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\"By presenting chapter-specific roadmaps, this book offers a behind-the-scenes chronology of the response to COVID-19 and provides a rubric for future pandemic response. Targeted at lay and scientific audiences, reflections and lessons learned grant the reader an opportunity to leverage this knowledge and improve the outcomes of future pandemics\"-- Provided by publisher.

The primary objective of the study was to determine the sensitivity, specificity and accuracy, as well as positive predictive validity and negative predictive validity of the Diagnostic Assessment Research Tool (DART) Screener, a self-report screening questionnaire for identifying possible DSM-5 disorders. The design of the screening tool allows it to be used as a standalone measure or in conjunction with the DART Interview, a semistructured diagnostic interview for assessing DSM-5 disorders. Participants included a sample of treatment-seeking individuals (N = 562) who presented at an outpatient anxiety disorder clinic for an intake assessment. The DART Screener was administered prior to the DART Interview. Overall, the DART Screener achieved high sensitivity and low to moderate specificity across the separate items. In addition, the DART Screener demonstrated high negative predictive validity and low to moderate positive predictive validity. The high sensitivity and low false negative rate of the DART Screener suggest that it is a helpful tool that can be used effectively as a stand-alone screening measure or to identify relevant DSM-5 disorders to assess via semistructured or clinical diagnostic interviews.

\"This comprehensive volume shows how to use both diagnostic and behavioral assessment knowledgeably and effectively throughout the process of treatment. The two traditions have developed along separate paths--each with its own conceptual underpinnings and psychometric strengths. Used together, they can produce a complete picture of a child's or adolescent's needs and strengths. The expert editors and contributors describe the full range of evidence-based assessment tools and illustrate their application with two intake-to-termination case examples. Reproducible tools include a behavioral recording form and a multipage case conceptualization worksheet that can be downloaded and printed in a convenient 8 1/2\" x 11\" size\"-- Provided by publisher.

We studied, using a data-driven approach, how different combinations of diagnostic tests contribute to the differential diagnosis of dementia. In this multicenter study, we included 356 patients with Alzheimer's disease, 87 frontotemporal dementia, 61 dementia with Lewy bodies, 38 vascular dementia, and 302 controls. We used a classifier to assess accuracy for individual performance and combinations of cognitive tests, cerebrospinal fluid biomarkers, and automated magnetic resonance imaging features for pairwise differentiation between dementia types. Cognitive tests had good performance in separating any type of dementia from controls. Cerebrospinal fluid optimally contributed to identifying Alzheimer's disease, whereas magnetic resonance imaging features aided in separating vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. Combining diagnostic tests increased the accuracy, with balanced accuracies ranging from 78% to 97%. Different diagnostic tests have their distinct roles in differential diagnostics of dementias. Our results indicate that combining different diagnostic tests may increase the accuracy further. •Performance of diagnostic tests in pairwise diagnostics differs by diagnostic groups.•Accuracy seems to increase when combining diagnostic tests.•Diagnostic groups might be better separated by different combinations of biomarkers.

Background Educational experts commonly agree that tailor-made guidance is the most efficient way to foster the learning and developmental process of learners. Diagnostic assessments using cognitive diagnostic models (CDMs) have the potential to provide individual profiles of learners’ strengths and weaknesses on a fine-grained level that can enable educators to assess the current position of learners. However, to obtain this necessary information a strong connection has to be made between cognition (the intended competence), observation (the observed learners’ responses while solving the tasks), and interpretation (the inferences made based on the observed responses of learners’ underlying competencies). To secure this stringent evidence-based reasoning, a principled framework for designing a technology-based diagnostic assessment is required—such as the evidence-centred game design (ECgD). Aim With regard to a diagnostic assessment, three aspects are of particular importance according to the ECgD approach: (I) the selection of a measurable set of competence facets (so-called skills) and their grain-size, (II) the constructed pool of skill-based tasks, and (III) the clear and valid specified task to skill assignments expressed within the so-called Q matrix. The Q matrix represents the a priori assumption for running the statistical CDM-procedure for identifying learners’ individual competence/skill profiles. These three prerequisites are not simply set by researchers’ definition nor by experts’ common sense. Rather, they require their own separate empirical studies. Hence, the focus of this paper is to evaluate the appropriateness and coherence of these three aspects (I: skill, II: tasks, and III: Q matrix). This study is a spin-off project based on the results of the governmental ASCOT research initiative on visualizing apprentices’ work-related competencies for a large-scale assessment—in particular, the intrapreneurship competence of industrial clerks. With the development of a CDM I go beyond the IRT-scaling offering the prerequisites for identifying individuals’ skill profiles as a point of departure for an informative individual feedback and guidance to enhance students’ learning processes. Methods Therefore, I shall use a triangulated approach to generate three empirically based Q matrix models from different sources (experts and target-group respondents), inquiry methods (expert ratings and think-aloud studies), and methods of analyses (frequency counts and a solver–non-solver comparison). Consequently, the four single Q matrix models (researchers’ Q matrix generated within the task construction process and the three empirically based Q matrix models) were additionally matched by different degrees of overlap for balancing the strengths and weaknesses of each source and method. By matching the patterns of the four single Q matrix models, the appropriateness of the set of intrapreneurship skills (I) and the pool of intrapreneurship tasks (II) were investigated. To identify and validate a reasonable proxy for the task to skill assignments for selecting the best fitting Q matrix model (III), the single as well as the matched Q matrix models where empirically contrasted against N = 919 apprentices’ responses won and scaled up within the ASCOT-project using psychometric procedures of cognitive diagnostic within the DINA (Haertel in J Educ Meas 26:301–323, 1989 ) model. Results The pattern matching resulted in a set of seven skills and 24 tasks. The appropriateness of these results was emphasized by model fit values of the different Q matrix models. They show acceptable up to good sizes (SRMSR between .053 and .055). The best fitting model is a matched Q matrix of which the match is not that strict or smooth with regard to the degree of overlap. Conclusions The study provides a principled design for a technology-based diagnostic assessment. The systematic and extensive validation process offers empirical evidence for (I) the relevance and importance of the specified intrapreneurship skills, (II) tasks prompting the intended skills, and (III) the sophisticated proxy of real cognitive processes (in terms of the Q matrix), but also give hints for revision. This—within a diagnostic assessment—preliminary work aims at identifying the best-fitting Q matrix to enable the next step of depicting learners’ individual strengths and weaknesses on a sound basis.

Abstract Introduction We conducted a meta-analysis of the conflicting epidemiologic evidence on the association between midlife body mass index (BMI) and dementia. Methods We searched standard databases to identify prospective, population-based studies of dementia risk by midlife underweight, overweight, and obesity. We performed random-effects meta-analyses and meta-regressions of adjusted relative risk (RR) estimates and formally explored between-study heterogeneity. Results We included 19 studies on 589,649 participants (2040 incident dementia cases) followed up for up to 42 years. Midlife (age 35 to 65 years) obesity (BMI ≥ 30) (RR, 1.33; 95% confidence interval [CI], 1.08–1.63), but not overweight (25 < BMI < 30) (RR, 1.07; 95% CI, 0.96–1.20), was associated with dementia in late life. The association with midlife underweight (RR, 1.39; 95% CI, 1.13–1.70) was potentially driven by residual confounding ( P from meta-regression = .004), selection ( P  = .046), and information bias ( P  = .007). Discussion Obesity in midlife increases the risk of dementia. The association between underweight and dementia remains controversial.

Incidence estimates of mild cognitive impairment (MCI) range widely. We obtained contemporary age-specific MCI incidence rates and examined sources of heterogeneity. We conducted a systematic review of population-based studies from the Americas, Europe, and Australia using restrictive inclusion criteria to limit heterogeneity. Incidence was examined using 5-year age categories for MCI and amnestic/nonamnestic subtypes. Data were synthesized using quantitative and qualitative descriptive analyses and quantitative meta-analyses. Meta-analysis estimates (95% CI) of MCI incidence per 1000 person-years were 22.5 (5.1–51.4) for ages 75–79y, 40.9 (7.7–97.5) for ages 80–84y, and 60.1 (6.7–159.0) for ages 85+y. Despite restrictive inclusion criteria, considerable heterogeneity (measured by I2) remained. Meta-analysis findings and simple descriptive statistics were consistent and supported by qualitative review. Heterogeneity in MCI incidence estimates persisted across age-specific estimates from population samples, likely reflecting differences in populations and methods. Incidence rate ranges are important to consider with summary point estimates. •Summary estimates for MCI incidence are not available, largely due to heterogeneity.•This study generated summary estimates using a multipronged approach.•Heterogeneity in our synthesized data remained, reflecting real-world challenges.•Incidence rate ranges may be more useful guides than single summary point estimates.

The Wisconsin Registry for Alzheimer's Prevention is a longitudinal observational cohort study enriched with persons with a parental history (PH) of probable Alzheimer's disease (AD) dementia. Since late 2001, Wisconsin Registry for Alzheimer's Prevention has enrolled 1561 people at a mean baseline age of 54 years. Participants return for a second visit 4 years after baseline, and subsequent visits occur every 2 years. Eighty-one percent (1270) of participants remain active in the study at a current mean age of 64 and 9 years of follow-up. Serially assessed cognition, self-reported medical and lifestyle histories (e.g., diet, physical and cognitive activity, sleep, and mood), laboratory tests, genetics, and linked studies comprising molecular imaging, structural imaging, and cerebrospinal fluid data have yielded many important findings. In this cohort, PH of probable AD is associated with 46% apolipoprotein E (APOE) ε4 positivity, more than twice the rate of 22% among persons without PH. Subclinical or worse cognitive decline relative to internal normative data has been observed in 17.6% of the cohort. Twenty-eight percent exhibit amyloid and/or tau positivity. Biomarker elevations, but not APOE or PH status, are associated with cognitive decline. Salutary health and lifestyle factors are associated with better cognition and brain structure and lower AD pathophysiologic burden. Of paramount importance is establishing the amyloid and tau AD endophenotypes to which cognitive outcomes can be linked. Such data will provide new knowledge on the early temporal course of AD pathophysiology and inform the design of secondary prevention clinical trials.

Total tau (t-tau) and phosphorylated tau (p-tau) are abnormally elevated in the brain and cerebrospinal fluid of individuals with Alzheimer's disease (AD). Tau is also present in the salivary gland tissue and saliva, and salivary measures might produce an accurate, accessible, and inexpensive biomarker. Using unstimulated saliva and Western blot analysis, we quantified the p-tau/t-tau ratio at different phosphorylation sites. We found that for one phosphorylation site, S396, p-tau/t-tau ratio was significantly elevated in patients with AD compared with normal elderly control subjects. The elevation in saliva, however, did not correlate with cerebrospinal fluid tau or with brain measures such as hippocampal volume. There is significant elevation of p-tau/t-tau ratio for the S396 phosphorylation site. Large variation in the AD salivary tau levels, however, limits the utility of this test as a clinical biomarker.

Background Ambulatory diagnostic errors are increasingly being recognized as an important quality and safety issue, and while measures of diagnostic quality have been sought, tools to evaluate diagnostic assessments in the medical record are lacking. Objective To develop and test a tool to measure diagnostic assessment note quality in primary care urgent encounters and identify common elements and areas for improvement in diagnostic assessment. Design Retrospective chart review of urgent care encounters at an urban academic setting. Participants Primary care physicians. Main Measures The Assessing the Assessment (ATA) instrument was evaluated for inter-rater reliability, internal consistency, and findings from its application to EHR notes. Key Results ATA had reasonable performance characteristics (kappa 0.63, overall Cronbach’s alpha 0.76). Variability in diagnostic assessment was seen in several domains. Two components of situational awareness tended to be well-documented (“Don’t miss diagnoses” present in 84% of charts, red flag symptoms in 87%), while Psychosocial context was present only 18% of the time. Conclusions The ATA tool is a promising framework for assessing and identifying areas for improvement in diagnostic assessments documented in clinical encounters.