We used exploratory factor analysis within the confirmatory analysis framework, and data provided by family members and friends of 205 decedents in Missoula, Montana, to construct a model of latent variable domains underlying the Quality of Dying and Death (QODD) questionnaire. We then used data from 182 surrogate respondents, representing Seattle decedents, to verify the latent variable structure. Results from the two samples suggested that survivors’ retrospective ratings of 13 specific aspects of decedents’ end-of-life experience served as indicators of four correlated, but distinct, latent variable domains: symptom control, preparation, connectedness, and transcendence. A model testing a unidimensional domain structure exhibited unsatisfactory fit to the data, implying that a single global quality measure of dying and death may provide insufficient evidence for guiding clinical practice, evaluating interventions to improve quality of care, or assessing the status or trajectory of individual patients. In anticipation of possible future research tying the quality of dying and death to theoretical constructs, we linked the inferred domains to concepts from Identity Theory and Existential Psychology. We conclude that research based on the current version of the QODD questionnaire might benefit from use of composite measures representing the four identified domains, but that future expansion and modification of the QODD are in order.

Rationale: Currently, no safe and effective pharmacologic interventions exist for acute kidney injury (AKI). One reason may be that heterogeneity exists within the AKI population, thereby hampering the identification of specific pathophysiologic pathways and therapeutic targets. Objective: The aim of this study was to identify and test whether AKI subphenotypes have prognostic and therapeutic implications. Methods: First, latent class analysis methodology was applied independently in two critically ill populations (discovery [n = 794] and replication [n = 425]) with AKI. Second, a parsimonious classification model was developed to identify AKI subphenotypes. Third, the classification model was applied to patients with AKI in VASST (Vasopressin and Septic Shock Trial; n = 271), and differences in treatment response were determined. In all three populations, AKI was defined using serum creatinine and urine output. Measurements and Main Results: A two-subphenotype latent class analysis model had the best fit in both the discovery (P = 0.004) and replication (P = 0.004) AKI groups. The risk of 7-day renal Conclusions: This analysis identified two molecularly distinct AKI subphenotypes with different clinical outcomes and responses to vasopressin therapy. Identification of AKI subphenotypes could improve risk prognostication and may be useful for predictive enrichment in clinical trials.

Purpose. The hypothesis tested was that experimental subjects, relative to controls, would demonstrate significant increases in school performance and decreases in drug involvement at program exit (5 months) and at follow-up (10 months). Design. A two-group, repeated-measures, intervention trial was the design used. Setting. The study involved four urban Northwest high schools. Subjects. Participants included 259 youth at high risk of potential school dropout, 101 in the experimental group and 158 in the control group. Intervention. The Personal Growth Class experimental condition was a one-semester, five-month elective course taken as one of five or six regular classes. It had a 1:12 teacher-student ratio, and integrated group support and life-skills training interventions. The control condition included a regular school schedule. Measures. School performance measures (semester GPA, class absences) came from school records. Drug use progression, drug control, and adverse consequences were measured by the Drug Involvement Scale for Adolescents. Self-esteem, school bonding, and deviant peer bonding were measured using the High School Questionnaire: Inventory of Experiences. All multi-item scales had acceptable reliability and validity. Results. As predicted, trend analyses revealed significantly different patterns of change over time between groups in drug control problems and consequences; in GPA (but not attendance); and in self-esteem, deviant peer bonding, and school bonding. The program appeared to stem the progression of drug use, but group differences only approached significance. Conclusion. Program efficacy was demonstrated particularly for decreasing drug control problems and consequences; increasing GPA and school bonding; and desired changes in self-esteem and deviant peer bonding. Program effects on progression of drug use were less definitive.

The purpose of this study was to explore the roles of anxiety, depression, and hopelessness as mediators between known risk factors and suicidal behaviors among 1,287 potential high school dropouts. As a step toward theory development, a model was tested that posited the relationships among these variables and their effects on suicidal behaviors. Structural equation models, estimated separately by gender, revealed support for the model, and substantial similarities between males and females. The results showed direct effects of depression and hopelessness on suicidal behaviors for males, and direct effects of hopelessness, but not depression, for females. For both males and females, anxiety was directly linked to depression and hopelessness; drug involvement had both direct and indirect effects on suicidal behavior. As hypothesized, lack of family support showed indirect influences on suicidal behaviors through anxiety for both males and females. The results have important implications for future model development regarding adolescent suicidal behaviors.

Successful implementation of school-based emotional health screening programs requires careful consideration of how to inform and obtain permission from parents.