08-01

    The self can be conceptualized as a mediating agent that translates personality into situated goal-directed activities and adaptation. This research used a level-of-analysis approach to link personality dimensions (Level I) to self-systems (Level II) and to teacher ratings of adjustment in African American, Mexican American, and European American students (N = 317). The authors hypothesized that links among aspects of self-esteem and teacher ratings of adjustment would be domain specific, and those links to dimensions of the 5-factor model would reflects the domain specificity. Structural equation modeling corroborated hypotheses about domain specificity in links between adjustment and 5-factor dimensions. Results were discussed in terms of levels of analysis for personality structure, personality development, and age-related adaptations to social contexts.

  12. A demand-side view of risk adjustment.

    PubMed

    Feldman, R; Dowd, B E; Maciejewski, M

    2001-01-01

    This paper analyzes the efficient allocation of consumers to health plans. Specifically, we address the question of why employers that offer multiple health plans often make larger contributions to the premiums of the high-cost plans. Our perspective is that the subsidy for high-cost plans represents a form of demand-side risk adjustment that improves efficiency. Without such subsidies (and in the absence of formal risk adjustment), too few employees would choose the high-cost plans preferred by high-risk workers. We test the theory by estimating a model of the employer premium subsidy, using data from a survey of large public employers in 1994. Our empirical analysis shows that employers are more likely to subsidize high-cost plans when the benefits of risk adjustment are greater. The findings suggest that the premium subsidy can accomplish some of the benefits of formal risk adjustment.

  13. PTSD symptoms and marital adjustment among ex-POWs' wives.

    PubMed

    Levin, Yafit; Greene, Talya; Solomon, Zahava

    2016-02-01

    This study prospectively assessed the implications of war captivity and former prisoners of war's (ex-POWs) posttraumatic stress disorder (PTSD) and PTSD trajectory on their wives' marital adjustment, adjusting for their secondary traumatization (ST). Results show that marital adjustment of the wives of ex-POWs with PTSD (N = 66) was lower compared to wives of ex-POWs (N = 37) and combat veterans (N = 55) without PTSD symptoms. Investigating the possible mechanism underlying the lower marital adjustment, via a mediating model, indicated that husbands' PTSD symptoms mediated the association between captivity and the wives' marital adjustment. Moreover, husbands' PTSD trajectories assessed over 17 years were implicated in their wives' marital adjustment; wives of ex-POWs with chronic PTSD reported lower marital adjustment compared to wives of resilient ex-POWs. The substantial novelty was revealed in prospective deterioration found in dyadic adjustment among wives of ex-POWs with delayed PTSD, but not for wives of chronic or resilient ex-POWs. Implications for research and practice are discussed. (c) 2016 APA, all rights reserved).

  14. Detection technology research on the one-way clutch of automatic brake adjuster

    NASA Astrophysics Data System (ADS)

    Jiang, Wensong; Luo, Zai; Lu, Yi

    2013-10-01

    In this article, we provide a new testing method to evaluate the acceptable quality of the one-way clutch of automatic brake adjuster. To analysis the suitable adjusting brake moment which keeps the automatic brake adjuster out of failure, we build a mechanical model of one-way clutch according to the structure and the working principle of one-way clutch. The ranges of adjusting brake moment both clockwise and anti-clockwise can be calculated through the mechanical model of one-way clutch. Its critical moment, as well, are picked up as the ideal values of adjusting brake moment to evaluate the acceptable quality of one-way clutch of automatic brake adjuster. we calculate the ideal values of critical moment depending on the different structure of one-way clutch based on its mechanical model before the adjusting brake moment test begin. In addition, an experimental apparatus, which the uncertainty of measurement is ±0.1Nm, is specially designed to test the adjusting brake moment both clockwise and anti-clockwise. Than we can judge the acceptable quality of one-way clutch of automatic brake adjuster by comparing the test results and the ideal values instead of the EXP. In fact, the evaluation standard of adjusting brake moment applied on the project are still using the EXP provided by manufacturer currently in China, but it would be unavailable when the material of one-way clutch changed. Five kinds of automatic brake adjusters are used in the verification experiment to verify the accuracy of the test method. The experimental results show that the experimental values of adjusting brake moment both clockwise and anti-clockwise are within the ranges of theoretical results. The testing method provided by this article vividly meet the requirements of manufacturer's standard.

  15. Using a Laboratory Conclusion Rubric

    ERIC Educational Resources Information Center

    Rutherford, Sandra

    2007-01-01

    Adding a strong conclusion can alter a cookbook lab into an inquiry lab by challenging the student to defend relevant data and clearly communicate his or her findings. A well-organized scoring guide makes it easier for students to understand what is involved in writing a strong conclusion. Examples of student writing that are accompanied with the…

  16. Adolescent leisure dimensions, psychosocial adjustment, and gender effects.

    PubMed

    Bradley, Graham L; Inglis, Brad C

    2012-10-01

    Leisure provides the context for much of adolescent behaviour and development. While both theory and research point to the benefits of participation in leisure activities that are highly structured, the association between structured leisure and psychosocial adjustment is not uniformly high. This paper presents a model of adolescent leisure comprising three dimensions: structure, effort, and social contact. Adolescent adjustment is hypothesized to increase with participation in activities characterized by each of these attributes. Adjustment is also predicted to vary with gender, and with the interaction of gender and leisure participation. These propositions were tested in a questionnaire-based study of 433 Australian adolescents. Results revealed majority support for hypotheses pertaining to the positive effects of the leisure dimensions, and for gender differences in leisure participation and adjustment. Evidence was also obtained of gender-differentiated effects of leisure on adjustment, with social leisure predicting adjustment more strongly in females than males. Copyright © 2012 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  17. Effect of Adding McKenzie Syndrome, Centralization, Directional Preference, and Psychosocial Classification Variables to a Risk-Adjusted Model Predicting Functional Status Outcomes for Patients With Lumbar Impairments.

    PubMed

    Werneke, Mark W; Edmond, Susan; Deutscher, Daniel; Ward, Jason; Grigsby, David; Young, Michelle; McGill, Troy; McClenahan, Brian; Weinberg, Jon; Davidow, Amy L

    2016-09-01

    Study Design Retrospective cohort. Background Patient-classification subgroupings may be important prognostic factors explaining outcomes. Objectives To determine effects of adding classification variables (McKenzie syndrome and pain patterns, including centralization and directional preference; Symptom Checklist Back Pain Prediction Model [SCL BPPM]; and the Fear-Avoidance Beliefs Questionnaire subscales of work and physical activity) to a baseline risk-adjusted model predicting functional status (FS) outcomes. Methods Consecutive patients completed a battery of questionnaires that gathered information on 11 risk-adjustment variables. Physical therapists trained in Mechanical Diagnosis and Therapy methods classified each patient by McKenzie syndromes and pain pattern. Functional status was assessed at discharge by patient-reported outcomes. Only patients with complete data were included. Risk of selection bias was assessed. Prediction of discharge FS was assessed using linear stepwise regression models, allowing 13 variables to enter the model. Significant variables were retained in subsequent models. Model power (R(2)) and beta coefficients for model variables were estimated. Results Two thousand sixty-six patients with lumbar impairments were evaluated. Of those, 994 (48%), 10 (<1%), and 601 (29%) were excluded due to incomplete psychosocial data, McKenzie classification data, and missing FS at discharge, respectively. The final sample for analyses was 723 (35%). Overall R(2) for the baseline prediction FS model was 0.40. Adding classification variables to the baseline model did not result in significant increases in R(2). McKenzie syndrome or pain pattern explained 2.8% and 3.0% of the variance, respectively. When pain pattern and SCL BPPM were added simultaneously, overall model R(2) increased to 0.44. Although none of these increases in R(2) were significant, some classification variables were stronger predictors compared with some other variables included in

  18. Adjustment factors to per capita health-care indicators in countries with expatriate male-majority populations.

    PubMed

    Hussin, A H

    2014-12-17

    From 2000 to 2010, the population in the Gulf Cooperation Council (GCC) countries underwent an increase of 53%, compared with an average global increase of 13%. The rates varied by country, ranging from 23% in Oman to 198% in Qatar. The main driving force for this sharp increase in population was the high demand for immigrant labour. The aim of this study was to adjust the population in the GCC countries in order to ensure that the comparisons of health-care key performance indicators with other countries account for the composition of the populations. The conclusion of the study was that adjusting the population in the GCC is instrumental for determining health spending and health outcomes, and that inaccurate forecasting would result in serious overestimation of the need for GCC countries to invest in the health-care sector. Policy-makers can utilize the population models in this study to accurately plan for health-care delivery.

  19. Differentiation of Self and Dyadic Adjustment in Couple Relationships: A Dyadic Analysis Using the Actor-Partner Interdependence Model.

    PubMed

    Lampis, Jessica; Cataudella, Stefania; Agus, Mirian; Busonera, Alessandra; Skowron, Elizabeth A

    2018-06-10

    Bowen's multigenerational theory provides an account of how the internalization of experiences within the family of origin promotes development of the ability to maintain a distinct self whilst also making intimate connections with others. Differentiated people can maintain their I-position in intimate relationships. They can remain calm in conflictual relationships, resolve relational problems effectively, and reach compromises. Fusion with others, emotional cut-off, and emotional reactivity instead are common reactions to relational stress in undifferentiated people. Emotional reactivity is the tendency to react to stressors with irrational and intense emotional arousal. Fusion with others is an excessive emotional involvement in significant relationships, whilst emotional cut-off is the tendency to manage relationship anxiety through physical and emotional distance. This study is based on Bowen's theory, starting from the assumption that dyadic adjustment can be affected both by a member's differentiation of self (actor effect) and by his or her partner's differentiation of self (partner effect). We used the Actor-Partner Interdependence Model to study the relationship between differentiation of self and dyadic adjustment in a convenience sample of 137 heterosexual Italian couples (nonindependent, dyadic data). The couples completed the Differentiation of Self Inventory and the Dyadic Adjustment Scale. Men's dyadic adjustment depended only on their personal I-position, whereas women's dyadic adjustment was affected by their personal I-position and emotional cut-off as well as by their partner's I-position and emotional cut-off. The empirical and clinical implications of the results are discussed. © 2018 Family Process Institute.

  20. Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality.

    PubMed

    Ames, Stefanie G; Davis, Billie S; Angus, Derek C; Carcillo, Joseph A; Kahn, Jeremy M

    2018-05-01

    With continued attention to pediatric sepsis at both the clinical and policy levels, it is important to understand the quality of hospitals in terms of their pediatric sepsis mortality. We sought to develop a method to evaluate hospital pediatric sepsis performance using 30-day risk-adjusted mortality and to assess hospital variation in risk-adjusted sepsis mortality in a large state-wide sample. Retrospective cohort study using administrative claims data. Acute care hospitals in the state of Pennsylvania from 2011 to 2013. Patients between the ages of 0-19 years admitted to a hospital with sepsis defined using validated International Classification of Diseases, Ninth revision, Clinical Modification, diagnosis and procedure codes. None. During the study period, there were 9,013 pediatric sepsis encounters in 153 hospitals. After excluding repeat visits and hospitals with annual patient volumes too small to reliably assess hospital performance, there were 6,468 unique encounters in 24 hospitals. The overall unadjusted mortality rate was 6.5% (range across all hospitals: 1.5-11.9%). The median number of pediatric sepsis cases per hospital was 67 (range across all hospitals: 30-1,858). A hierarchical logistic regression model for 30-day risk-adjusted mortality controlling for patient age, gender, emergency department admission, infection source, presence of organ dysfunction at admission, and presence of chronic complex conditions showed good discrimination (C-statistic = 0.80) and calibration (slope and intercept of calibration plot: 0.95 and -0.01, respectively). The hospital-specific risk-adjusted mortality rates calculated from this model varied minimally, ranging from 6.0% to 7.4%. Although a risk-adjustment model for 30-day pediatric sepsis mortality had good performance characteristics, the use of risk-adjusted mortality rates as a hospital quality measure in pediatric sepsis is not useful due to the low volume of cases at most hospitals. Novel metrics to

  1. Affordable Care Act risk adjustment: overview, context, and challenges.

    PubMed

    Kautter, John; Pope, Gregory C; Keenan, Patricia

    2014-01-01

    Beginning in 2014, individuals and small businesses will be able to purchase private health insurance through competitive marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment in the individual and small group markets in 2014 as Marketplaces are implemented and new market reforms take effect. The purpose of risk adjustment is to lessen or eliminate the influence of risk selection on the premiums that plans charge and the incentive for plans to avoid sicker enrollees. This article--the first of three in the Medicare & Medicaid Research Review--describes the key program goal and issues in the Department of Health and Human Services (HHS) developed risk adjustment methodology, and identifies key choices in how the methodology responds to these issues. The goal of the HHS risk adjustment methodology is to compensate health insurance plans for differences in enrollee health mix so that plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. The methodology includes a risk adjustment model and a risk transfer formula that together address this program goal as well as three issues specific to ACA risk adjustment: 1) new population; 2) cost and rating factors; and 3) balanced transfers within state/market. The risk adjustment model, described in the second article, estimates differences in health risks taking into account the new population and scope of coverage (actuarial value level). The transfer formula, described in the third article, calculates balanced transfers that are intended to account for health risk differences while preserving permissible premium differences.

  2. Longitudinal Psychosocial Adjustment of Women to Human Papillomavirus Infection.

    PubMed

    Hsu, Yu-Yun; Wang, Wei-Ming; Fetzer, Susan Jane; Cheng, Ya-Min; Hsu, Keng-Fu

    2018-05-29

    The aim of this study was to examine the psychosocial adjustment trajectory, focusing on psychological distress, sexual relationships and health care information, as well as factors which have an impact on adjustment on receiving a positive diagnosis of human papillomavirus infection. Human papillomavirus is a common sexually transmitted infection in females. To date, knowledge of the longitudinal psychosocial response to the diagnosis of human papillomavirus is limited. A prospective longitudinal design was conducted with a convenience sample. Women aged 20-65 years old were followed at one, 6 and 12 months after a diagnosis of HPV. Participants completed measures of initial emotional distress and followed-up psychosocial adjustment. A mixed-effects model was applied to analyze the longitudinal changes in psychosocial adjustment. Seventy human papillomavirus positive women participated in the study with nearly 20% of the women reporting emotional distress during their first visit. Mixed-effects model analyses showed that a trajectory of psychosocial adjustment in health care orientation, sexual relationship and psychosocial distress occur from one to 6 months after HPV diagnosis. However, a declining trend from 6-12 months was significant in health care orientation. Initial emotional distress was associated with changes in psychological adjustment. Psychosocial adjustment to human papillomavirus was worse at one month compared with 6 and 12 months after diagnosis. Healthcare providers should offer health information and psychosocial support to women according to their disease progression. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  3. Adjusting for Confounding in Early Postlaunch Settings: Going Beyond Logistic Regression Models.

    PubMed

    Schmidt, Amand F; Klungel, Olaf H; Groenwold, Rolf H H

    2016-01-01

    Postlaunch data on medical treatments can be analyzed to explore adverse events or relative effectiveness in real-life settings. These analyses are often complicated by the number of potential confounders and the possibility of model misspecification. We conducted a simulation study to compare the performance of logistic regression, propensity score, disease risk score, and stabilized inverse probability weighting methods to adjust for confounding. Model misspecification was induced in the independent derivation dataset. We evaluated performance using relative bias confidence interval coverage of the true effect, among other metrics. At low events per coefficient (1.0 and 0.5), the logistic regression estimates had a large relative bias (greater than -100%). Bias of the disease risk score estimates was at most 13.48% and 18.83%. For the propensity score model, this was 8.74% and >100%, respectively. At events per coefficient of 1.0 and 0.5, inverse probability weighting frequently failed or reduced to a crude regression, resulting in biases of -8.49% and 24.55%. Coverage of logistic regression estimates became less than the nominal level at events per coefficient ≤5. For the disease risk score, inverse probability weighting, and propensity score, coverage became less than nominal at events per coefficient ≤2.5, ≤1.0, and ≤1.0, respectively. Bias of misspecified disease risk score models was 16.55%. In settings with low events/exposed subjects per coefficient, disease risk score methods can be useful alternatives to logistic regression models, especially when propensity score models cannot be used. Despite better performance of disease risk score methods than logistic regression and propensity score models in small events per coefficient settings, bias, and coverage still deviated from nominal.

  4. Shortwave radiative forcing, rapid adjustment, and feedback to the surface by sulfate geoengineering: analysis of the Geoengineering Model Intercomparison Project G4 scenario

    DOE PAGES

    Kashimura, Hiroki; Abe, Manabu; Watanabe, Shingo; ...

    2017-03-08

    This paper evaluates the forcing, rapid adjustment, and feedback of net shortwave radiation at the surface in the G4 experiment of the Geoengineering Model Intercomparison Project by analysing outputs from six participating models. G4 involves injection of 5 Tg yr -1 of SO 2, a sulfate aerosol precursor, into the lower stratosphere from year 2020 to 2069 against a background scenario of RCP4.5. A single-layer atmospheric model for shortwave radiative transfer is used to estimate the direct forcing of solar radiation management (SRM), and rapid adjustment and feedbacks from changes in the water vapour amount, cloud amount, and surface albedo (compared with RCP4.5). The analysismore » shows that the globally and temporally averaged SRM forcing ranges from -3.6 to -1.6 W m -2, depending on the model. The sum of the rapid adjustments and feedback effects due to changes in the water vapour and cloud amounts increase the downwelling shortwave radiation at the surface by approximately 0.4 to 1.5 W m -2 and hence weaken the effect of SRM by around 50 %. The surface albedo changes decrease the net shortwave radiation at the surface; it is locally strong (~-4 W m -2) in snow and sea ice melting regions, but minor for the global average. The analyses show that the results of the G4 experiment, which simulates sulfate geoengineering, include large inter-model variability both in the direct SRM forcing and the shortwave rapid adjustment from change in the cloud amount, and imply a high uncertainty in modelled processes of sulfate aerosols and clouds.« less

  5. The method ADAMONT v1.0 for statistical adjustment of climate projections applicable to energy balance land surface models

    NASA Astrophysics Data System (ADS)

    Verfaillie, Deborah; Déqué, Michel; Morin, Samuel; Lafaysse, Matthieu

    2017-11-01

    We introduce the method ADAMONT v1.0 to adjust and disaggregate daily climate projections from a regional climate model (RCM) using an observational dataset at hourly time resolution. The method uses a refined quantile mapping approach for statistical adjustment and an analogous method for sub-daily disaggregation. The method ultimately produces adjusted hourly time series of temperature, precipitation, wind speed, humidity, and short- and longwave radiation, which can in turn be used to force any energy balance land surface model. While the method is generic and can be employed for any appropriate observation time series, here we focus on the description and evaluation of the method in the French mountainous regions. The observational dataset used here is the SAFRAN meteorological reanalysis, which covers the entire French Alps split into 23 massifs, within which meteorological conditions are provided for several 300 m elevation bands. In order to evaluate the skills of the method itself, it is applied to the ALADIN-Climate v5 RCM using the ERA-Interim reanalysis as boundary conditions, for the time period from 1980 to 2010. Results of the ADAMONT method are compared to the SAFRAN reanalysis itself. Various evaluation criteria are used for temperature and precipitation but also snow depth, which is computed by the SURFEX/ISBA-Crocus model using the meteorological driving data from either the adjusted RCM data or the SAFRAN reanalysis itself. The evaluation addresses in particular the time transferability of the method (using various learning/application time periods), the impact of the RCM grid point selection procedure for each massif/altitude band configuration, and the intervariable consistency of the adjusted meteorological data generated by the method. Results show that the performance of the method is satisfactory, with similar or even better evaluation metrics than alternative methods. However, results for air temperature are generally better than for

  6. 42 CFR § 512.300 - Determination of episode quality-adjusted target prices and actual episode payments.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.300 Determination of episode quality-adjusted... historical episode payments. (iii) For the AMI model, quality-adjusted target prices for anchor MS-DRGs 246... 100 percent regional historical episode payments. (iv) For the CABG model, quality-adjusted target...

  7. Case-mix adjustment for diabetes indicators: a systematic review.

    PubMed

    Calsbeek, Hiske; Markhorst, Joekle G M; Voerman, Gerlienke E; Braspenning, Jozé C C

    2016-02-01

    Case-mix adjustment is generally considered indispensable for fair comparison of healthcare performance. Inaccurate results are also unfair to patients as they are ineffective for improving quality. However, little is known about what factors should be adjusted for. We reviewed case-mix factors included in adjustment models for key diabetes indicators, the rationale for their inclusion, and their impact on performance. Systematic review. This systematic review included studies published up to June 2013 addressing case-mix factors for 6 key diabetes indicators: 2 outcomes and 2 process indicators for glycated hemoglobin (A1C), low-density lipoprotein cholesterol, and blood pressure. Factors were categorized as demographic, diabetes-related, comorbidity, generic health, geographic, or care-seeking, and were evaluated on the rationale for inclusion in the adjustment models, as well as their impact on indicator scores and ranking. Thirteen studies were included, mainly addressing A1C value and measurement. Twenty-three different case-mix factors, mostly demographic and diabetes-related, were identified, and varied from 1 to 14 per adjustment model. Six studies provided selection motives for the inclusion of case-mix factors. Marital status and body mass index showed a significant impact on A1C value. For the other factors, either no or conflicting associations were reported, or too few studies (n ≤ 2) investigated this association. Scientific knowledge about the relative importance of case-mix factors for diabetes indicators is emerging, especially for demographic and diabetes-related factors and indicators on A1C, but is still limited. Because arbitrary adjustment potentially results in inaccurate quality information, meaningful stratification that demonstrates inequity in care might be a better guide, as it can be a driver for quality improvement.

  8. Cross-national Consistency in the Relationship Between Bullying Behaviors and Psychosocial Adjustment

    PubMed Central

    Nansel, Tonja R.; Craig, Wendy; Overpeck, Mary D.; Saluja, Gitanjali; Ruan, W. June

    2008-01-01

    Objective To determine whether the relationship between bullying and psychosocial adjustment is consistent across countries by standard measures and methods. Design Cross-sectional self-report surveys were obtained from nationally representative samples of students in 25 countries. Involvement in bullying, as bully, victim, or both bully and victim, was assessed. Setting Surveys were conducted at public and private schools throughout the participating countries. Participants Participants included all consenting students in sampled classrooms, for a total of 113200 students at average ages of 11.5, 13.5, and 15.5 years. Main Outcome Measures Psychosocial adjustment dimensions assessed included health problems, emotional adjustment, school adjustment, relationships with classmates, alcohol use, and weapon carrying. Results Involvement in bullying varied dramatically across countries, ranging from 9% to 54% of youth. However, across all countries, involvement in bullying was associated with poorer psychosocial adjustment (P<.05). In all or nearly all countries, bullies, victims, and bully-victims reported greater health problems and poorer emotional and social adjustment. Victims and bully-victims consistently reported poorer relationships with classmates, whereas bullies and bully-victims reported greater alcohol use and weapon carrying. Conclusions The association of bullying with poorer psychosocial adjustment is remarkably similar across countries. Bullying is a critical issue for the health of youth internationally. PMID:15289243

  9. Shape adjustment optimization and experiment of cable-membrane reflectors

    NASA Astrophysics Data System (ADS)

    Du, Jingli; Gu, Yongzhen; Bao, Hong; Wang, Congsi; Chen, Xiaofeng

    2018-05-01

    Cable-membrane structures are widely employed for large space reflectors due to their lightweight, compact and easy package. In these structures, membranes are attached to cable net, serving as reflectors themselves or as supporting structures for other reflective surface. The cable length and membrane shape have to be carefully designed and fabricated to guarantee the desired reflector surface shape. However, due to inevitable error in cable length and membrane shape during the manufacture and assembly of cable-membrane reflectors, some cables have to be designed to be capable of length adjustment. By carefully adjusting the length of these cables, the degeneration in reflector shape precision due to this inevitable error can be effectively reduced. In the paper a shape adjustment algorithm for cable-membrane reflectors is proposed. Meanwhile, model updating is employed during shape adjustment to decrease the discrepancy of the numerical model with respect to the actual reflector. This discrepancy has to be considered because during attaching membranes to cable net, the accuracy of the membrane shape is hard to guarantee. Numerical examples and experimental results demonstrate the proposed method.

  10. 49 CFR 393.53 - Automatic brake adjusters and brake adjustment indicators.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... indicators. 393.53 Section 393.53 Transportation Other Regulations Relating to Transportation (Continued... brake adjustment indicators. (a) Automatic brake adjusters (hydraulic brake systems). Each commercial... vehicle at the time it was manufactured. (c) Brake adjustment indicator (air brake systems). On each...

  11. 49 CFR 393.53 - Automatic brake adjusters and brake adjustment indicators.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... indicators. 393.53 Section 393.53 Transportation Other Regulations Relating to Transportation (Continued... brake adjustment indicators. (a) Automatic brake adjusters (hydraulic brake systems). Each commercial... vehicle at the time it was manufactured. (c) Brake adjustment indicator (air brake systems). On each...

  12. Kinematic synthesis of adjustable robotic mechanisms

    NASA Astrophysics Data System (ADS)

    Chuenchom, Thatchai

    1993-01-01

    identification of adjustable member was also developed. The analytical synthesis techniques developed in this dissertation were successfully implemented in a graphic-intensive user-friendly computer program. A physical prototype of a general purpose adjustable robotic mechanism has been constructed to serve as a proof-of-concept model.

  13. Parental Perceptions of Family Adjustment in Childhood Developmental Disabilities

    ERIC Educational Resources Information Center

    Thompson, Sandra; Hiebert-Murphy, Diane; Trute, Barry

    2013-01-01

    Based on the adjustment phase of the double ABC-X model of family stress (McCubbin and Patterson, 1983) this study examined the impact of parenting stress, positive appraisal of the impact of child disability on the family, and parental self-esteem on parental perceptions of family adjustment in families of children with disabilities. For mothers,…

  14. Enhancing multiple-point geostatistical modeling: 1. Graph theory and pattern adjustment

    NASA Astrophysics Data System (ADS)

    Tahmasebi, Pejman; Sahimi, Muhammad

    2016-03-01

    In recent years, higher-order geostatistical methods have been used for modeling of a wide variety of large-scale porous media, such as groundwater aquifers and oil reservoirs. Their popularity stems from their ability to account for qualitative data and the great flexibility that they offer for conditioning the models to hard (quantitative) data, which endow them with the capability for generating realistic realizations of porous formations with very complex channels, as well as features that are mainly a barrier to fluid flow. One group of such models consists of pattern-based methods that use a set of data points for generating stochastic realizations by which the large-scale structure and highly-connected features are reproduced accurately. The cross correlation-based simulation (CCSIM) algorithm, proposed previously by the authors, is a member of this group that has been shown to be capable of simulating multimillion cell models in a matter of a few CPU seconds. The method is, however, sensitive to pattern's specifications, such as boundaries and the number of replicates. In this paper the original CCSIM algorithm is reconsidered and two significant improvements are proposed for accurately reproducing large-scale patterns of heterogeneities in porous media. First, an effective boundary-correction method based on the graph theory is presented by which one identifies the optimal cutting path/surface for removing the patchiness and discontinuities in the realization of a porous medium. Next, a new pattern adjustment method is proposed that automatically transfers the features in a pattern to one that seamlessly matches the surrounding patterns. The original CCSIM algorithm is then combined with the two methods and is tested using various complex two- and three-dimensional examples. It should, however, be emphasized that the methods that we propose in this paper are applicable to other pattern-based geostatistical simulation methods.

  15. Beginning without a Conclusion.

    ERIC Educational Resources Information Center

    Frazier, Richard

    1988-01-01

    Describes a series of activities without conclusions to introduce scientific reasoning in a ninth grade physical science course. Uses popcorn popping to get students to think about the concepts of graphing, histograms, frequency, probability, and scientific methodology. (CW)

  16. Adolescent Sibling Relationship Quality and Adjustment: Sibling Trustworthiness and Modeling, as Factors Directly and Indirectly Influencing These Associations

    ERIC Educational Resources Information Center

    Gamble, Wendy C.; Yu, Jeong Jin; Kuehn, Emily D.

    2011-01-01

    The main goal of this study was to examine the direct and moderating effects of trustworthiness and modeling on adolescent siblings' adjustment. Data were collected from 438 families including a mother, a younger sibling in fifth, sixth, or seventh grade (M = 11.6 years), and an older sibling (M = 14.3 years). Respondents completed Web-based…

  17. Automatic parameter estimation of multicompartmental neuron models via minimization of trace error with control adjustment.

    PubMed

    Brookings, Ted; Goeritz, Marie L; Marder, Eve

    2014-11-01

    We describe a new technique to fit conductance-based neuron models to intracellular voltage traces from isolated biological neurons. The biological neurons are recorded in current-clamp with pink (1/f) noise injected to perturb the activity of the neuron. The new algorithm finds a set of parameters that allows a multicompartmental model neuron to match the recorded voltage trace. Attempting to match a recorded voltage trace directly has a well-known problem: mismatch in the timing of action potentials between biological and model neuron is inevitable and results in poor phenomenological match between the model and data. Our approach avoids this by applying a weak control adjustment to the model to promote alignment during the fitting procedure. This approach is closely related to the control theoretic concept of a Luenberger observer. We tested this approach on synthetic data and on data recorded from an anterior gastric receptor neuron from the stomatogastric ganglion of the crab Cancer borealis. To test the flexibility of this approach, the synthetic data were constructed with conductance models that were different from the ones used in the fitting model. For both synthetic and biological data, the resultant models had good spike-timing accuracy. Copyright © 2014 the American Physiological Society.

  18. Gender identity and adjustment in black, Hispanic, and white preadolescents.

    PubMed

    Corby, Brooke C; Hodges, Ernest V E; Perry, David G

    2007-01-01

    The generality of S. K. Egan and D. G. Perry's (2001) model of gender identity and adjustment was evaluated by examining associations between gender identity (felt gender typicality, felt gender contentedness, and felt pressure for gender conformity) and social adjustment in 863 White, Black, and Hispanic 5th graders (mean age = 11.1 years). Relations between gender identity and adjustment varied across ethnic/racial groups, indicating that S. K. Egan and D. G. Perry's model requires amendment. It is suggested that the implications of gender identity for adjustment depend on the particular meanings that a child attaches to gender (e.g., the specific attributes the child regards as desirable for each sex); these meanings may vary across and within ethnic/racial groups. Cross-ethnic/racial investigation can aid theory building by pointing to constructs that are neglected in research with a single ethnic/racial group but that are crucial components of basic developmental processes. Copyright 2006 APA, all rights reserved.

  19. Risk-adjusted econometric model to estimate postoperative costs: an additional instrument for monitoring performance after major lung resection.

    PubMed

    Brunelli, Alessandro; Salati, Michele; Refai, Majed; Xiumé, Francesco; Rocco, Gaetano; Sabbatini, Armando

    2007-09-01

    The objectives of this study were to develop a risk-adjusted model to estimate individual postoperative costs after major lung resection and to use it for internal economic audit. Variable and fixed hospital costs were collected for 679 consecutive patients who underwent major lung resection from January 2000 through October 2006 at our unit. Several preoperative variables were used to develop a risk-adjusted econometric model from all patients operated on during the period 2000 through 2003 by a stepwise multiple regression analysis (validated by bootstrap). The model was then used to estimate the postoperative costs in the patients operated on during the 3 subsequent periods (years 2004, 2005, and 2006). Observed and predicted costs were then compared within each period by the Wilcoxon signed rank test. Multiple regression and bootstrap analysis yielded the following model predicting postoperative cost: 11,078 + 1340.3X (age > 70 years) + 1927.8X cardiac comorbidity - 95X ppoFEV1%. No differences between predicted and observed costs were noted in the first 2 periods analyzed (year 2004, $6188.40 vs $6241.40, P = .3; year 2005, $6308.60 vs $6483.60, P = .4), whereas in the most recent period (2006) observed costs were significantly lower than the predicted ones ($3457.30 vs $6162.70, P < .0001). Greater precision in predicting outcome and costs after therapy may assist clinicians in the optimization of clinical pathways and allocation of resources. Our economic model may be used as a methodologic template for economic audit in our specialty and complement more traditional outcome measures in the assessment of performance.

  20. Magnetically adjustable intraocular lens.

    PubMed

    Matthews, Michael Wayne; Eggleston, Harry Conrad; Pekarek, Steven D; Hilmas, Greg Eugene

    2003-11-01

    To provide a noninvasive, magnetic adjustment mechanism to the repeatedly and reversibly adjustable, variable-focus intraocular lens (IOL). University of Missouri-Rolla, Rolla, and Eggleston Adjustable Lens, St. Louis, Missouri, USA. Mechanically adjustable IOLs have been fabricated and tested. Samarium and cobalt rare-earth magnets have been incorporated into the poly(methyl methacrylate) (PMMA) optic of these adjustable lenses. The stability of samarium and cobalt in the PMMA matrix was examined with leaching studies. Operational force testing of the magnetic optics with emphasis on the rotational forces of adjustment was done. Prototype optics incorporating rare-earth magnetic inserts were consistently produced. After 32 days in solution, samarium and cobalt concentration reached a maximum of 5 ppm. Operational force measurements indicate that successful adjustments of this lens can be made using external magnetic fields with rotational torques in excess of 0.6 ounce inch produced. Actual lenses were remotely adjusted using magnetic fields. The magnetically adjustable version of this IOL is a viable and promising means of handling the common issues of postoperative refractive errors without the requirement of additional surgery. The repeatedly adjustable mechanism of this lens also holds promise for the developing eyes of pediatric patients and the changing needs of all patients.

  1. Using a conformal water bolus to adjust heating patterns of microwave waveguide applicators

    NASA Astrophysics Data System (ADS)

    Stauffer, Paul R.; Rodrigues, Dario B.; Sinahon, Randolf; Sbarro, Lyndsey; Beckhoff, Valeria; Hurwitz, Mark D.

    2017-02-01

    Background: Hyperthermia, i.e., raising tissue temperature to 40-45°C for 60 min, has been demonstrated to increase the effectiveness of radiation and chemotherapy for cancer. Although multi-element conformal heat applicators are under development to provide more adjustable heating of contoured anatomy, to date the most often used applicator to heat superficial disease is the simple microwave waveguide. With only a single power input, the operator must be resourceful to adjust heat treatment to accommodate variable size and shape tumors spreading across contoured anatomy. Methods: We used multiphysics simulation software that couples electromagnetic, thermal and fluid dynamics physics to simulate heating patterns in superficial tumors from commercially available microwave waveguide applicators. Temperature distributions were calculated inside homogenous muscle and layered skin-fat-muscle-tumor-bone tissue loads for a typical range of applicator coupling configurations and size of waterbolus. Variable thickness waterbolus was simulated as necessary to accommodate contoured anatomy. Physical models of several treatment configurations were constructed for comparison of simulation results with experimental specific absorption rate (SAR) measurements in homogenous muscle phantom. Results: Accuracy of the simulation model was confirmed with experimental SAR measurements of three unique applicator setups. Simulations demonstrated the ability to generate a wide range of power deposition patterns with commercially available waveguide antennas by controllably varying size and thickness of the waterbolus layer. Conclusion: Heating characteristics of 915 MHz waveguide antennas can be varied over a wide range by controlled adjustment of microwave power, coupling configuration, and waterbolus lateral size and thickness. The uniformity of thermal dose delivered to superficial tumors can be improved by cyclic switching of waterbolus thickness during treatment to proactively shift

  2. A Longitudinal Study of Perceived Family Adjustment and Emotional Adjustment in Early Adolescence.

    ERIC Educational Resources Information Center

    Ohannessian, Christine McCauley; And Others

    1994-01-01

    Examined the predictive relationship between family adjustment and emotional adjustment during early adolescence and the influence of adolescents' levels of self-worth, peer support, and coping abilities. Found that family adjustment and emotional adjustment are reciprocally related and that high levels of self-worth, peer support, and coping…

  3. Concurrent validity of the College Adjustment scales using comparison with the MMPI College Maladjustment Scale.

    PubMed

    Campbell, Michael H; Palmieri, Michael; Lasch, Brandi

    2006-12-01

    The concurrent validity of the College Adjustment Scales was assessed using comparison to the College Maladjustment Scale of the Minnesota Multiphasic Inventory-2. Undergraduate students (N=56, 40 women, M age = 21.3 yr., 87.5% white, non-Hispanic) completed both tests. Analysis indicated scores on 8 of 9 College Adjustment Scales correlated significantly in the predicted direction with those on the College Maladjustment Scale, thereby providing some additional support for convergent validity. While the conclusions are limited significantly by the small sample, this report provides an incremental contribution to the validity of the College Adjustment Scales.

  4. Validation of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QoL) and the adjusted DSWAL-QoL (aDSWAL-QoL) using item analysis with the Rasch model: a pilot study.

    PubMed

    Simpelaere, Ingeborg S; Van Nuffelen, Gwen; De Bodt, Marc; Vanderwegen, Jan; Hansen, Tina

    2017-04-07

    The Swallowing Quality-of-Life Questionnaire (SWAL-QoL) is considered the gold standard for assessing health-related QoL in oropharyngeal dysphagia. The Dutch translation (DSWAL-QoL) and its adjusted version (aDSWAL-QoL) have been validated using classical test theory (CTT). However, these scales have not been tested against the Rasch measurement model, which is required to establish the structural validity and objectivity of the total scale and subscale scores. Thus, the purpose of this study was to examine the psychometric properties of these scales using item analysis according to the Rasch model. Item analysis with the Rasch model was performed using RUMM2030 software with previously collected data from a validation study of 108 patients. The assessment included evaluations of overall model fit, reliability, unidimensionality, threshold ordering, individual item and person fits, differential item functioning (DIF), local item dependency (LID) and targeting. The analysis could not establish the psychometric properties of either of the scales or their subscales because they did not fit the Rasch model, and multidimensionality, disordered thresholds, DIF, and/or LID were found. The reliability and power of fit were high for the total scales (PSI = 0.93) but low for most of the subscales (PSI < 0.70). The targeting of persons and items was suboptimal. The main source of misfit was disordered thresholds for both the total scales and subscales. Based on the results of the analysis, adjustments to improve the scales were implemented as follows: disordered thresholds were rescaled, misfit items were removed and items were split for DIF. However, the multidimensionality and LID could not be resolved. The reliability and power of fit remained low for most of the subscales. This study represents the first analyses of the DSWAL-QoL and aDSWAL-QoL with the Rasch model. Relying on the DSWAL-QoL and aDSWAL-QoL total and subscale scores to make conclusions regarding

  5. Semi-Global Matching with Self-Adjusting Penalties

    NASA Astrophysics Data System (ADS)

    Karkalou, E.; Stentoumis, C.; Karras, G.

    2017-02-01

    The demand for 3D models of various scales and precisions is strong for a wide range of applications, among which cultural heritage recording is particularly important and challenging. In this context, dense image matching is a fundamental task for processes which involve image-based reconstruction of 3D models. Despite the existence of commercial software, the need for complete and accurate results under different conditions, as well as for computational efficiency under a variety of hardware, has kept image-matching algorithms as one of the most active research topics. Semi-global matching (SGM) is among the most popular optimization algorithms due to its accuracy, computational efficiency, and simplicity. A challenging aspect in SGM implementation is the determination of smoothness constraints, i.e. penalties P1, P2 for disparity changes and discontinuities. In fact, penalty adjustment is needed for every particular stereo-pair and cost computation. In this work, a novel formulation of self-adjusting penalties is proposed: SGM penalties can be estimated solely from the statistical properties of the initial disparity space image. The proposed method of self-adjusting penalties (SGM-SAP) is evaluated using typical cost functions on stereo-pairs from the recent Middlebury dataset of interior scenes, as well as from the EPFL Herz-Jesu architectural scenes. Results are competitive against the original SGM estimates. The significant aspects of self-adjusting penalties are: (i) the time-consuming tuning process is avoided; (ii) SGM can be used in image collections with limited number of stereo-pairs; and (iii) no heuristic user intervention is needed.

  6. A multiphase three-dimensional multi-relaxation time (MRT) lattice Boltzmann model with surface tension adjustment

    NASA Astrophysics Data System (ADS)

    Ammar, Sami; Pernaudat, Guillaume; Trépanier, Jean-Yves

    2017-08-01

    The interdependence of surface tension and density ratio is a weakness of pseudo-potential based lattice Boltzmann models (LB). In this paper, we propose a 3D multi-relaxation time (MRT) model for multiphase flows at large density ratios. The proposed model is capable of adjusting the surface tension independently of the density ratio. We also present the 3D macroscopic equations recovered by the proposed forcing scheme. A high order of isotropy for the interaction force is used to reduce the amplitude of spurious currents. The proposed 3D-MRT model is validated by verifying Laplace's law and by analyzing its thermodynamic consistency and the oscillation period of a deformed droplet. The model is then applied to the simulation of the impact of a droplet on a dry surface. Impact dynamics are determined and the maximum spread factor calculated for different Reynolds and Weber numbers. The numerical results are in agreement with data published in the literature. The influence of surface wettability on the spread factor is also investigated. Finally, our 3D-MRT model is applied to the simulation of the impact of a droplet on a wet surface. The propagation of transverse waves is observed on the liquid surface.

  7. Funding source, conflict of interest and positive conclusions in neuro-oncology clinical trials.

    PubMed

    Moraes, Fabio Y; Mendez, Lucas C; Taunk, Neil K; Raman, Srinivas; Suh, John H; Souhami, Luis; Slotman, Ben; Weltman, Eduardo; Spratt, Daniel E; Berlin, Alejandro; Marta, Gustavo N

    2018-02-01

    We aimed to test any association between authors' conclusions and self-reported COI or funding sources in central nervous system (CNS) studies. A review was performed for CNS malignancy clinical trials published in the last 5 years. Two investigators independently classified study conclusions according to authors' endorsement of the experimental therapy. Statistical models were used to test for associations between positive conclusions and trials characteristics. From February 2010 to February 2015, 1256 articles were retrieved; 319 were considered eligible trials. Positive conclusions were reported in 56.8% of trials with industry-only, 55.6% with academia-only, 44.1% with academia and industry, 77.8% with none, and 76.4% with not described funding source (p = 0.011). Positive conclusions were reported in 60.4% of trials with unrelated COI, 60% with related COI, and 60% with no COI reported (p = 0.997). Factors that were significantly associated with the presence of positive conclusion included trials design (phase 1) [OR 11.64 (95 CI 4.66-29.09), p < 0.001], geographic location (outside North America or Europe) [OR 1.96 (95 CI 1.05-3.79), P = 0.025], primary outcomes (non-overall or progression free survival) [OR 3.74 (95 CI 2.27-6.18), p < 0.001], and failure to disclose funding source [OR 2.45 (95 CI 1.22-5.22), p = 0.011]. In a multivariable regression model, all these factors remained significantly associated with trial's positive conclusion. Funding source and self-reported COI did not appear to influence the CNS trials conclusion. Funding source information and COI disclosure were under-reported in 14.1 and 17.2% of the CNS trials. Continued efforts are needed to increase rates of both COI and funding source reporting.

  8. Gender Identity and Adjustment in Black, Hispanic, and White Preadolescents

    ERIC Educational Resources Information Center

    Corby, Brooke C.; Hodges, Ernest V. E.; Perry, David G.

    2007-01-01

    The generality of S. K. Egan and D. G. Perry's (2001) model of gender identity and adjustment was evaluated by examining associations between gender identity (felt gender typicality, felt gender contentedness, and felt pressure for gender conformity) and social adjustment in 863 White, Black, and Hispanic 5th graders (mean age = 11.1 years).…

  9. Effects of Forecasts on the Revisions of Concurrent Seasonally Adjusted Data Using the X-11 Seasonal Adjustment Procedure.

    ERIC Educational Resources Information Center

    Bobbitt, Larry; Otto, Mark

    Three Autoregressive Integrated Moving Averages (ARIMA) forecast procedures for Census Bureau X-11 concurrent seasonal adjustment were empirically tested. Forty time series from three Census Bureau economic divisions (business, construction, and industry) were analyzed. Forecasts were obtained from fitted seasonal ARIMA models augmented with…

  10. On the nullspace of TLS multi-station adjustment

    NASA Astrophysics Data System (ADS)

    Sterle, Oskar; Kogoj, Dušan; Stopar, Bojan; Kregar, Klemen

    2018-07-01

    In the article we present an analytic aspect of TLS multi-station least-squares adjustment with the main focus on the datum problem. The datum problem is, compared to previously published researches, theoretically analyzed and solved, where the solution is based on nullspace derivation of the mathematical model. The importance of datum problem solution is seen in a complete description of TLS multi-station adjustment solutions from a set of all minimally constrained least-squares solutions. On a basis of known nullspace, estimable parameters are described and the geometric interpretation of all minimally constrained least squares solutions is presented. At the end a simulated example is used to analyze the results of TLS multi-station minimally constrained and inner constrained least-squares adjustment solutions.

  11. Assessment of Glacial Isostatic Adjustment in Greenland using GPS

    NASA Astrophysics Data System (ADS)

    Khan, S. A.; Bevis, M. G.; Sasgen, I.; van Dam, T. M.; Wahr, J. M.; Wouters, B.; Bamber, J. L.; Willis, M. J.; Knudsen, P.; Helm, V.; Kuipers Munneke, P.; Muresan, I. S.

    2015-12-01

    The Greenland GPS network (GNET) was constructed to provide a new means to assess viscoelastic and elastic adjustments driven by past and present-day changes in ice mass. Here we assess existing glacial isostatic adjustments (GIA) predictions by analysing 1995-2015 data from 61 continuous GPS receivers located along the margin of the Greenland ice sheet. Since GPS receivers measure both the GIA and elastic signals, we isolate GIA, by removing the elastic adjustments of the lithosphere due to present-day mass changes using high-resolution fields of ice surface elevation change derived from satellite and airborne altimetry measurements (ERS1/2, ICESat, ATM, ENVISAT, and CryoSat-2). For most GPS stations, our observed GIA rates contradict GIA predictions; particularly, we find huge uplift rates in southeast Greenland of up to 14 mm/yr while models predict rates of 0-2 mm/yr. Our results suggest possible improvements of GIA predictions, and hence of the poorly constrained ice load history and Earth structure models for Greenland.

  12. Suitability of a three-dimensional model to measure empathy and its relationship with social and normative adjustment in Spanish adolescents: a cross-sectional study.

    PubMed

    Herrera-López, Mauricio; Gómez-Ortiz, Olga; Ortega-Ruiz, Rosario; Jolliffe, Darrick; Romera, Eva M

    2017-09-25

    (1) To examine the psychometric properties of the Basic Empathy Scale (BES) with Spanish adolescents, comparing a two and a three-dimensional structure;(2) To analyse the relationship between the three-dimensional empathy and social and normative adjustment in school. Transversal and ex post facto retrospective study. Confirmatory factorial analysis, multifactorial invariance analysis and structural equations models were used. 747 students (51.3% girls) from Cordoba, Spain, aged 12-17 years (M=13.8; SD=1.21). The original two-dimensional structure was confirmed (cognitive empathy, affective empathy), but a three-dimensional structure showed better psychometric properties, highlighting the good fit found in confirmatory factorial analysis and adequate internal consistent valued, measured with Cronbach's alpha and McDonald's omega. Composite reliability and average variance extracted showed better indices for a three-factor model. The research also showed evidence of measurement invariance across gender. All the factors of the final three-dimensional BES model were direct and significantly associated with social and normative adjustment, being most strongly related to cognitive empathy. This research supports the advances in neuroscience, developmental psychology and psychopathology through a three-dimensional version of the BES, which represents an improvement in the original two-factorial model. The organisation of empathy in three factors benefits the understanding of social and normative adjustment in adolescents, in which emotional disengagement favours adjusted peer relationships. Psychoeducational interventions aimed at improving the quality of social life in schools should target these components of empathy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Adjustment of Measurements with Multiplicative Errors: Error Analysis, Estimates of the Variance of Unit Weight, and Effect on Volume Estimation from LiDAR-Type Digital Elevation Models

    PubMed Central

    Shi, Yun; Xu, Peiliang; Peng, Junhuan; Shi, Chuang; Liu, Jingnan

    2014-01-01

    Modern observation technology has verified that measurement errors can be proportional to the true values of measurements such as GPS, VLBI baselines and LiDAR. Observational models of this type are called multiplicative error models. This paper is to extend the work of Xu and Shimada published in 2000 on multiplicative error models to analytical error analysis of quantities of practical interest and estimates of the variance of unit weight. We analytically derive the variance-covariance matrices of the three least squares (LS) adjustments, the adjusted measurements and the corrections of measurements in multiplicative error models. For quality evaluation, we construct five estimators for the variance of unit weight in association of the three LS adjustment methods. Although LiDAR measurements are contaminated with multiplicative random errors, LiDAR-based digital elevation models (DEM) have been constructed as if they were of additive random errors. We will simulate a model landslide, which is assumed to be surveyed with LiDAR, and investigate the effect of LiDAR-type multiplicative error measurements on DEM construction and its effect on the estimate of landslide mass volume from the constructed DEM. PMID:24434880

  14. [Interpersonal motivation in a First Year Experience class influences freshmen's university adjustment].

    PubMed

    Nakayama, Rumiko; Nakanishi, Yoshifumi; Nagahama, Fumiyo; Nakajima, Makoto

    2015-06-01

    The present study examined the influence of interpersonal motivation on university adjustment in freshman students enrolled in a First Year Experience (FYE) class. An interpersonal motivation scale and a university adjustment (interpersonal adjustment and academic adjustment) scale were administered twice to 116 FYE students; data from the 88 students who completed both surveys were analyzed. Results from structural equation modeling indicated a causal relationship between interpersonal, motivation and university adjustment: interpersonal adjustment served as a mediator between academic adjustment and interpersonal motivation, the latter of which was assessed using the internalized motivation subscale of the Interpersonal Motivation Scale as well as the Relative Autonomy Index, which measures the autonomy in students' interpersonal attitudes. Thus, revising the FYE class curriculum to include approaches to lowering students' feelings of obligation and/or anxiety in their interpersonal interactions might improve their adjustment to university.

  15. Capitation pricing: Adjusting for prior utilization and physician discretion

    PubMed Central

    Anderson, Gerard F.; Cantor, Joel C.; Steinberg, Earl P.; Holloway, James

    1986-01-01

    As the number of Medicare beneficiaries receiving care under at-risk capitation arrangements increases, the method for setting payment rates will come under increasing scrutiny. A number of modifications to the current adjusted average per capita cost (AAPCC) methodology have been proposed, including an adjustment for prior utilization. In this article, we propose use of a utilization adjustment that includes only hospitalizations involving low or moderate physician discretion in the decision to hospitalize. This modification avoids discrimination against capitated systems that prevent certain discretionary admissions. The model also explains more of the variance in per capita expenditures than does the current AAPCC. PMID:10312010

  16. A structural model for stress, coping, and psychosocial adjustment: A multi-group analysis by stages of survivorship in Korean women with breast cancer.

    PubMed

    Jang, Miyoung; Kim, Jiyoung

    2018-04-01

    Prospective studies have examined factors directly affecting psychosocial adjustment during breast cancer treatment. Survivorship stage may moderate a direct effect of stress on psychosocial adjustment. This study aimed to examine relationships between stress, social support, self-efficacy, coping, and psychosocial adjustment to construct a model of the effect pathways between those factors, and determine if survivorship stage moderates those effects. Six hundred people with breast cancer completed questionnaires. Examined stages of survivorship after treatment were as follows: acute (i.e., <2 years), extended (2-5 years), and lasting (>5 years). Stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), self-efficacy (New General Self Efficacy Scale), coping (Ways of Coping Checklist), and psychosocial adjustment (Psychosocial Adjustment to Illness Scale-Self-Report-Korean Version) were measured. Self-efficacy significantly correlated with psychosocial adjustment in the acute survival stage (γ = -0.37, P < .001). Stress inversely correlated with coping only in the extended survival stage (γ = -0.56, P < .001). Social support's benefit to psychosocial adjustment was greater in the acute (γ = -0.42, P < .001) and extended survival stages (γ = -0.56, P < .001) than in the lasting survival stage. Stress's negative correlation with psychosocial adjustment was stronger in the lasting survival stage (β = 0.42, P < .001) than in the acute survival stage. Based on these results, it is necessary to improve self-efficacy, social support, and manage stress according to survival stage for psychosocial adjustment of female breast cancer patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Reach-Scale Channel Adjustments to Channel Network Geometry in Mountain Bedrock Streams

    NASA Astrophysics Data System (ADS)

    Plitzuweit, S. J.; Springer, G. S.

    2008-12-01

    surveys in order to analyze whether stream power and shear stress are adjusted to reflect CNG at the reach- scale. These models are compared to those with discharges calculated using drainage area and precipitation totals alone. We conclude that gradients in bedrock mountain streams may reflect basin-scale hydrology (CNG) and not simply local geological or geomorphic factors. This challenges the conclusions of others who ascribe local channel adjustments to: i) lithology and structure alone, or ii) local colluvium grain sizes.

  18. Custodial Grandmothers' Psychological Distress, Dysfunctional Parenting, and Grandchildren's Adjustment

    ERIC Educational Resources Information Center

    Smith, Gregory C.; Palmieri, Patrick A.; Hancock, Gregory R.; Richardson, Rhonda A.

    2008-01-01

    An adaptation of the Family Stress Model (FSM) with hypothesized linkages between family contextual factors, custodial grandmothers' psychological distress, parenting practices, and grandchildren's adjustment was tested with structural equation modeling. Interview data from 733 custodial grandmothers of grandchildren between ages 4-17 revealed…

  19. Mexican-Origin Parents’ Work Conditions and Adolescents’ Adjustment

    PubMed Central

    Wheeler, Lorey A.; Updegraff, Kimberly A.; Crouter, Ann

    2015-01-01

    Mexican-origin parents’ work experiences are a distal extra-familial context for adolescents’ adjustment. This two-wave multi-informant study examined the prospective mechanisms linking parents’ work conditions (i.e., self-direction, work pressure, workplace discrimination) to adolescents’ adjustment (i.e., educational expectations, depressive symptoms, risky behavior) across the transition to high school drawing on work socialization and spillover models. We examined the indirect effects of parental work conditions on adolescent adjustment through parents’ psychological functioning (i.e., depressive symptoms, role overload) and aspects of the parent-adolescent relationship (i.e., parental solicitation, parent-adolescent conflict), as well as moderation by adolescent gender. Participants were 246 predominantly immigrant, Mexican-origin, two-parent families who participated in home interviews when adolescents were approximately 13 and 15 years of age. Results supported the positive impact of fathers’ occupational self-direction on all three aspects of adolescents’ adjustment through decreased father-adolescent conflict, after controlling for family socioeconomic status and earner status, and underemployment. Parental work pressure and discrimination were indirectly linked to adolescents’ adjustment, with different mechanisms emerging for mothers and fathers. Adolescents’ gender moderated the associations between fathers’ self-direction and girls’ depressive symptoms, and fathers’ experiences of discrimination and boys’ risk behavior. Results suggest that Mexican-origin mothers’ and fathers’ perceptions of work conditions have important implications for multiple domains of adolescents’ adjustment across the transition to high school. PMID:25938710

  20. On-board adaptive model for state of charge estimation of lithium-ion batteries based on Kalman filter with proportional integral-based error adjustment

    NASA Astrophysics Data System (ADS)

    Wei, Jingwen; Dong, Guangzhong; Chen, Zonghai

    2017-10-01

    With the rapid development of battery-powered electric vehicles, the lithium-ion battery plays a critical role in the reliability of vehicle system. In order to provide timely management and protection for battery systems, it is necessary to develop a reliable battery model and accurate battery parameters estimation to describe battery dynamic behaviors. Therefore, this paper focuses on an on-board adaptive model for state-of-charge (SOC) estimation of lithium-ion batteries. Firstly, a first-order equivalent circuit battery model is employed to describe battery dynamic characteristics. Then, the recursive least square algorithm and the off-line identification method are used to provide good initial values of model parameters to ensure filter stability and reduce the convergence time. Thirdly, an extended-Kalman-filter (EKF) is applied to on-line estimate battery SOC and model parameters. Considering that the EKF is essentially a first-order Taylor approximation of battery model, which contains inevitable model errors, thus, a proportional integral-based error adjustment technique is employed to improve the performance of EKF method and correct model parameters. Finally, the experimental results on lithium-ion batteries indicate that the proposed EKF with proportional integral-based error adjustment method can provide robust and accurate battery model and on-line parameter estimation.

  1. Weighted triangulation adjustment

    USGS Publications Warehouse

    Anderson, Walter L.

    1969-01-01

    The variation of coordinates method is employed to perform a weighted least squares adjustment of horizontal survey networks. Geodetic coordinates are required for each fixed and adjustable station. A preliminary inverse geodetic position computation is made for each observed line. Weights associated with each observed equation for direction, azimuth, and distance are applied in the formation of the normal equations in-the least squares adjustment. The number of normal equations that may be solved is twice the number of new stations and less than 150. When the normal equations are solved, shifts are produced at adjustable stations. Previously computed correction factors are applied to the shifts and a most probable geodetic position is found for each adjustable station. Pinal azimuths and distances are computed. These may be written onto magnetic tape for subsequent computation of state plane or grid coordinates. Input consists of punch cards containing project identification, program options, and position and observation information. Results listed include preliminary and final positions, residuals, observation equations, solution of the normal equations showing magnitudes of shifts, and a plot of each adjusted and fixed station. During processing, data sets containing irrecoverable errors are rejected and the type of error is listed. The computer resumes processing of additional data sets.. Other conditions cause warning-errors to be issued, and processing continues with the current data set.

  2. Protein structure prediction with local adjust tabu search algorithm

    PubMed Central

    2014-01-01

    Background Protein folding structure prediction is one of the most challenging problems in the bioinformatics domain. Because of the complexity of the realistic protein structure, the simplified structure model and the computational method should be adopted in the research. The AB off-lattice model is one of the simplification models, which only considers two classes of amino acids, hydrophobic (A) residues and hydrophilic (B) residues. Results The main work of this paper is to discuss how to optimize the lowest energy configurations in 2D off-lattice model and 3D off-lattice model by using Fibonacci sequences and real protein sequences. In order to avoid falling into local minimum and faster convergence to the global minimum, we introduce a novel method (SATS) to the protein structure problem, which combines simulated annealing algorithm and tabu search algorithm. Various strategies, such as the new encoding strategy, the adaptive neighborhood generation strategy and the local adjustment strategy, are adopted successfully for high-speed searching the optimal conformation corresponds to the lowest energy of the protein sequences. Experimental results show that some of the results obtained by the improved SATS are better than those reported in previous literatures, and we can sure that the lowest energy folding state for short Fibonacci sequences have been found. Conclusions Although the off-lattice models is not very realistic, they can reflect some important characteristics of the realistic protein. It can be found that 3D off-lattice model is more like native folding structure of the realistic protein than 2D off-lattice model. In addition, compared with some previous researches, the proposed hybrid algorithm can more effectively and more quickly search the spatial folding structure of a protein chain. PMID:25474708

  3. ADJUSTABLE DOUBLE PULSE GENERATOR

    DOEpatents

    Gratian, J.W.; Gratian, A.C.

    1961-08-01

    >A modulator pulse source having adjustable pulse width and adjustable pulse spacing is described. The generator consists of a cross coupled multivibrator having adjustable time constant circuitry in each leg, an adjustable differentiating circuit in the output of each leg, a mixing and rectifying circuit for combining the differentiated pulses and generating in its output a resultant sequence of negative pulses, and a final amplifying circuit for inverting and square-topping the pulses. (AEC)

  4. Children Born Through Reproductive Donation: A Longitudinal Study of Psychological Adjustment

    PubMed Central

    Golombok, Susan; Blake, Lucy; Casey, Polly; Roman, Gabriela; Jadva, Vasanti

    2012-01-01

    Background Parenting and children’s adjustment were examined in 30 surrogacy families, 31 egg donation families, 35 donor insemination families, and 53 natural conception families. Methods Parenting was assessed at age 3 by a standardized interview designed to assess quality of parenting and by questionnaire measures of anxiety, depression and marital quality. Children’s adjustment was assessed at ages 3, 7 and 10 using the Strengths and Difficulties Questionnaire (SDQ). Results Although children born through reproductive donation obtained SDQ scores within the normal range, surrogacy children showed higher levels of adjustment difficulties at age 7 than children conceived by gamete donation. Mothers who had kept their child’s origins secret showed elevated levels of distress. However, maternal distress had a more negative impact on children who were aware of their origins. Conclusions The absence of a gestational connection to the mother may be more problematic for children than the absence of a genetic link. PMID:23176601

  5. Parental HIV/AIDS and Psychosocial Adjustment among Rural Chinese Children

    PubMed Central

    Fang, Xiaoyi; Stanton, Bonita; Hong, Yan; Zhang, Liying; Zhao, Guoxiang; Zhao, Junfeng; Lin, Xiuyun; Lin, Danhua

    2009-01-01

    Objective To assess the relationship between parental HIV/AIDS and psychosocial adjustment of children in rural central China. Methods Participants included 296 double AIDS orphans (children who had lost both their parents to AIDS), 459 single orphans (children who had lost one parent to AIDS), 466 vulnerable children who lived with HIV-infected parents, and 404 comparison children who did not experience HIV/AIDS-related illness and death in their families. The measures included depressive symptoms, loneliness, self-esteem, future expectations, hopefulness about the future, and perceived control over the future. Results AIDS orphans and vulnerable children consistently demonstrated poorer psychosocial adjustment than comparison children in the same community. The level of psychosocial adjustment was similar between single orphans and double orphans, but differed by care arrangement among double orphans. Conclusion The findings underscore the urgency and importance of culturally and developmentally appropriate intervention efforts targeting psychosocial problems among children affected by AIDS and call for more exploration of risk and resilience factors, both individual and contextual, affecting the psychosocial wellbeing of these children. PMID:19208701

  6. Baseline adjustments for binary data in repeated cross-sectional cluster randomized trials.

    PubMed

    Nixon, R M; Thompson, S G

    2003-09-15

    Analysis of covariance models, which adjust for a baseline covariate, are often used to compare treatment groups in a controlled trial in which individuals are randomized. Such analysis adjusts for any baseline imbalance and usually increases the precision of the treatment effect estimate. We assess the value of such adjustments in the context of a cluster randomized trial with repeated cross-sectional design and a binary outcome. In such a design, a new sample of individuals is taken from the clusters at each measurement occasion, so that baseline adjustment has to be at the cluster level. Logistic regression models are used to analyse the data, with cluster level random effects to allow for different outcome probabilities in each cluster. We compare the estimated treatment effect and its precision in models that incorporate a covariate measuring the cluster level probabilities at baseline and those that do not. In two data sets, taken from a cluster randomized trial in the treatment of menorrhagia, the value of baseline adjustment is only evident when the number of subjects per cluster is large. We assess the generalizability of these findings by undertaking a simulation study, and find that increased precision of the treatment effect requires both large cluster sizes and substantial heterogeneity between clusters at baseline, but baseline imbalance arising by chance in a randomized study can always be effectively adjusted for. Copyright 2003 John Wiley & Sons, Ltd.

  7. Computing Robust, Bootstrap-Adjusted Fit Indices for Use with Nonnormal Data

    ERIC Educational Resources Information Center

    Walker, David A.; Smith, Thomas J.

    2017-01-01

    Nonnormality of data presents unique challenges for researchers who wish to carry out structural equation modeling. The subsequent SPSS syntax program computes bootstrap-adjusted fit indices (comparative fit index, Tucker-Lewis index, incremental fit index, and root mean square error of approximation) that adjust for nonnormality, along with the…

  8. Least-Squares Data Adjustment with Rank-Deficient Data Covariance Matrices

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Williams, J.G.

    2011-07-01

    A derivation of the linear least-squares adjustment formulae is required that avoids the assumption that the covariance matrix of prior parameters can be inverted. Possible proofs are of several kinds, including: (i) extension of standard results for the linear regression formulae, and (ii) minimization by differentiation of a quadratic form of the deviations in parameters and responses. In this paper, the least-squares adjustment equations are derived in both these ways, while explicitly assuming that the covariance matrix of prior parameters is singular. It will be proved that the solutions are unique and that, contrary to statements that have appeared inmore » the literature, the least-squares adjustment problem is not ill-posed. No modification is required to the adjustment formulae that have been used in the past in the case of a singular covariance matrix for the priors. In conclusion: The linear least-squares adjustment formula that has been used in the past is valid in the case of a singular covariance matrix for the covariance matrix of prior parameters. Furthermore, it provides a unique solution. Statements in the literature, to the effect that the problem is ill-posed are wrong. No regularization of the problem is required. This has been proved in the present paper by two methods, while explicitly assuming that the covariance matrix of prior parameters is singular: i) extension of standard results for the linear regression formulae, and (ii) minimization by differentiation of a quadratic form of the deviations in parameters and responses. No modification is needed to the adjustment formulae that have been used in the past. (author)« less

  9. Can statistic adjustment of OR minimize the potential confounding bias for meta-analysis of case-control study? A secondary data analysis.

    PubMed

    Liu, Tianyi; Nie, Xiaolu; Wu, Zehao; Zhang, Ying; Feng, Guoshuang; Cai, Siyu; Lv, Yaqi; Peng, Xiaoxia

    2017-12-29

    Different confounder adjustment strategies were used to estimate odds ratios (ORs) in case-control study, i.e. how many confounders original studies adjusted and what the variables are. This secondary data analysis is aimed to detect whether there are potential biases caused by difference of confounding factor adjustment strategies in case-control study, and whether such bias would impact the summary effect size of meta-analysis. We included all meta-analyses that focused on the association between breast cancer and passive smoking among non-smoking women, as well as each original case-control studies included in these meta-analyses. The relative deviations (RDs) of each original study were calculated to detect how magnitude the adjustment would impact the estimation of ORs, compared with crude ORs. At the same time, a scatter diagram was sketched to describe the distribution of adjusted ORs with different number of adjusted confounders. Substantial inconsistency existed in meta-analysis of case-control studies, which would influence the precision of the summary effect size. First, mixed unadjusted and adjusted ORs were used to combine individual OR in majority of meta-analysis. Second, original studies with different adjustment strategies of confounders were combined, i.e. the number of adjusted confounders and different factors being adjusted in each original study. Third, adjustment did not make the effect size of original studies trend to constringency, which suggested that model fitting might have failed to correct the systematic error caused by confounding. The heterogeneity of confounder adjustment strategies in case-control studies may lead to further bias for summary effect size in meta-analyses, especially for weak or medium associations so that the direction of causal inference would be even reversed. Therefore, further methodological researches are needed, referring to the assessment of confounder adjustment strategies, as well as how to take this kind

  10. Comparing colon cancer outcomes: The impact of low hospital case volume and case-mix adjustment.

    PubMed

    Fischer, C; Lingsma, H F; van Leersum, N; Tollenaar, R A E M; Wouters, M W; Steyerberg, E W

    2015-08-01

    When comparing performance across hospitals it is essential to consider the noise caused by low hospital case volume and to perform adequate case-mix adjustment. We aimed to quantify the role of noise and case-mix adjustment on standardized postoperative mortality and anastomotic leakage (AL) rates. We studied 13,120 patients who underwent colon cancer resection in 85 Dutch hospitals. We addressed differences between hospitals in postoperative mortality and AL, using fixed (ignoring noise) and random effects (incorporating noise) logistic regression models with general and additional, disease specific, case-mix adjustment. Adding disease specific variables improved the performance of the case-mix adjustment models for postoperative mortality (c-statistic increased from 0.77 to 0.81). The overall variation in standardized mortality ratios was similar, but some individual hospitals changed considerably. For the standardized AL rates the performance of the adjustment models was poor (c-statistic 0.59 and 0.60) and overall variation was small. Most of the observed variation between hospitals was actually noise. Noise had a larger effect on hospital performance than extended case-mix adjustment, although some individual hospital outcome rates were affected by more detailed case-mix adjustment. To compare outcomes between hospitals it is crucial to consider noise due to low hospital case volume with a random effects model. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Parental bonding in males with adjustment disorder and hyperventilation syndrome.

    PubMed

    Lung, For-Wey; Lee, Ting-Hsuan; Huang, Mei-Feng

    2012-06-06

    The purpose of the study was to identify the style of parental bonding and the personality characteristics that might increase the risk of hyperventilation and adjustment disorder. A total of 917 males were recruited, 156 with adjustment disorder and hyperventilation syndrome (AD + HY), 273 with adjustment disorder without hyperventilation syndrome (AD-HY), and 488 healthy controls. All participants completed the Parental Bonding Instrument, Eysenck Personality Questionnaire, and Chinese Health Questionnaire. Analysis using structural equation models identified a pathway relationship in which parental bonding affected personality characteristics, personality characteristics affected mental health condition, and mental health condition affected the development of hyperventilation or adjustment disorder. Males with AD-HY perceived less paternal care, and those with AD + HY perceived more maternal protection than those with adjustment disorder and those in the control group. Participants with AD-HY were more neurotic and less extroverted than those with AD + HY. Both groups showed poorer mental health than the controls. Although some patients with hyperventilation syndrome demonstrated symptoms of adjustment disorder, there were different predisposing factors between the two groups in terms of parental bonding and personality characteristics. This finding is important for the early intervention and prevention of hyperventilation and adjustment disorder.

  12. Seasonal Influenza Forecasting in Real Time Using the Incidence Decay With Exponential Adjustment Model.

    PubMed

    Nasserie, Tahmina; Tuite, Ashleigh R; Whitmore, Lindsay; Hatchette, Todd; Drews, Steven J; Peci, Adriana; Kwong, Jeffrey C; Friedman, Dara; Garber, Gary; Gubbay, Jonathan; Fisman, David N

    2017-01-01

    Seasonal influenza epidemics occur frequently. Rapid characterization of seasonal dynamics and forecasting of epidemic peaks and final sizes could help support real-time decision-making related to vaccination and other control measures. Real-time forecasting remains challenging. We used the previously described "incidence decay with exponential adjustment" (IDEA) model, a 2-parameter phenomenological model, to evaluate the characteristics of the 2015-2016 influenza season in 4 Canadian jurisdictions: the Provinces of Alberta, Nova Scotia and Ontario, and the City of Ottawa. Model fits were updated weekly with receipt of incident virologically confirmed case counts. Best-fit models were used to project seasonal influenza peaks and epidemic final sizes. The 2015-2016 influenza season was mild and late-peaking. Parameter estimates generated through fitting were consistent in the 2 largest jurisdictions (Ontario and Alberta) and with pooled data including Nova Scotia counts (R 0 approximately 1.4 for all fits). Lower R 0 estimates were generated in Nova Scotia and Ottawa. Final size projections that made use of complete time series were accurate to within 6% of true final sizes, but final size was using pre-peak data. Projections of epidemic peaks stabilized before the true epidemic peak, but these were persistently early (~2 weeks) relative to the true peak. A simple, 2-parameter influenza model provided reasonably accurate real-time projections of influenza seasonal dynamics in an atypically late, mild influenza season. Challenges are similar to those seen with more complex forecasting methodologies. Future work includes identification of seasonal characteristics associated with variability in model performance.

  13. CATS EYES Adjustment Procedures

    DTIC Science & Technology

    1993-04-01

    AL-TR-1 993-0025 AD-A264 069 CATS EYES ADJUSTMENT PROCEDURES A R M Joseph C. Antonio DTIC S ELECTET University of Dayton Research Institute MAY 13...Final November 1992 - January 1993 4. TITLE AND SUBTITLE S. FUNDING NUMBERS C F33615-90-C-0005 CATS EYES Adjustment Procedures PE - 62205F 6. AUTHOR(S) PR...the loss of NVG performance resulting from improper goggle adjustments. This report describes correct adjustment procedures for the CATS EYES NVG system

  14. Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas

    PubMed Central

    Ellis, Randall P.; Fernandez, Juan Gabriel

    2013-01-01

    Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting, regulations, and diverse selection problems that risk adjustment is intended to fix. Perhaps because of this, the existing literature and their recommendations for optimal risk adjustment or optimal payment systems are sometimes confusing. In this paper, we present a unified way of thinking about the organizational structure of health care systems, which enables us to focus on two key dimensions of markets that have received less attention: what choices are available that may lead to selection problems, and what financial or regulatory tools other than risk adjustment are used to influence these choices. We specifically examine the health care systems, choices, and problems in four countries: the US, Canada, Chile, and Colombia, and examine the relationship between selection-related efficiency and fairness problems and the choices that are allowed in each country, and discuss recent regulatory reforms that affect choices and selection problems. In this sample, countries and insurance programs with more choices have more selection problems. PMID:24284351

  15. A statistical adjustment approach for climate projections of snow conditions in mountain regions using energy balance land surface models

    NASA Astrophysics Data System (ADS)

    Verfaillie, Deborah; Déqué, Michel; Morin, Samuel; Lafaysse, Matthieu

    2017-04-01

    Projections of future climate change have been increasingly called for lately, as the reality of climate change has been gradually accepted and societies and governments have started to plan upcoming mitigation and adaptation policies. In mountain regions such as the Alps or the Pyrenees, where winter tourism and hydropower production are large contributors to the regional revenue, particular attention is brought to current and future snow availability. The question of the vulnerability of mountain ecosystems as well as the occurrence of climate-related hazards such as avalanches and debris-flows is also under consideration. In order to generate projections of snow conditions, however, downscaling global climate models (GCMs) by using regional climate models (RCMs) is not sufficient to capture the fine-scale processes and thresholds at play. In particular, the altitudinal resolution matters, since the phase of precipitation is mainly controlled by the temperature which is altitude-dependent. Simulations from GCMs and RCMs moreover suffer from biases compared to local observations, due to their rather coarse spatial and altitudinal resolution, and often provide outputs at too coarse time resolution to drive impact models. RCM simulations must therefore be adjusted using empirical-statistical downscaling and error correction methods, before they can be used to drive specific models such as energy balance land surface models. In this study, time series of hourly temperature, precipitation, wind speed, humidity, and short- and longwave radiation were generated over the Pyrenees and the French Alps for the period 1950-2100, by using a new approach (named ADAMONT for ADjustment of RCM outputs to MOuNTain regions) based on quantile mapping applied to daily data, followed by time disaggregation accounting for weather patterns selection. We first introduce a thorough evaluation of the method using using model runs from the ALADIN RCM driven by a global reanalysis over the

  16. Mexican-origin parents' work conditions and adolescents' adjustment.

    PubMed

    Wheeler, Lorey A; Updegraff, Kimberly A; Crouter, Ann

    2015-06-01

    Mexican-origin parents' work experiences are a distal extrafamilial context for adolescents' adjustment. This 2-wave multiinformant study examined the prospective mechanisms linking parents' work conditions (i.e., self-direction, work pressure, workplace discrimination) to adolescents' adjustment (i.e., educational expectations, depressive symptoms, risky behavior) across the transition to high school drawing on work socialization and spillover models. We examined the indirect effects of parental work conditions on adolescent adjustment through parents' psychological functioning (i.e., depressive symptoms, role overload) and aspects of the parent-adolescent relationship (i.e., parental solicitation, parent-adolescent conflict), as well as moderation by adolescent gender. Participants were 246 predominantly immigrant, Mexican-origin, 2-parent families who participated in home interviews when adolescents were approximately 13 and 15 years of age. Results supported the positive impact of fathers' occupational self-direction on all 3 aspects of adolescents' adjustment through decreased father-adolescent conflict, after controlling for family socioeconomic status and earner status, and underemployment. Parental work pressure and discrimination were indirectly linked to adolescents' adjustment, with different mechanisms emerging for mothers and fathers. Adolescents' gender moderated the associations between fathers' self-direction and girls' depressive symptoms, and fathers' experiences of discrimination and boys' risk behavior. Results suggest that Mexican-origin mothers' and fathers' perceptions of work conditions have important implications for multiple domains of adolescents' adjustment across the transition to high school. (c) 2015 APA, all rights reserved).

  17. Genetic value of herd life adjusted for milk production.

    PubMed

    Allaire, F R; Gibson, J P

    1992-05-01

    Cow herd life adjusted for lactational milk production was investigated as a genetic trait in the breeding objective. Under a simple model, the relative economic weight of milk to adjusted herd life on a per genetic standard deviation basis was equal to CVY/dCVL where CVY and CVL are the genetic coefficients of variation of milk production and adjusted herd life, respectively, and d is the depreciation per year per cow divided by the total fixed costs per year per cow. The relative economic value of milk to adjusted herd life at the prices and parameters for North America was about 3.2. An increase of 100-kg milk was equivalent to 2.2 mo of adjusted herd life. Three to 7% lower economic gain is expected when only improved milk production is sought compared with a breeding objective that included both production and adjusted herd life for relative value changed +/- 20%. A favorable economic gain to cost ratio probably exists for herd life used as a genetic trait to supplement milk in the breeding objective. Cow survival records are inexpensive, and herd life evaluations from such records may not extend the generation interval when such an evaluation is used in bull sire selection.

  18. Cross-Cultural Adjustment of Chinese Students in Japan: School Adjustment and Educational Support

    ERIC Educational Resources Information Center

    Li, Yuan Xiang; Sano, Hideki; Ahn, Ruth

    2013-01-01

    This study investigates Chinese immigrant students' cross-cultural and school adjustment issues in Japanese schools. Using a quantitative method, a survey which collected students' demographic information, cross-cultural adjustment, and school adjustment questions was administered to 143 Chinese junior high and high school students in Tokyo and…

  19. Conclusion

    NASA Technical Reports Server (NTRS)

    Arnold, Steven M.; Wong, Terry T.

    2011-01-01

    This compilation of papers in this book represents approximately half of the works discussed at the MS&T 2010 symposium entitled Tools, Models, Databases, and Simulation Tools Developed and Needed to Realize the Vision of Integrated Computational Materials Engineering at Materials Science & Technology wherein five sessions comprised of 33 presentations was organized. The goal of the symposium was two fold To provide a forum in which current state-of-the-art methods for ICME (e.g., information informatics, experimentation, and modeling) could be openly discussed and critiqued by not only materials scientist but also structural engineers/researchers, component designers, industrial leaders and government program managers. To leave the symposium and in particular the panel discussion with a clear idea of the gaps and barriers (both technical, cultural and economical) that must be addressed in order for ICME to fully succeed. The organizers felt that these goals were met, as particularly evident by the standing room only attendance during a lively panel discussion session at the end of the Symposium. However it is the firm belief of the editors of this book that this symposium was merely a start in the right direction, and that subsequent conferences/symposium (e.g., First World Congress on Integrated Computational Materials Engineering to be held July 10-14, 2011 at Seven Springs Mountain Resort in Pennsylvania) must work hard to ensure that a truly diverse, multidisciplinary, community of researchers and practitioners are present and have ample opportunity for interaction. This will ensure that a proper balance between push and pull disciplines and technologies is maintained so that this emerging focus area, Integrated Computational Materials Engineering (ICME), has the greatest potential for success and impact on "system-level" payoffs. Similarly, a pro-active approach is required to reform historical modes of operation in industry, government and the academic

  20. Social Constraints are Associated with Negative Psychological and Physical Adjustment in Bereavement.

    PubMed

    Juth, Vanessa; Smyth, Joshua M; Carey, Michael P; Lepore, Stephen J

    2015-07-01

    Losing a loved one is a normative life event, yet there is great variability in subsequent interpersonal experiences and adjustment. The Social-Cognitive Processing (SCP) model suggests that social constraints (i.e. limited opportunities to disclose thoughts and feelings in a supportive context) impede emotional and cognitive processing of stressful life events, which may lead to maladjustment. This study investigates personal and loss-related correlates of social constraints during bereavement, the links between social constraints and post-loss adjustment, and whether social constraints moderate the relations between loss-related intrusive thoughts and adjustment. A community sample of bereaved individuals (n = 238) provided demographic and loss-related information and reported on their social constraints, loss-related intrusions, and psychological and physical adjustment. Women, younger people, and those with greater financial concerns reported more social constraints. Social constraints were significantly associated with more depressive symptoms, perceived stress, somatic symptoms, and worse global health. Individuals with high social constraints and high loss-related intrusions had the highest depressive symptoms and perceived life stress. Consistent with the SCP model, loss-related social constraints are associated with poorer adjustment, especially psychological adjustment. In particular, experiencing social constraints in conjunction with loss-related intrusions may heighten the risk for poor psychological health. © 2015 The International Association of Applied Psychology.

  1. The influence of pelvic adjustment on vertical jump height in female university students with functional leg length inequality.

    PubMed

    Gong, Wontae

    2015-01-01

    [Purpose] This study aimed to investigate the effect of pelvic adjustment on vertical jump height (VJH) in female university students with functional leg length inequality (FLLI). [Subjects] Thirty female university students with FLLI were divided into a pelvic adjustment group (n = 15) and a stretching (control) group (n = 15). [Methods] VJH was measured using an OptoGait. [Results] After the intervention, jump height improved significantly compared with the pre-intervention height only in the pelvic adjustment group, while FLLI showed statistically significant improvement in both groups. [Conclusion] Pelvic adjustment as per the Gonstead method can be applied as a method of reducing FLLI and increasing VJH.

  2. Cross-cultural adjustment to the United States: the role of contextualized extraversion change

    PubMed Central

    Liu, Mengqiao; Huang, Jason L.

    2015-01-01

    Personality traits can predict how well-sojourners and expatriates adjust to new cultures, but the adjustment process remains largely unexamined. Based on recent findings that reveal personality traits predict as well as respond to life events and experiences, this research focuses on within-person change in contextualized extraversion and its predictive validity for cross-cultural adjustment in international students who newly arrived in US colleges. We proposed that the initial level as well as the rate of change in school extraversion (i.e., contextualized extraversion that reflects behavioral tendency in school settings) will predict cross-cultural adjustment, withdrawal cognitions, and school satisfaction. Latent growth modeling of three-wave longitudinal surveys of 215 new international students (54% female, Mage = 24 years) revealed that the initial level of school extraversion significantly predicted cross-cultural adjustment, (lower) withdrawal cognitions, and satisfaction, while the rate of change (increase) in school extraversion predicted cross-cultural adjustment and (lower) withdrawal cognitions. We further modeled global extraversion and cross-cultural motivation as antecedents and explored within-person change in school extraversion as a proximal factor that affects adjustment outcomes. The findings highlight the malleability of contextualized personality, and more importantly, the importance of understanding within-person change in contextualized personality in a cross-cultural adjustment context. The study points to more research that explicate the process of personality change in other contexts. PMID:26579033

  3. Cross-cultural adjustment to the United States: the role of contextualized extraversion change.

    PubMed

    Liu, Mengqiao; Huang, Jason L

    2015-01-01

    Personality traits can predict how well-sojourners and expatriates adjust to new cultures, but the adjustment process remains largely unexamined. Based on recent findings that reveal personality traits predict as well as respond to life events and experiences, this research focuses on within-person change in contextualized extraversion and its predictive validity for cross-cultural adjustment in international students who newly arrived in US colleges. We proposed that the initial level as well as the rate of change in school extraversion (i.e., contextualized extraversion that reflects behavioral tendency in school settings) will predict cross-cultural adjustment, withdrawal cognitions, and school satisfaction. Latent growth modeling of three-wave longitudinal surveys of 215 new international students (54% female, M age = 24 years) revealed that the initial level of school extraversion significantly predicted cross-cultural adjustment, (lower) withdrawal cognitions, and satisfaction, while the rate of change (increase) in school extraversion predicted cross-cultural adjustment and (lower) withdrawal cognitions. We further modeled global extraversion and cross-cultural motivation as antecedents and explored within-person change in school extraversion as a proximal factor that affects adjustment outcomes. The findings highlight the malleability of contextualized personality, and more importantly, the importance of understanding within-person change in contextualized personality in a cross-cultural adjustment context. The study points to more research that explicate the process of personality change in other contexts.

  4. A field intervention examining the impact of an office ergonomics training and a highly adjustable chair on visual symptoms in a public sector organization

    PubMed Central

    Amick, Benjamin C.; Menéndez, Cammie Chaumont; Bazzani, Lianna; Robertson, Michelle; DeRango, Kelly; Rooney, Ted; Moore, Anne

    2016-01-01

    Objective Examine the effect of a multi-component office ergonomics intervention on visual symptom reductions. Methods Office workers were assigned to either a group receiving a highly adjustable chair with office ergonomics training (CWT), a training-only group (TO) or a control group (C). A work environment and health questionnaire was administered 2 and 1 month(s) pre-intervention and 3, 6, and 12 months post-intervention. Multi-level statistical models tested hypotheses. Results The CWT intervention lowered daily visual symptoms (p < 0.01) post-intervention. The TO group did not significantly differ from the control group. The CWT group differed significantly from the TO group (p = 0.01) post-intervention. Conclusion Workers who received a highly adjustable chair and office ergonomics training had reduced visual symptoms and the effect was maintained through twelve months post-intervention. The lack of a training-only group effect supports implementing training in conjunction with the highly adjustable chair to reduce visual symptoms. PMID:21963250

  5. Bayesian effect estimation accounting for adjustment uncertainty.

    PubMed

    Wang, Chi; Parmigiani, Giovanni; Dominici, Francesca

    2012-09-01

    Model-based estimation of the effect of an exposure on an outcome is generally sensitive to the choice of which confounding factors are included in the model. We propose a new approach, which we call Bayesian adjustment for confounding (BAC), to estimate the effect of an exposure of interest on the outcome, while accounting for the uncertainty in the choice of confounders. Our approach is based on specifying two models: (1) the outcome as a function of the exposure and the potential confounders (the outcome model); and (2) the exposure as a function of the potential confounders (the exposure model). We consider Bayesian variable selection on both models and link the two by introducing a dependence parameter, ω, denoting the prior odds of including a predictor in the outcome model, given that the same predictor is in the exposure model. In the absence of dependence (ω= 1), BAC reduces to traditional Bayesian model averaging (BMA). In simulation studies, we show that BAC, with ω > 1, estimates the exposure effect with smaller bias than traditional BMA, and improved coverage. We, then, compare BAC, a recent approach of Crainiceanu, Dominici, and Parmigiani (2008, Biometrika 95, 635-651), and traditional BMA in a time series data set of hospital admissions, air pollution levels, and weather variables in Nassau, NY for the period 1999-2005. Using each approach, we estimate the short-term effects of on emergency admissions for cardiovascular diseases, accounting for confounding. This application illustrates the potentially significant pitfalls of misusing variable selection methods in the context of adjustment uncertainty. © 2012, The International Biometric Society.

  6. SLIT ADJUSTMENT CLAMP

    DOEpatents

    McKenzie, K.R.

    1959-07-01

    An electrode support which permits accurate alignment and adjustment of the electrode in a plurality of planes and about a plurality of axes in a calutron is described. The support will align the slits in the electrode with the slits of an ionizing chamber so as to provide for the egress of ions. The support comprises an insulator, a leveling plate carried by the insulator and having diametrically opposed attaching screws screwed to the plate and the insulator and diametrically opposed adjusting screws for bearing against the insulator, and an electrode associated with the plate for adjustment therewith.

  7. Age adjustment in ecological studies: using a study on arsenic ingestion and bladder cancer as an example.

    PubMed

    Guo, How-Ran

    2011-10-20

    Despite its limitations, ecological study design is widely applied in epidemiology. In most cases, adjustment for age is necessary, but different methods may lead to different conclusions. To compare three methods of age adjustment, a study on the associations between arsenic in drinking water and incidence of bladder cancer in 243 townships in Taiwan was used as an example. A total of 3068 cases of bladder cancer, including 2276 men and 792 women, were identified during a ten-year study period in the study townships. Three methods were applied to analyze the same data set on the ten-year study period. The first (Direct Method) applied direct standardization to obtain standardized incidence rate and then used it as the dependent variable in the regression analysis. The second (Indirect Method) applied indirect standardization to obtain standardized incidence ratio and then used it as the dependent variable in the regression analysis instead. The third (Variable Method) used proportions of residents in different age groups as a part of the independent variables in the multiple regression models. All three methods showed a statistically significant positive association between arsenic exposure above 0.64 mg/L and incidence of bladder cancer in men and women, but different results were observed for the other exposure categories. In addition, the risk estimates obtained by different methods for the same exposure category were all different. Using an empirical example, the current study confirmed the argument made by other researchers previously that whereas the three different methods of age adjustment may lead to different conclusions, only the third approach can obtain unbiased estimates of the risks. The third method can also generate estimates of the risk associated with each age group, but the other two are unable to evaluate the effects of age directly.

  8. Summary and conclusions [Chapter 11

    Treesearch

    Daniel G. Neary; John N. Rinne; Alvin L. Medina

    2012-01-01

    Summaries and conclusions of each chapter are compiled here to provide a “Quick Reference” guide of major results and recommendations for the UVR. More detail can be obtained from individual chapters.

  9. Accuracy Validation of Large-scale Block Adjustment without Control of ZY3 Images over China

    NASA Astrophysics Data System (ADS)

    Yang, Bo

    2016-06-01

    Mapping from optical satellite images without ground control is one of the goals of photogrammetry. Using 8802 three linear array stereo images (a total of 26406 images) of ZY3 over China, we propose a large-scale and non-control block adjustment method of optical satellite images based on the RPC model, in which a single image is regarded as an adjustment unit to be organized. To overcome the block distortion caused by unstable adjustment without ground control and the excessive accumulation of errors, we use virtual control points created by the initial RPC model of the images as the weighted observations and add them into the adjustment model to refine the adjustment. We use 8000 uniformly distributed high precision check points to evaluate the geometric accuracy of the DOM (Digital Ortho Model) and DSM (Digital Surface Model) production, for which the standard deviations of plane and elevation are 3.6 m and 4.2 m respectively. The geometric accuracy is consistent across the whole block and the mosaic accuracy of neighboring DOM is within a pixel, thus, the seamless mosaic could take place. This method achieves the goal of an accuracy of mapping without ground control better than 5 m for the whole China from ZY3 satellite images.

  10. Applying the Transactional Stress and Coping Model to Sickle Cell Disorder and Insulin-Dependent Diabetes Mellitus: Identifying Psychosocial Variables Related to Adjustment and Intervention

    ERIC Educational Resources Information Center

    Hocking, Matthew C.; Lochman, John E.

    2005-01-01

    This review paper examines the literature on psychosocial factors associated with adjustment to sickle cell disease and insulin-dependent diabetes mellitus in children through the framework of the transactional stress and coping (TSC) model. The transactional stress and coping model views adaptation to a childhood chronic illness as mediated by…

  11. Probing the big five in adolescence: personality and adjustment during a developmental transition.

    PubMed

    Graziano, W G; Ward, D

    1992-06-01

    The present study probed the links among Big Five personality differences, self-reported personality differences, and adjustment to school among young adolescents. We used a multimethod converging analysis, with three sources of data: (a) adolescent self-report on standardized personality inventories; (b) classroom teacher trait ratings and evaluations of adjustment; and (c) school guidance counselor evaluations of adjustment. Evaluations of adolescent adjustment were systematically related to Big Five personality differences, as assessed by both classroom teachers' and school counselors' ratings. For classroom teachers, adjustment was closely related to evaluations on the Big Five dimension of Conscientiousness. Adolescent self-report on several standardized measures was not related to adult evaluation of school adjustment. We suggest that the five-factor model may be a useful tool for probing adjustment during the transition to adolescence.

  12. The social psychology of seismic hazard adjustment: re-evaluating the international literature

    NASA Astrophysics Data System (ADS)

    Solberg, C.; Rossetto, T.; Joffe, H.

    2010-08-01

    The majority of people at risk from earthquakes do little or nothing to reduce their vulnerability. Over the past 40 years social scientists have tried to predict and explain levels of seismic hazard adjustment using models from behavioural sciences such as psychology. The present paper is the first to synthesise the major findings from the international literature on psychological correlates and causes of seismic adjustment at the level of the individual and the household. It starts by reviewing research on seismic risk perception. Next, it looks at norms and normative beliefs, focusing particularly on issues of earthquake protection responsibility and trust between risk stakeholders. It then considers research on attitudes towards seismic adjustment attributes, specifically beliefs about efficacy, control and fate. It concludes that an updated model of seismic adjustment must give the issues of norms, trust, power and identity a more prominent role. These have been only sparsely represented in the social psychological literature to date.

  13. Adaptively Adjusted Event-Triggering Mechanism on Fault Detection for Networked Control Systems.

    PubMed

    Wang, Yu-Long; Lim, Cheng-Chew; Shi, Peng

    2016-12-08

    This paper studies the problem of adaptively adjusted event-triggering mechanism-based fault detection for a class of discrete-time networked control system (NCS) with applications to aircraft dynamics. By taking into account the fault occurrence detection progress and the fault occurrence probability, and introducing an adaptively adjusted event-triggering parameter, a novel event-triggering mechanism is proposed to achieve the efficient utilization of the communication network bandwidth. Both the sensor-to-control station and the control station-to-actuator network-induced delays are taken into account. The event-triggered sensor and the event-triggered control station are utilized simultaneously to establish new network-based closed-loop models for the NCS subject to faults. Based on the established models, the event-triggered simultaneous design of fault detection filter (FDF) and controller is presented. A new algorithm for handling the adaptively adjusted event-triggering parameter is proposed. Performance analysis verifies the effectiveness of the adaptively adjusted event-triggering mechanism, and the simultaneous design of FDF and controller.

  14. A Test of the Family Stress Model on Toddler-Aged Children's Adjustment among Hurricane Katrina Impacted and Nonimpacted Low-Income Families

    ERIC Educational Resources Information Center

    Scaramella, Laura V.; Sohr-Preston, Sara L.; Callahan, Kristin L.; Mirabile, Scott P.

    2008-01-01

    Hurricane Katrina dramatically altered the level of social and environmental stressors for the residents of the New Orleans area. The Family Stress Model describes a process whereby felt financial strain undermines parents' mental health, the quality of family relationships, and child adjustment. Our study considered the extent to which the Family…

  15. The combined geodetic network adjusted on the reference ellipsoid - a comparison of three functional models for GNSS observations

    NASA Astrophysics Data System (ADS)

    Kadaj, Roman

    2016-12-01

    The adjustment problem of the so-called combined (hybrid, integrated) network created with GNSS vectors and terrestrial observations has been the subject of many theoretical and applied works. The network adjustment in various mathematical spaces was considered: in the Cartesian geocentric system on a reference ellipsoid and on a mapping plane. For practical reasons, it often takes a geodetic coordinate system associated with the reference ellipsoid. In this case, the Cartesian GNSS vectors are converted, for example, into geodesic parameters (azimuth and length) on the ellipsoid, but the simple form of converted pseudo-observations are the direct differences of the geodetic coordinates. Unfortunately, such an approach may be essentially distorted by a systematic error resulting from the position error of the GNSS vector, before its projection on the ellipsoid surface. In this paper, an analysis of the impact of this error on the determined measures of geometric ellipsoid elements, including the differences of geodetic coordinates or geodesic parameters is presented. Assuming that the adjustment of a combined network on the ellipsoid shows that the optimal functional approach in relation to the satellite observation, is to create the observational equations directly for the original GNSS Cartesian vector components, writing them directly as a function of the geodetic coordinates (in numerical applications, we use the linearized forms of observational equations with explicitly specified coefficients). While retaining the original character of the Cartesian vector, one avoids any systematic errors that may occur in the conversion of the original GNSS vectors to ellipsoid elements, for example the vector of the geodesic parameters. The problem is theoretically developed and numerically tested. An example of the adjustment of a subnet loaded from the database of reference stations of the ASG-EUPOS system was considered for the preferred functional model of the GNSS

  16. Divorce Stress and Adjustment Model: Locus of Control and Demographic Predictors.

    ERIC Educational Resources Information Center

    Barnet, Helen Smith

    This study depicts the divorce process over three time periods: predivorce decision phase, divorce proper, and postdivorce. Research has suggested that persons with a more internal locus of control experience less intense and shorter intervals of stress during the divorce proper and better postdivorce adjustment than do persons with a more…

  17. Nonlinear Theory of The Geostrophic Adjustment

    NASA Astrophysics Data System (ADS)

    Zeitlin, V.

    Nonlinear geostrophic adjustment and splitting of the fast and slow dynamical vari- ables are analysed in the framework of multi-layer and continuously stratified prim- itive equations by means of the multi-scale perturbation theory in the Rossby num- ber applied to localized initial disturbances. Two basic dynamical regimes: the quasi- geostrophic (QG) and the frontal geostrophic (FG) with small and large deviations of the isopycnal surfaces, respectively, are considered and differences in corresponding adjustment scenarios are displayed. Decoupling of the fast component of the flow is proven up to the third order in Rossby number and long-time corrections to the stan- dard balanced QG and FG models are found. Peculiarities of splitting in the FG regime due to the quasi-inertial oscillations are displayed and a Schrodinger-like modulation equations for the envelope of these latter are derived.

  18. Adjusting for overdispersion in piecewise exponential regression models to estimate excess mortality rate in population-based research.

    PubMed

    Luque-Fernandez, Miguel Angel; Belot, Aurélien; Quaresma, Manuela; Maringe, Camille; Coleman, Michel P; Rachet, Bernard

    2016-10-01

    In population-based cancer research, piecewise exponential regression models are used to derive adjusted estimates of excess mortality due to cancer using the Poisson generalized linear modelling framework. However, the assumption that the conditional mean and variance of the rate parameter given the set of covariates x i are equal is strong and may fail to account for overdispersion given the variability of the rate parameter (the variance exceeds the mean). Using an empirical example, we aimed to describe simple methods to test and correct for overdispersion. We used a regression-based score test for overdispersion under the relative survival framework and proposed different approaches to correct for overdispersion including a quasi-likelihood, robust standard errors estimation, negative binomial regression and flexible piecewise modelling. All piecewise exponential regression models showed the presence of significant inherent overdispersion (p-value <0.001). However, the flexible piecewise exponential model showed the smallest overdispersion parameter (3.2 versus 21.3) for non-flexible piecewise exponential models. We showed that there were no major differences between methods. However, using a flexible piecewise regression modelling, with either a quasi-likelihood or robust standard errors, was the best approach as it deals with both, overdispersion due to model misspecification and true or inherent overdispersion.

  19. Uranium Associations with Kidney Outcomes Vary by Urine Concentration Adjustment Method

    PubMed Central

    Shelley, Rebecca; Kim, Nam-Soo; Parsons, Patrick J.; Lee, Byung-Kook; Agnew, Jacqueline; Jaar, Bernard G.; Steuerwald, Amy J.; Matanoski, Genevieve; Fadrowski, Jeffrey; Schwartz, Brian S.; Todd, Andrew C.; Simon, David; Weaver, Virginia M.

    2017-01-01

    Uranium is a ubiquitous metal that is nephrotoxic at high doses. Few epidemiologic studies have examined the kidney filtration impact of chronic environmental exposure. In 684 lead workers environmentally exposed to uranium, multiple linear regression was used to examine associations of uranium measured in a four-hour urine collection with measured creatinine clearance, serum creatinine- and cystatin-C-based estimated glomerular filtration rates, and N-acetyl-β-D-glucosaminidase (NAG). Three methods were utilized, in separate models, to adjust uranium levels for urine concentration - μg uranium/g creatinine; μg uranium/L and urine creatinine as separate covariates; and μg uranium/4 hr. Median urine uranium levels were 0.07 μg/g creatinine and 0.02 μg/4 hr and were highly correlated (rs =0.95). After adjustment, higher ln-urine uranium was associated with lower measured creatinine clearance and higher NAG in models that used urine creatinine to adjust for urine concentration but not in models that used total uranium excreted (μg/4 hr). These results suggest that, in some instances, associations between urine toxicants and kidney outcomes may be statistical, due to the use of urine creatinine in both exposure and outcome metrics, rather than nephrotoxic. These findings support consideration of non-creatinine-based methods of adjustment for urine concentration in nephrotoxicant research. PMID:23591699

  20. Patterns of Children’s Adrenocortical Reactivity to Interparental Conflict and Associations with Child Adjustment: A Growth Mixture Modeling Approach

    PubMed Central

    Koss, Kalsea J.; George, Melissa R. W.; Davies, Patrick T.; Cicchetti, Dante; Cummings, E. Mark; Sturge-Apple, Melissa L.

    2013-01-01

    Examining children’s physiological functioning is an important direction for understanding the links between interparental conflict and child adjustment. Utilizing growth mixture modeling, the present study examined children’s cortisol reactivity patterns in response to a marital dispute. Analyses revealed three different patterns of cortisol responses, consistent with both a sensitization and an attenuation hypothesis. Child-rearing disagreements and perceived threat were associated with children exhibiting a rising cortisol pattern whereas destructive conflict was related to children displaying a flat pattern. Physiologically rising patterns were also linked with emotional insecurity and internalizing and externalizing behaviors. Results supported a sensitization pattern of responses as maladaptive for children in response to marital conflict with evidence also linking an attenuation pattern with risk. The present study supports children’s adrenocortical functioning as one mechanism through which interparental conflict is related to children’s coping responses and psychological adjustment. PMID:22545835

  1. Synthesis and evaluation of chondroitin sulfate based hydrogels of loxoprofen with adjustable properties as controlled release carriers.

    PubMed

    Khalid, Ikrima; Ahmad, Mahmood; Usman Minhas, Muhammad; Barkat, Kashif

    2018-02-01

    Mixtures of polymer (chondroitin sulfate) and monomer (AMPS) in the presence of co-monomer (MBA) were employed for the production of hydrogels, with adjustable properties, following free radical copolymerization. The hydrogel's structural properties were assessed by FTIR, DSC, TGA, SEM and XRD which confirmed the development and stability of synthesized structure. The results from FTIR analysis showed that CS react with the AMPS monomer during the polymerization process and confirmed the grafting of AMPS chains onto CS backbone. The surface morphology of CS-co-poly(AMPS) hydrogels, as evident by SEM, corresponds to their improved swelling ability due to high porosity. Thermal analysis showed that crosslinking formed a stable hydrogel network which is thermally more stable than its basic ingredients. The effects of pH revealed an increasing trend in swelling with increasing concentration of either CS or AMPS. In addition, different modalities for drug loading were studied with respect to drug homogeneous distribution; loxoprofen sodium was employed as model drug and was loaded by swelling-diffusion method. In vitro drug release profiles and kinetics were assessed to confirm their reproducibility and reliability. Higuchi model is the best fit model to explain drug release from formed gels indicating diffusion-controlled release. Similarly, Korsmeyer-Peppas model yields remarkably good adjustments where release kinetics involves a combination of diffusion in hydrated matrix and polymer relaxation. Conclusively, CS-co-poly(AMPS) hydrogels could be a potential alternate to conventional dosage forms for controlled delivery of loxoprofen sodium for extended period of time. Copyright © 2017. Published by Elsevier Ltd.

  2. Challenging the myths about parents' adjustment after the sudden, violent death of a child.

    PubMed

    Murphy, Shirley A; Johnson, L Clark; Lohan, Janet

    2003-01-01

    To examine three commonly held myths: (a) a child's death by suicide results in the worst parental outcomes compared with other causes of violent death, (b) divorce is not only more common among bereaved than nonbereaved married couples, it might be inevitable, and (c) "letting go and moving on" is an essential bereavement task needed for a satisfactory adjustment following the violent death of a child. Review of empirical evidence and critical reviews, review of Internet resources available to the general public, and the inclusion of original data obtained from a longitudinal, prospective study conducted by the authors. Conclusive evidence was found to dispel two of the three myths, but sufficient evidence was not found to draw conclusions about the third myth regarding parents' adjustment to a child's suicidal death. Myths in regard to parental bereavement are resistant to disconfirming evidence and they appear to persist among professional practitioners and the general public despite contrary empirical evidence.

  3. Nuclear Cataract Shows Significant Familial Aggregation in an Older Population after Adjustment for Possible Shared Environmental Factors

    PubMed Central

    Congdon, Nathan; Broman, Karl W.; Lai, Hong; Munoz, Beatriz; Bowie, Heidi; Gilber, Donna; Wojciechowski, Robert; Alston, Christine; West, Sheila K.

    2011-01-01

    Purpose To quantify the association between siblings in age-related nuclear cataract, after adjusting for known environmental and personal risk factors. Methods All participants (probands) in the Salisbury Eye Evaluation (SEE) project and their locally resident siblings underwent digital slit lamp photography and were administered a questionnaire to assess risk factors for cataract including: age, gender, lifetime sun exposure, smoking and diabetes history, and use of alcohol and medications such as estrogens and steroids. In addition, blood pressure, body mass index, and serum antioxidants were measured in all participants. Lens photographs were graded by trained observers masked to the subjects' identity, using the Wilmer Cataract Grading System. The odds ratio for siblings for affectedness with nuclear cataract and the sibling correlation of nuclear cataract grade, after adjusting for covariates, were estimated with generalized estimating equations. Results Among 307 probands (mean age, 77.6 ± 4.5 years) and 434 full siblings (mean age, 72.4 ± 7.4 years), the average sibship size was 2.7 per family. After adjustment for covariates, the probability of development of nuclear cataract was significantly increased (odds ratio [OR] = 2.07, 95% confidence interval [CI], 1.30–3.30) among individuals with a sibling with nuclear cataract (nuclear grade ≥ 3.0). The final fitted model indicated a magnitude of heritability for nuclear cataract of 35.6% (95% CI: 21.0%–50.3%) after adjustment for the covariates. Conclusions Findings in this study are consistent with a genetic effect for age-related nuclear cataract, a common and clinically significant form of lens opacity. PMID:15223793

  4. Generalized Parameter-Adjusted Stochastic Resonance of Duffing Oscillator and Its Application to Weak-Signal Detection.

    PubMed

    Lai, Zhi-Hui; Leng, Yong-Gang

    2015-08-28

    A two-dimensional Duffing oscillator which can produce stochastic resonance (SR) is studied in this paper. We introduce its SR mechanism and present a generalized parameter-adjusted SR (GPASR) model of this oscillator for the necessity of parameter adjustments. The Kramers rate is chosen as the theoretical basis to establish a judgmental function for judging the occurrence of SR in this model; and to analyze and summarize the parameter-adjusted rules under unmatched signal amplitude, frequency, and/or noise-intensity. Furthermore, we propose the weak-signal detection approach based on this GPASR model. Finally, we employ two practical examples to demonstrate the feasibility of the proposed approach in practical engineering application.

  5. Modeling Fluvial Incision and Transient Landscape Evolution: Influence of Dynamic Channel Adjustment

    NASA Astrophysics Data System (ADS)

    Attal, M.; Tucker, G. E.; Cowie, P. A.; Whittaker, A. C.; Roberts, G. P.

    2007-12-01

    Channel geometry exerts a fundamental control on fluvial processes. Recent work has shown that bedrock channel width (W) depends on a number of parameters, including channel slope, and is not only a function of drainage area (A) as is commonly assumed. The present work represents the first attempt to investigate the consequences, for landscape evolution, of using a static expression of channel width (W ~ A0.5) versus a relationship that allows channels to dynamically adjust to changes in slope. We consider different models for the evolution of the channel geometry, including constant width-to-depth ratio (after Finnegan et al., Geology, v. 33, no. 3, 2005), and width-to-depth ratio varying as a function of slope (after Whittaker et al., Geology, v. 35, no. 2, 2007). We use the Channel-Hillslope Integrated Landscape Development (CHILD) model to analyze the response of a catchment to a given tectonic disturbance. The topography of a catchment in the footwall of an active normal fault in the Apennines (Italy) is used as a template for the study. We show that, for this catchment, the transient response can be fairly well reproduced using a simple detachment-limited fluvial incision law. We also show that, depending on the relationship used to express channel width, initial steady-state topographies differ, as do transient channel width, slope, and the response time of the fluvial system. These differences lead to contrasting landscape morphologies when integrated at the scale of a whole catchment. Our results emphasize the importance of channel width in controlling fluvial processes and landscape evolution. They stress the need for using a dynamic hydraulic scaling law when modeling landscape evolution, particularly when the uplift field is non-uniform.

  6. Response Monitoring and Adjustment: Differential Relations with Psychopathic Traits

    PubMed Central

    Bresin, Konrad; Finy, M. Sima; Sprague, Jenessa; Verona, Edelyn

    2014-01-01

    Studies on the relation between psychopathy and cognitive functioning often show mixed results, partially because different factors of psychopathy have not been considered fully. Based on previous research, we predicted divergent results based on a two-factor model of psychopathy (interpersonal-affective traits and impulsive-antisocial traits). Specifically, we predicted that the unique variance of interpersonal-affective traits would be related to increased monitoring (i.e., error-related negativity) and adjusting to errors (i.e., post-error slowing), whereas impulsive-antisocial traits would be related to reductions in these processes. Three studies using a diverse selection of assessment tools, samples, and methods are presented to identify response monitoring correlates of the two main factors of psychopathy. In Studies 1 (undergraduates), 2 (adolescents), and 3 (offenders), interpersonal-affective traits were related to increased adjustment following errors and, in Study 3, to enhanced monitoring of errors. Impulsive-antisocial traits were not consistently related to error adjustment across the studies, although these traits were related to a deficient monitoring of errors in Study 3. The results may help explain previous mixed findings and advance implications for etiological models of psychopathy. PMID:24933282

  7. Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis

    PubMed Central

    2011-01-01

    Background Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations. Method A total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES). Results Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression. Conclusion There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations. PMID:21854599

  8. Variability in case-mix adjusted in-hospital cardiac arrest rates.

    PubMed

    Merchant, Raina M; Yang, Lin; Becker, Lance B; Berg, Robert A; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G; Mitra, Nandita; Bradley, Steven M; Abella, Benjamin S; Groeneveld, Peter W

    2012-02-01

    It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Adult patients with IHCA. Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; P<0.0001). Case-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

  9. Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey

    PubMed Central

    Paddison, Charlotte; Elliott, Marc; Parker, Richard; Staetsky, Laura; Lyratzopoulos, Georgios; Campbell, John L

    2012-01-01

    Objectives Uncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. Design/setting Secondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects. Main outcome measures Primary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services. Results Depending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors. Conclusions While its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would ‘cream-skim’ by not enrolling patients from vulnerable socio

  10. Differences between evolution of Titan's and Earth's rivers - further conclusions

    NASA Astrophysics Data System (ADS)

    Misiura, Katarzyna; Czechowski, Leszek

    2014-05-01

    Titan is the only celestial body, beside the Earth, where liquid is present on the surface. Liquid forms a number of lakes and rivers. In our research we use numerical model of the river to determine differences of evolution of rivers on the Earth and on Titan. We have found that transport of sediments on Titan is more effective than on Earth for the same river geometry and discharge. We have found also the theoretical explanations for this conclusion. 2.Introduction Titan is a very special body in the Solar System. It is the only moon that has dense atmosphere and flowing liquid on its surface. The Cassini-Huygens mission has found on Titan meandering rivers, and indicated processes of erosion, transport of solid material and its sedimentation. This paper is aimed to investigate the similarity and differences between these processes on Titan and the Earth. 3. Basic equations of our model The dynamical analysis of the considered rivers is performed using the package CCHE modified for the specific conditions on Titan. The package is based on the Navier-Stokes equations for depth-integrated two dimensional, turbulent flow and three dimensional convection-diffusion equation of sediment transport. 4. Parameters of the model We considered our model for a few kinds of liquid found on Titan. The liquid that falls as a rain (75% methane, 25% nitrogen) has different properties than the fluid forming lakes (74% ethane, 10% methane, 7% propane, 8.5% butane, 0.5% nitrogen). Other parameters of our model are: inflow discharge, outflow level, grain size of sediments etc. For every calculation performed for Titan's river similar calculations are performed for terrestrial ones. 5. Results and Conclusions The results of our simulation show the differences in behaviour of the flow and of sedimentation on Titan and on the Earth. Our preliminary results indicate that transport of material by Titan's rivers is more efficient than by terrestrial rivers of the same geometry parameters

  11. Hardiness scales in Iranian managers: evidence of incremental validity in relationships with the five factor model and with organizational and psychological adjustment.

    PubMed

    Ghorbani, Nima; Watson, P J

    2005-06-01

    This study examined the incremental validity of Hardiness scales in a sample of Iranian managers. Along with measures of the Five Factor Model and of Organizational and Psychological Adjustment, Hardiness scales were administered to 159 male managers (M age = 39.9, SD = 7.5) who had worked in their organizations for 7.9 yr. (SD=5.4). Hardiness predicted greater Job Satisfaction, higher Organization-based Self-esteem, and perceptions of the work environment as being less stressful and constraining. Hardiness also correlated positively with Assertiveness, Emotional Stability, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness and negatively with Depression, Anxiety, Perceived Stress, Chance External Control, and a Powerful Others External Control. Evidence of incremental validity was obtained when the Hardiness scales supplemented the Five Factor Model in predicting organizational and psychological adjustment. These data documented the incremental validity of the Hardiness scales in a non-Western sample and thus confirmed once again that Hardiness has a relevance that extends beyond the culture in which it was developed.

  12. HMO penetration, competition, and risk-adjusted hospital mortality.

    PubMed Central

    Mukamel, D B; Zwanziger, J; Tomaszewski, K J

    2001-01-01

    OBJECTIVE: HMOs have been shown to have an effect on the care provided directly to their enrollees. They may also influence the care provided to individuals in fee-for-service plans through a spill-over effect. The objective of this study was to investigate the associations among HMO market penetration, HMO and hospital competition, and the quality of care received by Medicare fee-for-service patients measured by risk-adjusted hospital mortality rates. DATA SOURCES: The 1990 data for 1,927 hospitals in 134 metropolitan statistical areas (with five or more hospitals) included Medicare fee-for-service risk-adjusted mortality rates from the Medicare Hospital Information Reports, hospital characteristics from the American Hospital Association annual survey, and HMO market penetration and competition calculated from InterStudy and Group Health Association of America data. STUDY DESIGN: Statistical regression techniques were used to identify the associations between HMO market penetration, competition, and risk-adjusted mortality, controlling for other hospital characteristics and region. PRINCIPAL FINDINGS: Higher HMO market penetration and to a lesser degree increased HMO competition were associated with better mortality outcomes for fee-for-service Medicare enrollees. Competition between hospitals did not exhibit a significant association. CONCLUSIONS: HMOs may have a spill-over effect on quality of care received by individuals enrolled in fee-for-service plans. These findings may be explained by a positive effect on local practice styles or a preferential selection by HMOs for areas with better hospital care. PMID:11775665

  13. [Remuneration distribution - should morbidity-dependent overall remuneration also be distributed after adjustments for morbidity?].

    PubMed

    Walendzik, A; Trottmann, M; Leonhardt, R; Wasem, J

    2013-04-01

    In the 2009 reform of the German collective remuneration system for outpatient medical care, on the level of overall remuneration, the morbidity risk was transferred to the health funds fulfilling a long-term demand of physicians. Nevertheless not transferring morbidity adjustment to the levels of physician groups and singular practices can lead to budgets not related to patient needs and to incentives for risk selection for individual doctors. The systematics of the distribution of overall remuneration in the German remuneration system for outpatient care are analysed focusing on the aspect of morbidity adjustment. Using diagnostic and pharmaceutical information of about half a million insured subjects, a risk adjustment model able to predict individual expenditures for outpatient care for different provider groups is presented. This model enables to additively split the individual care burden into several parts attributed to different physician groups. Conditions for the use of the model in the distribution of overall remuneration between physician groups are developed. A simulation of the use of diagnoses-based risk adjustment in standard service volumes then highlights the conditions for a successfull installation of standard service volumes representing a higher degree of risk adjustment. The presented estimation model is generally applicable for the distribution of overall remuneration to different physician groups. The simulation of standard service volumes using diagnosis-based risk adjustment does not provide a more accurate prediction of the expenditures on the level of physician practices than the age-related calculation currently used in the German remuneration system for outpatient medical care. Using elements of morbidity-based risk adjustment the current German collective system for outpatient medical care could be transformed towards a higher degree of distributional justice concerning medical care for patients and more appropriate incentives

  14. Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period.

    PubMed

    Whisman, Mark A; Davila, Joanne; Goodman, Sherryl H

    2011-06-01

    The associations between relationship adjustment and symptoms of depression and anxiety were evaluated in a sample of pregnant married or cohabiting women (N = 113) who were at risk for perinatal depression because of a prior history of major depression. Women completed self-report measures of relationship adjustment, depressive symptoms, and anxiety symptoms monthly during pregnancy and for the first six months following the birth of their child. Multilevel modeling was used to examine concurrent and time-lagged within-subjects effects for relationship adjustment and depressive and anxiety symptoms. Results revealed that (a) relationship adjustment was associated with both depressive symptoms and anxiety symptoms in concurrent analyses; (b) relationship adjustment was predictive of subsequent anxiety symptoms but not subsequent depressive symptoms in lagged analyses; and (c) depressive symptoms were predictive of subsequent relationship adjustment in lagged analyses with symptoms of depression and anxiety examined simultaneously. These results support the continued investigation into the cross-sectional and longitudinal associations between relationship functioning and depressive and anxiety symptoms in women during pregnancy and the postpartum period. 2011 APA, all rights reserved

  15. Spiritual Well-Being and Dyadic Adjustment: Mediator Effects for Family Strengths.

    PubMed

    Ghaffari, Majid

    2016-09-01

    The aim of the present study was to test a structural model of hypothesized relationships between spiritual well-being, intervening variables of personal worth of self and others, commitment to relationship stability, commitment to relationship growth, positive interaction/appreciation, communication/conflict resolution, time spent together, and, the dependent variable, dyadic adjustment. Two hundred and sixty eight (171 females and 97 males) married parent subjects were selected by convenience sampling from three universities in Mazandaran, Iran, to take part in this study. They were all volunteers and were not paid and their age range was 23 to 47 (31.07 ± 4.37 years). All participants were asked to complete the spiritual well-being scale (SWBS), family strengths scale (FSS) and revised dyadic adjustment scale (RDAS). The results from structural equation modeling confirmed a hierarchy for the development of family strengths, and indicated that spiritual well-being and strength in most characteristics affected dyadic adjustment, positively (P <0.05). Couples' level of dyadic adjustment is increased when they have higher spiritual well-being, value each other, have commitment to each other, communicate well, enjoy being with each other, and spend time together.

  16. Acculturation and adjustment among immigrant Chinese parents: mediating role of parenting efficacy.

    PubMed

    Costigan, Catherine L; Koryzma, Céline M

    2011-04-01

    This study examined parenting efficacy beliefs as a mediator of the association between acculturation and adjustment. The sample consisted of 177 immigrant Chinese mothers and fathers with early adolescent children in Canada. Acculturation was assessed bidimensionally as Canadian and Chinese orientations. A latent psychological adjustment variable was composed of symptoms of depression, feelings of self-esteem, and life satisfaction. Results showed that relations between Canadian orientation and psychological adjustment were partially mediated by parenting efficacy. As expected, the more parents were oriented toward Canadian culture, the more efficacious they felt in their parenting, which in turn was associated with better psychological adjustment. In contrast, mediation of relations between Chinese orientation and psychological adjustment was not supported, as Chinese orientation was not associated with parenting efficacy and was positively associated with psychological adjustment for mothers only. Similar results were found when the meditational model was extended to evaluate parenting practices as an outcome (i.e., warmth, reasoning, and monitoring). That is, parenting efficacy mediated the relation between higher Canadian orientation and more positive parenting practices, whereas Chinese orientation was unrelated to parenting practices. Invariance testing suggested that the models were similar for mothers and fathers. Results support the theory that higher orientation to Canadian culture may advance feelings of parenting efficacy because parents have the cultural knowledge and skills to feel confident parenting in a new intercultural context. Further, they support the expectation that parenting efficacy beliefs, in turn, are important determinants of psychological adjustment and effective parenting for immigrant parents. 2011 APA, all rights reserved

  17. Examining the Components of Children's Peer Liking as Antecedents of School Adjustment

    ERIC Educational Resources Information Center

    Betts, Lucy R.; Rotenberg, Ken J.; Trueman, Mark; Stiller, James

    2012-01-01

    Children's social interactions with their peers influence their psychosocial adjustment; consequently, the relationship between class-wide peer liking, same-gender peer liking, and school adjustment was explored in two age groups. Peer liking was analysed using the social relations model (SRM). In Study 1, 205 children (103 female and 102 male,…

  18. Nonlinear predictive control for adaptive adjustments of deep brain stimulation parameters in basal ganglia-thalamic network.

    PubMed

    Su, Fei; Wang, Jiang; Niu, Shuangxia; Li, Huiyan; Deng, Bin; Liu, Chen; Wei, Xile

    2018-02-01

    The efficacy of deep brain stimulation (DBS) for Parkinson's disease (PD) depends in part on the post-operative programming of stimulation parameters. Closed-loop stimulation is one method to realize the frequent adjustment of stimulation parameters. This paper introduced the nonlinear predictive control method into the online adjustment of DBS amplitude and frequency. This approach was tested in a computational model of basal ganglia-thalamic network. The autoregressive Volterra model was used to identify the process model based on physiological data. Simulation results illustrated the efficiency of closed-loop stimulation methods (amplitude adjustment and frequency adjustment) in improving the relay reliability of thalamic neurons compared with the PD state. Besides, compared with the 130Hz constant DBS the closed-loop stimulation methods can significantly reduce the energy consumption. Through the analysis of inter-spike-intervals (ISIs) distribution of basal ganglia neurons, the evoked network activity by the closed-loop frequency adjustment stimulation was closer to the normal state. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Using chronic disease risk factors to adjust Medicare capitation payments

    PubMed Central

    Schauffler, Helen Halpin; Howland, Jonathan; Cobb, Janet

    1992-01-01

    This study evaluates the use of risk factors for chronic disease as health status adjusters for Medicare's capitation formula, the average adjusted per capita costs (AAPCC). Risk factor data for the surviving members of the Framingham Study cohort who were examined in 1982-83 were merged with 100 percent Medicare payment data for 1984 and 1985, matching on Social Security number and sex. Seven different AAPCC models were estimated to assess the independent contributions of risk factors and measures of prior utilization and disability in increasing the explanatory power of AAPCC. The findings suggest that inclusion of risk factors for chronic disease as health status adjusters can improve substantially the predictive accuracy of AAPCC. PMID:10124441

  20. 29 CFR 417.12 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Proposed findings and conclusions. 417.12 Section 417.12... findings and conclusions. Within 10 days following the close of hearings, interested persons may submit proposed findings and conclusions to the Administrative Law Judge, together with supporting reasons...

  1. 39 CFR 952.23 - Proposed findings and conclusions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... fact, conclusions of law, orders and supporting reasons either in oral or written form in the... submit proposed findings of fact, conclusions of law, orders, and supporting reasons. Unless given orally, the date set for filing of proposed findings of fact, conclusions of law, orders and supporting...

  2. Effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy

    PubMed Central

    Poudel, Anju

    2016-01-01

    Background Stoma can pose extensive challenges for colorectal cancer survivors. Identifying the psychological and social adjustment among them and how it differs by gender will aid in identifying those particularly at risk of having poor adjustment and in planning programs to improve their adjustment. The purpose of this study was to determine the effect of gender on psychosocial adjustment of colorectal cancer survivors with ostomy. Methods A descriptive cross sectional study was carried out in the stoma clinic of B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal. A purposive sample of 122 patients with ostomy was taken from the above mentioned setting. Selection criteria included colorectal cancer survivors having ostomy for at least 6 months. Data on socio-demographic and clinical variables were collected. Psychosocial adjustment was measured using Ostomy Adjustment Inventory-23 (OAI-23). Results A total of 122 patients were included in the study. Mean time since ostomy surgery was 2.53 and 1.98 years for men and women respectively. Both men and women had significant impairment in the psychosocial adjustment, however, men had significantly lower psychosocial adjustment score (37.68±12.96 vs. 43.45±12.81, t=−2.47, P=0.015) at 95% CI as compared to women and they reported more negative emotions. Furthermore, men significantly predicted low acceptance {β=−3.078, P=0.023, ΔR2=0.036, F [4,117] =7.90, P<0.001} and social engagement score {β=−2.501, P<0.001, ΔR2=0.098, F [4,117] =6.03, P<0.001}. Conclusions Colorectal cancer survivors with ostomy should be monitored for psychosocial concerns in regular basis and health care providers should tailor care based on their need. Approaches of survivorship care and psychosocial interventions in colorectal cancer survivors with ostomy should take into account gender specific concerns and requirements to aid adjustment. PMID:28078117

  3. Risk Adjustment for Medicare Total Knee Arthroplasty Bundled Payments.

    PubMed

    Clement, R Carter; Derman, Peter B; Kheir, Michael M; Soo, Adrianne E; Flynn, David N; Levin, L Scott; Fleisher, Lee

    2016-09-01

    The use of bundled payments is growing because of their potential to align providers and hospitals on the goal of cost reduction. However, such gain sharing could incentivize providers to "cherry-pick" more profitable patients. Risk adjustment can prevent this unintended consequence, yet most bundling programs include minimal adjustment techniques. This study was conducted to determine how bundled payments for total knee arthroplasty (TKA) should be adjusted for risk. The authors collected financial data for all Medicare patients (age≥65 years) undergoing primary unilateral TKA at an academic center over a period of 2 years (n=941). Multivariate regression was performed to assess the effect of patient factors on the costs of acute inpatient care, including unplanned 30-day readmissions. This analysis mirrors a bundling model used in the Medicare Bundled Payments for Care Improvement initiative. Increased age, American Society of Anesthesiologists (ASA) class, and the presence of a Medicare Major Complications/Comorbid Conditions (MCC) modifier (typically representing major complications) were associated with increased costs (regression coefficients, $57 per year; $729 per ASA class beyond I; and $3122 for patients meeting MCC criteria; P=.003, P=.001, and P<.001, respectively). Differences in costs were not associated with body mass index, sex, or race. If the results are generalizable, Medicare bundled payments for TKA encompassing acute inpatient care should be adjusted upward by the stated amounts for older patients, those with elevated ASA class, and patients meeting MCC criteria. This is likely an underestimate for many bundling models, including the Comprehensive Care for Joint Replacement program, incorporating varying degrees of postacute care. Failure to adjust for factors that affect costs may create adverse incentives, creating barriers to care for certain patient populations. [Orthopedics. 2016; 39(5):e911-e916.]. Copyright 2016, SLACK Incorporated.

  4. Evaluating diagnosis-based risk-adjustment methods in a population with spinal cord dysfunction.

    PubMed

    Warner, Grace; Hoenig, Helen; Montez, Maria; Wang, Fei; Rosen, Amy

    2004-02-01

    To examine performance of models in predicting health care utilization for individuals with spinal cord dysfunction. Regression models compared 2 diagnosis-based risk-adjustment methods, the adjusted clinical groups (ACGs) and diagnostic cost groups (DCGs). To improve prediction, we added to our model: (1) spinal cord dysfunction-specific diagnostic information, (2) limitations in self-care function, and (3) both 1 and 2. Models were replicated in 3 populations. Samples from 3 populations: (1) 40% of veterans using Veterans Health Administration services in fiscal year 1997 (FY97) (N=1,046,803), (2) veteran sample with spinal cord dysfunction identified by codes from the International Statistical Classification of Diseases, 9th Revision, Clinical Modifications (N=7666), and (3) veteran sample identified in Veterans Affairs Spinal Cord Dysfunction Registry (N=5888). Not applicable. Inpatient, outpatient, and total days of care in FY97. The DCG models (R(2) range,.22-.38) performed better than ACG models (R(2) range,.04-.34) for all outcomes. Spinal cord dysfunction-specific diagnostic information improved prediction more in the ACG model than in the DCG model (R(2) range for ACG,.14-.34; R(2) range for DCG,.24-.38). Information on self-care function slightly improved performance (R(2) range increased from 0 to.04). The DCG risk-adjustment models predicted health care utilization better than ACG models. ACG model prediction was improved by adding information.

  5. 47 CFR 1.263 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Proposed findings and conclusions. 1.263... Proceedings Hearing and Intermediate Decision § 1.263 Proposed findings and conclusions. (a) Each party to the proceeding may file proposed findings of fact and conclusions, briefs, or memoranda of law: Provided, however...

  6. Evaluating a novel tiered scarcity adjusted water budget and pricing structure using a holistic systems modelling approach.

    PubMed

    Sahin, Oz; Bertone, Edoardo; Beal, Cara; Stewart, Rodney A

    2018-06-01

    Population growth, coupled with declining water availability and changes in climatic conditions underline the need for sustainable and responsive water management instruments. Supply augmentation and demand management are the two main strategies used by water utilities. Water demand management has long been acknowledged as a least-cost strategy to maintain water security. This can be achieved in a variety of ways, including: i) educating consumers to limit their water use; ii) imposing restrictions/penalties; iii) using smart and/or efficient technologies; and iv) pricing mechanisms. Changing water consumption behaviours through pricing or restrictions is challenging as it introduces more social and political issues into the already complex water resources management process. This paper employs a participatory systems modelling approach for: (1) evaluating various forms of a proposed tiered scarcity adjusted water budget and pricing structure, and (2) comparing scenario outcomes against the traditional restriction policy regime. System dynamics modelling was applied since it can explicitly account for the feedbacks, interdependencies, and non-linear relations that inherently characterise the water tariff (price)-demand-revenue system. A combination of empirical water use data, billing data and customer feedback on future projected water bills facilitated the assessment of the suitability and likelihood of the adoption of scarcity-driven tariff options for a medium-sized city within Queensland, Australia. Results showed that the tiered scarcity adjusted water budget and pricing structure presented was preferable to restrictions since it could maintain water security more equitably with the lowest overall long-run marginal cost. Copyright © 2018 Elsevier Ltd. All rights reserved.

  7. A replicated field intervention study evaluating the impact of a highly adjustable chair and office ergonomics training on visual symptoms☆

    PubMed Central

    Menéndez, Cammie Chaumont; Amick, Benjamin C.; Robertson, Michelle; Bazzani, Lianna; DeRango, Kelly; Rooney, Ted; Moore, Anne

    2016-01-01

    Objective Examine the effects of two office ergonomics interventions in reducing visual symptoms at a private sector worksite. Methods A quasi-experimental study design evaluated the effects of a highly adjustable chair with office ergonomics training intervention (CWT group) and the training only (TO group) compared with no intervention (CO group). Data collection occurred 2 and 1 month(s) pre-intervention and 2, 6 and 12 months post-intervention. During each data collection period, a work environment and health questionnaire (covariates) and daily health diary (outcomes) were completed. Multilevel statistical models tested hypotheses. Results Both the training only intervention (p < 0.001) and the chair with training intervention (p = 0.01) reduced visual symptoms after 12 months. Conclusion The office ergonomics training alone and coupled with a highly adjustable chair reduced visual symptoms. In replicating results from a public sector worksite at a private sector worksite the external validity of the interventions is strengthened, thus broadening its generalizability. PMID:22030069

  8. Singularity-sensitive gauge-based radar rainfall adjustment methods for urban hydrological applications

    NASA Astrophysics Data System (ADS)

    Wang, L.-P.; Ochoa-Rodríguez, S.; Onof, C.; Willems, P.

    2015-09-01

    Gauge-based radar rainfall adjustment techniques have been widely used to improve the applicability of radar rainfall estimates to large-scale hydrological modelling. However, their use for urban hydrological applications is limited as they were mostly developed based upon Gaussian approximations and therefore tend to smooth off so-called "singularities" (features of a non-Gaussian field) that can be observed in the fine-scale rainfall structure. Overlooking the singularities could be critical, given that their distribution is highly consistent with that of local extreme magnitudes. This deficiency may cause large errors in the subsequent urban hydrological modelling. To address this limitation and improve the applicability of adjustment techniques at urban scales, a method is proposed herein which incorporates a local singularity analysis into existing adjustment techniques and allows the preservation of the singularity structures throughout the adjustment process. In this paper the proposed singularity analysis is incorporated into the Bayesian merging technique and the performance of the resulting singularity-sensitive method is compared with that of the original Bayesian (non singularity-sensitive) technique and the commonly used mean field bias adjustment. This test is conducted using as case study four storm events observed in the Portobello catchment (53 km2) (Edinburgh, UK) during 2011 and for which radar estimates, dense rain gauge and sewer flow records, as well as a recently calibrated urban drainage model were available. The results suggest that, in general, the proposed singularity-sensitive method can effectively preserve the non-normality in local rainfall structure, while retaining the ability of the original adjustment techniques to generate nearly unbiased estimates. Moreover, the ability of the singularity-sensitive technique to preserve the non-normality in rainfall estimates often leads to better reproduction of the urban drainage system

  9. Adjustable link for kinematic mounting systems

    DOEpatents

    Hale, Layton C.

    1997-01-01

    An adjustable link for kinematic mounting systems. The adjustable link is a low-cost, passive device that provides backlash-free adjustment along its single constraint direction and flexural freedom in all other directions. The adjustable link comprises two spheres, two sockets in which the spheres are adjustable retain, and a connection link threadly connected at each end to the spheres, to provide a single direction of restraint and to adjust the length or distance between the sockets. Six such adjustable links provide for six degrees of freedom for mounting an instrument on a support. The adjustable link has applications in any machine or instrument requiring precision adjustment in six degrees of freedom, isolation from deformations of the supporting platform, and/or additional structural damping. The damping is accomplished by using a hollow connection link that contains an inner rod and a viscoelastic separation layer between the two.

  10. Adjustable link for kinematic mounting systems

    DOEpatents

    Hale, L.C.

    1997-07-01

    An adjustable link for kinematic mounting systems is disclosed. The adjustable link is a low-cost, passive device that provides backlash-free adjustment along its single constraint direction and flexural freedom in all other directions. The adjustable link comprises two spheres, two sockets in which the spheres are adjustable retain, and a connection link threadly connected at each end to the spheres, to provide a single direction of restraint and to adjust the length or distance between the sockets. Six such adjustable links provide for six degrees of freedom for mounting an instrument on a support. The adjustable link has applications in any machine or instrument requiring precision adjustment in six degrees of freedom, isolation from deformations of the supporting platform, and/or additional structural damping. The damping is accomplished by using a hollow connection link that contains an inner rod and a viscoelastic separation layer between the two. 3 figs.

  11. Unmitigated agency, social support, and psychological adjustment in men with cancer.

    PubMed

    Hoyt, Michael A; Stanton, Annette L

    2011-04-01

    Unmitigated agency (UA), a gender-linked characteristic, has been associated with poorer cancer adjustment. Support from one's social network typically predicts adjustment but may be poorly matched to UA. The influence of UA on the utility of social support on adjustment over time is examined. Men with cancer (N=55) were assessed initially and 6 months later on three indicators of adjustment. Multilevel modeling analyses varied by adjustment indicator. UA was associated with increased cancer-related psychosocial symptoms but not depressive symptoms or cancer-related thought intrusion. Social support predicted fewer depressive symptoms and less cancer-related thought intrusion. However, a cross-level interaction revealed that the utility of social support on cancer-related thought intrusion was weaker for men with greater levels of UA. Men with cancer likely respond differently to changes in social support depending on their endorsement of UA. © 2011 The Authors. Journal of Personality © 2011, Wiley Periodicals, Inc.

  12. 10 CFR 2.712 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Proposed findings and conclusions. 2.712 Section 2.712... ORDERS Rules for Formal Adjudications § 2.712 Proposed findings and conclusions. (a) Any party to a proceeding may, or if directed by the presiding officer shall, file proposed findings of fact and conclusions...

  13. 39 CFR 952.23 - Proposed findings and conclusions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., conclusions of law, orders and supporting reasons either in oral or written form in the discretion of the... findings of fact, conclusions of law, orders, and supporting reasons. Unless given orally, the date set for filing of proposed findings of fact, conclusions of law, orders and supporting reasons shall be within 30...

  14. 39 CFR 952.23 - Proposed findings and conclusions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., conclusions of law, orders and supporting reasons either in oral or written form in the discretion of the... findings of fact, conclusions of law, orders, and supporting reasons. Unless given orally, the date set for filing of proposed findings of fact, conclusions of law, orders and supporting reasons shall be within 30...

  15. 39 CFR 952.23 - Proposed findings and conclusions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., conclusions of law, orders and supporting reasons either in oral or written form in the discretion of the... findings of fact, conclusions of law, orders, and supporting reasons. Unless given orally, the date set for filing of proposed findings of fact, conclusions of law, orders and supporting reasons shall be within 30...

  16. 40 CFR 209.29 - Proposed findings, conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Proposed findings, conclusions. 209.29... Governing Hearings for Orders Issued Under Section 11(d) of the Noise Control Act § 209.29 Proposed findings... consideration of the administrative law judge proposed findings of fact, conclusions of law, and a proposed rule...

  17. 26 CFR 1.9001-3 - Basis adjustments for taxable years between changeover date and 1956 adjustment date.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... changeover date and 1956 adjustment date. 1.9001-3 Section 1.9001-3 Internal Revenue INTERNAL REVENUE SERVICE....9001-3 Basis adjustments for taxable years between changeover date and 1956 adjustment date. (a) In... before the taxpayer's 1956 adjustment date. This adjusted basis shall be used for all purposes of the...

  18. Pre-entry Characteristics, Perceived Social Support, Adjustment and Academic Achievement in First-Year Spanish University Students: A Path Model.

    PubMed

    Rodríguez, María Soledad; Tinajero, Carolina; Páramo, María Fernanda

    2017-11-17

    Transition to university is a multifactorial process to which scarce consideration has been given in Spain, despite this being one of the countries with the highest rates of academic failure and attrition within the European Union. The present study proposes an empirical model for predicting Spanish students' academic achievement at university by considering pre-entry characteristics, perceived social support and adaptation to university, in a sample of 300 traditional first-year university students. The findings of the path analysis showed that pre-university achievement and academic and personal-emotional adjustment were direct predictors of academic achievement. Furthermore, gender, parents' education and family support were indirect predictors of academic achievement, mediated by pre-university grades and adjustment to university. The current findings supporting evidence that academic achievement in first-year Spanish students is the cumulative effect of pre-entry characteristics and process variables, key factors that should be taken into account in designing intervention strategies involving families and that establish stronger links between research findings and university policies.

  19. Generalized Parameter-Adjusted Stochastic Resonance of Duffing Oscillator and Its Application to Weak-Signal Detection

    PubMed Central

    Lai, Zhi-Hui; Leng, Yong-Gang

    2015-01-01

    A two-dimensional Duffing oscillator which can produce stochastic resonance (SR) is studied in this paper. We introduce its SR mechanism and present a generalized parameter-adjusted SR (GPASR) model of this oscillator for the necessity of parameter adjustments. The Kramers rate is chosen as the theoretical basis to establish a judgmental function for judging the occurrence of SR in this model; and to analyze and summarize the parameter-adjusted rules under unmatched signal amplitude, frequency, and/or noise-intensity. Furthermore, we propose the weak-signal detection approach based on this GPASR model. Finally, we employ two practical examples to demonstrate the feasibility of the proposed approach in practical engineering application. PMID:26343671

  20. The value of qualitative conclusions for the interpretation of Super Soft Source grating spectra

    NASA Astrophysics Data System (ADS)

    Ness, J.

    2017-10-01

    High-resolution (grating) X-ray spectra of Super Soft Sources (SSS) contain a large amount of information. Main-stream interpretation approaches apply radiation transport models that, if uniquely constrained by the data, would provide information about temperature and mass of the underlying white dwarf and chemical composition of the ejecta. The complexity of the grating spectra has so far prohibited unique conclusions because realistic effects such as inhomogeneous density distribution, asymmetric ejecta, expansion etc open up an almost infinite number of dimensions to the problem. Further development of models are with no doubt needed, but unbiased inspection of the observed spectra is needed to narrow down where new developments are needed. In this presentation I illustrate how much we can already conclude without any models and remind of the value of qualitative conclusions. I show examples of past and recent observations and how comparisons with other observations help us to reveal common mechanisms. Albeit the high degree of complexity, some astonishing similarities between very different systems are found which can tailor the development of new models.

  1. The Structure of PhD Conclusion Chapters

    ERIC Educational Resources Information Center

    Bunton, David

    2005-01-01

    This paper considers the generic structure of "Conclusion" chapters in PhD theses or dissertations. From a corpus of 45 PhD theses covering a range of disciplines, chapters playing a concluding role were identified and analysed for their functional moves and steps. Most "Conclusions" were found to restate purpose, consolidate research space with a…

  2. Flow adjustment inside homogeneous canopies after a leading edge – An analytical approach backed by LES

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kroniger, Konstantin; Banerjee, Tirtha; De Roo, Frederik

    A two-dimensional analytical model for describing the mean flow behavior inside a vegetation canopy after a leading edge in neutral conditions was developed and tested by means of large eddy simulations (LES) employing the LES code PALM. The analytical model is developed for the region directly after the canopy edge, the adjustment region, where one-dimensional canopy models fail due to the sharp change in roughness. The derivation of this adjustment region model is based on an analytic solution of the two-dimensional Reynolds averaged Navier–Stokes equation in neutral conditions for a canopy with constant plant area density (PAD). The main assumptionsmore » for solving the governing equations are separability of the velocity components concerning the spatial variables and the neglection of the Reynolds stress gradients. These two assumptions are verified by means of LES. To determine the emerging model parameters, a simultaneous fitting scheme was applied to the velocity and pressure data of a reference LES simulation. Furthermore a sensitivity analysis of the adjustment region model, equipped with the previously calculated parameters, was performed varying the three relevant length, the canopy height ( h), the canopy length and the adjustment length ( Lc), in additional LES. Even if the model parameters are, in general, functions of h/ Lc, it was found out that the model is capable of predicting the flow quantities in various cases, when using constant parameters. Subsequently the adjustment region model is combined with the one-dimensional model of Massman, which is applicable for the interior of the canopy, to attain an analytical model capable of describing the mean flow for the full canopy domain. As a result, the model is tested against an analytical model based on a linearization approach.« less

  3. Flow adjustment inside homogeneous canopies after a leading edge – An analytical approach backed by LES

    DOE PAGES

    Kroniger, Konstantin; Banerjee, Tirtha; De Roo, Frederik; ...

    2017-10-06

    A two-dimensional analytical model for describing the mean flow behavior inside a vegetation canopy after a leading edge in neutral conditions was developed and tested by means of large eddy simulations (LES) employing the LES code PALM. The analytical model is developed for the region directly after the canopy edge, the adjustment region, where one-dimensional canopy models fail due to the sharp change in roughness. The derivation of this adjustment region model is based on an analytic solution of the two-dimensional Reynolds averaged Navier–Stokes equation in neutral conditions for a canopy with constant plant area density (PAD). The main assumptionsmore » for solving the governing equations are separability of the velocity components concerning the spatial variables and the neglection of the Reynolds stress gradients. These two assumptions are verified by means of LES. To determine the emerging model parameters, a simultaneous fitting scheme was applied to the velocity and pressure data of a reference LES simulation. Furthermore a sensitivity analysis of the adjustment region model, equipped with the previously calculated parameters, was performed varying the three relevant length, the canopy height ( h), the canopy length and the adjustment length ( Lc), in additional LES. Even if the model parameters are, in general, functions of h/ Lc, it was found out that the model is capable of predicting the flow quantities in various cases, when using constant parameters. Subsequently the adjustment region model is combined with the one-dimensional model of Massman, which is applicable for the interior of the canopy, to attain an analytical model capable of describing the mean flow for the full canopy domain. As a result, the model is tested against an analytical model based on a linearization approach.« less

  4. In search of laterally heterogeneous viscosity models of Glacial Isostatic Adjustment with the ICE-6G_C global ice history model

    NASA Astrophysics Data System (ADS)

    Li, Tanghua; Wu, Patrick; Steffen, Holger; Wang, Hansheng

    2018-05-01

    Most models of Glacial Isostatic Adjustment (GIA) assume that the Earth is laterally homogeneous. However, seismic and geological observations clearly show that the Earth's mantle is laterally heterogeneous. Previous studies of GIA with lateral heterogeneity mostly focused on its effect or sensitivity on GIA predictions, and it is not clear to what extent can lateral heterogeneity solve the misfits between GIA predictions and observations. Our aim is to search for the best 3D viscosity models that can simultaneously fit the global relative sea-level (RSL) data, the peak uplift rates (u-dot from GNSS) and peak gravity-rate-of-change (g-dot from the GRACE satellite mission) in Laurentia and Fennoscandia. However, the search is dependent on the ice and viscosity model inputs - the latter depends on the background viscosity and the seismic tomography models used. In this paper, the ICE-6G_C ice model, with Bunge & Grand's seismic tomography model and background viscosity models close to VM5 will be assumed. A Coupled Laplace-Finite Element Method is used to compute gravitationally self-consistent sea level change with time dependent coastlines and rotational feedback in addition to changes in deformation, gravity and the state of stress. Several laterally heterogeneous models are found to fit the global sea level data better than laterally homogeneous models. Two of these laterally heterogeneous models also fit the ICE-6G_C peak g-dot and u-dot rates observed in Laurentia simultaneously. However, even with the introduction of lateral heterogeneity, no model that is able to fit the present-day g-dot and uplift rate data in Fennoscandia has been found. Therefore, either the ice history of ICE-6G_C in Fennoscandia and Barent Sea needs some modifications, or the sub-lithospheric property/non-thermal effect underneath northern Europe must be different from that underneath Laurentia.

  5. The anchor-based minimal important change, based on receiver operating characteristic analysis or predictive modeling, may need to be adjusted for the proportion of improved patients.

    PubMed

    Terluin, Berend; Eekhout, Iris; Terwee, Caroline B

    2017-03-01

    Patients have their individual minimal important changes (iMICs) as their personal benchmarks to determine whether a perceived health-related quality of life (HRQOL) change constitutes a (minimally) important change for them. We denote the mean iMIC in a group of patients as the "genuine MIC" (gMIC). The aims of this paper are (1) to examine the relationship between the gMIC and the anchor-based minimal important change (MIC), determined by receiver operating characteristic analysis or by predictive modeling; (2) to examine the impact of the proportion of improved patients on these MICs; and (3) to explore the possibility to adjust the MIC for the influence of the proportion of improved patients. Multiple simulations of patient samples involved in anchor-based MIC studies with different characteristics of HRQOL (change) scores and distributions of iMICs. In addition, a real data set is analyzed for illustration. The receiver operating characteristic-based and predictive modeling MICs equal the gMIC when the proportion of improved patients equals 0.5. The MIC is estimated higher than the gMIC when the proportion improved is greater than 0.5, and the MIC is estimated lower than the gMIC when the proportion improved is less than 0.5. Using an equation including the predictive modeling MIC, the log-odds of improvement, the standard deviation of the HRQOL change score, and the correlation between the HRQOL change score and the anchor results in an adjusted MIC reflecting the gMIC irrespective of the proportion of improved patients. Adjusting the predictive modeling MIC for the proportion of improved patients assures that the adjusted MIC reflects the gMIC. We assumed normal distributions and global perceived change scores that were independent on the follow-up score. Additionally, floor and ceiling effects were not taken into account. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Uncertainty and psychological adjustment in patients with lung cancer

    PubMed Central

    Kurita, Keiko; Garon, Edward B.; Stanton, Annette L.; Meyerowitz, Beth E.

    2014-01-01

    Background For many patients with lung cancer, disease progression occurs without notice or with vague symptoms, and unfortunately, most treatments are not curative. Given this unpredictability, we hypothesized the following: (1) poorer psychological adjustment (specifically, more depressive symptoms, higher perceptions of stress, and poorer emotional well-being) would be associated with higher intolerance for uncertainty, higher perceived illness-related ambiguity, and their interaction; and (2) greater avoidance would mediate associations between higher intolerance of uncertainty and poorer psychological adjustment. Methods Participants (N = 49) diagnosed with lung cancer at least 6 months prior to enrollment completed the Center for Epidemiologic Studies – Depression Scale, the Functional Assessment of Cancer Therapy – Lung Emotional Well-being subscale, the Perceived Stress scale, the Intolerance of Uncertainty scale, the Mishel Uncertainty in Illness Scale Ambiguity subscale, the Impact of Event – Revised Avoidance subscale, and the Short-scale Eysenck Personality Questionnaire – Revised Neuroticism subscale. Mean age was 64.2 years (standard deviation [SD] = 11.0), mean years of education was 15.6 (SD = 3.1), and 71.4% were female. Hypotheses were tested with regression analyses, adjusted for neuroticism. Results Higher perceptions of stress and poorer emotional well-being were associated with higher levels of intolerance of uncertainty and higher perceived illness-related ambiguity. Non-somatic depressive symptoms were associated with higher levels of intolerance of uncertainty. Avoidance was found to mediate relations of intolerance of uncertainty with non-somatic depressive symptoms and emotional well-being only. Conclusions Findings suggest that interventions to address avoidance and intolerance of uncertainty in individuals with lung cancer may help improve psychological adjustment. PMID:22887017

  7. Constraints of GRACE on the Ice Model and Mantle Rheology in Glacial Isostatic Adjustment Modeling in North-America

    NASA Astrophysics Data System (ADS)

    van der Wal, W.; Wu, P.; Sideris, M.; Wang, H.

    2009-05-01

    GRACE satellite data offer homogeneous coverage of the area covered by the former Laurentide ice sheet. The secular gravity rate estimated from the GRACE data can therefore be used to constrain the ice loading history in Laurentide and, to a lesser extent, the mantle rheology in a GIA model. The objective of this presentation is to find a best fitting global ice model and use it to study how the ice model can be modified to fit a composite rheology, in which creep rates from a linear and non-linear rheology are added. This is useful because all the ice models constructed from GIA assume that mantle rheology is linear, but creep experiments on rocks show that nonlinear rheology may be the dominant mechanism in some parts of the mantle. We use CSR release 4 solutions from August 2002 to October 2008 with continental water storage effects removed by the GLDAS model and filtering with a destriping and Gaussian filter. The GIA model is a radially symmetric incompressible Maxwell Earth, with varying upper and lower mantle viscosity. Gravity rate misfit values are computed for with a range of viscosity values with the ICE-3G, ICE-4G and ICE-5G models. The best fit is shown for models with ICE-3G and ICE-4G, and the ICE-4G model is selected for computations with a so-called composite rheology. For the composite rheology, the Coupled Laplace Finite-Element Method is used to compute the GIA response of a spherical self-gravitating incompressible Maxwell Earth. The pre-stress exponent (A) derived from a uni- axial stress experiment is varied between 3.3 x 10-34/10-35/10-36 Pa-3s-1, the Newtonian viscosity η is varied between 1 and 3 x 1021 Pa-s, and the stress exponent is taken to be 3. Composite rheology in general results in geoid rates that are too small compared to GRACE observations. Therefore, simple modifications of the ICE-4G history are investigated by scaling ice heights or delaying glaciation. It is found that a delay in glaciation is a better way to adjust ice

  8. Adjustable Pitot Probe

    NASA Technical Reports Server (NTRS)

    Ashby, George C., Jr.; Robbins, W. Eugene; Horsley, Lewis A.

    1991-01-01

    Probe readily positionable in core of uniform flow in hypersonic wind tunnel. Formed of pair of mating cylindrical housings: transducer housing and pitot-tube housing. Pitot tube supported by adjustable wedge fairing attached to top of pitot-tube housing with semicircular foot. Probe adjusted both radially and circumferentially. In addition, pressure-sensing transducer cooled internally by water or other cooling fluid passing through annulus of cooling system.

  9. The New York Sepsis Severity Score: Development of a Risk-Adjusted Severity Model for Sepsis.

    PubMed

    Phillips, Gary S; Osborn, Tiffany M; Terry, Kathleen M; Gesten, Foster; Levy, Mitchell M; Lemeshow, Stanley

    2018-05-01

    In accordance with Rory's Regulations, hospitals across New York State developed and implemented protocols for sepsis recognition and treatment to reduce variations in evidence informed care and preventable mortality. The New York Department of Health sought to develop a risk assessment model for accurate and standardized hospital mortality comparisons of adult septic patients across institutions using case-mix adjustment. Retrospective evaluation of prospectively collected data. Data from 43,204 severe sepsis and septic shock patients from 179 hospitals across New York State were evaluated. Prospective data were submitted to a database from January 1, 2015, to December 31, 2015. None. Maximum likelihood logistic regression was used to estimate model coefficients used in the New York State risk model. The mortality probability was estimated using a logistic regression model. Variables to be included in the model were determined as part of the model-building process. Interactions between variables were included if they made clinical sense and if their p values were less than 0.05. Model development used a random sample of 90% of available patients and was validated using the remaining 10%. Hosmer-Lemeshow goodness of fit p values were considerably greater than 0.05, suggesting good calibration. Areas under the receiver operator curve in the developmental and validation subsets were 0.770 (95% CI, 0.765-0.775) and 0.773 (95% CI, 0.758-0.787), respectively, indicating good discrimination. Development and validation datasets had similar distributions of estimated mortality probabilities. Mortality increased with rising age, comorbidities, and lactate. The New York Sepsis Severity Score accurately estimated the probability of hospital mortality in severe sepsis and septic shock patients. It performed well with respect to calibration and discrimination. This sepsis-specific model provides an accurate, comprehensive method for standardized mortality comparison of adult

  10. No-Touch Technique and a New Donor Adjuster for Descemet's Stripping Automated Endothelial Keratoplasty

    PubMed Central

    Kobayashi, Akira; Yokogawa, Hideaki; Sugiyama, Kazuhisa

    2012-01-01

    Purpose One difficulty with Descemet's stripping automated endothelial keratoplasty (DSAEK) is air management during surgery and donor endothelial lamella centering. We evaluated the no-touch technique for donor centering and the use of a newly developed DSAEK donor adjuster. Methods We evaluated the records of 12 consecutive patients (mean age 75.3 years) with bullous keratopathy who had undergone DSAEK. In all cases, the no-touch technique was attempted first. When the no-touch technique failed, a DSAEK donor adjuster with a 30-gauge cannula resembling a curved reverse Sinskey hook was used for donor centering. The adjuster allows air injection during donor centering. Results The no-touch technique using simple corneal surface massage to center the graft was successful in 4 cases (33.3%), while 4 cases required ocular tilting (33.3%) in addition to corneal surface massage. The no-touch technique was ineffective in 4 cases (33.3%), but the donor adjuster was used successfully and easily for these patients. Comparing the endothelial cell loss rate between the no-touch technique group and the donor adjuster group, there was no significant difference at 6 months. Conclusions The no-touch technique was useful for better control of DSAEK donor centering in most cases. When the no-touch technique was ineffective, the DSAEK donor adjuster was uniformly successful. PMID:22807910

  11. Correction of aortic insufficiency with an external adjustable prosthetic aortic ring.

    PubMed

    Gogbashian, Andrew; Ghanta, Ravi K; Umakanthan, Ramanan; Rangaraj, Aravind T; Laurence, Rita G; Fox, John A; Cohn, Lawrence H; Chen, Frederick Y

    2007-09-01

    Less invasive, valve-sparing options are needed for patients with aortic insufficiency (AI). We sought to evaluate the feasibility of reducing AI with an external adjustable aortic ring in an ovine model. To create AI, five sheep underwent patch plasty enlargement of the aortic annulus and root by placement of a 10 x 15 mm pericardial patch between the right and noncoronary cusps. An adjustable external ring composed of a nylon band was fabricated and placed around the aortic root. Aortic flow, aortic pressure, and left ventricular pressures were measured with the ring loose (off) and tightened (on). Mean regurgitant orifice area decreased by 86%, from 0.07 +/- 0.03 cm2 (ring loose, off) to 0.01 +/- 0.00 cm2 (ring tightened, on) [p < 0.01]. The regurgitant fraction decreased from 18 +/- 4% to 2 +/- 1% [p < 0.01]. The ring did not significantly affect stroke volume and aortic pressure. An ovine model of aortic root dilatation resulting in acute AI has been developed. In this model, application of an external, adjustable constricting aortic ring eliminated AI. An aortic ring may be a useful adjunct in reducing AI secondary to annular dilatation.

  12. Adolescent Leisure Dimensions, Psychosocial Adjustment, and Gender Effects

    ERIC Educational Resources Information Center

    Bradley, Graham L.; Inglis, Brad C.

    2012-01-01

    Leisure provides the context for much of adolescent behaviour and development. While both theory and research point to the benefits of participation in leisure activities that are highly structured, the association between structured leisure and psychosocial adjustment is not uniformly high. This paper presents a model of adolescent leisure…

  13. Motivating drivers to correctly adjust head restraints: assessing effectiveness of three different interventions.

    PubMed

    Fockler, S K; Vavrik, J; Kristiansen, L

    1998-11-01

    Three types of driver educational strategies were tested to determine the most effective approach for motivating drivers to adjust their head restraints to the correct vertical position: (1) a human interactive personal contact with a member of an ICBC-trained head restraint adjustment team, (2) a passive video presentation of the consequences of correct and incorrect head restraint adjustment, and (3) an interactive three-dimensional kinetic model showing the consequences of correct and incorrect head restraint adjustment. An experimental pretest-posttest control group design was used. A different educational treatment was used in each of three lanes of a vehicle emissions testing facility, with a fourth lane with no intervention serving as a control group. Observational and self-reported data were obtained from a total of 1,974 vehicles entering and exiting the facility. The human intervention led to significantly more drivers actually adjusting their head restraints immediately after the intervention than the passive video or interactive kinetic model approaches, which were both no different from the control group. The human intervention was recommended as the most effective and was implemented successfully on a limited basis during 3 months of 1995 and again during 3 months of 1996.

  14. Method of Individual Adjustment for 3D CT Analysis: Linear Measurement.

    PubMed

    Kim, Dong Kyu; Choi, Dong Hun; Lee, Jeong Woo; Yang, Jung Dug; Chung, Ho Yun; Cho, Byung Chae; Choi, Kang Young

    2016-01-01

    Introduction . We aim to regularize measurement values in three-dimensional (3D) computed tomography (CT) reconstructed images for higher-precision 3D analysis, focusing on length-based 3D cephalometric examinations. Methods . We measure the linear distances between points on different skull models using Vernier calipers (real values). We use 10 differently tilted CT scans for 3D CT reconstruction of the models and measure the same linear distances from the picture archiving and communication system (PACS). In both cases, each measurement is performed three times by three doctors, yielding nine measurements. The real values are compared with the PACS values. Each PACS measurement is revised based on the display field of view (DFOV) values and compared with the real values. Results . The real values and the PACS measurement changes according to tilt value have no significant correlations ( p > 0.05). However, significant correlations appear between the real values and DFOV-adjusted PACS measurements ( p < 0.001). Hence, we obtain a correlation expression that can yield real physical values from PACS measurements. The DFOV value intervals for various age groups are also verified. Conclusion . Precise confirmation of individual preoperative length and precise analysis of postoperative improvements through 3D analysis is possible, which is helpful for facial-bone-surgery symmetry correction.

  15. [Relationship between family variables and conjugal adjustment].

    PubMed

    Jiménez-Picón, Nerea; Lima-Rodríguez, Joaquín-Salvador; Lima-Serrano, Marta

    2018-04-01

    To determine whether family variables, such as type of relationship, years of marriage, existence of offspring, number of members of family, stage of family life cycle, transition between stages, perceived social support, and/or stressful life events are related to conjugal adjustment. A cross-sectional and correlational study using questionnaires. Primary care and hospital units of selected centres in the province of Seville, Spain. Consecutive stratified sampling by quotas of 369 heterosexual couples over 18years of age, who maintained a relationship, with or without children, living in Seville. A self-report questionnaire for the sociodemographic variables, and the abbreviated version of the Dyadic Adjustment Scale, Questionnaire MOS Perceived Social Support, and Social Readjustment Rating Scale, were used. Descriptive and inferential statistics were performed with correlation analysis and multivariate regression. Statistically significant associations were found between conjugal adjustment and marriage years (r=-10: P<.05), stage of family life cycle (F=2.65; P<.05), the transition between stages (RPB=.11; P<.05) and perceived social support (r=.44; P<.001). The regression model showed the predictive power of perceived social support and the family life cycle stage (mature-aged stage) on conjugal adjustment (R2=.21; F=9.9; df=356; P<.001). Couples may be assessed from Primary Care and be provide with resources and support. In addition, it can identify variables that may help improve the conjugal relationship. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  16. When methods meet politics: how risk adjustment became part of Medicare managed care.

    PubMed

    Weissman, Joel S; Wachterman, Melissa; Blumenthal, David

    2005-06-01

    Health-based risk adjustment has long been touted as key to the success of competitive models of health care. Because it decreases the incentive to enroll only healthy patients in insurance plans, risk adjustment was incorporated into Medicare policy via the Balanced Budget Act of 1997. However, full implementation of risk adjustment was delayed due to clashes with the managed care industry over payment policy, concerns over perverse incentives, and problems of data burden. We review the history of risk adjustment leading up to the Balanced Budget Act and examine the controversies surrounding attempts to stop or delay its implementation during the years that followed. The article provides lessons for the future of health-based risk adjustment and possible alternatives.

  17. 39 CFR 3010.25 - Limitation on unused rate adjustment authority rate adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Limitation on unused rate adjustment authority rate adjustments. 3010.25 Section 3010.25 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL REGULATION OF RATES FOR MARKET DOMINANT PRODUCTS Rules for Applying the Price Cap § 3010.25 Limitation on...

  18. Dietary and Behavioral Adjustments to Manage Bowel Dysfunction After Surgery in Long-Term Colorectal Cancer Survviors

    PubMed Central

    Sun, Virginia; Grant, Marcia; Wendel, Christopher S.; McMullen, Carmit K.; Bulkley, Joanna E.; Altschuler, Andrea; Ramirez, Michelle; Baldwin, Carol M.; Herrinton, Lisa J.; Hornbrook, Mark C.; Krouse, Robert S.

    2015-01-01

    BACKGROUND Bowel dysfunction is a known complication of colorectal cancer (CRC) surgery. Poor bowel control has a detrimental impact on survivors’ health-related quality of life (HRQOL). This analysis describes the dietary and behavioral adjustments used by CRC survivors to manage bowel dysfunction and compares adjustments used by survivors with permanent ostomy to those with anastomosis. METHODS This mixed-methods analysis included pooled data from several studies that assessed HRQOL in CRC survivors. In all studies, CRC survivors with or without permanent ostomies (N=856) were surveyed using the City of Hope Quality of Life Colorectal Cancer tool. Dietary adjustments were compared by ostomy status and by overall HRQOL score (high versus low). Qualitative data from 13 focus groups and 30 interviews were analyzed to explore specific strategies used by survivors to manage bowel dysfunction. RESULTS CRC survivors made substantial, permanent dietary and behavioral adjustments after surgery, regardless of ostomy status. Survivors who took longer after surgery to become comfortable with their diet or regain their appetite were more likely to report worse HRQOL. Adjustments to control bowel function were divided into four major strategies: dietary adjustments, behavioral adjustments, exercise, and medication use. CONCLUSIONS CRC survivors struggled with unpredictable bowel function and may fail to find a set of management strategies to achieve regularity. Understanding the myriad adjustments used by CRC survivors may lead to evidence-based interventions to foster positive adjustments after surgery and through long-term survivorship. PMID:26159443

  19. Validation of a Novel Laparoscopic Adjustable Gastric Band Simulator

    PubMed Central

    Sankaranarayanan, Ganesh; Adair, James D.; Halic, Tansel; Gromski, Mark A.; Lu, Zhonghua; Ahn, Woojin; Jones, Daniel B.; De, Suvranu

    2011-01-01

    Background Morbid obesity accounts for more than 90,000 deaths per year in the United States. Laparoscopic adjustable gastric banding (LAGB) is the second most common weight loss procedure performed in the US and the most common in Europe and Australia. Simulation in surgical training is a rapidly advancing field that has been adopted by many to prepare surgeons for surgical techniques and procedures. Study Aim The aim of our study was to determine face, construct and content validity for a novel virtual reality laparoscopic adjustable gastric band simulator. Methods Twenty-eight subjects were categorized into two groups (Expert and Novice), determined by their skill level in laparoscopic surgery. Experts consisted of subjects who had at least four years of laparoscopic training and operative experience. Novices consisted of subjects with medical training, but with less than four years of laparoscopic training. The subjects performed the virtual reality laparoscopic adjustable band surgery simulator. They were automatically scored, according to various tasks. The subjects then completed a questionnaire to evaluate face and content validity. Results On a 5-point Likert scale (1 – lowest score, 5 – highest score), the mean score for visual realism was 4.00 ± 0.67 and the mean score for realism of the interface and tool movements was 4.07 ± 0.77 [Face Validity]. There were significant differences in the performance of the two subject groups (Expert and Novice), based on total scores (p<0.001) [Construct Validity]. Mean scores for utility of the simulator, as addressed by the Expert group, was 4.50 ± 0.71 [Content Validity]. Conclusion We created a virtual reality laparoscopic adjustable gastric band simulator. Our initial results demonstrate excellent face, construct and content validity findings. To our knowledge, this is the first virtual reality simulator with haptic feedback for training residents and surgeons in the laparoscopic adjustable gastric banding

  20. The effect of low force chiropractic adjustments on body surface electromagnetic field

    PubMed Central

    Zhang, John; Snyder, Brian J; Vernor, Lori

    2004-01-01

    Objective The purpose of this study was to investigate the body surface electromagnetic field (EMF) changes using a sensitive magnetometer before and after a specific Toftness chiropractic adjustment in asymptomatic human subjects. Method Forty-four subjects were randomly assigned into control (20 subjects) and experimental groups (24 subjects) in a pre and post-test design. The Triaxial Fluxgate Magnetometer FGM-5DTAA (Walker Scientific, Worcester, Massachusetts) with five digit display and resolution of 1 nanotesla (nT) was used for EMF detection. The EMF in the research room and on the adjustment table was monitored and recorded. The subjects’ body surface (cervical, thoracic, lumbar and sacral areas) EMF was determined in the prone position before and after the chiropractic adjustment. A low force Toftness chiropractic adjustment was applied to the cervical, thoracic, lumbar and sacral areas as determined by the practitioner. Results The EMF in the research room was recorded as 41611 nT at the Z axis (earth field), 13761 nT at the X axis and 7438 nT at the Y axis. The EMF on the adjusting table changed minimally during the 15 minute observation period. The EMF on the subjects’ body surface decreased at 4 spinal locations after chiropractic adjustment. The EMF (mean ± SD in nT) decreased significantly at the cervical region from 42449 ± 907 to 41643 ± 1165 (p < 0.01) and at the sacral regions from 43206 ± 760 to 42713 ± 552 (p < 0.01). The EMF at the lumbar and thoracic regions decreased but did not reach a statistically significant level. No significant changes of the body surface EMF were found in the control group. Conclusion A low force Toftness chiropractic adjustment in the cervical and sacral areas resulted in a significant reduction of the cervical and sacral surface EMF. No significant body surface EMF changes were observed in the lumbar and thoracic regions. The mechanisms of the EMF reduction after chiropractic adjustment are not known. PMID

  1. Parents' and Children's Beliefs about Peer Victimization: Attributions, Coping Responses, and Child Adjustment

    ERIC Educational Resources Information Center

    Harper, Bridgette D.

    2012-01-01

    This study examined how parents' and children's beliefs about peer victimization are related to children's adjustment. A mediational model was proposed that addressed how adjustment is predicted by degree of victimization, as well as causal attributions of and coping responses to victimization. The participants were 100 fifth- or sixth-grade…

  2. 42 CFR § 510.300 - Determination of episode quality-adjusted target prices.

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ... OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.300 Determination of episode quality... hospitals for each performance year of the model as specified in this section. Episode quality-adjusted...

  3. [Effects in the adherence treatment and psychological adjustment after the disclosure of HIV/AIDS diagnosis with the "DIRE" clinical model in Colombian children under 17].

    PubMed

    Trejos, Ana María; Reyes, Lizeth; Bahamon, Marly Johana; Alarcón, Yolima; Gaviria, Gladys

    2015-08-01

    A study in five Colombian cities in 2006, confirms the findings of other international studies: the majority of HIV-positive children not know their diagnosis, caregivers are reluctant to give this information because they believe that the news will cause emotional distress to the child becoming primary purpose of this study to validate a model of revelation. We implemented a clinical model, referred to as: "DIRE" that hypothetically had normalizing effects on psychological adjustment and adherence to antiretroviral treatment of HIV seropositive children, using a quasi-experimental design. Test were administered (questionnaire to assess patterns of disclosure and non-disclosure of the diagnosis of VIH/SIDA on children in health professionals and participants caregivers, Family Apgar, EuroQol EQ- 5D, MOS Social Support Survey Questionnaire Information treatment for VIH/SIDA and child Symptom Checklist CBCL/6-18 adapted to Latinos) before and after implementation of the model to 31 children (n: 31), 30 caregivers (n: 30) and 41 health professionals. Data processing was performed using the Statistical Package for the Social Science version 21 by applying parametric tests (Friedman) and nonparametric (t Student). No significant differences in adherence to treatment (p=0.392), in the psychological adjustment were found positive significant differences at follow-ups compared to baseline 2 weeks (p: 0.001), 3 months (p: 0.000) and 6 months (p: 0.000). The clinical model demonstrated effectiveness in normalizing of psychological adjustment and maintaining treatment compliance. The process also generated confidence in caregivers and health professionals in this difficult task.

  4. Influence of Parenting Styles on the Adjustment and Academic Achievement of Traditional College Freshmen.

    ERIC Educational Resources Information Center

    Hickman, Gregory P.; Bartholomae, Suzanne; McKenry, Patrick C.

    2000-01-01

    Examines the relationship between parenting styles and academic achievement and adjustment of traditional college freshmen (N=101). Multiple regression models indicate that authoritative parenting style was positively related to student's academic adjustment. Self-esteem was significantly predictive of social, personal-emotional, goal…

  5. Parental Divorce and Children's Adjustment.

    PubMed

    Lansford, Jennifer E

    2009-03-01

    This article reviews the research literature on links between parental divorce and children's short-term and long-term adjustment. First, I consider evidence regarding how divorce relates to children's externalizing behaviors, internalizing problems, academic achievement, and social relationships. Second, I examine timing of the divorce, demographic characteristics, children's adjustment prior to the divorce, and stigmatization as moderators of the links between divorce and children's adjustment. Third, I examine income, interparental conflict, parenting, and parents well-being as mediators of relations between divorce and children's adjustment. Fourth, I note the caveats and limitations of the research literature. Finally, I consider notable policies related to grounds for divorce, child support, and child custody in light of how they might affect children s adjustment to their parents divorce. © 2009 Association for Psychological Science.

  6. Examining the components of children's peer liking as antecedents of school adjustment.

    PubMed

    Betts, Lucy R; Rotenberg, Ken J; Trueman, Mark; Stiller, James

    2012-06-01

    Children's social interactions with their peers influence their psychosocial adjustment; consequently, the relationship between class-wide peer liking, same-gender peer liking, and school adjustment was explored in two age groups. Peer liking was analysed using the social relations model (SRM). In Study 1, 205 children (103 female and 102 male, M(age) = 7.15, SD= 7 months) completed measures of peer liking and school adjustment, and teachers completed the Short-Form Teacher Rating Scale of School Adjustment (Short-Form TRSSA). In Study 2, 197 children (98 female and 90 male, M(age) = 9.87, SD= 5.9 months) completed measures of peer liking and school adjustment. Both studies yielded evidence of reciprocal liking and individual differences in the ratings of liking awarded to, and elicited from, both peer groups. Multigroup path analysis, with groups created according to gender, revealed that elements of liking predicted different aspects of school adjustment with some variation according to age and gender. Together, these findings suggest that the SRM can be used to examine peer liking and underscore the importance of children's peers for school adjustment. © 2011 The British Psychological Society.

  7. Adjusted hospital death rates: a potential screen for quality of medical care.

    PubMed

    Dubois, R W; Brook, R H; Rogers, W H

    1987-09-01

    Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist.

  8. How Noisy Does a Noisy Miner Have to Be? Amplitude Adjustments of Alarm Calls in an Avian Urban ‘Adapter’

    PubMed Central

    Lowry, Hélène; Lill, Alan; Wong, Bob B. M.

    2012-01-01

    Background Urban environments generate constant loud noise, which creates a formidable challenge for many animals relying on acoustic communication. Some birds make vocal adjustments that reduce auditory masking by altering, for example, the frequency (kHz) or timing of vocalizations. Another adjustment, well documented for birds under laboratory and natural field conditions, is a noise level-dependent change in sound signal amplitude (the ‘Lombard effect’). To date, however, field research on amplitude adjustments in urban environments has focused exclusively on bird song. Methods We investigated amplitude regulation of alarm calls using, as our model, a successful urban ‘adapter’ species, the Noisy miner, Manorina melanocephala. We compared several different alarm calls under contrasting noise conditions. Results Individuals at noisier locations (arterial roads) alarm called significantly more loudly than those at quieter locations (residential streets). Other mechanisms known to improve sound signal transmission in ‘noise’, namely use of higher perches and in-flight calling, did not differ between site types. Intriguingly, the observed preferential use of different alarm calls by Noisy miners inhabiting arterial roads and residential streets was unlikely to have constituted a vocal modification made in response to sound-masking in the urban environment because the calls involved fell within the main frequency range of background anthropogenic noise. Conclusions The results of our study suggest that a species, which has the ability to adjust the amplitude of its signals, might have a ‘natural’ advantage in noisy urban environments. PMID:22238684

  9. A risk-adjusted financial model to estimate the cost of a video-assisted thoracoscopic surgery lobectomy programme.

    PubMed

    Brunelli, Alessandro; Tentzeris, Vasileios; Sandri, Alberto; McKenna, Alexandra; Liew, Shan Liung; Milton, Richard; Chaudhuri, Nilanjan; Kefaloyannis, Emmanuel; Papagiannopoulos, Kostas

    2016-05-01

    To develop a clinically risk-adjusted financial model to estimate the cost associated with a video-assisted thoracoscopic surgery (VATS) lobectomy programme. Prospectively collected data of 236 VATS lobectomy patients (August 2012-December 2013) were analysed retrospectively. Fixed and variable intraoperative and postoperative costs were retrieved from the Hospital Accounting Department. Baseline and surgical variables were tested for a possible association with total cost using a multivariable linear regression and bootstrap analyses. Costs were calculated in GBP and expressed in Euros (EUR:GBP exchange rate 1.4). The average total cost of a VATS lobectomy was €11 368 (range €6992-€62 535). Average intraoperative (including surgical and anaesthetic time, overhead, disposable materials) and postoperative costs [including ward stay, high dependency unit (HDU) or intensive care unit (ICU) and variable costs associated with management of complications] were €8226 (range €5656-€13 296) and €3029 (range €529-€51 970), respectively. The following variables remained reliably associated with total costs after linear regression analysis and bootstrap: carbon monoxide lung diffusion capacity (DLCO) <60% predicted value (P = 0.02, bootstrap 63%) and chronic obstructive pulmonary disease (COPD; P = 0.035, bootstrap 57%). The following model was developed to estimate the total costs: 10 523 + 1894 × COPD + 2376 × DLCO < 60%. The comparison between predicted and observed costs was repeated in 1000 bootstrapped samples to verify the stability of the model. The two values were not different (P > 0.05) in 86% of the samples. A hypothetical patient with COPD and DLCO less than 60% would cost €4270 more than a patient without COPD and with higher DLCO values (€14 793 vs €10 523). Risk-adjusting financial data can help estimate the total cost associated with VATS lobectomy based on clinical factors. This model can be used to audit the internal financial

  10. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... risk adjustment factors used to adjust payments, as required under §§ 422.304(a) and (c). CMS also may... submission of risk adjustment data. Risk adjustment factors for each payment year are based on risk... factors for affected individuals to determine if adjustments to payments are necessary. Risk adjustment...

  11. 42 CFR 422.310 - Risk adjustment data.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... risk adjustment factors used to adjust payments, as required under §§ 422.304(a) and (c). CMS also may... submission of risk adjustment data. Risk adjustment factors for each payment year are based on risk... factors for affected individuals to determine if adjustments to payments are necessary. Risk adjustment...

  12. Longitudinal Associations Between Sibling Relational Aggression and Adolescent Adjustment.

    PubMed

    Gallagher, Annabella M; Updegraff, Kimberly A; Padilla, Jenny; McHale, Susan M

    2018-06-20

    Sibling relational aggression is an important but understudied dimension of sibling relationships that has potential implications for adolescents' adjustment. This study examined the longitudinal associations between being the target of sibling relational aggression and adolescent adjustment (i.e., depressive symptoms, risky behavior, self-worth, and romantic competence) among younger and older siblings over a three-year period in adolescence. The moderating roles of birth order, sibling gender, and sibling dyad gender constellation also were tested. Participants were 196 European American adolescent (firstborn-secondborn) sibling pairs who were 16.47 years (SD = 0.80) and 13.88 years (SD = 1.15) of age, respectively, at the onset of this study. Data were collected separately from each sibling during home interviews. Multilevel models revealed that being the target of sibling relational aggression was associated with all four adjustment outcomes at the between-person level, and with risky behavior and romantic competence at the within-person level. However, some of these effects were moderated by sibling dyad characteristics. Although often overlooked in the literature on adolescence, sibling relationship dynamics play a key role in youth development and adjustment.

  13. Demand-Adjusted Shelf Availability Parameters: A Second Look.

    ERIC Educational Resources Information Center

    Schwarz, Philip

    1983-01-01

    Data gathered in application of Paul Kantor's demand-adjusted shelf availability model to medium-sized academic library indicate significant differences in shelf availability when data are analyzed by last circulation date, acquisition date, and imprint date, and when they are gathered during periods of low and high use. Ten references are cited.…

  14. Post implantation adjustable intraocular lenses.

    PubMed

    Schwartz, D M; Jethmalani, J M; Sandstedt, C A; Kornfield, J A; Grubbs, R H

    2001-06-01

    To eliminate persistent refractive errors after cataract and phakic IOL surgery, photosensitive silicone IOLs have been developed. These IOL formulations enable precise laser adjustment of IOL power to correct spherical and toric errors post-operatively, after wound and IOL stabilization. Initial experience with these laser adjustable IOLs indicate excellent biocompatability and adjustability of more than five diopters.

  15. Location memory for dots in polygons versus cities in regions: evaluating the category adjustment model.

    PubMed

    Friedman, Alinda; Montello, Daniel R; Burte, Heather

    2012-09-01

    We conducted 3 experiments to examine the category adjustment model (Huttenlocher, Hedges, & Duncan, 1991) in circumstances in which the category boundaries were irregular schematized polygons made from outlines of maps. For the first time, accuracy was tested when only perceptual and/or existing long-term memory information about identical locations was cued. Participants from Alberta, Canada and California received 1 of 3 conditions: dots-only, in which a dot appeared within the polygon, and after a 4-s dynamic mask the empty polygon appeared and the participant indicated where the dot had been; dots-and-names, in which participants were told that the first polygon represented Alberta/California and that each dot was in the correct location for the city whose name appeared outside the polygon; and names-only, in which there was no first polygon, and participants clicked on the city locations from extant memory alone. Location recall in the dots-only and dots-and-names conditions did not differ from each other and had small but significant directional errors that pointed away from the centroids of the polygons. In contrast, the names-only condition had large and significant directional errors that pointed toward the centroids. Experiments 2 and 3 eliminated the distribution of stimuli and overall screen position as causal factors. The data suggest that in the "classic" category adjustment paradigm, it is difficult to determine a priori when Bayesian cue combination is applicable, making Bayesian analysis less useful as a theoretical approach to location estimation. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  16. Sediment trapping efficiency of adjustable check dam in laboratory and field experiment

    NASA Astrophysics Data System (ADS)

    Wang, Chiang; Chen, Su-Chin; Lu, Sheng-Jui

    2014-05-01

    Check dam has been constructed at mountain area to block debris flow, but has been filled after several events and lose its function of trapping. For the reason, the main facilities of our research is the adjustable steel slit check dam, which with the advantages of fast building, easy to remove or adjust it function. When we can remove transverse beams to drain sediments off and keep the channel continuity. We constructed adjustable steel slit check dam on the Landow torrent, Huisun Experiment Forest station as the prototype to compare with model in laboratory. In laboratory experiments, the Froude number similarity was used to design the dam model. The main comparisons focused on types of sediment trapping and removing, sediment discharge, and trapping rate of slit check dam. In different types of removing transverse beam showed different kind of sediment removal and differences on rate of sediment removing, removing rate, and particle size distribution. The sediment discharge in check dam with beams is about 40%~80% of check dam without beams. Furthermore, the spacing of beams is considerable factor to the sediment discharge. In field experiment, this research uses time-lapse photography to record the adjustable steel slit check dam on the Landow torrent. The typhoon Soulik made rainfall amounts of 600 mm in eight hours and induced debris flow in Landow torrent. Image data of time-lapse photography demonstrated that after several sediment transport event the adjustable steel slit check dam was buried by debris flow. The result of lab and field experiments: (1)Adjustable check dam could trap boulders and stop woody debris flow and flush out fine sediment to supply the need of downstream river. (2)The efficiency of sediment trapping in adjustable check dam with transverse beams was significantly improved. (3)The check dam without transverse beams can remove the sediment and keep the ecosystem continuity.

  17. Rating long-term care facilities on pressure ulcer development: importance of case-mix adjustment.

    PubMed

    Berlowitz, D R; Ash, A S; Brandeis, G H; Brand, H K; Halpern, J L; Moskowitz, M A

    1996-03-15

    To determine the importance of case-mix adjustment in interpreting differences in rates of pressure ulcer development in Department of Veterans Affairs long- term care facilities. A sample assembled from the Patient Assessment File, a Veterans Affairs administrative database, was used to derive predictors of pressure ulcer development; the resulting model was validated in a separate sample. Facility-level rates of pressure ulcer development, both unadjusted and adjusted for case mix using the predictive model, were compared. Department of Veterans Affairs long-term care facilities. The derivation sample consisted of 31 150 intermediate medicine and nursing home residents who were initially free of pressure ulcers and were institutionalized between October 1991 and April 1993. The validation sample consisted of 17 946 residents institutionalized from April 1993 to October 1993. Development of a stage 2 or greater pressure ulcer. 11 factors predicted pressure ulcer development. Validated performance properties of the resulting model were good. Model-predicted rates of pressure ulcer development at individual long-term care facilities varied from 1.9% to 6.3%, and observed rates ranged from 0% to 10.9%. Case-mix-adjusted rates and ranks of facilities differed considerably from unadjusted ratings. For example, among five facilities that were identified as high outliers on the basis of unadjusted rates, two remained as outliers after adjustment for case mix. Long-term care facilities differ in case mix. Adjustments for case mix result in different judgments about facility performance and should be used when facility incidence rates are compared.

  18. Moving backwards, moving forward: the experiences of older Filipino migrants adjusting to life in New Zealand

    PubMed Central

    Montayre, Jed; Neville, Stephen; Holroyd, Eleanor

    2017-01-01

    ABSTRACT Purpose: To explore the experiences of older Filipino migrants adjusting to living permanently in New Zealand. Method: The qualitative descriptive approach taken in this study involved 17 individual face-to-face interviews of older Filipino migrants in New Zealand. Results: Three main themes emerged from the data. The first theme was “moving backwards and moving forward”, which described how these older Filipino migrants adjusted to challenges they experienced with migration. The second theme was “engaging with health services” and presented challenges relating to the New Zealand healthcare system, including a lack of knowledge of the nature of health services, language barriers, and differences in cultural views. The third theme, “new-found home”, highlighted establishing a Filipino identity in New Zealand and adjusting to the challenges of relocation. Conclusion: Adjustment to life in New Zealand for these older Filipino migrants meant starting over again by building new values through learning the basics and then moving forward from there. PMID:28705087

  19. 12 CFR 19.240 - Inflation adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Inflation adjustments. 19.240 Section 19.240... PROCEDURE Civil Money Penalty Inflation Adjustments § 19.240 Inflation adjustments. (a) The maximum amount... Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note) as follows: ER10NO08.001 (b) The...

  20. [Risk-adjusted assessment: late-onset infection in neonates].

    PubMed

    Gmyrek, Dieter; Koch, Rainer; Vogtmann, Christoph; Kaiser, Annette; Friedrich, Annette

    2011-01-01

    The weak point of the countrywide perinatal/neonatal quality surveillance is the ignorance of interhospital differences in the case mix of patients. As a result, this approach does not produce reliable benchmarking. The objective of this study was to adjust the result of the late-onset infection incidence of different hospitals according to their risk profile of patients by multivariate analysis. The perinatal/neonatal database of 41,055 newborns of the Saxonian quality surveillance from 1998 to 2004 was analysed. Based on 18 possible risk factors, a logistic regression model was used to develop a specific risk predictor for the quality indicator "late-onset infection". The developed risk predictor for the incidence of late-onset infection could be described by 4 of the 18 analysed risk factors, namely gestational age, admission from home, hypoxic ischemic encephalopathy and B-streptococcal infection. The AUC(ROC) value of this quality indicator was 83.3%, which demonstrates its reliability. The hospital ranking based on the adjusted risk assessment was very different from hospital rankings before this adjustment. The average correction of ranking position was 4.96 for 35 clinics. The application of the risk adjustment method proposed here allows for a more objective comparison of the incidence of the quality indicator "late onset infection" among different hospitals. Copyright © 2011. Published by Elsevier GmbH.

  1. Frequency of neck and shoulder pain and use of adjustable computer workstation among bankers

    PubMed Central

    Shabbir, Maryam; Rashid, Sajid; Umar, Bilal; Ahmad, Aqeel; Ehsan, Sarah

    2016-01-01

    Background & Objective: Neck and shoulder are the most susceptible areas for developing musculoskeletal symptoms among computer users. The modifiable risk factors for these work related musculoskeletal disorders include physical office environment and psychosocial work related factors. Computer workstation layout had been shown to be an important physical aspect of work environment that influences the upper quadrant symptoms. Our objective was to find the frequency of neck and shoulder pain and use of adjustable computer workstation among bankers of Islamabad/Rawalpindi/Multan Methods: A cross sectional study was conducted and 120 participants were questioned. Purposive sampling technique was used in this study. Maastricht Upper Extremity Questionnaire (MUEQ) was remodeled and important questions were extracted from its detailed version. The tool was then validated by taking expert opinion. Frequencies and percentages were calculated for categorical variables. Results: Pain in the neck during working hours was experienced by 71.67% of the respondents and 48.33% of the participants had experienced shoulder pain during working hours. Adjustable keyboards were used by 16.67% of respondents. Back care material was used by 40% bankers. Adjustable chairs were used by 95.83% of the participants. Only 3% of the bankers did not have chairs with adjustable heights. Chairs with adjustable armrests were used by 25% bankers. Conclusion: Neck and shoulder pain are common occurrences among bankers. Most of the components of workstations of bankers were adjustable but some of them still need attention. PMID:27182253

  2. A survey of outcome of adjustable suture as first operation in patients with strabismus

    PubMed Central

    Razmjoo, Hasan; Attarzadeh, Hosein; Karbasi, Najmeh; Najarzadegan, Mohammad Reza; Salam, Hasan; Jamshidi, Aliraza

    2014-01-01

    Background: Adjustable suture used for years to improve the outcome of strabismus surgery. We surveyed outcome of our patients with strabismus who underwent adjustable suture. Materials and Methods: This retrospective study was performed at Ophthalmology Centre of Feiz Hospital in Isfahan on 95 participants that candidate for adjustable suture strabismus surgery. Patients were divided into three age groups: Under 10 years, 10-19 years, and 20 years and over. Outcome of adjustable suture surgery consequence of residual postoperative deviation was divided into four groups: Excellent, good, acceptable, and unacceptable. Results: Out of 95 patients studied, 51 (53.7%) were males and 44 (46.3%) were females. The mean of deviation angles were 53.8 ± 17.9 PD (Prism dioptres) in alt XT, 44.5 ± 12 PD in alt ET and 52 ± 13.5 PD in const ET, 47.1 ± 13.1PD in cons XT, respectively. There was no significant difference between the groups (P = 0.051). Results of surgery were in 38 patients (40%) excellent, in 31 patients (32.6%) good, in 19 patients (20%) acceptable, and in 7 patients (7.4%) unacceptable. Seven (7.4%) patients required reoperation. Conclusions: In the present study, the frequency of re-operation was much lower than other similar studies (7.4% vs. 30-50%). This suggests that the adjustable technique that used in our study can be associated with lower reoperation than other adjustable techniques used in the other similar studies. PMID:25250293

  3. Social support and substitute voice acquisition on psychological adjustment among patients after laryngectomy.

    PubMed

    Kotake, Kumiko; Suzukamo, Yoshimi; Kai, Ichiro; Iwanaga, Kazuyo; Takahashi, Aya

    2017-03-01

    The objective is to clarify whether social support and acquisition of alternative voice enhance the psychological adjustment of laryngectomized patients and which part of the psychological adjustment structure would be influenced by social support. We contacted 1445 patients enrolled in a patient association using mail surveys and 679 patients agreed to participate in the study. The survey items included age, sex, occupation, post-surgery duration, communication method, psychological adjustment (by the Nottingham Adjustment Scale Japanese Laryngectomy Version: NAS-J-L), and the formal support (by Hospital Patient Satisfaction Questionnaire-25: HPSQ-25). Social support and communication methods were added to the three-tier structural model of psychological adjustment shown in our previous study, and a covariance structure analysis was conducted. Formal/informal supports and acquisition of alternative voice influence only the "recognition of oneself as voluntary agent", the first tier of the three-tier structure of psychological adjustment. The results suggest that social support and acquisition of alternative voice may enhance the recognition of oneself as voluntary agent and promote the psychological adjustment.

  4. Effects of autistic traits on social and school adjustment in children and adolescents: the moderating roles of age and gender.

    PubMed

    Hsiao, Mei-Ni; Tseng, Wan-Ling; Huang, Hui-Yi; Gau, Susan Shur-Fen

    2013-01-01

    This study examined the associations between children's and adolescents' autistic-like social deficits and school and social adjustment as well as the moderating roles of age and gender in these associations. The sample consisted of 1321 students (48.7% boys) in Grade 1 to Grade 8 from northern Taiwan. Children's and adolescents' autistic-like social deficits were assessed using the Social Responsiveness Scale (SRS), and their school and social adjustment (i.e., academic performance, negative attitudes toward schoolwork/teachers/classmates, behavioral problems at schools, negative peer relationships, and problems with peers) were assessed using the Social Adjustment Inventory for Children and Adolescents (SAICA). Both measures were completed by the mothers of the participants. Results from the linear mixed models demonstrated that autistic-like social deficits were associated with poor academic performance, negative attitudes toward schoolwork, teachers, and classmates, behavioral problems at schools, negative peer relationships, and problematic peer interactions. Moreover, gender and/or age moderated the associations between autistic-like social deficits and school and social adjustment problems. For example, autistic-like social deficits were more strongly related to negative school attitude, school social problems, and negative peer relationships in boys than in girls. Further, autistic-like social deficits were more strongly related to problems with peers in older girls than in older boys or younger children (regardless of gender). In conclusion, the present study suggests that autistic-like social deficits may place children and adolescents at increased risk for social and school maladjustment and that the extent of maladjustment may vary with the child's age and gender and the domains of adjustment under discussion. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. A stratification approach using logit-based models for confounder adjustment in the study of continuous outcomes.

    PubMed

    Tan, Chuen Seng; Støer, Nathalie C; Chen, Ying; Andersson, Marielle; Ning, Yilin; Wee, Hwee-Lin; Khoo, Eric Yin Hao; Tai, E-Shyong; Kao, Shih Ling; Reilly, Marie

    2017-01-01

    The control of confounding is an area of extensive epidemiological research, especially in the field of causal inference for observational studies. Matched cohort and case-control study designs are commonly implemented to control for confounding effects without specifying the functional form of the relationship between the outcome and confounders. This paper extends the commonly used regression models in matched designs for binary and survival outcomes (i.e. conditional logistic and stratified Cox proportional hazards) to studies of continuous outcomes through a novel interpretation and application of logit-based regression models from the econometrics and marketing research literature. We compare the performance of the maximum likelihood estimators using simulated data and propose a heuristic argument for obtaining the residuals for model diagnostics. We illustrate our proposed approach with two real data applications. Our simulation studies demonstrate that our stratification approach is robust to model misspecification and that the distribution of the estimated residuals provides a useful diagnostic when the strata are of moderate size. In our applications to real data, we demonstrate that parity and menopausal status are associated with percent mammographic density, and that the mean level and variability of inpatient blood glucose readings vary between medical and surgical wards within a national tertiary hospital. Our work highlights how the same class of regression models, available in most statistical software, can be used to adjust for confounding in the study of binary, time-to-event and continuous outcomes.

  6. 26 CFR 1.9001-2 - Basis adjustments for taxable years beginning on or after 1956 adjustment date.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... on or after 1956 adjustment date. 1.9001-2 Section 1.9001-2 Internal Revenue INTERNAL REVENUE SERVICE....9001-2 Basis adjustments for taxable years beginning on or after 1956 adjustment date. (a) In general. Subsection (d) of the Act provides the basis adjustments required to be made by the taxpayer as of the 1956...

  7. Early parental adjustment and bereavement after childhood cancer death.

    PubMed

    Barrera, Maru; O'Connor, Kathleen; D'Agostino, Norma Mammone; Spencer, Lynlee; Nicholas, David; Jovcevska, Vesna; Tallet, Susan; Schneiderman, Gerald

    2009-07-01

    This study comprehensively explored parental bereavement and adjustment at 6 months post-loss due to childhood cancer. Interviews were conducted with 18 mothers and 13 fathers. Interviews were transcribed verbatim and analyzed based on qualitative methodology. A model describing early parental bereavement and adaptation emerged with 3 domains: (1) Perception of the Child, describing bereavement and adjustment prior to and after the loss; (2) Perception of Others, including relationships with partners, surviving children, and their social network; and (3) Perception of the World, exploring parents' perceived meanings of the experience in the context of their worldview. Domains are illustrated by quotes. Profiles of parental bereavement emerged.

  8. New Design for an Adjustable Cise Space Maintainer

    PubMed Central

    2018-01-01

    Objective The aim of this study is to present a new adjustable Cise space maintainer for preventive orthodontic applications. Methods Stainless steel based new design consists of six main components. In order to understand the major displacement and stress fields, structural analysis for the design is considered by using finite element method. Results Similar to major displacement at y-axis, critical stresses σx and τxy possess a linear distribution with constant increasing. Additionally, strain energy density (SED) plays an important role to determine critical biting load capacity. Conclusion Structural analysis shows that the space maintainer is stable and is used for maintaining and/or regaining the space which arouses early loss of molar tooth. PMID:29854764

  9. The 4C framework for making reasonable adjustments for people with learning disabilities.

    PubMed

    Marsden, Daniel; Giles, Rachel

    2017-01-18

    Background People with learning disabilities experience significant inequalities in accessing healthcare. Legal frameworks, such as the Equality Act 2010, are intended to reduce such disparities in care, and require organisations to make 'reasonable adjustments' for people with disabilities, including learning disabilities. However, reasonable adjustments are often not clearly defined or adequately implemented in clinical practice. Aim To examine and synthesise the challenges in caring for people with learning disabilities to develop a framework for making reasonable adjustments for people with learning disabilities in hospital. This framework would assist ward staff in identifying and managing the challenges of delivering person-centred, safe and effective healthcare to people with learning disabilities in this setting. Method Fourth-generation evaluation, collaborative thematic analysis, reflection and a secondary analysis were used to develop a framework for making reasonable adjustments in the hospital setting. The authors attended ward manager and matron group meetings to collect their claims, concerns and issues, then conducted a collaborative thematic analysis with the group members to identify the main themes. Findings Four main themes were identified from the ward manager and matron group meetings: communication, choice-making, collaboration and coordination. These were used to develop the 4C framework for making reasonable adjustments for people with learning disabilities in hospital. Discussion The 4C framework has provided a basis for delivering person-centred care for people with learning disabilities. It has been used to inform training needs analyses, develop audit tools to review delivery of care that is adjusted appropriately to the individual patient; and to develop competencies for learning disability champions. The most significant benefit of the 4C framework has been in helping to evaluate and resolve practice-based scenarios. Conclusion Use of

  10. Observational intensity bias associated with illness adjustment: cross sectional analysis of insurance claims

    PubMed Central

    Staiger, Douglas O; Sharp, Sandra M; Gottlieb, Daniel J; Bevan, Gwyn; McPherson, Klim; Welch, H Gilbert

    2013-01-01

    Objective To determine the bias associated with frequency of visits by physicians in adjusting for illness, using diagnoses recorded in administrative databases. Setting Claims data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design Cross sectional analysis. Participants 20% sample of fee for service Medicare beneficiaries residing in the United States in 2007 (n=5 153 877). Main outcome measures The effect of illness adjustment on regional mortality and spending rates using standard and visit corrected illness methods for adjustment. The standard method adjusts using comorbidity measures based on diagnoses listed in administrative databases; the modified method corrects these measures for the frequency of visits by physicians. Three conventions for measuring comorbidity are used: the Charlson comorbidity index, Iezzoni chronic conditions, and hierarchical condition categories risk scores. Results The visit corrected Charlson comorbidity index explained more of the variation in age, sex, and race mortality across the 306 hospital referral regions than did the standard index (R2=0.21 v 0.11, P<0.001) and, compared with sex and race adjusted mortality, reduced regional variation, whereas adjustment using the standard Charlson comorbidity index increased it. Although visit corrected and age, sex, and race adjusted mortality rates were similar in hospital referral regions with the highest and lowest fifths of visits, adjustment using the standard index resulted in a rate that was 18% lower in the highest fifth (46.4 v 56.3 deaths per 1000, P<0.001). Age, sex, and race adjusted spending as well as visit corrected spending was more than 30% greater in the highest fifth of visits than in the lowest fifth, but only 12% greater after adjustment using the standard index. Similar results were obtained using the Iezzoni and the hierarchical condition categories conventions for measuring comorbidity. Conclusion The

  11. 44 CFR 62.21 - Claims adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HOMELAND SECURITY INSURANCE AND HAZARD MITIGATION National Flood Insurance Program SALE OF INSURANCE AND ADJUSTMENT OF CLAIMS Claims Adjustment, Claims Appeals, and Judicial Review § 62.21 Claims adjustment. (a) In...

  12. Design of motion adjusting system for space camera based on ultrasonic motor

    NASA Astrophysics Data System (ADS)

    Xu, Kai; Jin, Guang; Gu, Song; Yan, Yong; Sun, Zhiyuan

    2011-08-01

    Drift angle is a transverse intersection angle of vector of image motion of the space camera. Adjusting the angle could reduce the influence on image quality. Ultrasonic motor (USM) is a new type of actuator using ultrasonic wave stimulated by piezoelectric ceramics. They have many advantages in comparison with conventional electromagnetic motors. In this paper, some improvement was designed for control system of drift adjusting mechanism. Based on ultrasonic motor T-60 was designed the drift adjusting system, which is composed of the drift adjusting mechanical frame, the ultrasonic motor, the driver of Ultrasonic Motor, the photoelectric encoder and the drift adjusting controller. The TMS320F28335 DSP was adopted as the calculation and control processor, photoelectric encoder was used as sensor of position closed loop system and the voltage driving circuit designed as generator of ultrasonic wave. It was built the mathematic model of drive circuit of the ultrasonic motor T-60 using matlab modules. In order to verify the validity of the drift adjusting system, was introduced the source of the disturbance, and made simulation analysis. It designed the control systems of motor drive for drift adjusting system with the improved PID control. The drift angle adjusting system has such advantages as the small space, simple configuration, high position control precision, fine repeatability, self locking property and low powers. It showed that the system could accomplish the mission of drift angle adjusting excellent.

  13. Injunctive and Descriptive Peer Group Norms and the Academic Adjustment of Rural Early Adolescents

    ERIC Educational Resources Information Center

    Hamm, Jill V.; Schmid, Lorrie; Farmer, Thomas W.; Locke, Belinda

    2011-01-01

    This study integrates diverse literatures on peer group influence by conceptualizing and examining the relationship of peer group injunctive norms to the academic adjustment of a large and ethnically diverse sample of rural early adolescents' academic adjustment. Results of three-level hierarchical linear modeling indicated that peer groups were…

  14. Birth-Order Complementarity and Marital Adjustment.

    ERIC Educational Resources Information Center

    Vos, Cornelia J. Vanderkooy; Hayden, Delbert J.

    1985-01-01

    Tested the influence of birth-order complementarity on marital adjustment among 327 married women using the Spanier Dyadic Adjustment Scale (1976). Birth-order complementarity was found to be unassociated with marital adjustment. (Author/BL)

  15. Parents' Perceived Discrimination and Adolescent Adjustment in Chinese American Families: Mediating Family Processes.

    PubMed

    Hou, Yang; Kim, Su Yeong; Hazen, Nancy; Benner, Aprile D

    2017-01-01

    Parental discriminatory experiences can have significant implications for adolescent adjustment. This study examined family processes linking parental perceived discrimination to adolescent depressive symptoms and delinquent behaviors by using the family stress model and incorporating family systems theory. Participants were 444 Chinese American adolescents (M age.wave1  = 13.03) and their parents residing in Northern California. Testing of actor-partner interdependent models showed a significant indirect effect from earlier paternal (but not maternal) perceived discrimination to later adolescent adjustment through paternal depressive symptoms and maternal hostility toward adolescents. The results highlight the importance of including both parents and examining actor and partner effects to provide a more comprehensive understanding of how maternal and paternal perceived discrimination differentially and indirectly relate to adolescent adjustment. © 2016 The Authors. Child Development © 2016 Society for Research in Child Development, Inc.

  16. Family functioning and children's adjustment: associations among parents' depressed mood, marital hostility, parent-child hostility, and children's adjustment.

    PubMed

    Low, Sabina M; Stocker, Clare

    2005-09-01

    Relations between parents' depressed mood, marital conflict, parent-child hostility, and children's adjustment were examined in a community sample of 136 ten-year-olds and their parents. Videotaped observational and self-report data were used to examine these relations in path analyses. A proposed model was tested in which mothers' and fathers' depressed mood and marital hostility were associated with children's adjustment problems through disruptions in parent-child relationships. Results showed that both mothers' and fathers' marital hostility were linked to parent-child hostility, which in turn was linked to children's internalizing problems. Fathers' depressed mood was linked to children's internalizing problems indirectly through father-child hostility. Fathers' depressed mood was directly linked to children's externalizing problems and indirectly linked through father-child hostility. For mothers, marital hostility was directly linked to children's externalizing problems, and marital hostility in fathers was indirectly linked to children's externalizing problems through father-child hostility. (c) 2005 APA, all rights reserved

  17. The Need and Keys for a New Generation Network Adjustment Software

    NASA Astrophysics Data System (ADS)

    Colomina, I.; Blázquez, M.; Navarro, J. A.; Sastre, J.

    2012-07-01

    Orientation and calibration of photogrammetric and remote sensing instruments is a fundamental capacity of current mapping systems and a fundamental research topic. Neither digital remote sensing acquisition systems nor direct orientation gear, like INS and GNSS technologies, made block adjustment obsolete. On the contrary, the continuous flow of new primary data acquisition systems has challenged the capacity of the legacy block adjustment systems - in general network adjustment systems - in many aspects: extensibility, genericity, portability, large data sets capacity, metadata support and many others. In this article, we concentrate on the extensibility and genericity challenges that current and future network systems shall face. For this purpose we propose a number of software design strategies with emphasis on rigorous abstract modeling that help in achieving simplicity, genericity and extensibility together with the protection of intellectual proper rights in a flexible manner. We illustrate our suggestions with the general design approach of GENA, the generic extensible network adjustment system of GeoNumerics.

  18. 22 CFR 18.18 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Proposed findings and conclusions. 18.18 Section 18.18 Foreign Relations DEPARTMENT OF STATE PERSONNEL REGULATIONS CONCERNING POST EMPLOYMENT CONFLICT OF INTEREST Administrative Enforcement Proceedings § 18.18 Proposed findings and conclusions...

  19. 22 CFR 18.18 - Proposed findings and conclusions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Proposed findings and conclusions. 18.18 Section 18.18 Foreign Relations DEPARTMENT OF STATE PERSONNEL REGULATIONS CONCERNING POST EMPLOYMENT CONFLICT OF INTEREST Administrative Enforcement Proceedings § 18.18 Proposed findings and conclusions...

  20. 22 CFR 18.18 - Proposed findings and conclusions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Proposed findings and conclusions. 18.18 Section 18.18 Foreign Relations DEPARTMENT OF STATE PERSONNEL REGULATIONS CONCERNING POST EMPLOYMENT CONFLICT OF INTEREST Administrative Enforcement Proceedings § 18.18 Proposed findings and conclusions...

  1. 22 CFR 18.18 - Proposed findings and conclusions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Proposed findings and conclusions. 18.18 Section 18.18 Foreign Relations DEPARTMENT OF STATE PERSONNEL REGULATIONS CONCERNING POST EMPLOYMENT CONFLICT OF INTEREST Administrative Enforcement Proceedings § 18.18 Proposed findings and conclusions...

  2. 22 CFR 18.18 - Proposed findings and conclusions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Proposed findings and conclusions. 18.18 Section 18.18 Foreign Relations DEPARTMENT OF STATE PERSONNEL REGULATIONS CONCERNING POST EMPLOYMENT CONFLICT OF INTEREST Administrative Enforcement Proceedings § 18.18 Proposed findings and conclusions...

  3. Generalized adjustment by least squares ( GALS).

    USGS Publications Warehouse

    Elassal, A.A.

    1983-01-01

    The least-squares principle is universally accepted as the basis for adjustment procedures in the allied fields of geodesy, photogrammetry and surveying. A prototype software package for Generalized Adjustment by Least Squares (GALS) is described. The package is designed to perform all least-squares-related functions in a typical adjustment program. GALS is capable of supporting development of adjustment programs of any size or degree of complexity. -Author

  4. 39 CFR 3010.28 - Maximum size of unused rate adjustment authority rate adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Maximum size of unused rate adjustment authority rate adjustments. 3010.28 Section 3010.28 Postal Service POSTAL REGULATORY COMMISSION PERSONNEL REGULATION OF RATES FOR MARKET DOMINANT PRODUCTS Rules for Applying the Price Cap § 3010.28 Maximum size of...

  5. Adjusting for the Confounding Effects of Treatment Switching—The BREAK-3 Trial: Dabrafenib Versus Dacarbazine

    PubMed Central

    Abrams, Keith R.; Amonkar, Mayur M.; Stapelkamp, Ceilidh; Swann, R. Suzanne

    2015-01-01

    Background. Patients with previously untreated BRAF V600E mutation-positive melanoma in BREAK-3 showed a median overall survival (OS) of 18.2 months for dabrafenib versus 15.6 months for dacarbazine (hazard ratio [HR], 0.76; 95% confidence interval, 0.48–1.21). Because patients receiving dacarbazine were allowed to switch to dabrafenib at disease progression, we attempted to adjust for the confounding effects on OS. Materials and Methods. Rank preserving structural failure time models (RPSFTMs) and the iterative parameter estimation (IPE) algorithm were used. Two analyses, “treatment group” (assumes treatment effect could continue until death) and “on-treatment observed” (assumes treatment effect disappears with discontinuation), were used to test the assumptions around the durability of the treatment effect. Results. A total of 36 of 63 patients (57%) receiving dacarbazine switched to dabrafenib. The adjusted OS HRs ranged from 0.50 to 0.55, depending on the analysis. The RPSFTM and IPE “treatment group” and “on-treatment observed” analyses performed similarly well. Conclusion. RPSFTM and IPE analyses resulted in point estimates for the OS HR that indicate a substantial increase in the treatment effect compared with the unadjusted OS HR of 0.76. The results are uncertain because of the assumptions associated with the adjustment methods. The confidence intervals continued to cross 1.00; thus, the adjusted estimates did not provide statistically significant evidence of a treatment benefit on survival. However, it is clear that a standard intention-to-treat analysis will be confounded in the presence of treatment switching—a reliance on unadjusted analyses could lead to inappropriate practice. Adjustment analyses provide useful additional information on the estimated treatment effects to inform decision making. Implications for Practice: Treatment switching is common in oncology trials, and the implications of this for the interpretation of the

  6. Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism.

    PubMed

    Takach Lapner, Sarah; Julian, Jim A; Linkins, Lori-Ann; Bates, Shannon; Kearon, Clive

    2017-10-05

    Two new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7 %) and the age-adjusted strategy (99.6 %) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1 % vs, 50.9 %; difference 5.2 %; 95 % CI 3.5 % to 6.8 %). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

  7. Parents' psychological adjustment in families of children with Spina Bifida: a meta-analysis

    PubMed Central

    Vermaes, Ignace PR; Janssens, Jan MAM; Bosman, Anna MT; Gerris, Jan RM

    2005-01-01

    Background Spina Bifida (SB) is the second most common birth defect worldwide. Since the chances of survival in children with severe SB-forms have increased, medical care has shifted its emphasis from life-saving interventions to fostering the quality of life for these children and their families. Little is known, however, about the impact of SB on family adjustment. Reviewers have struggled to synthesize the few contradictory studies available. In this systematic review a new attempt was made to summarize the findings by using meta-analysis and by delimiting the scope of review to one concept of family adjustment: Parents' psychological adjustment. The questions addressed were: (a) do parents of children with SB have more psychological distress than controls? (b) do mothers and fathers differ? and (c) which factors correlate with variations in psychological adjustment? Methods PsycInfo, Medline, and reference lists were scanned. Thirty-three relevant studies were identified of which 15 were eligible for meta-analysis. Results SB had a negative medium-large effect on parents' psychological adjustment. The effect was more heterogeneous for mothers than for fathers. In the reviewed studies child factors (age, conduct problems, emotional problems, and mental retardation), parent factors (SES, hope, appraised stress, coping, and parenting competence), family factors (family income, partner relationship, and family climate), and environmental factors (social support) were found to be associated with variations in parents' psychological adjustment. Conclusion Meta-analysis proved to be helpful in organizing studies. Clinical implications indicate a need to be especially alert to psychological suffering in mothers of children with SB. Future research should increase sample sizes through multi-center collaborations. PMID:16120229

  8. The necessity of sociodemographic status adjustment in hospital value rankings for perforated appendicitis in children.

    PubMed

    Tian, Yao; Sweeney, John F; Wulkan, Mark L; Heiss, Kurt F; Raval, Mehul V

    2016-06-01

    Hospitals are increasingly focused on demonstration of high-value care for common surgical procedures. Although sociodemographic status (SDS) factors have been tied to various surgical outcomes, the impact of SDS factors on hospital value rankings has not been well explored. Our objective was to examine effects of SDS factors on high-value surgical care at the patient level, and to illustrate the importance of SDS adjustment when evaluating hospital-level performance. Perforated appendicitis hospitalizations were identified from the 2012 Kids' Inpatient Database. The primary outcome of interest was high-value care as defined by evaluation of duration of stay and cost. SDS factors included race, health insurance type, median household income, and patient location. The impact of SDS on high-value care was estimated using regression models after accounting for hospital-level variation. Risk-adjusted value rankings were compared before and after adjustment for SDS. From 9,986 hospitalizations, 998 high-value encounters were identified. African Americans were less likely to experience high-value care compared with white patients after adjusting for all SDS variables. Although private insurance and living in nonmetro counties were associated independently with high-value care, the effects were attenuated in the fully adjusted models. For the 136 hospitals ranked according to risk-adjusted value status, 59 hospitals' rankings improved after adjustment and 53 hospitals' rankings declined. After adjustment for patient and hospital factors, SDS has a small but significant impact on risk-adjusted hospital performance ranking for pediatric appendicitis. Adjustment for SDS should be considered in future comparative performance assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Early Parental Adjustment and Bereavement after Childhood Cancer Death

    ERIC Educational Resources Information Center

    Barrera, Maru; O'connor, Kathleen; D'Agostino, Norma Mammone; Spencer, Lynlee; Nicholas, David; Jovcevska, Vesna; Tallet, Susan; Schneiderman, Gerald

    2009-01-01

    This study comprehensively explored parental bereavement and adjustment at 6 months post-loss due to childhood cancer. Interviews were conducted with 18 mothers and 13 fathers. Interviews were transcribed verbatim and analyzed based on qualitative methodology. A model describing early parental bereavement and adaptation emerged with 3 domains:…

  10. Adjustable-Torque Truss-Joint Mechanism

    NASA Technical Reports Server (NTRS)

    Bush, Harold G.; Wallsom, Richard E.

    1993-01-01

    Threaded pin tightened or loosened; tedious trial-and-error procedure shortened. Mechanism joining strut and node in truss structure preloaded to desired stress to ensure tight, compressive fit preventing motion of strut during loading or vibration. Preload stress on stack of Belleville spring washers adjusted by tightening or loosening threaded Belleville-washer-alignment pin. Pin turned, by use of allen wrench, to adjust compression preload on Belleville washers and adjusts joint-operating torque.

  11. 16 CFR 1025.46 - Proposed findings, conclusions, and order.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Proposed findings, conclusions, and order... PRACTICE FOR ADJUDICATIVE PROCEEDINGS Hearings § 1025.46 Proposed findings, conclusions, and order. Within..., including proposed findings of fact and conclusions of law, as well as a proposed order. The Presiding...

  12. Gender adjustment or stratification in discerning upper extremity musculoskeletal disorder risk?

    PubMed

    Silverstein, Barbara; Fan, Z Joyce; Smith, Caroline K; Bao, Stephen; Howard, Ninica; Spielholz, Peregrin; Bonauto, David; Viikari-Juntura, Eira

    2009-03-01

    The aim was to explore whether "adjustment" for gender masks important exposure differences between men and women in a study of rotator cuff syndrome (RCS) and carpal tunnel syndrome (CTS) and work exposures. This cross-sectional study of 733 subjects in 12 health care and manufacturing workplaces used detailed individual health and work exposure assessment methods. Multiple logistic regression analysis was used to compare gender stratified and adjusted models. Prevalence of RCS and CTS among women was 7.1% and 11.3% respectively, and among men 7.8% and 6.4%. In adjusted (gender, age, body mass index) multivariate analyses of RCS and CTS, gender was not statistically significantly different. For RCS, upper arm flexion >/=45 degrees and forceful pinch increased the odds in the gender-adjusted model (OR 2.66, 95% CI 1.26-5.59) but primarily among women in the stratified analysis (OR 6.68, 95% CI 1.81-24.66 versus OR 1.45, 95% CI 0.53-4.00). For CTS, wrist radial/ulnar deviation >/=4% time and lifting >/=4.5kg >3% time, the adjusted OR was higher for women (OR 4.85, 95% CI 2.12-11.11) and in the gender stratified analyses, the odds were increased for both genders (women OR 5.18, 95% CI 1.70-15.81 and men OR 3.63, 95% CI 1.08-12.18). Gender differences in response to physical work exposures may reflect gender segregation in work and potential differences in pinch and lifting capacity. Reduction in these exposures may reduce prevalence of upper extremity disorders for all workers.

  13. Searching for 3D Viscosity Models of Glacial Isostatic Adjustment in Support of the Global ICE-6G_C Ice History Model

    NASA Astrophysics Data System (ADS)

    LI, T., II; Wu, P.; Steffen, H.; Wang, H.

    2017-12-01

    The global ice history model ICE-6G_C was constructed based on the laterally homogeneous earth model VM5a. The combined model of glacial isostatic adjustment (GIA) called ICE-6G_C (VM5a) fits global observations of GIA simultaneously well. However, seismic and geological observations clearly show that the Earth's mantle is laterally heterogeneous. Our aim therefore is to search for the best laterally heterogeneous viscosity models with ICE-6G_C ice history that is able to fit the global relative sea-level (RSL) data, the peak uplift rates (from GNSS) and peak g-dot rates (from the GRACE satellite mission) in Laurentia and Fennoscandia simultaneously. The Coupled Laplace-Finite Element Method is used to compute gravitationally self-consistent sea levels with time dependent coastlines and rotational feedback in addition to changes in deformation, gravity and the state of stress. As a start, the VM5a Earth model is used as the radial background viscosity structure but other radial background viscosity models will also be investigated. Lateral mantle viscosity structure is obtained by the superposition of the radial background viscosity and the lateral viscosity perturbations logarithmically. The latter is inferred from a seismic tomography model using a scaling relationship that takes into account the effects of anharmonicity, anelasticity and non-thermal effects. We will show that several laterally heterogeneous mantle viscosity models can fit the global sea level, GPS and GRACE data better than laterally homogeneous models, provided that the scaling relationship for mantle heterogeneity under northern Europe is allowed to be different from that under Laurentia. In addition, the effects of laterally heterogeneous lithosphere, as inferred from seismic tomography, and the lateral changes in sub-lithospheric properties will also be presented.

  14. Real-time adjusting of rainfall estimates from commercial microwave links

    NASA Astrophysics Data System (ADS)

    Fencl, Martin; Dohnal, Michal; Bareš, Vojtěch

    2017-04-01

    Urban stormwater predictions require reliable rainfall information with space-time resolution higher than commonly provided by standard rainfall monitoring networks of national weather services. Rainfall data from commercial microwave links (CMLs) could fill this gap. CMLs are line-of-sight radio connections widely used by cellular operators which operate at millimeter bands, where radio waves are attenuated by raindrops. Attenuation data of each single CML in the cellular network can be remotely accessed in (near) real-time with virtually arbitrary sampling frequency and convert to rainfall intensity. Unfortunately, rainfall estimates from CMLs can be substantially biased. Fencl et al., (2017), therefore, proposed adjusting method which enables to correct for this bias. They used rain gauge (RG) data from existing rainfall monitoring networks, which would have otherwise insufficient spatial and temporal resolution for urban rainfall monitoring when used alone without CMLs. In this investigation, we further develop the method to improve its performance in a real-time setting. First, a shortcoming of the original algorithm which delivers unreliable results at the beginning of a rainfall event is overcome by introducing model parameter prior distributions estimated from previous parameter realizations. Second, weights reflecting variance between RGs are introduced into cost function, which is minimized when optimizing model parameters. Finally, RG data used for adjusting are preprocessed by moving average filter. The performance of improved adjusting method is evaluated on four short CMLs (path length < 2 km) located in the small urban catchment (2.3 km2) in Prague-Letnany (CZ). The adjusted CMLs are compared to reference rainfall calculated from six RGs in the catchment. The suggested improvements of the method lead on average to 10% higher Nash-Sutcliffe efficiency coefficient (median value 0.85) for CML adjustment to hourly RG data. Reliability of CML rainfall

  15. 31 CFR 8.67 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Proposed findings and conclusions. 8... THE BUREAU OF ALCOHOL, TOBACCO AND FIREARMS Disciplinary Proceedings § 8.67 Proposed findings and... afford the parties a reasonable opportunity to submit proposed findings and conclusions and their...

  16. 31 CFR 10.75 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Proposed findings and conclusions. 10... THE INTERNAL REVENUE SERVICE Rules Applicable to Disciplinary Proceedings § 10.75 Proposed findings... submit proposed findings and conclusions and their supporting reasons to the Administrative Law Judge. ...

  17. 40 CFR 35.6820 - Conclusion of the SSC.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... STATE AND LOCAL ASSISTANCE Cooperative Agreements and Superfund State Contracts for Superfund Response Actions Requirements for Administering A Superfund State Contract (ssc) § 35.6820 Conclusion of the SSC... (See § 35.6805(i)(4)). (b) After the administrative conclusion of the Superfund State Contract, EPA may...

  18. 40 CFR 35.6820 - Conclusion of the SSC.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... STATE AND LOCAL ASSISTANCE Cooperative Agreements and Superfund State Contracts for Superfund Response Actions Requirements for Administering A Superfund State Contract (ssc) § 35.6820 Conclusion of the SSC... (See § 35.6805(i)(4)). (b) After the administrative conclusion of the Superfund State Contract, EPA may...

  19. 40 CFR 35.6820 - Conclusion of the SSC.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... STATE AND LOCAL ASSISTANCE Cooperative Agreements and Superfund State Contracts for Superfund Response Actions Requirements for Administering A Superfund State Contract (ssc) § 35.6820 Conclusion of the SSC... (See § 35.6805(i)(4)). (b) After the administrative conclusion of the Superfund State Contract, EPA may...

  20. 40 CFR 35.6820 - Conclusion of the SSC.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... STATE AND LOCAL ASSISTANCE Cooperative Agreements and Superfund State Contracts for Superfund Response Actions Requirements for Administering A Superfund State Contract (ssc) § 35.6820 Conclusion of the SSC... (See § 35.6805(i)(4)). (b) After the administrative conclusion of the Superfund State Contract, EPA may...

  1. 40 CFR 35.6820 - Conclusion of the SSC.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... STATE AND LOCAL ASSISTANCE Cooperative Agreements and Superfund State Contracts for Superfund Response Actions Requirements for Administering A Superfund State Contract (ssc) § 35.6820 Conclusion of the SSC... (See § 35.6805(i)(4)). (b) After the administrative conclusion of the Superfund State Contract, EPA may...

  2. A typology of interpartner conflict and maternal parenting practices in high-risk families: examining spillover and compensatory models and implications for child adjustment.

    PubMed

    Sturge-Apple, Melissa L; Davies, Patrick T; Cicchetti, Dante; Fittoria, Michael G

    2014-11-01

    The present study incorporates a person-based approach to identify spillover and compartmentalization patterns of interpartner conflict and maternal parenting practices in an ethnically diverse sample of 192 2-year-old children and their mothers who had experienced higher levels of socioeconomic risk. In addition, we tested whether sociocontextual variables were differentially predictive of theses profiles and examined how interpartner-parenting profiles were associated with children's physiological and psychological adjustment over time. As expected, latent class analyses extracted three primary profiles of functioning: adequate functioning, spillover, and compartmentalizing families. Furthermore, interpartner-parenting profiles were differentially associated with both sociocontextual predictors and children's adjustment trajectories. The findings highlight the developmental utility of incorporating person-based approaches to models of interpartner conflict and maternal parenting practices.

  3. [Adjustment of the Andersen's model to the Mexican context: access to prenatal care].

    PubMed

    Tamez-González, Silvia; Valle-Arcos, Rosa Irene; Eibenschutz-Hartman, Catalina; Méndez-Ramírez, Ignacio

    2006-01-01

    The aim of this work was to propose an adjustment to the Model of Andersen who answers better to the social inequality of the population in the Mexico City and allows to evaluate the effect of socioeconomic factors in the access to the prenatal care of a sample stratified according to degree of marginalization. The data come from a study of 663 women, randomly selected from a framework sample of 21,421 homes in Mexico City. This work collects information about factors that affect utilization of health services, as well as predisposing factors (age and socioeconomic level), as enabling factors (education, social support, entitlement, pay out of pocket and opinion of health services), and need factors. The sample was ranked according to exclusion variables into three stratums. The data were analyzed through the technique of path analysis. The results indicate that socioeconomic level takes part like predisposed variable for utilization of prenatal care services into three stratums. Otherwise, education and social support were the most important enabling variables for utilization of prenatal care services in the same three groups. In regard to low stratum, the most important enabling variables were education and entitlement. For high stratum the principal enabling variables were pay out of pocket and social support. The medium stratum shows atypical behavior which it was difficult to explain and understand. There was not mediating role with need variable in three models. This indicated absence of equality in all stratums. However, the most correlations in high stratum perhaps indicate less inequitable conditions regarding other stratums.

  4. Chiropractic Adjustment

    MedlinePlus

    ... physical function. Why it's done Low back pain, neck pain and headache are the most common problems for ... headaches and other spine-related conditions, such as neck pain. Not everyone responds to chiropractic adjustments. A lot ...

  5. 29 CFR 458.87 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Proposed findings and conclusions. 458.87 Section 458.87... OF CONDUCT STANDARDS OF CONDUCT Hearing and Related Matters § 458.87 Proposed findings and... findings and conclusions to the Administrative Law Judge, together with supporting reasons therefor, which...

  6. 39 CFR 952.23 - Proposed findings and conclusions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... law, orders and supporting reasons either in oral or written form in the discretion of the presiding... fact, conclusions of law, orders, and supporting reasons. Unless given orally, the date set for filing of proposed findings of fact, conclusions of law, orders and supporting reasons shall be within 15...

  7. 25 CFR 39.145 - Can a school receive both a small school adjustment and a small high school adjustment?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... small high school adjustment? 39.145 Section 39.145 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE... Adjustment § 39.145 Can a school receive both a small school adjustment and a small high school adjustment? A school that meets the criteria in § 39.140 can receive both a small school adjustment and a small high...

  8. 25 CFR 39.145 - Can a school receive both a small school adjustment and a small high school adjustment?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... small high school adjustment? 39.145 Section 39.145 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE... Adjustment § 39.145 Can a school receive both a small school adjustment and a small high school adjustment? A school that meets the criteria in § 39.140 can receive both a small school adjustment and a small high...

  9. 25 CFR 39.145 - Can a school receive both a small school adjustment and a small high school adjustment?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... small high school adjustment? 39.145 Section 39.145 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE... Adjustment § 39.145 Can a school receive both a small school adjustment and a small high school adjustment? A school that meets the criteria in § 39.140 can receive both a small school adjustment and a small high...

  10. Measurement and risk adjustment of prelabor cesarean rates in a large sample of California hospitals.

    PubMed

    Huesch, Marco D; Currid-Halkett, Elizabeth; Doctor, Jason N

    2014-05-01

    Prelabor cesareans in women without a prior cesarean is an important quality measure, yet one that is seldom tracked. We estimated patient-level risks and calculated how sensitive hospital rankings on this proposed quality metric were to risk adjustment. This retrospective cohort study linked Californian patient data from the Agency for Healthcare Research and Quality with hospital-level operational and financial data. Using the outcome of primary prelabor cesarean, we estimated patient-level logistic regressions in progressively more detailed models. We assessed incremental fit and discrimination, and aggregated the predicted patient-level event probabilities to construct hospital-level rankings. Of 408,355 deliveries by women without prior cesareans at 254 hospitals, 11.0% were prelabor cesareans. Including age, ethnicity, race, insurance, weekend and unscheduled admission, and 12 well-known patient risk factors yielded a model c-statistic of 0.83. Further maternal comorbidities, and hospital and obstetric unit characteristics only marginally improved fit. Risk adjusting hospital rankings led to a median absolute change in rank of 44 places compared to rankings based on observed rates. Of the 48 (49) hospitals identified as in the best (worst) quintile on observed rates, only 23 (18) were so identified by the risk-adjusted model. Models predict primary prelabor cesareans with good discrimination. Systematic hospital-level variation in patient risk factors requires risk adjustment to avoid considerably different classification of hospitals by outcome performance. An opportunity exists to define this metric and report such risk-adjusted outcomes to stakeholders. Copyright © 2014 Mosby, Inc. All rights reserved.

  11. End user evaluation of a Kneeling Wheelchair with "on the fly" adjustable seating functions.

    PubMed

    Mattie, Johanne; Wong, Angie; Leland, Danny; Borisoff, Jaimie

    2018-04-18

    A "kneeling" ultralight wheelchair prototype has been developed that allows users to adjust seat position "on the fly" for different activities throughout the day. The wheelchair includes independent adjustment functions for rear seat height, front seat height ("kneeling") and backrest angle.  Aim: This work aimed to gather feedback about the wheelchair's functionality and performance through end user evaluation trials.  Methods: Eight manual wheelchair users evaluated the prototype Kneeling Wheelchair for a range of activities. User perspectives on parameters such as usability, comfort, stability and effectiveness were obtained through both open-ended and Likert-scale rating questions.  Results: Results indicate several potential benefits of the adjustment functions of the Kneeling Wheelchair. Rear seat height adjustment may facilitate a number of activities of daily living, as well as provide benefits for comfort and social interactions. Back rest adjustment may increase comfort and stability on slopes. Front seat height adjustment may be beneficial for transfers and conducting sustained low-to-the-ground activities. While benefits of this adjustment function were described by many participants, some struggled with usability of the kneeling mechanism and rated this function less favourably than the other two.  Conclusion: The findings of this study will inform future iterations of the Kneeling Wheelchair design and may spur future developments in wheeled mobility. In the long-term, it is anticipated that novel wheelchair solutions, such as the one described in this paper, may support improved health, quality of life and community participation for people with mobility impairments. Implications for rehabilitation Wheelchairs that allow users to easily adjust seat and backrest position "on the fly" to better suit different tasks throughout the day may provide benefits such as facilitating activities of daily living. A front seat height adjustment feature on a

  12. Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

    PubMed Central

    Lettieri, Christopher J.; Paolino, Nathalie; Eliasson, Arn H.; Shah, Anita A.; Holley, Aaron B.

    2011-01-01

    Study Objectives: To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA. Methods: Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success. Results: We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. Conclusions: Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance. Citation: Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med 2011;7(5):439-445. PMID:22003337

  13. Factor Analysis of the Modified Sexual Adjustment Questionnaire-Male

    PubMed Central

    Wilmoth, Margaret C.; Hanlon, Alexandra L.; Ng, Lit Soo; Bruner, Debra W.

    2015-01-01

    Background and Purpose The Sexual Adjustment Questionnaire (SAQ) is used in National Cancer Institute–sponsored clinical trials as an outcome measure for sexual functioning. The tool was revised to meet the needs for a clinically useful, theory-based outcome measure for use in both research and clinical settings. This report describes the modifications and validity testing of the modified Sexual Adjustment Questionnaire-Male (mSAQ-Male). Methods This secondary analysis of data from a large Radiation Therapy Oncology Group trial employed principal axis factor analytic techniques in estimating validity of the revised tool. The sample size was 686; most subjects were White, older than the age 60 years, and with a high school education and a Karnofsky performance scale (KPS) score of greater than 90. Results A 16-item, 3-factor solution resulted from the factor analysis. The mSAQ-Male was also found to be sensitive to changes in physical sexual functioning as measured by the KPS. Conclusion The mSAQ-Male is a valid self-report measure of sexuality that can be used clinically to detect changes in male sexual functioning. PMID:25255676

  14. Personal resilience, cognitive appraisals, and coping: an integrative model of adjustment to abortion.

    PubMed

    Major, B; Richards, C; Cooper, M L; Cozzarelli, C; Zubek, J

    1998-03-01

    We hypothesized that the effects of personality (self-esteem, control, and optimism) on postabortion adaptation (distress, well-being, and decision satisfaction) would be fully mediated by preabortion cognitive appraisals (stress appraisals and self-efficacy appraisals) and postabortion coping. We further proposed that the effects of preabortion appraisals on adaptation would be fully mediated by postabortion coping. Results of a longitudinal study of 527 women who had first-trimester abortions supported our hypotheses. Women with more resilient personalities appraised their abortion as less stressful and had higher self-efficacy for coping with the abortion. More positive appraisals predicted greater acceptance/reframing coping and lesser avoidance/denial, venting, support seeking, and religious coping. Acceptance-reframing predicted better adjustment on all measures, whereas avoidance-denial and venting related to poorer adjustment on all measures. Greater support seeking was associated with reduced distress, and greater religious coping was associated with less decision satisfaction.

  15. Direct risk standardisation: a new method for comparing casemix adjusted event rates using complex models.

    PubMed

    Nicholl, Jon; Jacques, Richard M; Campbell, Michael J

    2013-10-29

    Comparison of outcomes between populations or centres may be confounded by any casemix differences and standardisation is carried out to avoid this. However, when the casemix adjustment models are large and complex, direct standardisation has been described as "practically impossible", and indirect standardisation may lead to unfair comparisons. We propose a new method of directly standardising for risk rather than standardising for casemix which overcomes these problems. Using a casemix model which is the same model as would be used in indirect standardisation, the risk in individuals is estimated. Risk categories are defined, and event rates in each category for each centre to be compared are calculated. A weighted sum of the risk category specific event rates is then calculated. We have illustrated this method using data on 6 million admissions to 146 hospitals in England in 2007/8 and an existing model with over 5000 casemix combinations, and a second dataset of 18,668 adult emergency admissions to 9 centres in the UK and overseas and a published model with over 20,000 casemix combinations and a continuous covariate. Substantial differences between conventional directly casemix standardised rates and rates from direct risk standardisation (DRS) were found. Results based on DRS were very similar to Standardised Mortality Ratios (SMRs) obtained from indirect standardisation, with similar standard errors. Direct risk standardisation using our proposed method is as straightforward as using conventional direct or indirect standardisation, always enables fair comparisons of performance to be made, can use continuous casemix covariates, and was found in our examples to have similar standard errors to the SMR. It should be preferred when there is a risk that conventional direct or indirect standardisation will lead to unfair comparisons.

  16. Correlates of household seismic hazard adjustment adoption.

    PubMed

    Lindell, M K; Whitney, D J

    2000-02-01

    This study examined the relationships of self-reported adoption of 12 seismic hazard adjustments (pre-impact actions to reduce danger to persons and property) with respondents' demographic characteristics, perceived risk, perceived hazard knowledge, perceived protection responsibility, and perceived attributes of the hazard adjustments. Consistent with theoretical predictions, perceived attributes of the hazard adjustments differentiated among the adjustments and had stronger correlations with adoption than any of the other predictors. These results identify the adjustments and attributes that emergency managers should address to have the greatest impact on improving household adjustment to earthquake hazard.

  17. Body mass index adjustments to increase the validity of body fatness assessment in UK Black African and South Asian children

    PubMed Central

    Hudda, M T; Nightingale, C M; Donin, A S; Fewtrell, M S; Haroun, D; Lum, S; Williams, J E; Owen, C G; Rudnicka, A R; Wells, J C K; Cook, D G; Whincup, P H

    2017-01-01

    Background/Objectives: Body mass index (BMI) (weight per height2) is the most widely used marker of childhood obesity and total body fatness (BF). However, its validity is limited, especially in children of South Asian and Black African origins. We aimed to quantify BMI adjustments needed for UK children of Black African and South Asian origins so that adjusted BMI related to BF in the same way as for White European children. Methods: We used data from four recent UK studies that made deuterium dilution BF measurements in UK children of White European, South Asian and Black African origins. A height-standardized fat mass index (FMI) was derived to represent BF. Linear regression models were then fitted, separately for boys and girls, to quantify ethnic differences in BMI–FMI relationships and to provide ethnic-specific BMI adjustments. Results: We restricted analyses to 4–12 year olds, to whom a single consistent FMI (fat mass per height5) could be applied. BMI consistently underestimated BF in South Asians, requiring positive BMI adjustments of +1.12 kg m−2 (95% confidence interval (CI): 0.83, 1.41 kg m−2; P<0.0001) for boys and +1.07 kg m−2 (95% CI: 0.74, 1.39 kg m−2; P<0.0001) for girls of all age groups and FMI levels. BMI overestimated BF in Black Africans, requiring negative BMI adjustments for Black African children. However, these were complex because there were statistically significant interactions between Black African ethnicity and FMI (P=0.004 boys; P=0.003 girls) and also between FMI and age group (P<0.0001 for boys and girls). BMI adjustments therefore varied by age group and FMI level (and indirectly BMI); the largest adjustments were in younger children with higher unadjusted BMI and the smallest in older children with lower unadjusted BMI. Conclusions: BMI underestimated BF in South Asians and overestimated BF in Black Africans. Ethnic-specific adjustments, increasing BMI in South Asians and reducing BMI in Black

  18. Perceived parenting style and adolescent adjustment: revisiting directions of effects and the role of parental knowledge.

    PubMed

    Kerr, Margaret; Stattin, Håkan; Ozdemir, Metin

    2012-11-01

    In the present research on parenting and adolescent behavior, there is much focus on reciprocal, bidirectional, and transactional processes, but parenting-style research still adheres to a unidirectional perspective in which parents affect youth behavior but are unaffected by it. In addition, many of the most cited parenting-style studies have used measures of parental behavioral control that are questionable because they include measures of parental knowledge. The goals of this study were to determine whether including knowledge items might have affected results of past studies and to test the unidirectional assumption. Data were from 978 adolescents participating in a longitudinal study. Parenting-style and adolescent adjustment measures at 2 time points were used, with a 2-year interval between time points. A variety of internal and external adjustment measures were used. Results showed that including knowledge items in measures of parental behavioral control elevated links between behavioral control and adjustment. Thus, the results and conclusions of many of the most highly cited studies are likely to have been stronger than if the measures had focused strictly on parental behavior. In addition, adolescent adjustment predicted changes in authoritative and neglectful parenting styles more robustly than these styles predicted changes in adolescent adjustment. Adolescent adjustment also predicted changes in authoritativeness more robustly than authoritativeness predicted changes in adjustment. Thus, parenting style cannot be seen as independent of the adolescent. In summary, both the theoretical premises of parenting-style research and the prior findings should be revisited.

  19. Adjusting slash pine growth and yield for silvicultural treatments

    Treesearch

    Stephen R. Logan; Barry D. Shiver

    2006-01-01

    With intensive silvicultural treatments such as fertilization and competition control now commonplace in today's slash pine (Pinus elliottii Engelm.) plantations, a method to adjust current growth and yield models is required to accurately account for yield increases due to these practices. Some commonly used ad-hoc methods, such as raising site...

  20. Risk adjustment for comparing hospital quality with surgery: how many variables are needed?

    PubMed

    Dimick, Justin B; Osborne, Nicholas H; Hall, Bruce L; Ko, Clifford Y; Birkmeyer, John D

    2010-04-01

    The American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) will soon be reporting procedure-specific outcomes, and hopes to reduce the burden of data collection by collecting fewer variables. We sought to determine whether these changes threaten the robustness of the risk adjustment of hospital quality comparisons. We used prospective, clinical data from the ACS NSQIP from 2005 to 2007 (184 hospitals, 74,887 patients). For the 5 general surgery operations in the procedure-specific NSQIP, we compared the ability of the full model (21 variables), an intermediate model (12 variables), and a limited model (5 variables) to predict patient outcomes and to risk-adjust hospital outcomes. The intermediate and limited models were comparable with the full model in all analyses. In the assessment of patient risk, the limited and full models had very similar discrimination at the patient level (C-indices for all 5 procedures combined of 0.93 versus 0.91 for mortality and 0.78 versus 0.76 for morbidity) and showed good calibration across strata of patient risk. In assessing hospital-specific outcomes, results from the limited and full-risk models were highly correlated for both mortality (range 0.94 to 0.99 across the 5 operations) and morbidity (range 0.96 to 0.99). Procedure-specific hospital quality measures can be adequately risk-adjusted with a limited number of variables. In the context of the ACS NSQIP, moving to a more limited model will dramatically reduce the burden of data collection for participating hospitals. Published by Elsevier Inc.

  1. Study of Spiritual Intelligence and Adjustment Among Arts and Science College Students.

    PubMed

    Devi, R Kalpana; Rajesh, Nakulan V; Devi, M Anisha

    2017-06-01

    A study to evaluate the relationship between the spiritual intelligence and adjustment among the college students was conducted on a sample of 250 students in six various colleges of Tuticorin district, Tamil Nadu, India. Gender, religion, community, major subject, educational qualification of father and mother, student locality, college type, father and mother's occupation and monthly family income (n = 11 variables) were chosen for the study. Test of significance for spiritual intelligence and adjustment was studied and found them nonsignificant except student locality, found to be significant. Two valid and reliable instruments were used to assess student's spiritual intelligence and adjustment. Correlation and Chi-square analysis using structural equation model were used to analyze these data. Correlation analysis showed significant relationship between the variables among the college students (n = 250). Chi-square analysis of association between adjustments of college students showed that most variables are nonsignificant unlike father's educational qualification and mother's occupation. The results disclosed the significant positive relationship with spiritual intelligence and adjustment among adolescents.

  2. Parenting and late adolescent emotional adjustment: mediating effects of discipline and gender.

    PubMed

    McKinney, Cliff; Milone, Mary Catherine; Renk, Kimberly

    2011-08-01

    Research suggests that parenting styles are related to the types of discipline parents utilize and that the coupling of parenting styles and discipline techniques are related to child outcomes. Although extant research examines the effects of parenting styles and discipline on child and early adolescent adjustment, less is known about adjustment in late adolescents, also described as emerging adults. Thus, the current study investigated the relationships among parenting styles (e.g., authoritative, authoritarian, permissive), discipline strategies (e.g., non-violent discipline, psychological aggression, physical assault), and emerging adult emotional adjustment (e.g., self-esteem, depression, and anxiety). The sample consisted of 526 participants ranging in age from 18 to 22 years. Results were analyzed with structural equation modeling and suggest that, although perceived parenting styles and discipline are both correlated with emerging adult emotional adjustment, perceived parenting is associated with emerging adult emotional adjustment for females but not males when examined simultaneously with perceived discipline. This finding demonstrates the importance of examining the direct and indirect relationships in the context of gender dyads.

  3. 13 CFR 315.16 - Adjustment proposal requirements.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... OF COMMERCE TRADE ADJUSTMENT ASSISTANCE FOR FIRMS Adjustment Proposals § 315.16 Adjustment proposal... reasonably calculated to contribute materially to the economic adjustment of the Firm (i.e., that such... generally consists of knowledge-based services such as market penetration studies, customized business...

  4. Adjustment Problems of Korean American Elderly.

    ERIC Educational Resources Information Center

    Kiefer, Christie W.; And Others

    1985-01-01

    Interviewed 50 elderly Korean immigrants to identify adjustment problems. Ratings of overall stress and adjustment were made in five areas of functioning: social, cultural, economic, health, and emotional/cognitive. Adjustment was positively related to education, length of residence in the United States, and multigenerational household structure.…

  5. Introductory Statistics Students' Conceptual Understanding of Study Design and Conclusions

    NASA Astrophysics Data System (ADS)

    Fry, Elizabeth Brondos

    Recommended learning goals for students in introductory statistics courses include the ability to recognize and explain the key role of randomness in designing studies and in drawing conclusions from those studies involving generalizations to a population or causal claims (GAISE College Report ASA Revision Committee, 2016). The purpose of this study was to explore introductory statistics students' understanding of the distinct roles that random sampling and random assignment play in study design and the conclusions that can be made from each. A study design unit lasting two and a half weeks was designed and implemented in four sections of an undergraduate introductory statistics course based on modeling and simulation. The research question that this study attempted to answer is: How does introductory statistics students' conceptual understanding of study design and conclusions (in particular, unbiased estimation and establishing causation) change after participating in a learning intervention designed to promote conceptual change in these areas? In order to answer this research question, a forced-choice assessment called the Inferences from Design Assessment (IDEA) was developed as a pretest and posttest, along with two open-ended assignments, a group quiz and a lab assignment. Quantitative analysis of IDEA results and qualitative analysis of the group quiz and lab assignment revealed that overall, students' mastery of study design concepts significantly increased after the unit, and the great majority of students successfully made the appropriate connections between random sampling and generalization, and between random assignment and causal claims. However, a small, but noticeable portion of students continued to demonstrate misunderstandings, such as confusion between random sampling and random assignment.

  6. Case-mix adjustment of consumer reports about managed behavioral health care and health plans.

    PubMed

    Eselius, Laura L; Cleary, Paul D; Zaslavsky, Alan M; Huskamp, Haiden A; Busch, Susan H

    2008-12-01

    To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent). Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

  7. Appraisal and coping as mediators of the effects of cumulative risk on preadolescent adjustment

    PubMed Central

    Thompson, Stephanie F.; Lengua, Liliana J.; Garcia, Connie Meza

    2016-01-01

    This study examined the concurrent and longitudinal relations among cumulative risk, appraisal, coping, and adjustment. Longitudinal path models were tested in a community sample of 316 children in preadolescence to examine hypotheses that threat appraisal and avoidant coping mediate the effects of cumulative risk on child adjustment, whereas positive appraisal and active coping were hypothesized to predict better adjustment independently. Children and their mothers were assessed during in-home interviews at three time points at one-year intervals. Children reported on appraisal and coping strategies. Mothers and children reported on child adjustment problems and positive adjustment. Rank-order changes in appraisal and coping predicted rank-order changes in adjustment. Cumulative risk was concurrently related to higher threat appraisal and avoidant coping at each time point. Threat appraisal and avoidant coping mediated the relations of cumulative risk to rank-order changes in adjustment. There is specificity in the relations of cumulative risk to threat appraisal and avoidant coping, whereas positive appraisal and active coping are independent of risk and operate as individual resource factors. PMID:27110087

  8. Sociocultural adjustment among sojourning Malaysian students in Britain: a replication and path analytic extension.

    PubMed

    Swami, Viren; Arteche, Adriane; Chamorro-Premuzic, Tomas; Furnham, Adrian

    2010-01-01

    The present study examined the sociocultural adjustment of 249 sojourning Malaysian undergraduates in Britain. One-hundred and ten Malay and 139 Chinese students enrolled in various courses answered a self-report questionnaire that examined various aspects of sociocultural adjustment and socio-demographics. Overall, Malay students reported significantly poorer sociocultural adjustment than Chinese students, as well as more negative outcomes on a range of predictors. Path analysis for the total sample showed that higher family income led to greater sociocultural adjustment, but partially because it led to more contact with host and conationals, better language proficiency, lower perceived cultural differences and less perceived discrimination. Moreover, participants with higher English proficiency were better adapted, but partially because they perceived less cultural differences as well as having more contact with host nationals. Additionally, individuals reporting better sociocultural adjustment also reported better health statuses. The same model was equally useful at predicting sociocultural adjustment for both Malay and Chinese participants. These results are discussed in terms of the role played by income in buffering against the negative aspects of sociocultural adjustment.

  9. Macroeconomic adjustment in developing countries: instability, short-run growth, and external dependency

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Leff, N.H.; Sato, K.

    1980-05-01

    This paper presents an aggregate model for analyzing macroeconomic adjustment and short-run growth in less-developed countries. The model is built on standard theoretical lines; but an important finding of the paper is that empirically, macroeconomic adjustment in the real sector of some differs from the professional expectations that may be prevalent in more-developed countries. This observation leads us to a reconsideration of the macroeconomics of the developing economies, and particularly of some short-term features that affect the long-run expansion path. The analysis also shows why these economies are often subject to chronic inflation and macroeconmic dependence on foreign-capital inflows. 13more » references, 4 tables.« less

  10. Crustal motion measurements from the POLENET Antarctic Network: comparisons with glacial isostatic adjustment models

    NASA Astrophysics Data System (ADS)

    Wilson, T. J.; Konfal, S. A.; Bevis, M. G.; Spada, G.; Melini, D.; Barletta, V. R.; Kendrick, E. C.; Saddler, D.; Smalley, R., Jr.; Dalziel, I. W. D.; Willis, M. J.

    2016-12-01

    Crustal motions measured by GPS provide a unique proxy record of ice mass change, due to the elastic and viscoelastic response of the earth to removal of ice loads. The ANET/POLENET array of bedrock GPS sites spans much of the Antarctic interior, encompassing regions where glacial isostatic adjustment (GIA) models predict large crustal displacements due to LGM ice loss and including coastal West Antarctica where major modern ice mass loss is documented. To isolate the long-term GIA component of measured crustal motions, we computed and removed elastic displacements due to recent ice mass change. We used the annually resolved ice mass balance data from Martín-Español et al. (2016) derived from a statistical inversion of satellite altimetry, gravimetry, and elastic-corrected GPS data for the period 2003-2013. The Regional Elastic Rebound Calculator (REAR) [Melini et al., 2015] was used to compute elastic vertical and horizontal surface displacements. Uplift due to elastic rebound is substantial in West Antarctica, very minimal in East Antarctica, and variable across the Weddell Embayment. The ANET GPS-derived crustal motion patterns ascribed to non-elastic GIA are spatially complex and differ significantly in magnitude from model predictions. We present a systematic comparison of measured and predicted velocities within different sectors of Antarctica, in order to examine spatial patterns relative to modern ice mass changes, ice history model uncertainties, and lateral variations in earth properties. In the Weddell Embayment region most vertical velocities are lower than uplift predicted by GIA models. Several sites in the southernmost Transantarctic Mountains and the Whitmore Mountains, where small ice mass increase occurs, have vertical uplift significantly exceeding GIA model predictions. There is an intriguing spatial correlation of these fast-moving sites with a low-velocity anomaly in the upper mantle documented by analysis of teleseismic Rayleigh waves by

  11. Posttraumatic Stress Disorder Symptoms, Relationship Adjustment, and Relationship Aggression in a Sample of Female Flood Victims

    PubMed Central

    Monson, Candice M.; Schumm, Jeremiah A.; Watkins, Laura E.; Panuzio, Jillian; Resick, Patricia A.

    2010-01-01

    This study tested a model examining the interrelationships among posttraumatic stress disorder (PTSD) symptoms, intimate relationship adjustment, and intimate relationship aggression in a sample of 205 adult female flood victims. At the bivariate level, higher PTSD symptoms were associated with higher physical and psychological aggression victimization, poorer relationship adjustment, and higher physical and psychological aggression perpetration. Results from structural equation modeling (SEM) analyses indicated that relationship aggression victimization influenced aggression perpetration directly, and in the case of physical aggression, indirectly through its relationship with PTSD symptoms and relationship adjustment. The influence of PTSD symptoms on physical aggression perpetration was fully explained by poorer relationship adjustment. These findings extend prior work from other traumatized populations documenting associations between variables reflecting PTSD symptomatology and indices of relationship functioning, and indicate a need for further investigation in this area of inquiry. PMID:21057584

  12. Parenting and adolescents' psychological adjustment: Longitudinal moderation by adolescents' genetic sensitivity.

    PubMed

    Stocker, Clare M; Masarik, April S; Widaman, Keith F; Reeb, Ben T; Boardman, Jason D; Smolen, Andrew; Neppl, Tricia K; Conger, Katherine J

    2017-10-01

    We examined whether adolescents' genetic sensitivity, measured by a polygenic index score, moderated the longitudinal associations between parenting and adolescents' psychological adjustment. The sample included 323 mothers, fathers, and adolescents (177 female, 146 male; Time 1 [T1] average age = 12.61 years, SD = 0.54 years; Time 2 [T2] average age = 13.59 years, SD = 0.59 years). Parents' warmth and hostility were rated by trained, independent observers using videotapes of family discussions. Adolescents reported their symptoms of anxiety, depressed mood, and hostility at T1 and T2. The results from autoregressive linear regression models showed that adolescents' genetic sensitivity moderated associations between observations of both mothers' and fathers' T1 parenting and adolescents' T2 composite maladjustment, depression, anxiety, and hostility. Compared to adolescents with low genetic sensitivity, adolescents with high genetic sensitivity had worse adjustment outcomes when parenting was low on warmth and high on hostility. When parenting was characterized by high warmth and low hostility, adolescents with high genetic sensitivity had better adjustment outcomes than their counterparts with low genetic sensitivity. The results support the differential susceptibility model and highlight the complex ways that genes and environment interact to influence development.

  13. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HHS on behalf of the State. (b) Risk adjustment data storage. An issuer that offers risk adjustment... adjustment issuer requirements. (a) Data requirements. An issuer that offers risk adjustment covered plans must submit or make accessible all required risk adjustment data for those risk adjustment covered...

  14. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... HHS on behalf of the State. (b) Risk adjustment data storage. An issuer that offers risk adjustment... adjustment issuer requirements. (a) Data requirements. An issuer that offers risk adjustment covered plans must submit or make accessible all required risk adjustment data for those risk adjustment covered...

  15. 45 CFR 153.610 - Risk adjustment issuer requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HHS on behalf of the State. (b) Risk adjustment data storage. An issuer that offers risk adjustment... adjustment issuer requirements. (a) Data requirements. An issuer that offers risk adjustment covered plans must submit or make accessible all required risk adjustment data for those risk adjustment covered...

  16. Risk adjustment and the fear of markets: the case of Belgium.

    PubMed

    Schokkaert, E; Van de Voorde, C

    2000-02-01

    In Belgium the management and administration of the compulsory and universal health insurance is left to a limited number of non-governmental non-profit sickness funds. Since 1995 these sickness funds are partially financed in a prospective way. The risk adjustment scheme is based on a regression model to explain medical expenditures for different social groups. Medical supply is taken out of the formula to construct risk-adjusted capitation payments. The risk-adjustment formula still leaves scope for risk selection. At the same time, the sickness funds were not given the instruments to exert a real influence on expenditures and the health insurance market has not been opened for new entrants. As a consequence, Belgium runs the danger of ending up in a situation with little incentives for efficiency and considerable profits from cream skimming.

  17. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 3 2010-04-01 2010-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.205 Salary adjustments. Any negative adjustment to pay arising out of an employee's election...

  18. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 3 2014-04-01 2014-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.205 Salary adjustments. Any negative adjustment to pay arising out of an employee's election...

  19. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 3 2011-04-01 2011-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.205 Salary adjustments. Any negative adjustment to pay arising out of an employee's election...

  20. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 3 2013-04-01 2013-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.205 Salary adjustments. Any negative adjustment to pay arising out of an employee's election...

  1. 19 CFR 201.205 - Salary adjustments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 3 2012-04-01 2012-04-01 false Salary adjustments. 201.205 Section 201.205 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION GENERAL RULES OF GENERAL APPLICATION Debt Collection § 201.205 Salary adjustments. Any negative adjustment to pay arising out of an employee's election...

  2. 29 CFR 785.42 - Adjusting grievances.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Adjusting Grievances, Medical Attention, Civic and Charitable Work, and Suggestion Systems § 785.42 Adjusting grievances. Time spent in adjusting grievances between an employer and employees during the time the employees are required to be on the premises is hours worked, but in the event a bona fide union...

  3. 24 CFR 5.611 - Adjusted income.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Adjusted income. 5.611 Section 5... Serving Persons with Disabilities: Family Income and Family Payment; Occupancy Requirements for Section 8 Project-Based Assistance Family Income § 5.611 Adjusted income. Adjusted income means annual income (as...

  4. 12 CFR 313.55 - Salary adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Salary adjustments. 313.55 Section 313.55 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PROCEDURES FOR CORPORATE DEBT COLLECTION Salary Offset § 313.55 Salary adjustments. Any negative adjustment to pay arising...

  5. On the implementation of faults in finite-element glacial isostatic adjustment models

    NASA Astrophysics Data System (ADS)

    Steffen, Rebekka; Wu, Patrick; Steffen, Holger; Eaton, David W.

    2014-01-01

    Stresses induced in the crust and mantle by continental-scale ice sheets during glaciation have triggered earthquakes along pre-existing faults, commencing near the end of the deglaciation. In order to get a better understanding of the relationship between glacial loading/unloading and fault movement due to the spatio-temporal evolution of stresses, a commonly used model for glacial isostatic adjustment (GIA) is extended by including a fault structure. Solving this problem is enabled by development of a workflow involving three cascaded finite-element simulations. Each step has identical lithospheric and mantle structure and properties, but evolving stress conditions along the fault. The purpose of the first simulation is to compute the spatio-temporal evolution of rebound stress when the fault is tied together. An ice load with a parabolic profile and simple ice history is applied to represent glacial loading of the Laurentide Ice Sheet. The results of the first step describe the evolution of the stress and displacement induced by the rebound process. The second step in the procedure augments the results of the first, by computing the spatio-temporal evolution of total stress (i.e. rebound stress plus tectonic background stress and overburden pressure) and displacement with reaction forces that can hold the model in equilibrium. The background stress is estimated by assuming that the fault is in frictional equilibrium before glaciation. The third step simulates fault movement induced by the spatio-temporal evolution of total stress by evaluating fault stability in a subroutine. If the fault remains stable, no movement occurs; in case of fault instability, the fault displacement is computed. We show an example of fault motion along a 45°-dipping fault at the ice-sheet centre for a two-dimensional model. Stable conditions along the fault are found during glaciation and the initial part of deglaciation. Before deglaciation ends, the fault starts to move, and fault

  6. The impact of statistical adjustment on conditional standard errors of measurement in the assessment of physician communication skills.

    PubMed

    Raymond, Mark R; Clauser, Brian E; Furman, Gail E

    2010-10-01

    The use of standardized patients to assess communication skills is now an essential part of assessing a physician's readiness for practice. To improve the reliability of communication scores, it has become increasingly common in recent years to use statistical models to adjust ratings provided by standardized patients. This study employed ordinary least squares regression to adjust ratings, and then used generalizability theory to evaluate the impact of these adjustments on score reliability and the overall standard error of measurement. In addition, conditional standard errors of measurement were computed for both observed and adjusted scores to determine whether the improvements in measurement precision were uniform across the score distribution. Results indicated that measurement was generally less precise for communication ratings toward the lower end of the score distribution; and the improvement in measurement precision afforded by statistical modeling varied slightly across the score distribution such that the most improvement occurred in the upper-middle range of the score scale. Possible reasons for these patterns in measurement precision are discussed, as are the limitations of the statistical models used for adjusting performance ratings.

  7. Inter-provider comparison of patient-reported outcomes: developing an adjustment to account for differences in patient case mix.

    PubMed

    Nuttall, David; Parkin, David; Devlin, Nancy

    2015-01-01

    This paper describes the development of a methodology for the case-mix adjustment of patient-reported outcome measures (PROMs) data permitting the comparison of outcomes between providers on a like-for-like basis. Statistical models that take account of provider-specific effects form the basis of the proposed case-mix adjustment methodology. Indirect standardisation provides a transparent means of case mix adjusting the PROMs data, which are updated on a monthly basis. Recently published PROMs data for patients undergoing unilateral knee replacement are used to estimate empirical models and to demonstrate the application of the proposed case-mix adjustment methodology in practice. The results are illustrative and are used to highlight a number of theoretical and empirical issues that warrant further exploration. For example, because of differences between PROMs instruments, case-mix adjustment methodologies may require instrument-specific approaches. A number of key assumptions are made in estimating the empirical models, which could be open to challenge. The covariates of post-operative health status could be expanded, and alternative econometric methods could be employed. © 2013 Crown copyright.

  8. Social Cognitive Predictors of Adjustment to Engineering Majors across Gender and Race/Ethnicity

    ERIC Educational Resources Information Center

    Lent, Robert W.; Miller, Matthew J.; Smith, Paige E.; Watford, Bevlee A.; Lim, Robert H.; Hui, Kayi; Morrison, M. Ashley; Wilkins, Gregory; Williams, Kevin

    2013-01-01

    We tested a social cognitive model of academic adjustment in a sample of 1377 students enrolled in engineering schools at two predominantly White and two historically Black state universities. The model brought together central elements of social cognitive career theory's (SCCT) segmental models of educational/vocational satisfaction, interest,…

  9. 12 CFR 1780.80 - Inflation adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Inflation adjustments. 1780.80 Section 1780.80... DEVELOPMENT RULES OF PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE Civil Money Penalty Inflation Adjustments § 1780.80 Inflation adjustments. The maximum amount of each civil money penalty within OFHEO's...

  10. How do attachment dimensions affect bereavement adjustment? A mediation model of continuing bonds.

    PubMed

    Yu, Wei; He, Li; Xu, Wei; Wang, Jianping; Prigerson, Holly G

    2016-04-30

    The current study aims to examine mechanisms underlying the impact of attachment dimensions on bereavement adjustment. Bereaved mainland Chinese participants (N=247) completed anonymous, retrospective, self-report surveys assessing attachment dimensions, continuing bonds (CB), grief symptoms and posttraumatic growth (PTG). Results demonstrated that attachment anxiety predicted grief symptoms via externalized CB and predicted PTG via internalized CB at the same time, whereas attachment avoidance positively predicted grief symptoms via externalized CB but negatively predicted PTG directly. Findings suggested that individuals with a high level of attachment anxiety could both suffer from grief and obtain posttraumatic growth after loss, but it depended on which kind of CB they used. By contrast, attachment avoidance was associated with a heightened risk of maladaptive bereavement adjustment. Future grief therapy may encourage the bereaved to establish CB with the deceased and gradually shift from externalized CB to internalized CB. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. 28 CFR 85.2 - Calculation of adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 85.2 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CIVIL MONETARY PENALTIES INFLATION ADJUSTMENT § 85.2 Calculation of adjustment. (a) The inflation adjustments described in § 85.3 were... Inflation Adjustment Act of 1990, Pub. L. 101-410. Any increase so determined was rounded to the nearest— (1...

  12. Smooth individual level covariates adjustment in disease mapping.

    PubMed

    Huque, Md Hamidul; Anderson, Craig; Walton, Richard; Woolford, Samuel; Ryan, Louise

    2018-05-01

    Spatial models for disease mapping should ideally account for covariates measured both at individual and area levels. The newly available "indiCAR" model fits the popular conditional autoregresssive (CAR) model by accommodating both individual and group level covariates while adjusting for spatial correlation in the disease rates. This algorithm has been shown to be effective but assumes log-linear associations between individual level covariates and outcome. In many studies, the relationship between individual level covariates and the outcome may be non-log-linear, and methods to track such nonlinearity between individual level covariate and outcome in spatial regression modeling are not well developed. In this paper, we propose a new algorithm, smooth-indiCAR, to fit an extension to the popular conditional autoregresssive model that can accommodate both linear and nonlinear individual level covariate effects while adjusting for group level covariates and spatial correlation in the disease rates. In this formulation, the effect of a continuous individual level covariate is accommodated via penalized splines. We describe a two-step estimation procedure to obtain reliable estimates of individual and group level covariate effects where both individual and group level covariate effects are estimated separately. This distributed computing framework enhances its application in the Big Data domain with a large number of individual/group level covariates. We evaluate the performance of smooth-indiCAR through simulation. Our results indicate that the smooth-indiCAR method provides reliable estimates of all regression and random effect parameters. We illustrate our proposed methodology with an analysis of data on neutropenia admissions in New South Wales (NSW), Australia. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. 7 CFR 1744.64 - Budget adjustment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false Budget adjustment. 1744.64 Section 1744.64... Disbursement of Funds § 1744.64 Budget adjustment. (a) If more funds are required than are available in a budget account, the borrower may request RUS's approval of a budget adjustment to use funds from another...

  14. 77 FR 5262 - Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-02

    ...] Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment AGENCY... per capita indicator for recommending cost share adjustments for major disasters declared on or after... INFORMATION: Pursuant to 44 CFR 206.47, the statewide per capita indicator that is used to recommend an...

  15. 78 FR 9935 - Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-12

    ...] Notice of Adjustment of Statewide Per Capita Indicator for Recommending a Cost Share Adjustment AGENCY... per capita indicator for recommending cost share adjustments for major disasters declared on or after... INFORMATION: Pursuant to 44 CFR 206.47, the statewide per capita indicator that is used to recommend an...

  16. 19 CFR 351.413 - Disregarding insignificant adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... any group of adjustments having an ad valorem effect of less than 1.0 percent, of the export price, constructed export price, or normal value, as the case may be. Groups of adjustments are adjustments for differences in circumstances of sale under § 351.410, adjustments for differences in the physical...

  17. 42 CFR 412.316 - Geographic adjustment factors.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Geographic adjustment factors. 412.316 Section 412... Costs § 412.316 Geographic adjustment factors. (a) Local cost variation. CMS adjusts for local cost... part. The adjustment factor equals the hospital wage index value applicable to the hospital raised to...

  18. 48 CFR 252.215-7000 - Pricing adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Pricing adjustments. 252... Provisions And Clauses 252.215-7000 Pricing adjustments. As prescribed in 215.408(1), use the following clause: Pricing Adjustments (DEC 1991) The term “pricing adjustment,” as used in paragraph (a) of the...

  19. Work-Family Balance and Psychosocial Adjustment of Married International Students

    ERIC Educational Resources Information Center

    Bulgan, Gökçe; Çiftçi, Ayse

    2018-01-01

    The authors investigated how work-family balance mediated the relationship between personality traits, gender roles, social support, and psychosocial adjustment. Data were collected from 243 married international graduate students (MIGSs) studying in the United States. Results of structural equation modeling indicated that personality traits…

  20. New methodology for adjusting rotating shadowband irradiometer measurements

    NASA Astrophysics Data System (ADS)

    Vignola, Frank; Peterson, Josh; Wilbert, Stefan; Blanc, Philippe; Geuder, Norbert; Kern, Chris

    2017-06-01

    A new method is developed for correcting systematic errors found in rotating shadowband irradiometer measurements. Since the responsivity of photodiode-based pyranometers typically utilized for RST sensors is dependent upon the wavelength of the incident radiation and the spectral distribution of the incident radiation is different for the Direct Normal Trradiance and the Diffuse Horizontal Trradiance, spectral effects have to be considered. These cause the most problematic errors when applying currently available correction functions to RST measurements. Hence, direct normal and diffuse contributions are analyzed and modeled separately. An additional advantage of this methodology is that it provides a prescription for how to modify the adjustment algorithms to locations with different atmospheric characteristics from the location where the calibration and adjustment algorithms were developed. A summary of results and areas for future efforts are then discussed.

  1. Comparing Self-Reported Health Status and Diagnosis-Based Risk Adjustment to Predict 1- and 2 to 5-Year Mortality

    PubMed Central

    Pietz, Kenneth; Petersen, Laura A

    2007-01-01

    Objectives To compare the ability of two diagnosis-based risk adjustment systems and health self-report to predict short- and long-term mortality. Data Sources/Study Setting Data were obtained from the Department of Veterans Affairs (VA) administrative databases. The study population was 78,164 VA beneficiaries at eight medical centers during fiscal year (FY) 1998, 35,337 of whom completed an 36-Item Short Form Health Survey for veterans (SF-36V) survey. Study Design We tested the ability of Diagnostic Cost Groups (DCGs), Adjusted Clinical Groups (ACGs), SF-36V Physical Component score (PCS) and Mental Component Score (MCS), and eight SF-36V scales to predict 1- and 2–5 year all-cause mortality. The additional predictive value of adding PCS and MCS to ACGs and DCGs was also evaluated. Logistic regression models were compared using Akaike's information criterion, the c-statistic, and the Hosmer–Lemeshow test. Principal Findings The c-statistics for the eight scales combined with age and gender were 0.766 for 1-year mortality and 0.771 for 2–5-year mortality. For DCGs with age and gender the c-statistics for 1- and 2–5-year mortality were 0.778 and 0.771, respectively. Adding PCS and MCS to the DCG model increased the c-statistics to 0.798 for 1-year and 0.784 for 2–5-year mortality. Conclusions The DCG model showed slightly better performance than the eight-scale model in predicting 1-year mortality, but the two models showed similar performance for 2–5-year mortality. Health self-report may add health risk information in addition to age, gender, and diagnosis for predicting longer-term mortality. PMID:17362210

  2. Towards an Integrated Model of Individual, Psychosocial, and Organizational Predictors of Retirement Adjustment

    ERIC Educational Resources Information Center

    Wong, Jessica Y.; Earl, Joanne K.

    2009-01-01

    This cross-sectional study examines three predictors of retirement adjustment: individual (demographic and health), psychosocial (work centrality), and organizational (conditions of workforce exit). It also examines the effect of work centrality on post-retirement activity levels. Survey data was collected from 394 retirees (aged 45-93 years).…

  3. Associations between faith, distress and mental adjustment--a Danish survivorship study.

    PubMed

    Johannessen-Henry, Christine Tind; Deltour, Isabelle; Bidstrup, Pernille Envold; Dalton, Susanne O; Johansen, Christoffer

    2013-02-01

    Several studies have suggested that religion and spirituality are important for overcoming psychological distress and adjusting mentally to cancer, but these studies did not differentiate between spiritual well-being and specific aspects of faith. We examined the extent to which spiritual well-being, the faith dimension of spiritual well-being and aspects of performed faith are associated with distress and mental adjustment among cancer patients. In a cross-sectional design, 1043 survivors of various cancers filled in a questionnaire on spiritual well-being (FACIT-Sp-12), specific aspects of faith ('belief in a god', 'belief in a god with whom I can talk' and 'experiences of god or a higher power'), religious community and church attendance (DUREL), distress (POMS-SF), adjustment to cancer (Mini-MAC) and sociodemographic factors. Linear regression models were used to analyze the associations between exposure (spiritual well-being and specific faith aspects) and outcome (distress and adjustment to cancer) with adjustment for age, gender, cancer diagnosis and physical and social well-being. Higher spiritual well-being was associated with less total distress (β = -0.79, CI -0.92; -0.66) and increased adjustment to cancer (fighting spirit, anxious preoccupation, helplessness-hopelessness). Specific aspects of faith were associated with high confusion-bewilderment and tension-anxiety, but also lower score on vigor-activity, and with higher anxious-preoccupation, both higher and lower cognitive avoidance, but also more fighting spirit. As hypothesized, spiritual well-being were associated with less distress and better mental adjustment. However, specific aspects of faith were both positively and negatively associated with distress and mental adjustment. The results illustrate the complexity of associations between spiritual well-being and specific aspects of faith with psychological function among cancer survivors.

  4. Jumping to conclusions and persecutory delusions.

    PubMed

    Startup, Helen; Freeman, Daniel; Garety, Philippa A

    2008-09-01

    It is unknown whether a 'jumping to conclusions' (JTC) data-gathering bias is apparent in specific delusion sub-types. A group with persecutory delusions is compared with a sample of non-clinical controls on a probabilistic reasoning task. Results suggest JTC is apparent in individuals with the persecutory sub-type of delusions.

  5. Teacher characteristics, social classroom relationships, and children's social, emotional, and behavioral classroom adjustment in special education.

    PubMed

    Breeman, L D; Wubbels, T; van Lier, P A C; Verhulst, F C; van der Ende, J; Maras, A; Hopman, J A B; Tick, N T

    2015-02-01

    The goal of this study was to explore relations between teacher characteristics (i.e., competence and wellbeing); social classroom relationships (i.e., teacher-child and peer interactions); and children's social, emotional, and behavioral classroom adjustment. These relations were explored at both the individual and classroom levels among 414 children with emotional and behavioral disorders placed in special education. Two models were specified. In the first model, children's classroom adjustment was regressed on social relationships and teacher characteristics. In the second model, reversed links were examined by regressing teacher characteristics on social relationships and children's adjustment. Results of model 1 showed that, at the individual level, better social and emotional adjustment of children was predicted by higher levels of teacher-child closeness and better behavioral adjustment was predicted by both positive teacher-child and peer interactions. At the classroom level, positive social relationships were predicted by higher levels of teacher competence, which in turn were associated with lower classroom levels of social problems. Higher levels of teacher wellbeing were directly associated with classroom adaptive and maladaptive child outcomes. Results of model 2 showed that, at the individual and classroom levels, only the emotional and behavioral problems of children predicted social classroom relationships. At the classroom level, teacher competence was best predicted by positive teacher-child relationships and teacher wellbeing was best predicted by classroom levels of prosocial behavior. We discuss the importance of positive teacher-child and peer interactions for children placed in special education and suggest ways of improving classroom processes by targeting teacher competence. Copyright © 2014 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

  6. Examining the Correlation between Objective Injury Parameters, Personality Traits, and Adjustment Measures among Burn Victims

    PubMed Central

    Weissman, Oren; Domniz, Noam; Petashnick, Yoel R.; Gilboa, Dalia; Raviv, Tal; Barzilai, Liran; Farber, Nimrod; Harats, Moti; Winkler, Eyal; Haik, Josef

    2015-01-01

    Background: Burn victims experience immense physical and mental hardship during their process of rehabilitation and regaining functionality. We examined different objective burn-related factors as well as psychological ones, in the form of personality traits that may affect the rehabilitation process and its outcome. Objective: To assess the influence and correlation of specific personality traits and objective injury-related parameters on the adjustment of burn victims post-injury. Methods: Sixty-two male patients admitted to our burn unit due to burn injuries were compared with 36 healthy male individuals by use of questionnaires to assess each group’s psychological adjustment parameters. Multivariate and hierarchical regression analysis was conducted to identify differences between the groups. Results: A significant negative correlation was found between the objective burn injury severity (e.g., total body surface area and burn depth) and the adjustment of burn victims (p < 0.05, p < 0.001, Table 3). Moreover, patients more severely injured tend to be more neurotic (p < 0.001), and less extroverted and agreeable (p < 0.01, Table 4). Conclusion: Extroverted burn victims tend to adjust better to their post-injury life while the neurotic patients tend to have difficulties adjusting. This finding may suggest new tools for early identification of maladjustment-prone patients and therefore provide them with better psychological support in a more dedicated manner. PMID:25874193

  7. Remotely Adjustable Hydraulic Pump

    NASA Technical Reports Server (NTRS)

    Kouns, H. H.; Gardner, L. D.

    1987-01-01

    Outlet pressure adjusted to match varying loads. Electrohydraulic servo has positioned sleeve in leftmost position, adjusting outlet pressure to maximum value. Sleeve in equilibrium position, with control land covering control port. For lowest pressure setting, sleeve shifted toward right by increased pressure on sleeve shoulder from servovalve. Pump used in aircraft and robots, where hydraulic actuators repeatedly turned on and off, changing pump load frequently and over wide range.

  8. Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

    PubMed Central

    Bermudez-Tamayo, Clara; Martin, Jose Jesus Martin; Ruiz-Pérez, Isabel; Lima, Antonio Olry de Labry

    2008-01-01

    Background The epidemic of HIV/AIDS and treatments that have emerged to alleviate, have brought about a shift in the burden of disease from death to quality of life/disability. The aim was to determine which factors are associated with improvements in the level of health of male and female patients with HIV/AIDS in Andalusia, in terms of disability-adjusted life years. Methods Descriptive study based on a sample group of 8800 people on the Andalusian AIDS register between 1983 and 2004. Dependent variables: Life lost due to premature mortality (YLL), years lost due to disability (YLD) and disability-adjusted life years (DALY). Independent variables: vital state, sex, age at the time of diagnosis, age at the time of death, transmission category, province of residence, AIDS-indicator disease and the period of diagnosis. A bivariate analysis was carried out to find out if the health level variables changed in accordance with the independent variables. Using the independent variables which had a statistically significant link with the level of health variables, a multivariate linear regression model, disaggregated by gender, was constructed. Results Amongst the women, we found a model which explained the level of health of 64.9%: a link was found between a higher level of health (lower DALYs) and not intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Amongst the men, we found a model which explained the level of health of 64.4%: a link was found between a higher level of health (lower DALYs) and intravenous drug use, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. Conclusion A higher level of health (lower DALY) amongst both men and women was found to be linked to not be intravenous drug user, the province of residence, being diagnosed during the HAART era and older age at the time of diagnosis. PMID:18939970

  9. Inverse probability weighting for covariate adjustment in randomized studies

    PubMed Central

    Li, Xiaochun; Li, Lingling

    2013-01-01

    SUMMARY Covariate adjustment in randomized clinical trials has the potential benefit of precision gain. It also has the potential pitfall of reduced objectivity as it opens the possibility of selecting “favorable” model that yields strong treatment benefit estimate. Although there is a large volume of statistical literature targeting on the first aspect, realistic solutions to enforce objective inference and improve precision are rare. As a typical randomized trial needs to accommodate many implementation issues beyond statistical considerations, maintaining the objectivity is at least as important as precision gain if not more, particularly from the perspective of the regulatory agencies. In this article, we propose a two-stage estimation procedure based on inverse probability weighting to achieve better precision without compromising objectivity. The procedure is designed in a way such that the covariate adjustment is performed before seeing the outcome, effectively reducing the possibility of selecting a “favorable” model that yields a strong intervention effect. Both theoretical and numerical properties of the estimation procedure are presented. Application of the proposed method to a real data example is presented. PMID:24038458

  10. Capacitance-Based Frequency Adjustment of Micro Piezoelectric Vibration Generator

    PubMed Central

    Mao, Xinhua; He, Qing; Li, Hong; Chu, Dongliang

    2014-01-01

    Micro piezoelectric vibration generator has a wide application in the field of microelectronics. Its natural frequency is unchanged after being manufactured. However, resonance cannot occur when the natural frequencies of a piezoelectric generator and the source of vibration frequency are not consistent. Output voltage of the piezoelectric generator will sharply decline. It cannot normally supply power for electronic devices. In order to make the natural frequency of the generator approach the frequency of vibration source, the capacitance FM technology is adopted in this paper. Different capacitance FM schemes are designed by different locations of the adjustment layer. The corresponding capacitance FM models have been established. Characteristic and effect of the capacitance FM have been simulated by the FM model. Experimental results show that the natural frequency of the generator could vary from 46.5 Hz to 42.4 Hz when the bypass capacitance value increases from 0 nF to 30 nF. The natural frequency of a piezoelectric vibration generator could be continuously adjusted by this method. PMID:25133237

  11. Evaluation of paediatric cardiosurgical model in Croatia by using the Aristotle basic complexity score and the risk adjustment for congenital cardiac surgery-1 method.

    PubMed

    Dilber, Daniel; Malcic, Ivan

    2010-08-01

    The Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method were developed and used to compare outcomes of congenital cardiac surgery. Both methods were used to compare results of procedures performed on our patients in Croatian cardiosurgical centres and results of procedures were taken abroad. The study population consisted of all patients with congenital cardiac disease born to Croatian residents between 1 October, 2002 and 1 October, 2007 undergoing a cardiovascular operation during this period. Of the 556 operations, the Aristotle basic complexity score could be assigned to 553 operations and the risk adjustment in congenital cardiac surgery-1 method to 536 operations. Procedures were performed in two institutions in Croatia and seven institutions abroad. The average complexity for cardiac procedures performed in Croatia was significantly lower. With both systems, along with the increase in complexity, there is also an increase in mortality before discharge and postoperative length of stay. Only after the adjustment for complexity there are marked differences in mortality and occurrence of postoperative complications. Both, the Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method were predictive of in-hospital mortality as well as prolonged postoperative length to stay, and can be used as a tool in our country to evaluate a cardiosurgical model and recognise potential problems.

  12. Soil-adjusted sorption isotherms for arsenic(V) and vanadium(V)

    NASA Astrophysics Data System (ADS)

    Rückamp, Daniel; Utermann, Jens; Florian Stange, Claus

    2017-04-01

    The sorption characteristic of a soil is usually determined by fitting a sorption isotherm model to laboratory data. However, such sorption isotherms are only valid for the studied soil and cannot be transferred to other soils. For this reason, a soil-adjusted sorption isotherm can be calculated by using the data of several soils. Such soil-adjusted sorption isotherms exist for cationic heavy metals, but are lacking for heavy metal oxyanions. Hence, the aim of this study is to establish soil-adjusted sorption isotherms for the oxyanions arsenate (arsenic(V)) and vanadate (vanadium(V)). For the laboratory experiment, 119 soils (samples from top- and subsoils) typical for Germany were chosen. The batch experiments were conducted with six concentrations of arsenic(V) and vanadium(V), respectively. By using the laboratory data, sorption isotherms for each soil were derived. Then, the soil-adjusted sorption isotherms were calculated by non-linear regression of the sorption isotherms with additional soil parameters. The results indicated a correlation between the sorption strength and oxalate-extractable iron, organic carbon, clay, and electrical conductivity for both, arsenic and vanadium. However, organic carbon had a negative regression coefficient. As total organic carbon was correlated with dissolved organic carbon; we attribute this observation to an effect of higher amounts of dissolved organic substances. We conclude that these soil-adjusted sorption isotherms can be used to assess the potential of soils to adsorb arsenic(V) and vanadium(V) without performing time-consuming sorption experiments.

  13. Newcomer adjustment during organizational socialization: a meta-analytic review of antecedents, outcomes, and methods.

    PubMed

    Bauer, Talya N; Bodner, Todd; Erdogan, Berrin; Truxillo, Donald M; Tucker, Jennifer S

    2007-05-01

    The authors tested a model of antecedents and outcomes of newcomer adjustment using 70 unique samples of newcomers with meta-analytic and path modeling techniques. Specifically, they proposed and tested a model in which adjustment (role clarity, self-efficacy, and social acceptance) mediated the effects of organizational socialization tactics and information seeking on socialization outcomes (job satisfaction, organizational commitment, job performance, intentions to remain, and turnover). The results generally supported this model. In addition, the authors examined the moderating effects of methodology on these relationships by coding for 3 methodological issues: data collection type (longitudinal vs. cross-sectional), sample characteristics (school-to-work vs. work-to-work transitions), and measurement of the antecedents (facet vs. composite measurement). Discussion focuses on the implications of the findings and suggestions for future research. 2007 APA, all rights reserved

  14. One stage vertical rectus muscle recession using adjustable sutures under local anaesthesia.

    PubMed Central

    Rauz, S; Govan, J A

    1996-01-01

    AIMS: To assess the results of visual axis alignment following one stage adjustable suture surgery to correct vertical diplopia. METHOD: Eight patients with a mean age of 44.9 years (range 16-80 years) complaining of vertical diplopia underwent rectus muscle recession under local anaesthesia with intraoperative adjustment of sutures. Diplopia was secondary to superior oblique paresis in four patients, dysthyroid eye disease in two patients, superior rectus paresis in one patient, and one developed a consecutive deviation after previous squint surgery. The surgery consisted of seven single muscle recessions (six inferior recti and one superior rectus) and one two muscle recession (inferior and lateral recti). The surgery was performed under topical anaesthesia supplemented with a subconjunctival injection of local anaesthetic over the muscle insertions. RESULTS: The patients remained comfortable throughout their surgery. All had a reduction in their vertical deviation. Six were asymptomatic and were eventually discharged. One had residual diplopia which was well tolerated without further intervention. One had persistent troublesome diplopia which was corrected by temporary Fresnel prisms. He became asymptomatic after further surgery of a 1 mm inferior rectus advancement. CONCLUSION: One stage adjustable suture surgery is recommended in all cases of strabismus surgery when postoperative results would otherwise be unpredictable. PMID:8949715

  15. Electronic gaming and psychosocial adjustment.

    PubMed

    Przybylski, Andrew K

    2014-09-01

    The rise of electronic games has driven both concerns and hopes regarding their potential to influence young people. Existing research identifies a series of isolated positive and negative effects, yet no research to date has examined the balance of these potential effects in a representative sample of children and adolescents. The objective of this study was to explore how time spent playing electronic games accounts for significant variation in positive and negative psychosocial adjustment using a representative cohort of children aged 10 to 15 years. A large sample of children and adolescents aged 10 to 15 years completed assessments of psychosocial adjustment and reported typical daily hours spent playing electronic games. Relations between different levels of engagement and indicators of positive and negative psychosocial adjustment were examined, controlling for participant age and gender and weighted for population representativeness. Low levels (<1 hour daily) as well as high levels (>3 hours daily) of game engagement was linked to key indicators of psychosocial adjustment. Low engagement was associated with higher life satisfaction and prosocial behavior and lower externalizing and internalizing problems, whereas the opposite was found for high levels of play. No effects were observed for moderate play levels when compared with non-players. The links between different levels of electronic game engagement and psychosocial adjustment were small (<1.6% of variance) yet statistically significant. Games consistently but not robustly associated with children's adjustment in both positive and negative ways, findings that inform policy-making as well as future avenues for research in the area. Copyright © 2014 by the American Academy of Pediatrics.

  16. The model of children's social adjustment under the gender-roles absence in single-parent families.

    PubMed

    Chen, I-Jun; Zhang, Hailun; Wei, Bingsi; Guo, Zeyao

    2018-01-14

    This study aimed to evaluate the effects of the gender-role types and child-rearing gender-role attitude of the single-parents, as well as their children's gender role traits and family socio-economic status, on social adjustment. We recruited 458 pairs of single parents and their children aged 8-18 by purposive sampling. The research tools included the Family Socio-economic Status Questionnaire, Sex Role Scales, Parental Child-rearing Gender-role Attitude Scale and Social Adjustment Scale. The results indicated: (a) single mothers' and their daughters' feminine traits were both higher than their masculine traits, and sons' masculine traits were higher than their feminine traits; the majority gender-role type of single parents and their children was androgyny; significant differences were found between children's gender-role types depending on different raiser, the proportion of girls' masculine traits raised by single fathers was significantly higher than those who were raised by single mothers; (b) family socio-economic status and single parents' gender-role types positively influenced parental child-rearing gender-role attitude, which in turn, influenced the children's gender traits, and further affected children's social adjustment. © 2018 International Union of Psychological Science.

  17. 42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

    Code of Federal Regulations, 2010 CFR

    2016-10-01

    ...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

  18. 42 CFR § 484.330 - Process for determining and applying the value-based payment adjustment under the Home Health...

    Code of Federal Regulations, 2010 CFR

    2017-10-01

    ...-based payment adjustment under the Home Health Value-Based Purchasing (HHVBP) Model. § 484.330 Section... (HHVBP) Model Components for Competing Home Health Agencies Within State Boundaries § 484.330 Process for determining and applying the value-based payment adjustment under the Home Health Value-Based Purchasing...

  19. 7 CFR 2201.30 - Adjustments.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Adjustments. 2201.30 Section 2201.30 Agriculture Regulations of the Department of Agriculture (Continued) LOCAL TELEVISION LOAN GUARANTEE BOARD LOCAL TELEVISION LOAN GUARANTEE PROGRAM-PROGRAM REGULATIONS Loan Guarantees § 2201.30 Adjustments. (a) The Board...

  20. Newcomer adjustment: Examining the role of managers' perception of newcomer proactive behavior during organizational socialization.

    PubMed

    Ellis, Allison M; Nifadkar, Sushil S; Bauer, Talya N; Erdogan, Berrin

    2017-06-01

    Separate streams of organizational socialization research have recognized the importance of (a) newcomer proactivity and (b) manager support in facilitating newcomer adjustment. However, extant research has largely focused on the newcomers' experience, leaving the perspectives of managers during socialization relatively unexplored-a theoretical gap that has implications both for newcomer adjustment and manager-newcomer interactions that may serve as a basis for future relationship development. Drawing from the "interlocked" employee behavior argument of Weick (1979), we propose that managers' perception of newcomers' proactive behaviors are associated with concordant manager behaviors, which, in turn, support newcomer adjustment. Further, we investigate a cognitive mechanism-managers' evaluation of newcomers' commitment to adjust-which we expect underlies the proposed relationship between newcomers' proactive behaviors and managers' supportive behaviors. Using a time-lagged, 4-phase data collection of a sample of new software engineers in India and their managers, we were able to test our hypothesized model as well as rule out alternative explanations via multilevel structural equation modeling. Results broadly supported our model even after controlling for manager-newcomer social exchange relationship, proactive personalities of both newcomers and managers, and potential effects of coworker information providing. The implications of our findings for theory and practice are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).