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Background: Sepsis is associated with about 20% of deaths worldwide. It often presents with non-specific initial symptoms, making its emergency treatment an interdisciplinary and cross-sectoral challenge. Three in four sepsis survivors suffers from new cognitive, psychological, or physical sequelae for which specific treatment concepts are scarce. The AVENIR project aims to improve the understanding of patient pathways, and subjective care experiences and needs along the entire healthcare pathway before, with and after sepsis. Based on this, concrete recommendations for the organization of care and patient information materials will be developed with close patient participation. Methods: Mixed-methods study including (1) analysis of anonymized nationwide health claims data from Germany, (2) linkage of health claims data with patient care reports (PCR) of emergency medical services from study regions in two federal states within Germany, and (3) qualitative exploration of the patient, relative, and care provider perspective on sepsis care. In (1), we analyze inpatient and outpatient health care utilization until 30 days pre-sepsis; clinical sepsis care including intra- and inter-hospital transfers; and rehabilitation, inpatient and outpatient aftercare of sepsis survivors as well as costs for health care utilization until 24 months post-sepsis. We attempt to identify survivor classes with similar health care utilization by Latent Class Analyses. In (2), PCR are linked with health claims data to establish a comprehensive database outlining care pathways for sepsis patients from pre-hospital to follow-up. We investigate e.g., whether correct initial assessment is associated with acute (e.g., same-day lethality) and long-term (e.g., new need for care, long-term mortality) outcomes of patients. We compare the performance of sepsis-specific screening tools such as qSOFA, NEWS-2 or PRESEP in the pre-clinical setting. In (3), semi-structured interviews as well as synchronous and asynchronous online focus groups are conducted and analyzed using qualitative content analyses techniques. Discussion: The results of the AVENIR study will contribute to a deeper understanding of sepsis care pathways in Germany. They may serve as a base for improvements and innovations in sepsis care, that in the long-term can contribute to reduce the personal, medical, and societal burden of sepsis and its sepsis sequelae. Trial registration: Registered at German Clinical Trial Register (ID: DRKS00031302, date of registration: 5th May 2023). [ABSTRACT FROM AUTHOR]

Background: Sepsis is a substantial health care burden. Data on regional variation in sepsis incidence in Germany and any possible associations with regional socioeconomic deprivation and health care capacity is lacking.Methods: Ecological study based on the nationwide hospital Diagnosis-related Groups (DRG) statistics data of 2016. We identified sepsis by ICD-10-codes and calculated crude and age-standardized incidence proportions in the 401 administrative German districts. Associations between socioeconomic and health care capacity indicators and crude and age-adjusted sepsis incidence were investigated by simple and multiple negative binomial (NB) regressions.Results: In 2016, sepsis incidence was 178 per 100,000 inhabitants and varied 10-fold between districts. We found that the rate of students leaving school without certificate was significantly associated with crude and age-standardized explicit sepsis incidence in the simple and multiple NB regressions. While we observed no evidence for an association to the capacity of hospital beds and general practitioners, the distance to the nearest pharmacy was associated with crude- and age-standardized sepsis incidence. In the multiple regression analyses, an increase of the mean distance + 1000 m was associated with an expected increase by 21.6 [95% CI, 10.1, 33.0] (p < 0.001), and 11.1 [95% CI, 1.0, 21.2]/100,000 population (p = .026) after adjusting for age differences between districts.Conclusions: Residence in districts with lower socioeconomic status (e.g., less education) and further distance to pharmacies are both associated with an increased sepsis incidence. This warrants further research with individual-level patient data to better model and understand such dependencies and to ultimately design public health interventions to address the burden of sepsis in Germany. [ABSTRACT FROM AUTHOR]

According to the social-investment principle, entering new environments is associated with new social roles that influence people's behaviors. In this study, we examined whether young adults' personality development is differentially related to their choice of either an academic or a vocational pathway (i.e., entering an academic-track school or beginning vocational training). The personality constructs of interest were Big Five personality traits and vocational-interest orientations. We used a longitudinal study design and propensity-score matching to create comparable groups before they entered one of the pathways and then tested the differences between these groups 6 years later. We expected the vocational pathway to reinforce more mature behavior and curtail investigative interest. Results indicated that choosing the vocational compared with the academic pathway was associated with higher conscientiousness and less interest in investigative, social, and enterprising activities. [ABSTRACT FROM AUTHOR]

The treatment of missing data in the social sciences has changed tremendously during the last decade. Modern missing data techniques such as multiple imputation and full-information maximum likelihood are used much more frequently. These methods assume that data are missing at random. One very common approach to increase the likelihood that missing at random is achieved consists of including many covariates as so-called auxiliary variables. These variables are either included based on data considerations or in an inclusive fashion; that is, taking all available auxiliary variables. In this article, we point out that there are some instances in which auxiliary variables exhibit the surprising property of increasing bias in missing data problems. In a series of focused simulation studies, we highlight some situations in which this type of biasing behavior can occur. We briefly discuss possible ways how one can avoid selecting bias-inducing covariates as auxiliary variables. [ABSTRACT FROM AUTHOR]

Objective Many studies have investigated the phenomenon of repression. Repressors are defined as individuals who deny or avoid the experience of negative affect. A common method for the identification of repressors is a median split approach using questionnaires that measure anxiety and social desirability. The present study aimed to evaluate this most frequently used procedure using a psychometric model. Design We applied item response theory using model assumptions comparable with those of the median split approach to detect repressors and examine the appropriateness of the median split procedure. Methods A mixed sample of 655 students and members of the general public completed the two scales usually used to identify repressors, namely the Taylor Manifest Anxiety Scale and the Marlowe-Crowne Social Desirability Scale. Results Employing item response theory mixture-model analyses, we were unable to replicate the median split solution on a latent level. Conclusions Our results did not support the identification of repressors via dichotomization of the two scales. The median split approach does not appear to detect repressors satisfactorily. The implications of the results for the conceptualization and assessment of repressors are discussed. Statement of contribution What is already known on this subject? Repression is a construct describing the suppression, denial or failure to exhibit negative emotions, and has been associated with many health outcomes. In much of the literature, two self-report scales are used to identify repressors, one measuring manifest anxiety and the other measuring social desirability. Median splits on these scales identify people low in manifest anxiety and high in self-reported social desirability as repressors. What does this study add? Using item-response theory we examined whether median splits are an appropriate method to identify repressors. We found that the latent classes did not show the characteristic pattern suggested by the median split approach and concluded that the psychometric model did not support the classification of individuals via median splits. Our findings have implications for future work using the repression construct and median splits to identify repressors. [ABSTRACT FROM AUTHOR]

Introduces the Perceptual-Experiential perspective to moral or character education. Major constructs of the experiential perspective; Youth stage-appropriate tools for constructing own moral reality within a social and environmental reality.

Different cross-domain trajectories in the development of students' ability self-concepts (ASCs) and their intrinsic valuing of math and language arts were examined in a cross-sequential study spanning Grades 1 through 12 (n = 1,069). Growth mixture modeling analyses identified a Moderate Math Decline/Stable High Language Arts class and a Moderate Math Decline/Strong Language Arts Decline class for students' ASC trajectories. Students' intrinsic value trajectories included a Strong Math Decline/Language Arts Decline Leveling Off, a Moderate Math Decline/Strong Language Arts Decline, and a Stable Math and Language Arts Trajectories class. These classes differed with regard to student characteristics, including gender, family background, and math and reading aptitudes. They also resulted in different high school math course enrollments, career aspirations, and adult careers. [ABSTRACT FROM AUTHOR]

Purpose: Return to a normal state of living is a key patient-relevant outcome for sepsis survivors. The Reintegration to Normal Living Index (RNLI) assesses self-perceived participation in patients with chronic disease, but its psychometric properties have been analyzed neither for patients after sepsis nor in a German patient cohort. This study aims to analyze the psychometric properties of the German version of the RNLI in sepsis survivors. Methods: In a prospective multicenter survey study, 287 sepsis survivors were interviewed 6 and 12 months after hospital discharge. Multiple-group categorical confirmatory factor analyses with three competing models were used to explore the factor structure of the RNLI. Concurrent validity was evaluated in relation to the EQ-5D-3L and the Barthel Index of Activities of Daily Living (ADL). Results: Regarding structural validity, all models showed an acceptable model fit. Because of high correlation between the latent variables in the two-factor models (up to r = 0.969) and for reason of parsimony, we opted for the common factor model to analyze the concurrent validity. Our analyses showed moderate positive correlations between RNLI score and ADL score (r ≥ 0.630), EQ-5D-3L visual analogue scale (r ≥ 0.656) and EQ-5D-3L utility score (r ≥ 0.548). The reliability assessed by McDonald's Omega was 0.94. Conclusion: We found convincing evidence for good reliability, structural and concurrent validity of the RNLI in German sepsis survivors. We propose to use the RNLI in addition to generic health-related quality of life measures to assess the reintegration to normal living after sepsis. [ABSTRACT FROM AUTHOR]

We investigated the development of narcissistic admiration (i.e., the assertive or extraverted dimension of narcissism; Back et al., 2013) and Machiavellianism (Mach) in early adulthood. Specifically, we examined (a) mean-level changes in narcissistic admiration and Mach during early adulthood and (b) how studying economics and experiencing any of 30 life events were related to individual differences in changes in narcissistic admiration and Mach. We used longitudinal data from 2 cohorts of young adults in Germany (N1 = 4,962 and N2 = 2,572). The mean levels of narcissistic admiration remained stable over time. Life events analyses indicated that narcissistic admiration increased among people who experienced a positively evaluated change in their eating or sleeping habits, a positively evaluated romantic break-up, or a negatively evaluated failure on an important exam. The mean levels of Mach decreased during early adulthood in both cohorts. Life events analyses showed that Mach decreased for only the 91% of young adults who had started a new job and evaluated it positively, suggesting that mastering occupational roles mitigates Mach in early adulthood. The results will be discussed in the light of previous longitudinal studies on narcissism and the Big Five and cross-sectional studies on how age is related to narcissism and Mach. [ABSTRACT FROM AUTHOR]

Research has shown that sustained homework effort enhances academic performance and that students’ conscientiousness is a powerful predictor of students’ homework effort. But does homework—as homework proponents claim—in turn also influence the development of conscientiousness over time? In the present study, we examined whether students’ homework effort in two subjects (i.e., mathematics and German) was associated with inter-individual differences in students’ development of conscientiousness in the early years of adolescence. Bivariate change models with a total of N = 2760 students revealed that homework effort and conscientiousness were systematically related over time (Grade 5 to Grade 8). Most importantly, students who invested more effort in their homework showed more positive development in conscientiousness. [ABSTRACT FROM AUTHOR]

The optimal treatment duration for vancomycin-resistant enterococcal (VRE) bacteraemia is still a matter of debate. The aim of the present study was to compare short-course (≤9 days) and long-course (≥10 days) antibiotic treatments in hospitalized adult patients with uncomplicated VRE bacteraemia. This retrospective study was conducted in four university hospitals in Germany. Adult patients with a positive blood culture for a VRE were screened from 1 January 2016 to 31 December 2018. Only patients who received a VRE-active antibiotic for at least 48 hours were included. The exclusion criteria were a survival of <10 days and a deep-seated source of infection requiring prolonged treatment. To compare the outcome of short-course therapy with that of long-course therapy, 30-day and 90-day overall mortality, relapse within 90 days, duration of hospitalization, and potential antibiotic-related adverse events were analysed by inverse probability of treatment weighting using the propensity score and by additional covariate adjustment. Of the 363 patients screened, 219 (60.3%) patients were included in the final analysis. Among them, 48 (21.9%) patients had underlying haematological diseases. Seventy-eight (35.6%) patients received short-course treatment (median, 7 days; interquartile range, 5–8 days) and 141 (64.4%) patients received long-course treatment (median, 15 days; interquartile range, 12–23.5 days). Thirty-day mortality was similar in both groups (19.2% vs. 22.0%; adjusted OR, 1.15; p 0.773). Duration of hospitalization (in total and after onset of bacteraemia) was significantly shorter (p < 0.05) in the short-course treatment group, whereas other secondary outcome parameters did not differ between both groups. Our study suggests that short-course treatment might not be associated with a worse outcome in patients with uncomplicated VRE bacteraemia. [ABSTRACT FROM AUTHOR]

Teachers play important roles in identifying and promoting gifted students. An open question is: Which student characteristics do teachers use to evaluate whether a student is gifted or not? We used data from a representative sample of Dutch primary school teachers (N = 1,304) who were asked whether or not they thought the students (N = 26,720) in their class were gifted. We investigated students' cognitive and noncognitive attributes as well as demographic factors that might be relevant for this judgment. In sum, the findings revealed that teachers considered students to be gifted when, in comparison with their peers, students were superior in cognitive domains, especially with respect to academic achievement, scored higher on openness to experience and lower on agreeableness, were male, were younger, and came from families with higher parental education. These findings are discussed in relation to research on teacher nominations, teachers' representations of giftedness and gifted students, and theoretical conceptions of giftedness. [ABSTRACT FROM AUTHOR]

The impact of response styles such as extreme response style (ERS) on trait estimation has long been a matter of concern to researchers and practitioners. This simulation study investigated three methods that have been proposed for the correction of trait estimates for ERS effects: (a) mixed Rasch models, (b) multidimensional item response models, and (c) regression residuals. The methods were compared with respect to their ability of recovering the true latent trait levels. Data were generated according to a unidimensional model with only one trait, a mixed Rasch model with two populations of ERS and non-ERS, and a two-dimensional model incorporating a trait and an ERS dimension. The data were analyzed using the same models as well as linear regression where the trait estimate is regressed on an ERS score and the resulting residual is considered the corrected trait estimate. Over all conditions, the two-dimensional model achieved the best trait recovery, though the difference to the unidimensional model was rather small. Mixed Rasch models were in general inferior to the other correction methods. When the trait and ERS showed no to weak correlations, ERS appeared to have a minor impact on trait estimation. [ABSTRACT FROM AUTHOR]

Mediation analysis, or more generally models with direct and indirect effects, are commonly used in the behavioral sciences. As we show in our illustrative example, traditional methods of mediation analysis that omit confounding variables can lead to systematically biased direct and indirect effects, even in the context of a randomized experiment. Therefore, several definitions of causal effects in mediation models have been presented in the literature (Baron & Kenny, 1986; Imai, Keele, & Tingley, 2010; Pearl, 2012). We illustrate the stochastic theory of causal effects as an alternative foundation of causal mediation analysis based on probability theory. In this theory we define total, direct, and indirect effects and show how they can be identified in the context of our illustrative example. A particular strength of the stochastic theory of causal effects are the causality conditions that imply causal unbiasedness of effect estimates. The causality conditions have empirically testable implications and can be used for covariate selection. In the discussion, we highlight some similarities and differences of the stochastic theory of causal effects with other theories of causal effects. [ABSTRACT FROM AUTHOR]

Objective: Incidence of primary mechanical complications and malpositions associated with landmark-guided central venous access procedures (CVAP) performed by experienced operators.Design: Prospective 5-year observational study on two intensive care units.Intervention: Only CVAPs using Seldinger technique were evaluated. Age, gender, puncture site, number of cannulation attempts, and complications within 24 hours and malpositions were recorded.Patients: 782 CVAPs in females aged 9-92 yrs and 1012 CVAPs in males aged 6-89 yrs.Results: We analyzed 1794 (1017 right- and 777 left-sided CVAP), of which 87.7% were accomplished without adverse events. More than one cannulation attempt was a risk factor for failed catheterization, other mechanical complications but not for malposition. Complications/malpositions were encountered in 220 CVAPs.In 51 CVAPs (2.8%) the cannulation failed at the attempted site, here 18 CVAPs were accompanied by further complications (35.3%). Otherwise, the rate for mechanical complications was low (3.3%). The most common mechanical complications (n = 127) were arterial punctures (n = 52; 2.9%), including four arterial cannulations (0.2%), and pneumothorax (n = 9; 0.6%). There was significant risk for arterial puncture with the internal jugular vein approach in comparison to the innominate vein (p = 0.004), but not to the subclavian vein (p = 0.065). Male patients had a lower risk for failure (2.1%) than females (3.8%, p = 0.028). One-hundred-twenty-one central venous catheters were malpositioned (6.7%) of which 35 were related to the left internal jugular vein.Conclusions: Even experienced operators cause a considerable number of early mechanical complications and malpositions. After two unsuccessful cannulation attempts failure and associated complications are very likely. [ABSTRACT FROM AUTHOR]

Position effects (PE) cause decreasing probabilities of correct item responses towards the end of a test. We analysed PEs in science, mathematics and reading tests administered in the German extension to the PISA 2006 study with respect to their variability at the student- and school-level. PEs were strongest in reading and weakest in mathematics. Variability in PEs was found at both levels of analysis. PEs were stronger for male students, for students with a migration background (science and mathematics), and for students with a less favourable socio-economic background (reading). At the school level, PEs were stronger in lower school tracks and in schools with a high proportion of students with a migration background. The relationships of the test scores with the covariates partly reflected the covariates' relationships with PEs. Our findings suggest that PEs should be taken seriously in large-scale assessments as they have an undesirable impact on the results. [ABSTRACT FROM AUTHOR]

The current study compares the closeness to unidimensionality (CU) and measurement precision (MP) of the Narcissistic Personality Inventory (NPI)—with either a pairwise forced-choice or 5-point Likert-type scale response format—to the Narcissistic Admiration and Rivalry Questionnaire (NARQ). Minimum rank factor analysis and item information curves from item response models were utilized. The results mainly confirmed our expectations that NPI subscales are lower in CU and MP compared with NARQ subscales when the NPI was administered with its traditional forced-choice response format. When the NPI was administered with a 5-point Likert-type scale response format, the NPI subscale Leadership/Authority and NPI Grandiose Exhibitionism showed similarly high levels of CU and MP as the two NARQ subscales. While the NPI subscale Entitlement/Exploitativeness had a higher CU than the NARQ subscales it showed considerably lower levels of MP. [ABSTRACT FROM AUTHOR]