A fiducial-based confidence interval for the linear combination of multinomial probabilities.

Across a broad set of applications, system outcomes may be summarized as probabilities in confusion or contingency tables. In settings with more than two outcomes (e.g.

The Relationship between Pet Ownership, Social Support, and Internalizing Symptoms in Students from the First to Fourth Year of College.

Internalizing symptoms are prevalent in students as they enter and complete college. Considering research suggesting mental health benefits of pet ownership, this study explores the relationship between pet ownership, social support (SS), and internalizing symptoms (IS) in a cohort of students across their 4-year college experience. With no differences at college entry, students growing up with pets had greater IS through the fourth year, and greater SS through the third year, than those without pets.

Choosing between the BP and BN sequential strategies.

Cost and burden of diagnostic testing may be reduced if fewer tests can be applied. Sequential testing involves selecting a sequence of tests, but only administering subsequent tests dependent on results of previous tests. This research provides guidance to choosing between single tests or the believe the positive (BP) and believe the negative (BN) sequential testing strategies, using accuracy (as measured by the Youden Index) as the primary determinant.

OR Time and Sacral Pressure Injuries in Critically Ill Surgical Patients.

Critically ill patients are at risk for developing pressure injuries during operative and other invasive procedures. The purpose of this secondary analysis was to explore the relationship of OR time to sacral pressure injuries in critically ill patients using high frequency ultrasound as a method of assessment. The 41 participants examined in this study had both time in the OR and up to eight days of pressure injury data.

Lack of Association of High Backrest With Sacral Tissue Changes in Adults Receiving Mechanical Ventilation.

Background: Although higher backrest elevation may be a theoretical risk for integrity of sacral tissues, few data support use of high backrest elevation.

Objective: To describe the effect of backrest elevation on the integrity of sacral tissue in critically ill adults receiving mechanical ventilation.

Methods: Patients from 3 critical care units (surgical trauma, medical respiratory, and neuroscience) who were expected to have mechanical ventilation for at least 24 hours were intubated and mechanical ventilation was started.

High-Frequency Ultrasound: Obtaining Optimal Images and the Effect of Image Artifacts on Image Quality.

High-frequency ultrasound (HFUS) images are being researched for use in the prevention, detection, and monitoring of pressure injuries in patients at risk. This seminal longitudinal study in mechanically ventilated adults describes image quality, the incidence of image artifacts, and their effect on image quality in critically ill subjects. Mechanically ventilated subjects from three adult intensive care units were enrolled, and multiple sacral images from each subject were obtained daily.

High-Frequency Ultrasound: Description of Sacral Tissue Characteristics in Healthy Adults.

Objectives: The purpose of this study was to describe selected sacral tissue characteristics in a convenience sample of healthy volunteer subjects.

Design: Descriptive.

Sample And Setting: Fifty healthy volunteers in a clinical learning center in a school of nursing.

High frequency ultrasound sacral images in the critically ill: Tissue characteristics versus visual evaluation.

Purpose: High frequency ultrasound (HFUS) systems may identify tissue injury. We compared HFUS tissue characteristics (dermal thickness and dermal density) with visual image examination.

Methods: Longitudinal study in critically ill mechanically ventilated adults, from three ICUs (Surgical Trauma, Medical Respiratory, Neuroscience) enrolled within 24hours of airway intubation.

Tissue interface pressure and skin integrity in critically ill, mechanically ventilated patients.

Objective: To describe tissue interface pressure, time spent above critical pressure levels and the effect on skin integrity at seven anatomical locations.

Design, Setting, Patients: Descriptive, longitudinal study in critically ill mechanically ventilated adults, from Surgical Trauma ICU-STICU; Medical Respiratory ICU-MRICU; Neuroscience ICU-NSICU in a Mid-Atlantic urban university medical centre. Subjects were enroled in the study within 24hours of intubation.

Backrest Elevation and Tissue Interface Pressure by Anatomical Location During Mechanical Ventilation.

Background: Backrest elevations less than 30° are recommended to reduce pressure ulcers, but positions greater than 30° are recommended during mechanical ventilation to reduce risk for ventilator-associated pneumonia. Interface pressure may vary with level of backrest elevation and anatomical location (eg, sacrum, heels).

Objective: To describe backrest elevation and anatomical location and intensity of skin pressure across the body in patients receiving mechanical ventilation.

A nonparametric fiducial interval for the Youden index in multi-state diagnostic settings.

The Youden index is a commonly employed metric to characterize the performance of a diagnostic test at its optimal point. For tests with three or more outcome classes, the Youden index has been extended; however, there are limited methods to compute a confidence interval (CI) about its value. Often, outcome classes are assumed to be normally distributed, which facilitates computational formulas for the CI bounds; however, many scenarios exist for which these assumptions cannot be made.

Effects of position and operator on high-frequency ultrasound scan quality.

Objectives: High-frequency ultrasound may evaluate those at risk for pressure ulcers. Images may be obtained by clinicians with limited training. The prone position is recommended for obtaining sacral scans but may not be feasible in the critically ill.

Use of high frequency ultrasound to detect changes in skin integrity: An image evaluation validation procedure.

Objectives: High frequency ultrasound (HFUS) scanning may be used for prevention, detection and monitoring of pressure ulcers in patients at risk and is amenable for portable, bedside use by a variety of clinicians. Limited data are available about the criteria to determine an ideal image or measures of tissue changes representative of tissue injury. We developed and evaluated criteria for overall image quality and measures of tissue integrity.

Predictors of agitation in critically ill adults.

Background: Agitation in critically ill adults is a frequent complication of hospitalization and results in multiple adverse outcomes. Potential causes of agitation are numerous; however, data on factors predictive of agitation are limited.

Objectives: To identify predictors of agitation by examining demographic and clinical characteristics of critically ill patients.

Agitation onset, frequency, and associated temporal factors in critically ill adults.

Background: Agitation is a frequent complication in critically ill adults, can result in life-threatening events for patients or care providers, and extends the hospital length of stay, thereby increasing hospital costs.

Objectives: To describe the incidence, onset, and temporal factors related to agitation in critically ill adults.

Methods: Data were collected for the first 5 days of stay of all adult patients consecutively admitted to a medical respiratory intensive care unit and a surgical trauma intensive care unit during a 2-month period.

Confidence intervals around Bayes Cost in multi-state diagnostic settings to estimate optimal performance.

A critical feature of diagnostic testing is correctly classifying subjects based upon specified thresholds of some measure. The commonly employed Youden index determines a test's optimal thresholds by maximizing the correct classification rates for a diagnostic scenario. An alternative to the Youden index is the cost function, Bayes Cost (BC).

Reducing cost in sequential testing: a limit of indifference approach.

In noninferiority studies, a limit of indifference is used to express a tolerance in results such that the clinician would regard such results as being acceptable or 'not worse'. We applied this concept to a measure of accuracy, the Receiver Operating Characteristic (ROC) curve, for a sequence of tests. We expressed a limit of indifference for the range of acceptable sensitivity values and examined the associated cost of testing within this range.

A pilot study of a weekend retreat intervention for family survivors of homicide.

Homicide causes negative unintended consequences for family survivors. Family survivors face complicated grief and overwhelming loss with minimal support from others. The authors offered a retreat intervention as a way to ameliorate the effects of the homicidal death for family survivors of homicide.

A longitudinal systems biology analysis of lactulose withdrawal in hepatic encephalopathy.

The pathogenesis of hepatic encephalopathy(HE) is unclear. However gut flora changes, inflammation and neuro-glial injury have been implicated. The aim was to evaluate factors that were associated with HE recurrence after lactulose withdrawal by analyzing the clinical phenotype, stool microbiome and systemic metabolome longitudinally.

Secular trends in body composition for children and young adults: the Fels Longitudinal Study.

Objectives: To determine secular trends by birth decade in body mass index (BMI), waist circumference/height (W/Ht), percent body fat (PBF), and fat-free mass adjusted for height squared (FFM/Ht(2) ) in children and adolescents aged 8-18 years.

Methods: Serial data were analyzed from 628 boys and 591 girls aged 8-18 years who participated in the Fels Longitudinal Study. Subjects were stratified by birth decade from 1960 to 1999.

Pain and inflammation in women with early-stage breast cancer prior to induction of chemotherapy.

Context: Pain is a commonly experienced and distressing symptom in women with breast cancer (BCA), and recent evidence suggests that immune activation may be associated with pain and other co-occurring symptoms. However, no studies to date have explored the relationships among perceived pain and biomarkers of inflammation in women with early-stage BCA during the initial course of treatment.

Objectives: The purpose of this research study was to examine the relationships among pro- and anti-inflammatory biomarkers and the presence of pain and other symptoms (anxiety, depression, fatigue, and sleep disorder) prior to induction of chemotherapy.

Supportive relationships, self-care confidence, and heart failure self-care.

Background: The theory of heart failure (HF) self-care proposes that confidence mediates relationships between social support and self-care behaviors.

Objective: This study aimed to examine the effects of supportive relationships on self-care behaviors and the mediating effects of self-care confidence in HF outpatients.

Methods: Structural equation modeling (SAS version 9.

Accuracy and cost comparison in medical testing using sequential testing strategies.

The practice of sequential testing is followed by the evaluation of accuracy, but not by the evaluation of cost. This paper focuses on three logic rules for combining two sequences of tests: believe the positive (BP), which diagnoses disease if any of two tests is positive, believe the negative (BN), which diagnoses disease if any of two tests is negative, and believe the extreme (BE), which diagnoses disease if the first test is positive or, after a first inconclusive test, a second test is positive for disease. Comparisons of these strategies are provided in terms of accuracy using false positive rate, sensitivity pairs that make up the maximum receiver operating characteristic curve, and cost of testing, defined as the proportion of subjects needing two tests to diagnose disease.

Tryptophan degradation in women with breast cancer: a pilot study.

Background: Altered tryptophan metabolism and indoleamine 2,3-dioxygenase activity are linked to cancer development and progression. In addition, these biological factors have been associated with the development and severity of neuropsychiatric syndromes, including major depressive disorder. However, this biological mechanism associated with both poor disease outcomes and adverse neuropsychiatric symptoms has received little attention in women with breast cancer.