Inter-rater Reliability and Construct Validity of the Lerner Defense Scale in Clinical and Non-clinical Groups

The current study investigated the inter-rater reliability and the construct validity of the Rorschach Lerner Defense Scale (LDS). In particular, it aimed to explore the inter-rater reliability, analyzing the most frequent coding mistakes in an attempt to improve the coding guidelines, and to investigate the ability of the scale to distinguish between individuals with neurotic-level and borderline-level personality organization, according to the Psychodynamic Diagnostic Manual-2 (PDM-2), and non-clinical subjects. Eighty clinical subjects and 80 non-clinical ones participated in the study. Among the clinical subjects, 40 have borderline-level personality organization and 40 have neurotic-level personality organization. Non-clinical subjects were drawn from an archival dataset of non-clinical individuals who previously participated in a Rorschach normative study. The LDS showed substantial inter-rater reliability; however, guidelines could be improved, specifically with regard to the threshold for coding Devaluation and Idealization at level 1. Furthermore, more examples should be included in the manual about the coding of Projective Identification and Denial. The LDS distinguished borderline-level subjects from both the non-clinical and neurotic groups with regard to Devaluation and Projective Identification, with borderline-level personality organization subjects reporting higher scores than either of the two other groups. Only the Denial scale discriminated between the non-clinical and neurotic group, with the latter reporting higher scores of high-level Denial.

An emergency department medical record review for adolescent intentional self-harm injuries

Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study developed a definition for identifying intentional self-harm (ISH) injuries in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. The definition is based on the injury-reporting framework proposed by the Centers for Disease Control and Prevention. The study sought to estimate the definition’s positive predictive value (PPV), and the proportion of ISH injuries with intent to die (i.e., suicide attempt). Methods The study definition, based on first-valid external cause-of-injury ICD-10-CM codes X71-X83, T14.91, T36-T65, or T71, captured 207 discharge records for initial encounters for ISH in one Kentucky ED. Medical records were reviewed to confirm provider-documented diagnosis for ISH, and identify intent to die or suicide ideation. The PPV of the study definition for capturing provider-documented ISH injuries was reported with its 95% confidence interval (95% CI). Results The estimated PPV for the study definition to capture ISH injuries was 88.9%, 95% CI (83.8%, 92.8%). The estimated percentage of ISH with intent to die was 45.9, 95% CI (47.1, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines restrict assignment of this code to cases in which the mechanism of the suicide attempt is unknown. Conclusions The proposed case definition supported a robust PPV for ISH injuries. Our findings add to the evidence that the current ICD-10-CM coding system and coding guidelines do not allow identification of ISH with intent to die; modifications are needed to address this issue.

Sifu - a cybersecurity awareness platform with challenge assessment and intelligent coach

Software vulnerabilities, when actively exploited by malicious parties, can lead to catastrophic consequences. Proper handling of software vulnerabilities is essential in the industrial context, particularly when the software is deployed in critical infrastructures. Therefore, several industrial standards mandate secure coding guidelines and industrial software developers’ training, as software quality is a significant contributor to secure software. CyberSecurity Challenges (CSC) form a method that combines serious game techniques with cybersecurity and secure coding guidelines to raise secure coding awareness of software developers in the industry. These cybersecurity awareness events have been used with success in industrial environments. However, until now, these coached events took place on-site. In the present work, we briefly introduce cybersecurity challenges and propose a novel platform that allows these events to take place online. The introduced cybersecurity awareness platform, which the authors call Sifu, performs automatic assessment of challenges in compliance to secure coding guidelines, and uses an artificial intelligence method to provide players with solution-guiding hints. Furthermore, due to its characteristics, the Sifu platform allows for remote (online) learning, in times of social distancing. The CyberSecurity Challenges events based on the Sifu platform were evaluated during four online real-life CSC events. We report on three surveys showing that the Sifu platform’s CSC events are adequate to raise industry software developers awareness on secure coding.

Rorschach Performance Assessment System (R-PAS) Interrater Reliability in a Brazilian Adolescent Sample and Comparisons With Three Other Studies

We examine interrater reliability for scoring the Rorschach Performance Assessment System (R-PAS) in a sample of 89 adolescents ( MAge = 13.2, SD = 1.01) from Brazil using exact agreement intraclass correlations coefficient (ICCs) for the 60 protocol-level scores that are the focus of interpretation. The first author completed or reviewed all of the primary coding, and seven R-PAS proficient psychologists trained at different sites independently produced secondary coding. Overall, excellent agreement was found ( M ICC = 0.89; SD = 0.09). When averaged across this study and three other comparison studies, stronger reliability was present, in general, for commonly coded variables ( M = 0.87) as opposed to rare or infrequent variables ( M = 0.78). In addition, 78.3% of the variables showed excellent interrater reliability and an additional 20.0% had good reliability. The results also showed that the ICCs for most variables had low variability across studies, suggesting clear coding guidelines. However, variables with higher ICC variability across studies indicated domains where it would be desirable to expand guidelines with more detailed parameters. Overall, the findings indicate excellent interrater reliability for the great majority of codes and present solid grounds for future research on interrater reliability with R-PAS.

Cybersecurity Challenges in Industry: Measuring the Challenge Solve Time to Inform Future Challenges

Cybersecurity vulnerabilities in industrial control systems have been steadily increasing over the last few years. One possible way to address this issue is through raising the awareness (through education) of software developers, with the intent to increase software quality and reduce the number of vulnerabilities. CyberSecurity Challenges (CSCs) are a novel serious game genre that aims to raise industrial software developers’ awareness of secure coding, secure coding guidelines, and secure coding best practices. An important industry-specific requirement to consider in designing these kinds of games is related to the whole event’s duration and how much time it takes to solve each challenge individually—the challenge solve time. In this work, we present two different methods to compute the challenge solve time: one method based on data collected from the CSC dashboard and another method based on a challenge heartbeat. The results obtained by both methods are presented; both methods are compared to each other, and the advantages and limitations of each method are discussed. Furthermore, we introduce the notion of a player profile, which is derived from dashboard data. Our results and contributions aim to establish a method to measure the challenge solve time, inform the design of future challenges, and improve coaching during CSC gameplay.

Positive Predictive Value of ICD-10-CM Definitions for Adolescent Intentional Self-Harm: An Emergency Department Medical Record Review

Background Non-suicidal self-injury and suicide attempts are increasing problems among American adolescents. This study proposed a definition for identifying intentional self-harm injuries (ISHIs) in emergency department (ED) records coded with International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes and sought to estimate: (1) the definition’s positive predictive value (PPV) in a pediatric population treated in one Kentucky ED, and (2) the proportion of Intentional self-harm injuries (ISHIs) with intent to die (i.e., suicide attempt) that cannot be captured by ICD-10-CM codes and can only be identified by a medical record abstraction. Methods The study definition captured initial encounters for ISHIs based on first valid external cause-of-injury self-harm codes in the ICD-10-CM range X71-X83, T14.91, T36-T65, or T71. Medical records for a random sample of 207 ED discharge records were reviewed following a specified protocol. The PPV for the study definition was reported with its 95% confidence interval (95%CI). Results The estimated PPV for the study definition’s ability to capture true ISHIs was 88.9%, 95%CI (83.8%, 92.8%). The estimated percentage of ISHIs with intent to die was 45.9%, 95%CI (47.1%, 61.0%). The ICD-10-CM code “suicide attempt” (T14.91) captured only 7 cases, but coding guidelines allow assignment of this code only when the mechanism of the suicide attempt is unknown. Conclusions This study demonstrated a critical shortcoming in U.S. morbidity surveillance. The ICD-10-CM coding system and coding guidelines do not allow accurate identification of ISHIs with intent to die; modifications are needed to address this issue.