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Background Anodyspareunia may be an adverse outcome of prostate cancer (PCa) treatment for gay, bisexual, and other men who have sex with men (GBM). Aim The aims of this study were to (1) describe the clinical symptoms of painful receptive anal intercourse (RAI) in GBM following PCa treatment, (2) estimate the prevalence of anodyspareunia, and (3) identify clinical and psychosocial correlates. Methods This was a secondary analysis of baseline and 24-month follow-up data from the Restore-2 randomized clinical trial of 401 GBM treated for PCa. The analytic sample included only those participants who attempted RAI during or since their PCa treatment (N = 195). Outcomes Anodyspareunia was operationalized as moderate to severe pain during RAI for ≥6 months that resulted in mild to severe distress. Additional quality-of-life outcomes included the Expanded Prostate Cancer Index Composite (bowel function and bother subscales), the Brief Symptom Inventory–18, and the Functional Assessment of Cancer Therapy–Prostate. Results Overall 82 (42.1%) participants reported pain during RAI since completing PCa treatment. Of these, 45.1% experienced painful RAI sometimes or frequently, and 63.0% indicated that the pain was persistent. The pain at its worst was moderate to very severe for 79.0%. The experience of pain was at least mildly distressing for 63.5%. Painful RAI worsened for a third (33.4%) of participants after completing PCa treatment. Of the 82 GBM, 15.4% were classified as meeting criteria for anodyspareunia. Antecedents of anodyspareunia included a lifelong history of painful RAI and bowel dysfunction following PCa treatment. Those reporting symptoms of anodyspareunia were more likely to avoid RAI due to pain (adjusted odds ratio, 4.37), which was negatively associated with sexual satisfaction (mean difference, −2.77) and self-esteem (mean difference, −3.33). The model explained 37.2% of the variance in overall quality of life. Clinical Implications Culturally responsive PCa care should include the assessment of anodyspareunia among GBM and explore treatment options. Strengths and Limitations This is the largest study to date focused on anodyspareunia among GBM treated for PCa. Anodyspareunia was assessed with multiple items characterizing the intensity, duration, and distress related to painful RAI. The external validity of the findings is limited by the nonprobability sample. Furthermore, the cause-and-effect relationships between the reported associations cannot be established by the research design. Conclusions Anodyspareunia should be considered a sexual dysfunction in GBM and investigated as an adverse outcome of PCa treatment.

Nonlinear mixed-effects models (NLMEMs) allow researchers to model curvilinear patterns of growth, but there is ambiguity as to what functional form the data follow. Often, researchers fit multiple nonlinear functions to data and use model selection criteria to decide which functional form fits the data "best." Frequently used model selection criteria only account for the number of parameters in a model but overlook the complexity of intrinsically nonlinear functional forms. This can lead to overfitting and hinder the generalizability and reproducibility of results. The primary goal of this study was to evaluate the performance of eight model selection criteria via a Monte Carlo simulation study and assess under what conditions these criteria are sensitive to model overfitting as it relates to functional form complexity. Results highlighted criteria with the potential to capture overfitting for intrinsically nonlinear functional forms for NLMEMs. Information criteria and the stochastic information complexity criterion recovered the true model more often than the average or conditional concordance correlation. Results also suggest that the amount of residual variance and sample size have an impact on model selection for NLMEMs. Implications for future research and recommendations for application are also provided.

To model growth over time, statistical techniques are available in both structural equation modeling (SEM) and random effects modeling frameworks. Liu et al. proposed a transformation and an inverse transformation for the linear–linear piecewise growth model with an unknown random knot, an intrinsically nonlinear function, in the SEM framework. This method allowed for the incorporation of time-invariant covariates. While the proposed method made novel contributions in this area of research, the use of transformations introduces some challenges to model estimation and dissemination. This commentary aims to illustrate the significant contributions of the authors’ proposed method in the SEM framework, along with presenting the challenges involved in implementing this method and opportunities available in an alternative framework.

Background/aims: Sexual minorities are small and under-researched populations that are at disproportionate risk for cancer and poor cancer outcomes. Described as a “hidden population,” the principal research challenge has been to develop effective methods to identify and recruit such cancer patients into cancer studies. Online recruitment strategies, as well as targeted clinic recruitment using patient-entered sexual orientation and gender identity data from electronic medical records have potential to transform recruitment, but studies testing the effects of how to recruit using these have not been published. Methods: In 2019, we conducted a naturalistic, three-arm, stratified prospective study to compare three recruitment strategies: (a) clinic based recruitment of prostate cancer patients from gay health and urology clinics; (b) directly from the gay community; and (c) online recruitment (through cancer support, sex/dating, and social sites). For each strategy, we estimated time, workload, and direct costs involved. To study how recruitment strategy may affect sampling, we tested for retention rates, demographic and outcome differences across sites. Using these methods, we successfully recruited 401 gay and bisexual prostate cancer patients into a randomized, controlled, 24-month trial testing an online sexual and urinary rehabilitation curriculum tailored for this population. Results: There were seven key results. First, it is possible to recruit substantial numbers of sexual minority men into prostate cancer studies provided online recruitment methods are used. Second, we observed big differences in dropout during study onboarding by recruitment source. Third, within online recruitment, the online sex/dating application (app) was the most successful and efficient, followed by the cancer support site, and then the social networking site. Fourth, while clinics were the cheapest source of recruitment, they were time intensive and low in yield. Fifth, the cancer support site and sex/dating app recruits differed by several characteristics, with the former being more rehabilitation-focused while the latter were younger and more sexually active. Sixth, we found almost no differences in outcomes across the three online recruitment sites. Seventh, because retention in online studies has been a concern, we confirm very low attrition at 3- and 6 months into the trial. Conclusion: For sexual minority cancer research, more research on how to use sexual orientation and gender identity electronic medical record data for clinic-based recruitment is needed. For other small or hard-to-reach populations, researchers should compare and publish online versus offline recruitment strategies.

Prostate cancer treatments disrupt receptive anal intercourse (RAI) for gay and bisexual men (GBM). Sexual dysfunction following prostate cancer treatment may include severe pain in the anorectum during RAI (i.e., anodyspareunia). The purpose of this study was to explore the impact of prostate cancer and its treatments on RAI among GBM. Data were from a cross-sectional online survey of 100 GBM prostate cancer survivors who reported pleasurable RAI prior to treatment. Approximately 47% of the sample reported recent RAI, which was more common among GBM in long-term relationships. RAI was also associated with engagement in other sexual behaviors (e.g., oral and insertive anal sex). Anodyspareunia was reported by 23% of the men who had attempted recent RAI. Anodyspareunia was negatively associated with mental health, performing oral sex on a partner, and bowel function. The overwhelming majority received no information from their healthcare providers about loss of RAI function prior to prostate cancer treatment. Culturally responsive cancer survivorship care may need to address the loss of RAI function for GBM prostate cancer survivors.

In regression, some or all of the predictors may be measured in common units: e.g. X1 = carbohydrate calories, X2 = protein calories, X3 = fat calories. Such predictors can occur in disciplines as ...

Introduction This is the first known study to investigate what gay and bisexual men are offered and what they try as rehabilitation to address the sexual and urinary effects of prostate cancer treatment. Methods A total of 193 gay and bisexual men with prostate cancer were recruited from a large male cancer survivor support and advocacy website. Online participants completed survey questions asking what rehabilitation treatments were offered, what they tried and what their satisfaction was with outcomes. Results Most participants (68.4%) reported being out as gay/bisexual to at least 1 cancer specialist. Only 8.8% reported that a sexual history was taken. The most common problems reported were loss of ejaculate (93.8%), erectile difficulties (89.6%), change in sense of orgasm (87.0%), loss of sexual confidence (76.7%), changes to the penis (65.8%), increased pain in receptive anal sex (64.8%), urinary incontinence not related to sex (64.2%) and urinary incontinence during sex (49.2%). Of these factors only loss of ejaculate, erectile difficulties and nonsexual urinary problems were commonly discussed by clinicians during prostate cancer treatment. Satisfaction with specific rehabilitation options varied widely. Conclusions Treatment for prostate cancer lacks adequate history taking and consensus around rehabilitation practices, resulting in idiosyncratic approaches to rehabilitation. Four clinical questions may improve outcomes. Prostate cancer specialists need education to become culturally competent in addressing the unique needs of gay and bisexual patients.

INTRODUCTION: While erectile dysfunction and urinary incontinence are well-documented effects of prostate cancer treatment, the impact of sexual concerns on the lives of gay and bisexual men treated for prostate cancer has not been well researched. Specifically there are no known studies investigating what gay and bisexual men want in sexual recovery treatment. METHODS: To conduct this needs assessment, we recruited 193 gay and bisexual men with prostate cancer from the largest online cancer support group in North America. As part of a wider study of sexual functioning, participants completed a 32-item needs assessment and a qualitative question assessing their needs. RESULTS: There was high interest in a sexual recovery program across race/ethnicity and by treatment type. The most preferred formats were a self-directed online curriculum and participation in a support group specific to gay and bisexual men with prostate cancer. A variety of formats, language and contents were deemed appropriate and important by most participants. Frank explicit language and content were preferred. Three themes emerged in the qualitative analysis. CONCLUSIONS: Gay and bisexual men treated for prostate cancer want a recovery curriculum that explicitly addresses the sexual challenges they face before, during and after treatment. While differences were identified across race and treatment type, they were relatively few and minor in magnitude, suggesting that a single online curriculum could advance rehabilitation for this population.

BACKGROUND/AIMS: Sexual minorities are small and under-researched populations that are at disproportionate risk for cancer and poor cancer outcomes. Described as a “hidden population,” the principal research challenge has been to develop effective methods to identify and recruit such cancer patients into cancer studies. Online recruitment strategies, as well as targeted clinic recruitment using patient-entered sexual orientation and gender identity (SOGI) data from electronic medical records have potential to transform recruitment, but studies testing the effects of how to recruit using these have not been published. METHODS: In 2019, we conducted a naturalistic, 3-arm, stratified prospective study to compare three recruitment strategies: (a) clinic based recruitment of prostate cancer patients from gay health and urology clinics; (b) directly from the gay community; and, (c) online recruitment (through cancer support, sex/dating, and social sites). For each strategy, we estimated time, workload, and direct costs involved. To study how recruitment strategy may affect sampling, we tested for retention rates, demographic and outcome differences across sites. Using these methods, we successfully recruited 401 gay and bisexual prostate cancer patients into a randomized, controlled, 24-month trial testing an online sexual and urinary rehabilitation curriculum tailored for this population. RESULTS: There were seven key results. First, it is possible to recruit substantial numbers of sexual minority men into prostate cancer studies provided online recruitment methods are used. Second, we observed big differences in drop out during study onboarding by recruitment source. Third, within online recruitment, the online sex/dating application (app) was the most successful and efficient, followed by the cancer support site, and then the social networking site. Fourth, while clinics were the cheapest source of recruitment, they were time intensive and low in yield. Fifth, the cancer support site and sex/dating app recruits differed by several characteristics, with the former being more rehabilitation-focused while the latter were younger and more sexually active. Sixth, we found almost no differences in outcomes across the three online recruitment sites. Seventh, because retention in online studies has been a concern, we confirm very low attrition at 3- and 6-months into the trial. CONCLUSION: For sexual minority cancer research, more research on how to use SOGI electronic medical record data for clinic-based recruitment is needed. For other small or hard-to-reach populations, researchers should compare and publish online versus offline recruitment strategies.

Background Existing measures of sexual functioning in prostate cancer survivors focus primarily on erectile function and do not adequately measure the experiences of sexual minority men. Aim To develop and psychometrically evaluate a new scale to measure sexual functioning among sexual minority men with prostate cancer. Methods Sexual minority prostate cancer patients (n = 401) completed an online battery of urinary and sexual functioning tests in 2019, including a new 37-item instrument about their sexual functioning post-treatment for prostate cancer. Outcomes We used confirmatory factor analysis to determine the construct validity of a new scale including five subscales: a four-factor model for all participants (n = 401) evaluated Sexual Satisfaction, Sexual Confidence, Frequency of Sexual Problems, and Urinary Incontinence in Sex. A single-factor model completed only by participants who had attempted or desired receptive anal sex (n = 255) was evaluated in the fifth subscale: Problematic Receptive Anal Sex. To evaluate criterion validity, we calculated the intercorrelations between each Sexual Minorities and Prostate Cancer Scale (SMACS) subscale and four related scales: the Expanded Prostate Cancer Index Composite-50 (EPIC), the Functional Assessment of Cancer Therapy-Prostate, the Brief Symptom Inventory-18, and the International Consultation on incontinence questionnaire. Cronbach’s alphas were calculated to measure internal consistency (ie, reliability). Results Cronbach’s alpha values ranged from 0.64 to 0.89. Loadings (0.479–0.926) and model fit indices were strong (Root Mean Square Error of Approximation: 0.085, Standardized root mean squared residual: 0.063, comparative fit index: 0.927, Tucker-Lewis Index: 0.907). For criterion validity, Sexual Satisfaction, Sexual Confidence, and Frequency of Sexual Problems were moderately correlated with EPIC function and bother scores (r = 0.50–0.72) and Urinary incontinence in sex correlated moderately with EPIC Urinary Function and International Consultation on incontinence questionnaire scores (0.45–0.56). Clinical Implications The SMACS can be used by clinicians and researchers to comprehensively measure sexual functioning in sexual minority men, in conjunction with existing scales. Strengths and limitations This new scale is validated in a large, geographically diverse cohort of sexual minority cancer survivors and fills an important gap in existing measures of sexual functioning. Limitations include a lack of a validation sample. Conclusion The SMACS is a valid and reliable new scale that measures sexual minority men’s experience of urinary incontinence in sex, problematic receptive anal sex, and sexual distress.

IntroductionProstate cancer treatment has established effects on the health-related quality of life (HRQOL) of patients. While racial/ethnic differences in HRQOL have been explored in heterosexual patients, this is the first study to examine racial/ethnic differences in a cohort of sexual minority prostate cancer survivors.MethodsWe used data from the Restore-1 study, an online cross-sectional survey of sexual and gender minority (SGM) prostate cancer survivors in North America, to explore the association between race/ethnicity and HRQOL. General mental and physical HRQOL was assessed using the Short-Form Health Survey version 2 (SF-12). The frequency and distress of prostate cancer specific symptoms was assessed using the Expanded Prostate Cancer Composite (EPIC) scale. Multivariable linear regression was used to estimate mean differences in HRQOL between sexual minority men of color and their white, non-Hispanic counterparts after adjustment for pertinent demographic and medical characteristics.ResultsAmong 190 participants, 23 (12%) self-identified as non-white and/or Hispanic. In unadjusted analysis, sexual minority men of color compared to their white counterparts reported worse HRQOL scores in the EPIC hormonal summary (73.8 vs. 81.8) and hormonal function (70.9 vs 80.5) domains. Clinically important differences between men of color and their white counterparts were seen in the EPIC bowel function (mean difference (MD): -4.5, 95% CI: -9.9, 0.8), hormonal summary (MD: -8.0, 95% CI: -15.6, -0.4), hormonal function (MD: -9.6, 95% CI: -17.6, -1.6), and hormonal bother (MD: -6.7, 95% CI: -14.4, 1.1) domains. After adjustment for covariates, clinically important differences persisted between men of color and white, non-Hispanic men on the hormonal summary (74.4 vs. 81.7), hormonal function (71.3 vs. 80.3), and hormonal bother (77.0 vs. 82.7) domains.ConclusionsThis exploratory study provides the first evidence that sexual minority men of color may have worse HRQOL outcomes compared to white, non-Hispanic sexual minority men following prostate cancer treatment.

Equitable cancer survivorship care for gay and bisexual male (GBM) prostate cancer survivors should be responsive to their sexual health needs. Rates of sexually transmitted infections (STIs) are higher among GBM compared to heterosexual men across the lifespan. In addition, evidence suggests that GBM will use a variety of strategies to cope with sexual dysfunction that may increase risk for STIs. The purpose of this study was to determine the prevalence of STIs following prostate cancer treatment among GBM and identify risk factors.In 2019, 401 GBM previously treated for prostate cancer were recruited into the Restore-2 Study. They completed a baseline online questionnaire with items assessing STIs diagnosed since being treated for prostate cancer. Any STI diagnoses was regressed on demographic, clinical, and relationship related variables using binary logistic regression.Forty-five participants (11.4%) were diagnosed with an STI during or following their prostate cancer treatment. The mostly commonly diagnosed STI was syphilis (4.3%), followed by gonorrhoea (2.8%), and chlamydia (2.5%). Four participants were infected with HIV following their prostate cancer treatment. Independent risk factors for STI diagnosis included time since prostate cancer diagnosis (aOR = 1.18; 95% CI: 1.10-1.26), nonmonogamous sexual relationship (aOR = 11.23; 95% CI: 2.11-59.73), better sexual function (aOR = 1.02; 95% CI: 1.01-1.04), penile injection treatment (aOR = 3.28; 95% CI: 1.48-7.29), and multiple sex partners (aOR = 5.57; 95% CI: 1.64-18.96).GBM prostate cancer survivors are at risk for STIs. Culturally responsive STI prevention should be incorporated into cancer survivorship plans, particularly as men are treated for and regain sexual function over time.

Introduction Studies have demonstrated worse health related quality of life (HRQOL) outcomes in gay and bisexual men (GBM) following prostate cancer treatment compared to heterosexual men potentially due to differences in comorbidity burden. Aim To establish the prevalence of comorbidities and their association with HRQOL metrics in GBM following prostate cancer treatment. Methods We evaluated HRQOL and prevalence of comorbidities in 193 GBM from the United States and Canada in a cross-sectional, online survey: the Masked for Review. HRQOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) and the 12-Item Short Form Health Survey (SF-12). Main Outcome Measures Our outcomes included comorbidity prevalence, mean differences for HRQOL scores by comorbidity status, and mean differences for HRQOL by comorbidity count. Results GBM were found to have a higher prevalence of blood vessel disease and mental health disorders but lower prevalence of obesity and type 2 diabetes when compared to published data in general prostate cancer populations. Statistically significant reductions in HRQOL metrics were associated with mental health diagnoses, diabetes, and obesity. Increased number of comorbidities was also associated with reductions in HRQOL metrics in nearly all categories. Conclusion These results suggest that the worse QOL outcomes in GBM following prostate cancer treatment may be due to differences in comorbidity burden. This study is the first to evaluate the relationship between comorbidities and HRQOL outcomes in GBM. Limitations of this study include a small sample size and cross-sectional study design. If confirmed in larger, longitudinal, clinically confirmed studies, these findings indicate a need to intervene on and consider comorbidities in GBM diagnosed with prostate cancer.

The NIH has identified sexual and gender minority persons as a health disparity population but little is known about cancer outcomes in these populations. The purpose of this study was to identify disparities in sexual minority prostate cancer patient-reported outcomes, to examine within group differences, and to test for alternative explanations for identified differences.In 2019, we recruited 401 gay and bisexual prostate cancer patients into theCompared to the normative (heterosexual) EPIC sample, participants had significantly worse urinary, bowel and hormonal function, better sexual function, and no difference on bother scores. They also had worse depression and overall mental health, and worse physical, social/family, functional, prostate specific and overall well-being quality of life outcomes. Across measures, no differences by age, gay versus bisexual orientation, race/ethnicity, and relationship status were observed. Those who had hormonal treatment had worse sexual and hormonal function than those who had radiation or surgery only. Those with a longer time since treatment had better urinary function. Differences remained when participants were matched to normative samples on cancer stage and time since treatment.This, the largest study of sexual minority prostate cancer patients to date, confirms health disparities in prostate cancer quality of life outcomes. Findings appear reliable and robust. To improve the clinical care of prostate cancer, it will be important to address the health disparities experienced by sexual minority prostate cancer patients.

a)Prostate cancer in sexual and gender minorities is an emerging medical and public health concern. The purpose of this review is to summarize the state of the science on prostate cancer in gay, bisexual, and other men who have sex with men (GBM) and transgender women (TGW). We undertook a literature review of all publications on this topic through February 2017. With 88 unique papers (83) on prostate cancer in GBM and 5 case reports of prostate cancer in TGW), a small but robust literature has emerged.b)The first half of this review critiques the literature to date, identifying gaps in approaches to study. The second half summarizes the key findings in eleven areas. In light of this admittedly limited literature, GBM appear to be screened for prostate cancer less than other men, but they are diagnosed with prostate cancer at about the same rate.c)Compared to other men, GBM have poorer urinary, bowel, and overall quality-of-life outcomes but better sexual outcomes after treatment; all these findings need more research. Prostate cancer in TGW remains rare and under researched, as the literature is limited to single-case clinical reports.

Understanding students’ readiness for precalculus and calculus at the community college level is critical not only because of the key role community colleges play in higher education but also because calculus remains a gateway course for students in advancing to higher level mathematics. The Algebra and Precalculus Concept Readiness Assessment for Community Colleges (APCR-CC) was designed to investigate community college students’ quantitative reasoning abilities and conceptual understanding in algebra. The present study investigates the psychometric properties of the APCR-CC instrument using item response theory based on a sample of intermediate and college algebra students from six community colleges collected in a pretest ( N = 1,131) and posttest ( N = 772) setting. We examine unidimensionality, item fit, local item independence, measurement invariance, and sensitivity to instruction. Our findings suggest that the APCR-CC instrument is sufficiently characterized by one underlying construct, local dependence does not seem to be an issue, and 80% of the items in the APCR-CC instrument are sensitive to instruction.

Prostate cancer is the second most common cancer in gay, bisexual, and other men who have sex with men (GBM). Few studies have assessed the effects of treatment on GBM’s sexual behavior. For an online survey, 193 gay and bisexual men with prostate cancer were recruited from the North American’s largest online cancer support group. Sexual functioning was measured using the Expanded Prostate Cancer Index Composite (EPIC) and a tailored Gay Sexual Functioning Inventory (GSFI). GBM have worse EPIC urinary and hormonal function and worse hormonal bother, but better sexual function and bother scores than published norms. In the GSFI, two-thirds of participants described their sexual functioning, post-treatment, as fair to poor. Only 22% reported erections sufficient for insertive anal sex. For receptive anal sex, one-third met criteria for anodyspareunia. Over half reported urination problems during sex or at orgasm. Erectile difficulties were common, severe, and a reason cited for not using condoms. Three men HIV seroconverted post-prostate cancer treatment. Differences in function and bother scores were observed by type of treatment, age, race/ethnicity, sexual orientation, but not relationship status. Sexual functioning significantly predicted long-term mental and physical health. GBM scored significantly worse on mental health and better on physical health than published norms. Sexual recovery after prostate cancer treatment is problematic for most GBM. Research to develop more effective sexual recovery, tailored to the needs of GBM treated for prostate cancer, is needed. Six implications for clinicians treating GBM with prostate cancer are identified.

Response to Intervention (RtI) is a commonly used framework to identify students in need of additional or specialized instruction. Special education eligibility decisions within RtI rely on the assumption that there are subpopulations of students: those who demonstrate appropriate growth and those who do not demonstrate appropriate growth, when provided specialized instruction. The purpose of the present study was to illustrate the use of random-effects mixture models (RMMs) to estimate the likely number of (unobserved) subpopulations within one curriculum-based measurement of oral reading (CBM-R) progress monitoring dataset. The dataset comprised second grade students' CBM-R data collected weekly over 20 weeks. RMMs were fit with several numbers of classes, and a two-class model best fit the data. Results suggest that RMMs are useful to understand subpopulations of students who need specialized instruction. Results also provide empirical support to some extent for the use of a dual-discrepancy model of learning disability identification within RtI.

OBJECTIVE: In this study, we investigated if outness is more a situational or a consistent characteristic in gay, bisexual, and other men who have sex with men (GBM) treated for prostate cancer and how the disclosure of sexual orientation impacts provider discussions of sexual side effects. METHODS: Data came from Restore, an online cross-sectional survey of 193 GBM prostate cancer survivors living in North America and were analyzed using various statistical models. RESULTS: Disclosure of sexual orientation and of living with prostate cancer were not significantly correlated. Participants who were out regarding sexual orientation were more likely to report that their surgeons and urologists discussed the sexual side effects of treatment. CONCLUSION: Outness appears to be a situational phenomenon. GBM prostate cancer survivors who were out regarding sexual orientation received more discussion surrounding sexual side effects of prostate cancer treatment from their providers. PRACTICE IMPLICATIONS: It is important for healthcare providers to inquire about patient’s sexual orientation to provide holistic care to these patients to address health disparities within this group.

Objectives a) To evaluate the item and scale properties of the Oral Health Literacy Adults Questionnaire (OHL-AQ) in an adult general population. b) To determine precision or accuracy of the respondents' estimated scores along the Oral Health Literacy (OHL) spectrum using item response theory (IRT) modeling. Methods Survey data were collected from a convenience sample of 405 adult attendees of the 2014 Minnesota State Fair. We used the two-parameter logistic (2PL) model for the item response theory (IRT) analyses of OHL-AQ data and calibrated items to estimate model-based item difficulty and discrimination parameters. Item and scale properties were also assessed by plotting and interpreting item characteristic curves (ICCs), test characteristic curve (TCC), and test information function (TIF). Results Based on interpretation of model coefficients, statistical testing, and model fit criteria, we deemed the 2PL model superior and selected this model to examine item and scale properties. Scale reliability was shown to be good through the test information function (TIF). TIF from our analysis showed that higher levels of OHL were measured less precisely than lower levels of OHL. Conclusion We demonstrated OHL-AQ as a whole has promising psychometric properties. However, for equiprecise measurement across the scale range, the scale needs more items for measuring higher levels of OHL.

Longitudinal processes rarely occur in isolation; often the growth curves of 2 or more variables are interdependent. Moreover, growth curves rarely exhibit a constant pattern of change. Many educational and psychological phenomena are comprised of different developmental phases (segments). Bivariate piecewise linear mixed-effects models (BPLMEM) are a useful and flexible statistical framework that allow simultaneous modeling of 2 processes that portray segmented change and investigates their associations over time. The purpose of the present study was to develop a BPLMEM using a Bayesian inference approach allowing the estimation of the association between the error variances and providing a more robust modeling choice for the joint random-effects of the 2 processes. This study aims to improve upon the limitations of the prior literature on bivariate piecewise mixed-effects models, such as only allowing the modeling of uncorrelated residual errors across the 2 longitudinal processes and restricting modeling choices for the random effects. The performance of the BPLMEM was investigated via a Monte Carlo simulation study. Furthermore, the utility of BPLMEM was illustrated by using a national educational dataset, Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), where we examined the joint development of mathematics and reading achievement scores and the association between their trajectories over 7 measurement occasions. The findings obtained shed new light on the relationship between these 2 prominent educational domains over time. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In 2016, the NIH designated sexual and gender minorities (SGM) a health disparity population. The next year, the American Society of Clinical Oncology highlighted the need to improve the suboptimal cancer and survivorship care received by SGM populations. There are currently no evidence-based training programs in culturally competent care of prostate cancer patients who are gay, bisexual and/or transgender. In this selective review, we summarize findings from the largest quantitative studies focused on sexual minority prostate cancer survivors and from 65 interviews with NIH staff, clinicians, and cancer clinics in 11 US cities. The report is divided into three parts and uses a question and answer format to address 21 questions relevant to clinicians providing care to SGM prostate cancer patients. First, we identify population-specific issues that are culturally relevant in the care of SGM patients with prostate cancer. While a body of research has emerged on sexual minority prostate cancer patients, the literature on gender minorities is limited to single case reports and inadequate to inform practice. This review covers definitions, population size, cultural and historical context, sexual behavior, population invisibility, sexual orientation and gender identity (SOGI) in the electronic medical record, disparities and evidence of discrimination in treatment provision. The second part focuses on promoting evidence-informed, patient-centered care. This includes current practices in assessing sexual orientation, management of disclosure of sexual orientation, how to address common problems sexual minority men experience post-treatment, common questions sexual minority patients have, management of urinary incontinence, HIV and STI risk during and post-treatment, and sub-groups of sexual minority patients with worse outcomes. It then identifies how male partners differ in prostate cancer support, current research on rehabilitation for sexual minority men, issues in advanced prostate cancer, and things to avoid with minority patients. Finally, we examine the cultural divide between provider and patient, advocating for cultural humility when working with minority patients. Training programs and continuing education can help providers both to become more aware of their own cultural assumptions, informed about health disparities, and able to provide quality care, and to make clinics more welcoming to SGM patients.

Repeated measures data are widely used in social and behavioral sciences, e.g., to investigate the trajectory of an underlying phenomenon over time. A variety of different mixed-effects models, a type of statistical modeling approach for repeated measures data, have been proposed and they differ mainly in two aspects: (1) the distributional assumption of the dependent variable and (2) the linearity of the model. Distinct combinations of these characteristics encompass a variety of modeling techniques. Although these models have been independently discussed in the literature, the most flexible framework -- the generalized nonlinear mixed-effects model (GNLMEM) -- can be used as a modeling umbrella to encompass these modeling options for repeated measures data. Therefore, the aim of this paper is to explicate on the different mixed-effects modeling techniques guided by the distributional assumption and model linearity choices using the GNLMEM as a general framework. Additionally, empirical examples are used to illustrate the versatility of this framework.

In this software review, we provide a brief overview of four different functions to fit a piecewise random-effects model with unknown changepoints (knots). Specifically, the four functions are: Fit...

Computer simulation studies represent an important tool for investigating processes difficult or impossible to study using mathematical theory or real data. Hoaglin and Andrews recommended these studies be treated as statistical sampling experiments subject to established principles of design and data analysis, but the survey of Hauck and Anderson suggested these recommendations had, at that point in time, generally been ignored. We update the survey results of Hauck and Anderson using a sample of studies applying simulation methods in statistical research to assess the extent to which the recommendations of Hoaglin and Andrews and others for conducting simulation studies have been adopted. The important role of statistical applications of computer simulation studies in enhancing the reproducibility of scientific findings is also discussed. The results speak to the state of the art and the extent to which these studies are realizing their potential to inform statistical practice and a program of s...

We assessed the structure and content of a new scale, the SHEPS, to assess change in sexual health confidence, knowledge and attitudes in nursing and midwifery students following an intervention (a 2-day standardized workshop on sexual health). Students were 78 Tanzanian nursing and midwifery students attending a University of Health Sciences, who were assessed immediately before and after the workshop on matched pre- and post-workshop questionnaires. Data confirmed significant changed pre- and post-test on knowledge and confidence on topics taught in the workshop, with the effect also extending to some topics not or minimally covered, suggesting that there was a general increase in confidence and a perception of increased knowledge following the workshop. There was power to detect differences even with a moderate sized matched sample. Correlations between knowledge and confidence on the same content items were between 0.52 and 0.63, suggesting that respondents could clearly distinguish between knowledge and confidence. There were no significant differences pre- and post-test on several controversial cultural and religious attitudes including on abortion and non-vaginal penetrative sex. Alpha coefficients were 0.93 for pre-test and 0.90 for post-test. This field test demonstrates the preliminary appropriateness of the SHEPS as a tool for evaluating sexual health interventions in health care workers.

Piecewise mixed-effects models are useful for analyzing longitudinal educational and psychological data sets to model segmented change over time. These models offer an attractive alternative to commonly used quadratic and higher-order polynomial models because the coefficients obtained from fitting the model have meaningful substantive interpretation. The current study thus focuses on the estimation of piecewise mixed-effects model with unknown random change points using maximum likelihood (ML) as described in Du Toit and Cudeck (2009). Previous simulation work (Wang & McArdle, 2008) showed that Bayesian estimation produced reliable parameter estimates for the piecewise model in comparison to frequentist procedures (i.e., first-order Taylor expansion and the adaptive Gaussian quadrature) across all simulation conditions. In the current article a small Monte Carlo simulation study was conducted to assess the performance of the ML approach, a frequentist procedure, and the Bayesian approach for fitting linear–linear piecewise mixed-effects model. The obtained findings show that ML estimation approach produces reliable and accurate estimates under the conditions of small residual variance of the observed variables, and that the size of the residual variance had the most impact on the quality of model parameter estimates. Second, neither ML nor Bayesian estimation procedures performed well under all manipulated conditions with respect to the accuracy and precision of the estimated model parameters.

Piecewise growth mixture models (PGMM) are a flexible and useful class of methods for analyzing segmented trends in individual growth trajectory over time, where the individuals come from a mixture of two or more latent classes. These models allow each segment of the overall developmental process within each class to have a different functional form; examples include two linear phases of growth, or a quadratic phase followed by a linear phase. The changepoint (knot) is the time of transition from one developmental phase (segment) to another. Inferring the location of the changepoint(s) is often of practical interest, along with inference for other model parameters. A random changepoint allows for individual differences in the transition time within each class. The primary objectives of our study are: (1) to develop a PGMM using a Bayesian inference approach that allows the estimation of multiple random changepoints within each class; (2) to develop a procedure to empirically detect the number of random changepoints within each class; and (3) to empirically investigate the bias and precision of the estimation of the model parameters, including the random changepoints, via a simulation study. We have developed the user-friendly package BayesianPGMM for R to facilitate the adoption of this methodology in practice, which is available at https://github.com/lockEF/BayesianPGMM . We describe an application to mouse-tracking data for a visual recognition task., 32 pages, 10 tables, 6 figures

OBJECTIVE Accurate estimation of developmental trajectories can inform instruction and intervention. We compared the fit of linear, quadratic, and piecewise mixed-effects models of reading development among students with learning disabilities relative to their typically developing peers. METHOD We drew an analytic sample of 1,990 students from the nationally representative Early Childhood Longitudinal Study-Kindergarten Cohort of 1998, using reading achievement scores from kindergarten through eighth grade to estimate three models of students' reading growth. RESULTS The piecewise mixed-effects models provided the best functional form of the students' reading trajectories as indicated by model fit indices. Results showed slightly different trajectories between students with learning disabilities and without disabilities, with varying but divergent rates of growth throughout elementary grades, as well as an increasing gap over time. CONCLUSIONS These results highlight the need for additional research on appropriate methods for modeling reading trajectories and the implications for students' response to instruction. (PsycINFO Database Record