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Aptitude requirements for US Air Force officer commissioning include completion of a college degree and minimum scores on the Air Force Officer Qualifying Test (AFOQT) Verbal and Quantitative composites. Although the AFOQT has demonstrated predictive validity for officer training, the Air Force has striven to improve predictive validity and diversity. To this end, a Situational judgment Test (SJT) was added to the AFOQT in 2015. SJT development was consistent with recommendations to broaden the competencies assessed by the AFOQT with the goal of providing incremental validity, while reducing adverse impact for historically underrepresented groups. To ensure content validity and realism, SJT development was based on competencies identified in a large-scale analysis of officership and input from junior officers in scenario and response generation and scoring. Psychometric evaluations have affirmed its potential benefits for inclusion on the AFOQT. An initial study showed the SJT to be perceived as highly face valid regardless of whether it was presented as a paper-and-pencil test (with narrative or scripted scenarios) or in a video-based format. Preliminary studies demonstrated criterion-related validity within small USAF samples, and a larger Army cadet sample. Additionally, operational administration of the SJT since 2015 has demonstrated its potential for improving diversity (i.e., reduced adverse impact relative to the AFOQT Verbal and Quantitative composites). Predictive validation studies with larger Air Force officer accession samples are ongoing to assess the incremental validity of the SJT beyond current AFOQT composites for predicting important outcomes across accession sources. [ABSTRACT FROM AUTHOR]

Criterion measures vary greatly in terms of their psychometric quality and ease of use. This paper serves two purposes. First, it provides a general summary of different approaches to criterion measurement in a military context. Second, it provides an extensive review of 16 specific types of criterion measurement methods (e.g., job performance rating scales, self-report questionnaires, job knowledge tests) on nine psychometric and ease-of-use evaluation factors. Eight criterion measurement experts read a summary of extant research and made ratings to evaluate each measurement method on the evaluation factors. Rater intra-class correlations (ICCs) were high, ranging from.75 to.95 across the evaluation dimensions with a median of.91. Data showed a quality-feasibility tradeoff, where criterion data that are easy to obtain often have technical flaws. Recommendations for military services and future directions in criterion measurement (e.g., applications of machine learning) are discussed. [ABSTRACT FROM AUTHOR]

Suicidality is significantly more common in autistic adults than the general population, yet the factors that increase risk for suicidality among autistic adults remain largely unknown. We identified characteristics associated with suicidal ideation and suicide attempts/self-inflicted injury in a U.S. national sample of Medicare-enrolled autistic adults. We conducted a case–control study of autistic adults aged 18–59 years (n = 21,792). Younger age, white race, depression disorders, and psychiatric healthcare utilization were associated with increased odds of suicidal ideation and suicide attempts. Co-occurring intellectual disability was associated with significantly greater odds of a suicide attempt, but lower odds of suicidal ideation. Findings underscore the need for improved methods to identify ideation prior to attempt among adults with autism and intellectual disability. [ABSTRACT FROM AUTHOR]

Aim: This study examined cross-sectional population-based rates in reported need and unmet need for occupational, physical, and speech therapy services in children with autism spectrum disorder (ASD) compared with children with attention-deficit-hyperactivity disorder (ADHD) and cerebral palsy (CP).Method: The 2005-2006 and 2009-2010 (USA) National Survey of Children with Special Health Care data sets were used to compare therapy need and unmet need among children younger than 18 years with ASD (n=5178), ADHD (n=20 566), and CP (n=1183). Bivariate approaches and multivariate logistic regression using imputed data were used to identify associations between child and family characteristics, and access to therapy services.Results: After adjusting for other variables, children with ASD had a significantly greater likelihood of having an unmet therapy need compared with children with ADHD (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.36-2.03), but a similar unmet need as children with CP (OR 1.30, 95% CI 0.97-1.74). Factors associated with unmet need included survey year, younger child age, no health insurance, and increased functional and behavioral difficulties.Interpretation: Children in our sample had greater unmet therapy needs in 2009 than in 2005. Caregiver-reported reasons for unmet need included cost and school resources. Research examining future trends in therapy access are warranted for children with ASD and CP.What This Paper Adds: Children with complex diagnoses of autism spectrum disorder and cerebral palsy had reported unmet need for therapy services. High costs of therapy were the primary reported reason contributing to reduced access among children. [ABSTRACT FROM AUTHOR]

Due to the prevalence, severity, and costs associated with autism spectrum disorders (ASDs), it has become a public health issue. In response, state governments have adopted ASD-specific private insurance mandates requiring coverage of ASD screening, diagnosis, and treatment. Despite rapid uptake of these laws, differences exist in the type and levels of coverage, especially for allied health services including occupational therapy. We piloted a structured legal research methodology to code ASD insurance mandates that impact allied health service provisions. State private insurance mandates were obtained from WestlawNext. A coding methodology was piloted on 14 states and included variables for age and service limits, treatments covered, and medical necessity. Coding methods were feasible and highly reliable among raters. Ten of 12 states had a coverage mandate, many with specific provisions for allied health providers. A full analysis of all 50 states is warranted to identify provisions affecting allied health providers serving individuals with ASD. [ABSTRACT FROM AUTHOR]

Objectives: We sought to describe the characteristics of adult patients with bronchiectasis enrolled in the US Bronchiectasis Research Registry (BRR).Methods: The BRR is a database of patients with non-cystic-fibrosis bronchiectasis (NCFB) enrolled at 13 sites in the United States. Baseline demographic, spirometric, imaging, microbiological, and therapeutic data were entered into a central Internet-based database. Patients were subsequently analyzed by the presence of NTM.Results: We enrolled 1,826 patients between 2008 and 2014. Patients were predominantly women (79%), white (89%), and never smokers (60%), with a mean age of 64 ± 14 years. Sixty-three percent of the patients had a history of NTM disease or NTM isolated at baseline evaluation for entry into the BRR. Patients with NTM were older, predominantly women, and had bronchiectasis diagnosed at a later age than those without NTM. Gastroesophageal reflux disease (GERD) was more common in those with NTM, whereas asthma, primary immunodeficiency, and primary ciliary dyskinesia were more common in those without NTM. Fifty-one percent of patients had spirometric evidence of airflow obstruction. Patients with NTM were more likely to have diffusely dilated airways and tree-in-bud abnormalities. Pseudomonas and Staphylococcus aureus isolates were cultured less commonly in patients with NTM. Bronchial hygiene measures were used more often in those with NTM, whereas antibiotics used for exacerbations, rotating oral antibiotics, steroid use, and inhaled bronchodilators were more commonly used in those without NTM.Conclusions: Adult patients with bronchiectasis enrolled in the US BRR are described, with differences noted in demographic, radiographic, microbiological, and treatment variables based on stratification of the presence of NTM. [ABSTRACT FROM AUTHOR]

Objective: To compare patient safety in major orthopedic procedures between an orthopedic hospital in Italy, and 26 US hospitals of similar size.Design: Retrospective analysis of administrative data from hospital discharge records in Italy and Florida, USA, 2011-13. Patient Safety Indicators (PSIs) developed by the Agency for Healthcare Quality and Research were used to identify inpatient adverse events (AEs). We examined the factors associated with the development of each different PSI, taking into account known confounders, using logistic regression.Setting: One Italian orthopedic hospital and 26 hospitals in Florida with ≥ 1000 major orthopedic procedures per year.Participants: Patients ≥ 18 years who underwent 1 of the 17 major orthopedic procedures, and with a length of stay (LOS) > 1 day.Intervention: Patient Safety management between Italy and the USA.Main Outcome Measure: Patient Safety Indicators.Results: A total of 14 393 patients in Italy (mean age = 59.8 years) and 131 371 in the USA (mean age = 65.4 years) were included. US patients had lower adjusted odds of developing a PSI compared to Italy for pressure ulcers (odds ratio [OR]: 0.21; 95% confidence interval [CI]: 0.10-0.45), hemorrhage or hematoma (OR: 0.42; CI 0.23-0.78), physiologic and metabolic derangement (OR: 0.08; CI 0.02-0.37). Italian patients had lower odds of pulmonary embolism/deep vein thrombosis (OR: 3.17; CI 2.16-4.67) compared to US patients.Conclusions: Important differences in patient safety events were identified across countries using US developed PSIs. Though caution about potential coding differences is wise when comparing PSIs internationally, other differences may explain AEs, and offer opportunities for cross-country learning about safe practices. [ABSTRACT FROM AUTHOR]

A study was conducted to investigate personality similarities and differences for a group of 200 business leaders, 100 each from Southern Mexico and the United States. Mexican and American leaders were administered the Sixteen Personality Factor Questionnaire (16PF) in their native language (Spanish or English). A demographic questionnaire solicited information about age, education, and gender. These variables were used as covariates in some analyses. After controlling for the effects of age, gender, and education level, the authors found that Mexican leaders scored higher than their American counterparts on the warmth, emotional stability, social boldness, and openness to change scales. American leaders scored higher on the abstractedness and self-reliance scales. On scales related to leadership there were between-nationality differences on emotional stability, social boldness, abstractedness, and self-reliance. Additional studies are suggested to illuminate cross-nationality similarities and differences. [ABSTRACT FROM AUTHOR]

Objective. To develop and characterize utilization–based service areas for the United States which reflect the travel of Medicare beneficiaries to primary care clinicians. Data Source/Study Setting. The 1996–1997 Part B and 1996 Outpatient File primary care claims for fee–for–service Medicare beneficiaries aged 65 and older. The 1995 Medicaid claims from six states (1995) and commercial claims from Blue Cross Blue Shield of Michigan (1996). Study Design. A patient origin study was conducted to assign 1999 U.S. zip codes to Primary Care Service Areas on the basis of the plurality of beneficiaries’ preference for primary care clinicians. Adjustments were made to establish geographic contiguity and minimum population and service localization. Generality of areas to younger populations was tested with Medicaid and commercial claims. Data Collection/Extraction Methods. Part B primary care claims were selected on the basis of provider specialty, place of service, and CPT code. Selection of Outpatient File claims used provider number, type of facility/service, and revenue center codes. Principal Findings. The study delineated 6,102 Primary Care Service Areas with a median population of 17,276 (range 1,005–1,253,240). Overall, 63 percent of the Medicare beneficiaries sought the plurality of their primary care from within area clinicians. Service localization compared to Medicaid (six states) and commercial primary care utilization (Michigan) was comparable but not identical. Conclusions. Primary Care Service Areas are a new tool for the measurement of primary care resources, utilization, and associated outcomes. Policymakers at all jurisdictional levels as well as researchers will have a standardized system of geographical units through which to assess access to, supply, use, organization, and financing of primary care services. [ABSTRACT FROM AUTHOR]

Examines the causal model of acquisition on job knowledge and flying skills of air pilots in the U.S. Influence of causal models on the cognitive ability of pilots; Comparison on the impact of cognitive ability on the flying skills between men and women; Importance of cognitive ability and job knowledge on pilot training performance.

Determines the situational awareness of the F-15 pilots of the U.S. Air Force. Completion of test battery representative of various psychological constructs; Prediction of performance in a wide variety of military and civilian jobs; Measurement of cognitive ability, psychomotor ability and personality.

Evaluates the outcome on the paper-and-pencil aptitude battery and computer-administered tests of Air Force pilot trainees in the U.S. Jet aircraft flying experience of the trainees; Correlation of aircraft flying criteria with the tests; Consideration of the paper-and-pencil tests as the best predictors on the aircraft flying ability of the trainees.

Two hundred forty-seven U.S. Air Force pilot candidates commissioned through the Air Force Reserve Officer Training Corps were tested on an experimental form of the Basic Attributes Test (BAT) battery twice on consecutive days at the beginning of a flight screening program. The purpose of this study was to examine the short-term retest reliability of the BAT battery. There was a moderate correlation between subjects' first and second administration test composites (Pearson r = .56, Spearman rho = .55). The magnitude of the retest correlations may have been underestimated due to reduced test length and preselection of subjects on operational selection instruments. Implications for an operational retest policy and for a planned measurement and metric equivalency study are discussed. [ABSTRACT FROM AUTHOR]

Although several valid predictors of U.S. Air Force pilot training performance have been identified, it was felt that our understanding of the relation between preselection personnel attribute data and training performance was limited by the dichotomous nature of the outcome indicators (i.e., graduation or elimination) and by the disproportionate number of people in the outcome categories. A weighted composite of Undergraduate Pilot Training (UPT) flying performance data (i.e., daily flying grades, check flight grades, and academic grades) was shown to be related closely to advanced training recommendations (fighter vs. nonfighter aircraft). This suggested that this composite score was a reasonable measure of pilot candidate quality because fighter aircraft assignments are considered more prestigious and demanding than nonfighter assignments. When the weighted composite algorithm was modified to include UPT eliminees, however, it demonstrated little utility in adding to our understanding of the relation between performance on selection instruments (i.e., test scores) and training performance (i.e., had little impact on the rankings of the applicants). These results were not surprising, however, as the dichotomous UPT final outcome indicator was strongly correlated with UPT performance as measured by the weighted composite scores. [ABSTRACT FROM AUTHOR]

Computerized testing in the United States Air Force finds its historical beginnings in apparatus tests developed during World War II. The advent of fast, small, and inexpensive computers led to the establishment of a research program to use computers in pilot selection. Later, computerized tests were demonstrated for more familiar aptitude measures such as verbal and quantitative ability. Several large-scale efforts to implement computerized testing have proved informative. Many Air Force tests are routinely administered by computer. Continued advances in computer technology promise to make computerized testing more common and more commonplace. Computer use in measuring physiological correlates of human ability is discussed. [ABSTRACT FROM AUTHOR]

Background: Emails securely exchanged between patients and clinicians offer the promise of improved access to care and indirectly improved health outcomes. Yet research to date is mixed on who-among both patients and clinicians-is using secure messaging.Objective: Using data from two large nationally representative cross-sectional surveys, this study aimed to compare the prevalence of secure messaging use among patients and their access to the functionality through their physicians, and to explore the clinical practice and physician characteristics and patient sociodemographic characteristics associated with the use of secure messaging.Methods: We conducted regression analyses to identity statistical associations between self-reported secure messaging use and access, and the patient, practice, and physician characteristics from the National Health Interview Survey (NHIS) and the National Ambulatory Medical Care Survey (NAMCS). The NHIS data collected between 2013 and 2018, with approximately 150,000 adult individuals, were used to evaluate patient characteristics associated with email communication with clinicians. The NAMCS data included 7340 physicians who reported on secure messaging use between 2013 and 2016 and provided context on physician specialty, use of certified health information technology (IT), and practice size and ownership associated with secure messaging access and use.Results: By 2016, two-thirds of ambulatory care visits were conducted by a physician who reported using secure messaging, up from 40.70% in 2013. The percentage of US residents who reported sending an email to their clinician, however, only increased from 7.22% to 16.67% between 2013 and 2018. We observed a strong positive association between certified health IT use and secure messaging use (odds ratio [OR] 11.46, 95% CI 7.55-17.39). Individuals who were black, had lower levels of education, had Medicaid or other public payer insurance, or those who were uninsured had reduced odds for using email to communicate with clinicians. No differences were observed in secure messaging use based on physician specialty, but significant differences were observed by practice size (OR 0.46, 95% CI 0.35-0.60 in solo practices vs nonsolo practices) and practice ownership (P<.001 for the different categories).Conclusions: This study is the first to use two large nationally representative surveys to produce longitudinal estimates on the access and use of patient-clinician email communication in the United States. The survey findings complement each other: one provides the patient perspective of their use and the other indicates potential patient access to secure messaging based on the use of the functionality by the physicians providing treatment. This study provides nationally representative data on the characteristics of patients and physicians who have access to and are using secure messaging. This information can be used to target interventions to promote adoption and use of secure messaging. [ABSTRACT FROM AUTHOR]