In psychology and the behavioral sciences generally, the use of the hierarchical linear model (HLM) and its extensions for discrete outcomes are popular methods for modeling clustered data. HLM and its discrete outcome extensions, however, are certainly not the only methods available to model clustered data. Although other methods exist and are widely implemented in other disciplines, it seems that psychologists have yet to consider these methods in substantive studies. This article compares and contrasts HLM with alternative methods including generalized estimating equations and cluster-robust standard errors. These alternative methods do not model random effects and thus make a smaller number of assumptions and are interpreted identically to single-level methods with the benefit that estimates are adjusted to reflect clustering of observations. Situations where these alternative methods may be advantageous are discussed including research questions where random effects are and are not required, when random effects can change the interpretation of regression coefficients, challenges of modeling with random effects with discrete outcomes, and examples of published psychology articles that use HLM that may have benefitted from using alternative methods. Illustrative examples are provided and discussed to demonstrate the advantages of the alternative methods and also when HLM would be the preferred method. (PsycINFO Database Record

Failure to respect the needs of vulnerable groups will seriously undermine response efforts

No abstract

The Intensive Care Unit (ICU) has the highest annual mortality rate (4.4M) of any hospital unit or 25% of all clinical admissions. Studies show a relationship between clinician cognitive load and workflow, and their impact on patient safety and the subsequent occurrence of medical mishaps due to diagnostic error -in spite of advances in health information technology, e.g., bedside and clinical decision support (CDS) systems. The aim of our research is to: 1) investigate the root causes (underlying mechanisms) of ICU error related to the effects of clinical workflow: medical cognition, team communication/collaboration, and the use of diagnostic/CDS systems and 2) construct and validate a novel workflow model that supports improved clinical workflow, with goals to decrease adverse events, increase safety, and reduce intensivist time, effort, and cognitive resources. Lastly, our long-term objective is to apply data from aims one and two to design the next generation of diagnostic visualization-communication (VizCom) system that improves intensive care workflow, communication, and effectiveness in healthcare.