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Parental and professional perceptions of problems associated with long-term pediatric home tube feeding.

We surveyed 24 caregivers of children fed by gastrostomy tube to identify day-to-day problems encountered in home enteral nutrition. In a second survey, 21 respondents cross-validated the problem list by rating how often they experienced each problem and how difficult each problem was to manage. Problems related to social functioning, recreational activities, and family functioning were rated by caregivers as the most frequent and difficult. We asked 11 pediatric feeding specialists to rate the same problems based on their perceptions of the frequency and severity of problems experienced by caregivers. Moderate agreement was found between professional and caregiver ratings, although professionals generally rated problems as more common and difficult than did the caregivers. Additionally, positive relationships were found between caregiver ratings of common gastrostomy-tube problems and general levels of stress in the home. Data suggest that problems identified by caregivers as most common and difficult are often in the social rather than the medical realm. A broadly based family assessment that focuses on medical and social aspects of home enteral nutrition may maximize nutritional benefits for the patient as well as improve general family functioning and reduce stress in the home.

Adolescent↗

The application of backpropagation neural networks to problems in pathology and laboratory medicine.

Neural networks are a group of computer-based pattern recognition technologies that have been applied to problems in clinical diagnosis. This review focuses on one member of the group of neural networks, the backpropagation network. The steps in creating a backpropagation network are (1) collecting adequate training facts, (2) choosing the specific network structure, (3) training the network, and (4) cross-validating the trained network. The first published applications of backpropagation networks to problems in pathology and laboratory medicine have appeared recently. These applications are in the areas of image analysis and interpretation of laboratory results, and they demonstrate the feasibility of the approach.

Evaluation Studies as Topic↗

Applying psychometric criteria to functional assessment in medical rehabilitation: III. Construct validity and predicting level of care.

A discriminant analysis was performed using Rasch ability estimates derived from four Patient Evaluation and Conference System (PECS) subscales, to distinguish among the functional independence and impairment profiles exhibited by patients admitted into any of three levels of medical rehabilitation delineated by the National Association of Rehabilitation Facilities (NARF): (1) inpatient hospital, (2) atypical nursing home (intermediate), or (3) day program. Two discriminant functions accounted for 91% and 9% of the between-group variance, respectively. Cross-validated classification of patients into one of the three levels of care, based on discriminant function scores, produced 75% correct classification; a 66% improvement over the percentage of correct classification likely by chance alone. Results support the construct validity of the PECS subscales and indicate they may be useful in validating clinically-based admission decisions among three of the levels of care promulgated by NARF.

Activities of Daily Living↗

Blocked arteries and multivariate regression.

Ultrasound blood flow waveforms may be used in the diagnosis of arterial occlusive disease in human legs. We develop a statistical model to predict disease severity, conditional on the ultrasound data and some training data. It belongs to the class of models known as seemingly unrelated regressions, for which the Bayesian predictive density function cannot be evaluated analytically. Allowing for missing components of response vectors in the training data, we describe a first-order approximation to the predictive density, based on a Bayes estimate of the precision matrix. This approximation is then used to generate cross-validated predictions of disease severity in a set of 31 patients. We conclude with a discussion of the results.

Arterial Occlusive Diseases↗

Validity of bioelectrical impedance equations for estimating fat-free weight in lean males.

The present study examined the validity of bioelectrical impedance (BIA) equations for estimating fat-free weight (FFW) in lean males (X +/- SD = 9.1 +/- 2.2% fat) by comparing the estimates with values obtained from underwater weighing. Sixty-eight Caucasian male volunteers served as subjects. Cross-validation analyses included examination of the constant error (CE), standard error of the estimate (SEE), r, and total error (TE). The results indicated that the equations of Oppliger et al. (16), which resulted in small TE (1.70 kg) and CE (-0.02 kg) values, most accurately estimated FFW. Simple linear regression showed that FFW was more highly correlated with body weight (BW) (r = 0.98, P < 0.0001) and resulted in a lower SEE (1.68 kg) than either height2/resistance (Ht2/R) (r = 0.81, P < 0.0001; SEE = 5.12 kg) or the independent variable (weight x resistance)/height2 [WR/Ht2] utilized by the manufacturer of the BIA analyzer (r = 0.15, P > 0.05; SEE = 8.59 kg). Multiple regression showed that when WR/Ht2, Ht2/R, resistance, body mass index, Ht2, and/or Ht was added to the prediction equation, which utilized BW alone, they accounted for less than 1% additional variance and reduced the SEE by < or = 0.16 kg. The results indicated that BW alone estimated FFW as accurately as any of the BIA equations in lean males.

Adipose Tissue↗

Noninvasive glucose monitoring in diabetic patients: a preliminary evaluation.

Noninvasive monitoring of blood/tissue glucose concentrations has been successfully accomplished in individual diabetic subjects by using near-infrared (NIR) spectroscopy coupled with chemometric methods. Three different spectrometer configurations were tested: a) a Fourier-transform infrared spectrometer with an indium antimonide detector; b) a grating monochromator equipped with a silicon (Si) array detector, without fiber optics; and c) a grating monochromator equipped with an Si detector, with fiber-optic sampling. NIR spectra were obtained from diabetic subjects by transmission through the finger during a meal-tolerance test. The maximum range of observed plasma glucose concentrations obtained from the blood samples was 2.5-27 mmol/L. The NIR spectra were processed by using the chemometric multivariate calibration methods of partial least squares and principal component regression. The best calibration yielded a cross-validated average absolute error in glucose concentration of 1.1 mmol/L. This predictive ability suggests that noninvasive glucose determinations by NIR/chemometrics is a viable analytical method.

Blood Glucose↗

Assessment of body composition in heart transplant patients.

Orthotopic heart transplantation (OHT) recipients often experience increased body weight (BW) following surgery. Using hydrostatic weighing (HW), this study assessed the body density (BD) and body composition of 17 white and seven black male OHT patients. It examined the cross-validity of the Jackson and Pollock seven and three site skinfold (SF) regression equations for predicting BD in these patients. We hypothesized that both prednisone (P) dose and months post-operative (MPO) would be inversely related to BD. The average of the last five of ten HW trials was used in computing BD. BW and % body fat (BF) were 88.5 +/- 17.8 kg (mean +/- SD) and 33.5 +/- 9.4%, respectively. The correlation coefficient between hydrostatically determined BD and BD determined via two of the three intercept revised Jackson and Pollock SF equations was r = 0.89, SE = 0.009. A polynomial regression model for BD using P dose and MPO provided a correlation coefficient of r = 0.71, SE = 0.015. Partial correlation techniques incorporating SF, age, MPO, and P dose indicated that neither P dose or MPO provided any significant additive effect, above SF and age, when predicting BD. We conclude that in OHT patients receiving glucocorticoids, the intercept revised Jackson and Pollock SF regression equations are generally applicable and associated with a SE of +/- 4 BF percentage points. Up to 49 months after OHT, both P dose and MPO are inversely related to BD but provide no additive value above SF for predicting BD.

Adult↗

The Maternal Characteristics Scale: a cross validation.

A device for organizing practitioners' observations, the Maternal Characteristics Scale has successfully identified traits distinguishing samples of Caucasian neglectful mothers from nonneglectful. This cross-validation tested the scale with new and more diverse samples of both mothers and practitioners. Relatedness, impulse control, confidence, and verbal accessibility were again found to be associated with vulnerability to becoming neglectful. The scale appears to be a promising diagnostic and prognostic tool in the prevention and treatment of child neglect.

Child↗

Evaluation of a neural-network classifier for PET scans of normal and Alzheimer's disease subjects.

The value of PET as an objective diagnostic tool for dementia may depend on the degree to which abnormal metabolic patterns can be detected by quantitative classification methods. In these studies, a neural-network classifier based on coarse region of interest analyses was used to classify normal and abnormal FDG-PET scans. The performance of neural networks and of an expert reader were evaluated by cross-validation testing. When the "abnormal" class was represented by subjects with clinical diagnoses of "Probable Alzheimer's," the areas under the relative-operating-characteristic (ROC) curves were 0.85 and 0.89 for the neural network and the expert reader, respectively. When testing with abnormal subjects represented by "Possible AD" cases, ROC areas for both the network and the expert were 0.81. The neural network out-performed discriminant analysis. It is concluded that PET has potential for the detection of abnormal brain function in dementing diseases, and that the combination of neural networks and PET is a useful diagnostic tool. Despite the low-resolution "view" afforded the neural network, its performance was nearly equivalent to that of an expert reader.

Adult↗

A coupling procedure for the discrimination of mixed data.

A procedure is described for coupling different discriminators to a new (common) decision rule using the corresponding allocation vectors only. This enables one to cope jointly with data of different structure and/or scales of measurement but without strong restrictions on the number of (especially categorical) features. The method is combined with a consequent cross-validation process securing the results reached. Examples from medical diagnostics demonstrate the usefulness of the proposed procedure, especially in comparison with the known linear discriminant analysis as judged from the error rates obtained.

Diagnosis↗

Relationships of structural dimensions to bench press strength in college males.

The purpose of this study was to determine the relationships between structural dimensions and bench press performance in college males. Members of required fitness classes (n = 170) were measured after 14 weeks of strength and aerobic endurance training. Anthropometric dimensions included upper arm and chest circumferences, upper and lower arm lengths, shoulder and hip widths, %fat, and height. Arm muscle cross-sectional area (CSA) was calculated from upper arm circumference corrected for triceps skinfold. Drop distance was measured from the bar to the pectoral muscles. Multiple regression analysis selected upper arm CSA, %fat, and chest circumference as the best items to predict bench press strength (R = 0.83; SEE = 11.6 kg). Cross-validation of the prediction equation on a similar sample (n = 89) produced an r = 0.74 between predicted and actual bench press (t = 0.53, p greater than 0.50). In a second cross validation sample (n = 57) who had trained more extensively with weights, the correlation between predicted and actual bench press was r = 0.57 (p less than 0.05). The prediction equations significantly (t = 6.59, p less than 0.01) underestimated bench press performance in the more extensively weight trained subjects. The results of this study suggest that bench press performance is related to structural dimensions in males and that extensive strength training may alter the relationship between size and strength.

Adult↗

Predictors of long-term sexual assault trauma among a national sample of victimized college women.

Several multivariate studies have attempted to delineate the major predictors of long-term, sexual assault-induced aftereffects. The present study was an attempt to extend previous work by supplementing known preassault, assault, and postassault predictors of trauma with cognitive measures. The data were cross-sectional and included responses from 1,213 victims of sexual assault who were recruited from a national sample of higher education students. Utilizing hierarchical multiple regression analyses and a cross-validation procedure, the results suggested that the prior mental status of the victims, the forcefulness of the assaults, as well as two cognitive variables related to a victim's beliefs about sex and relationships predicted victims' scores on standardized measures of anxiety and depression. The relationships were such that the most traumatized victims were those women who had evidenced a history of mental health problems, who had experienced the more aggressive assaults, who tended to believe that people in relationships are not trustworthy, and tended to place conservative restrictions on the sexual acts and circumstances under which sex should occur. Taken together these variables accounted for between 9%-14% of the variance in sexual assault aftereffects. The discussion emphasizes the contribution of cognitive processes to the understanding of sexual assault trauma.

Adult↗

Morphometry of the human thigh muscles. A comparison between anatomical sections and computer tomographic and magnetic resonance images.

The present study examined the relative accuracy and precision of MR and CT procedures for determining the CSA of individual muscles from the human thigh. Serial AN, CT and MR cross-sections were obtained from three cadaveric lower limbs. The MR measurements provided accurate and precise values for the CSAs of most thigh muscles, generally within +/- 7.5% of the AN standard. In contrast, CT tended systematically to overestimate the AN CSA by 10-20%. Retest procedures indicated that highly reliable measurements could be obtained from both MR and CT images. However, subjective interpretations of boundaries between closely apposed muscle bellies, particularly for muscles with more than one head, were necessary for resolving entities in the imaging records and this decreased the relative accuracy of MR and CT measures. Interestingly, MR records demonstrated an incomplete septum between vastus lateralis and vastus intermedius more prominently than AN cross-sections. The novel cross-validation procedures used in this study also highlighted several system-based errors in the MR records that, if undetected and left uncorrected, would have seriously biased the morphometric data obtained with this technique. In general, MR provides high resolution images of the human thigh muscles which may be used to obtain valid measures of the CSA of these structures.

Cadaver↗

Individual temperament as a predictor of health or premature disease.

Two studies of temperament as a possible predictor of continuing good health or premature disease are reported. In earlier work to determine youthful precursors of premature disease, a number of separate characteristics distinguishing medical students who remain healthy from those with premature disorders have been identified. Characterization by temperament, an expression of innate biological endowment, provides a more global portrayal of an organism that can an aggregate of separate characteristics alone. Criteria for designating three temperament types, termed Alpha, Beta and Gamma, are presented. In 1948, 45 subjects were assigned to one of these types on the basis of youthful characteristics. The subjects in the three temperament groups had different health outcomes 30 years later, significant at the p less than 0.01 level. Gamma type had the most disorders and deaths, Beta type the fewest. A cross-validation study on 127 subjects had similar results at the p less than 0.05 level. Temperament appears to be a variable of predictive potential of individual stamina, or of vulnerability to premature disease and death.

Adult↗

Prediction of maximal oxygen uptake in boys, ages 7-15 years.

Predictions of Vo2max (1 min-1 and ml kg-1 min-1) were obtained via multiple regression procedures from a sample of 100 boys, ages 6.7-14.8 years. Prediction equations for Vo2max (1 min-1) were obtained from the subjects' height, and the Vo2 (1 min-1) and heart rate observed during the third min of a treadmill walk (R = 0.95; CV = +/- 9.3%). A similar prediction was obtained when the subjects' age, height and weight were used (R = -0.94; CV = +/- 9.7%). Vo2max (ml kg-1 min-1) was predicted with similar accuracy (CV = +/- 8.4%) from age, and heart rate, VCO2(1 min-1), Vo2 (ml kg min-1), or from simply age, height and weight (CV = +/- 9.2%). Cross-validation of the equations with another sample of 39 boys demonstrated that the prediction equations based on laboratory data were quite stable, % errors approximately 1-2 +/- 9%. However, the equations based on age, height and weight underestimated the Vo2max slightly, both in 1 min (X = -0.091 min) and ml kg min (X = -2.2 ml kg min, P less than 0.05). The results indicate that reasonably reliable and accurate estimates of Vo2max for children may be obtained from either laboratory data, or simply from their age, height and weight.

Adolescent↗

Alcoholism-related content in the MMPI: item analysis of alcoholics vs. normal and general psychiatric populations.

An analysis of alcoholism-related content in the MMPI was undertaken using an alcoholic population, a psychiatric population and two normal populations. The alcoholic and psychiatric groups were drawn from facilities in the Minneapolis-St. Paul area, and the normal populations were the Hathaway Adult Group and the Mayo Clinic nonpsychiatric patient group. A derivation study and a cross-validation resulted in the identification of three item pools: 1) that discriminate alcoholics from both normals and psychiatric patients, 2) items that discriminate alcoholics from normals only, 3) items that discriminate alcoholics from psychiatric patients only. Only seven items discriminate both male and female alcoholics from both normals and psychiatric patients. These items have substantial face validity. As the core of alcoholism-related content in the MMPI, they can serve as a stem for the development of scales with more specialized purposes.

Alcoholism↗

Objective assessment of prior air traffic control-related experience through the use of an occupational knowledge test.

The Occupational Knowledge Test (OKT) 101-B was administered to 784 air traffic control trainees who entered the FAA Academy's 16-week training course in 1976. All trainees completed the nonradar laboratory portion of the training and, in addition, completed a preemployment questionnaire. Based on responses to the questionnaire, the trainees were assigned to one of three experience groups, corresponding to groups given credit for experience using Civil Service Commission (CSC) selection procedures. It was found that the OKT was highly correlated with experience (r = 0.64) and, in addition, had a higher correlation with successful completion of the nonradar lab than did experience (r = 0.25 vs. 0.12). It was determined that use of an OKT score of 75 or above to assign extra credit would result in a failure rate of 3.1% for those receiving credit, while use of the current experience scale would result in a failure rate of 7.6% for those receiving extra credit on the CSC selection battery. The results held up for a cross-validation sample of 432 trainees who entered the Academy during 1977. Based on the results, it is recommended that an OKT score of 75 or above be used to assign extra credit for experience in the selection of air traffic controllers.

Aviation↗

Schooling, occupational motivation, and personality as related to success in paramedical training.

Measures of prior school experience, motivation for working in a health care job, and personality were evaluated as potential predictors of success in Navy paramedical training. When, by multiple regression procedures, years of school completed, numbers of suspensions or expulsions from school, occupational motivation, and Comrey personality scale scores were combined with an aptitude measure that is used for guiding recruits into paramedical training, the cross-validity for predicting training completion was significantly increased (P less than 0.001) from 0.40 to 0.50. Practical means for applying these measures to the screening of candidates for paramedical training were developed. Results of the evaluation suggest that guiding people into jobs that they neither prefer nor perceive as congruent with their abilities and interests can significantly reduce the chances for occupational success.

Achievement↗