Despite the central role of posttraumatic stress disorder (PTSD) in international humanitarian aid work, there has been little examination of the measurement invariance of PTSD measures across culturally defined refugee subgroups. This leaves mental health workers in disaster settings with little to support inferences made using the results of standard clinical assessment tools, such as the severity of symptoms and prevalence rates. We examined measurement invariance in scores from the most widely used PTSD measure in refugee populations, the Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), in a multinational and multilingual sample of asylum seekers from 81 countries of origin in 11 global regions. Clustering HTQ responses to justify grouping regional groups by response patterns resulted in three groups for testing measurement invariance: West Africans, Himalayans, and all others. Comparing log-likelihood ratios showed that while configural invariance seemed to hold, metric and scalar invariance did not. These findings call into question the common practice of using standard cut-off scores on PTSD measures across culturally dissimilar refugee populations. In addition, high correlation between factors suggests that the construct validity of scores from North American and European measures of PTSD may not hold globally.

Human forecasts and other probabilistic judgments can be improved by elicitation and aggregation methods. Recent work on elicitation shows that deriving probability estimates from relative judgments (the ratio method) is advantageous, whereas other recent work on aggregation shows that it is beneficial to transform probabilities into coherent sets (coherentization) and to weight judges' assessments by their degree of coherence. We report an experiment that links these areas by examining the effect of coherentization and multiple forms of coherence weighting using direct and ratio elicitation methods on accuracy of probability judgments (both forecasts and events with known distributions). We found that coherentization invariably yields improvements to accuracy. Moreover, judges' levels of probabilistic coherence are related to their judgment accuracy. Therefore, coherence weighting can improve judgment accuracy, but the strength of the effect varies among elicitation and weighting methods. As well, the benefit of coherence weighting is stronger on “calibration” items that served as a basis for establishing the weights than for unrelated “test” items. Finally, echoing earlier research, we found overconfidence in judgment, and the degree of overconfidence was comparable between the two elicitation methods.

Violations of the Reduction of Compound Lottery axiom (ROCL) were documented, but they are not fully understood, and only few descriptive models were offered to model decision makers’ (DMs) decisions in such cases. This article comprehensively tests the effects of 6 factors that could influence DMs’ evaluations of compound lotteries, and models how DMs make decisions in their presence. In an experiment with 6 groups of subjects (n = 125), we elicited certainty equivalents of simple and compound lotteries via a 2-stage choice procedure. We confirmed the existence of the systematic violations of ROCL. We tested the effect of each factor and their interactions, and found that the number of stages and the global probability had prominent effects. We developed three classes of models to describe the weighting process for compound lotteries. The best fitting model was the one that assumes that DMs anchor on the lowest stage probability and then apply the weighting function. The “aggregate first and weigh second” overall outperformed the “weight first and aggregate second” models, presumably because this process is cognitively easier and more natural.

Background: The efficacy and noninferior of performing modified double-door laminoplasty (MDDL) (C4–C6 laminoplasty plus C3 laminectomy, alongside a dome-like resection of the inferior part of the C2 lamina and the superior part of the C7 lamina) in patients with multilevel cervical spondylotic myelopathy (MCSM) is equivocal. A randomized, controlled trial is warranted. Objective: The objective was to evaluate the clinical efficacy and noninferior of MDDL compared with traditional C3–C7 double-door laminoplasty. Study design: A single-blind, randomized, controlled trial. Methods: A single-blind, randomized, controlled trial was conducted in which patients who with MCSM with greater than or equal to 3 levels of spinal cord compression from the C3 to the C7 vertebral levels were enrolled and assigned to undergo either MDDL group or conventional double-door laminoplasty (CDDL) group in a 1:1 ratio. The primary outcome was the change in the Japanese Orthopedic Association score from baseline to 2-year follow-up. The secondary outcomes included changes in the Neck Disability Index (NDI) score, the Visual Analog Scale (VAS) for neck pain, and imaging parameters. Operative complications were also collected and reported. The outcome measures were compared between the groups at 3 months, 1 year, or 2 years after surgery. Results: A total of 96 patients (mean age 67 years, 39.8% women) underwent randomization. Of these patients, 93 completed 3-month follow-up, 79 completed 1-year follow-up, and 66 completed 2-year follow-up. The changes in the Japanese Orthopedic Association score did not differ significantly between the study groups at the three time points after surgery. With respect to amelioration of neck pain and disability related to neck pain, patients in the MDDL group had a significantly greater decrease in the VAS and NDI component summary score than did those in the CDDL group at 1-year (VAS: −2.5 vs. −3.2, difference −0.7, 95% CI −1.1 to −0.2, P=0.0035; NDI: −13.6 vs. −19.3, difference −5.7, 95% CI −10.3 to −1.1, P=0.0159) and 2-years (VAS: −2.1 vs. −2.9, difference −0.8, 95% CI −1.4 to −0.2, P=0.0109; NDI: −9.3 vs. −16.0, difference −6.7, 95% CI −11.9 to −1.5, P=0.0127). The changes in the range of motion (ROM), the C2–C7 Cobb angle, and the cervical sagittal vertical axis in the MDDL group were significantly less than those in the CDDL group (ROM: −9.2±6.4 vs. −5.0±6.0, P=0.0079; C2–C7 Cobb angle: −7.9±7.8 vs. −4.1±6.2, P=0.0345; cervical sagittal vertical axis: 0.6±0.9 vs. 0.2±0.6, P=0.0233). The MDDL group had less blood loss (428.1 vs. 349.1, P=0.0175) and a lower rate of axial symptoms (27.3 vs. 6.1%, P=0.0475) than the CDDL group. Conclusions: Among patients with MCSM, the MDDL produced similar cervical cord decompression compared with the conventional C3–C7 double-door laminoplasty. The modified laminoplasty was associated with meaningful improvement in amelioration of neck discomfort, maintaining a better cervical ROM and sagittal alignment, decreasing blood loss, and reducing the incidence of axial symptoms.