Though many modeling studies have demonstrated the impact of deep water formation changes on the overturning circulation, the
observational evidence for
such a linkage has been hard to come by for two reasons: (1) Deep water formation is difficult to quantify because the time and locale of production are highly variable from winter to winter, and (2) overturning circulation
measures require observations that span the basin, which have been limited in space and time.
Many of the scales demonstrated weak psychometrics in at least one of the following ways: (a) lack of psychometric data [i.e., reliability and / or validity; e.g., HFQ, MASC, PBS, Social Adjustment Scale - Self - Report (SAS - SR) and all perceived self - esteem and self - concept scales], (b) items that fall on more than one subscale (e.g., CBCL - 1991 version), (c) low alpha coefficients (e.g., below.60) for some subscales, which calls into question the utility of using these subscales in research and clinical work (e.g., HFQ, MMPI - A, CBCL - 1991 version, BASC, PSPCSAYC), (d) high correlations between subscales (e.g., PANAS - C), (e) lack of clarity regarding clinically - relevant cut - off scores, yielding high false positive and false negative rates (e.g., CES - D, CDI) and an inability to distinguish between minor (i.e., subclinical) and major (i.e., clinical) «cases» of a disorder (e.g., depression; CDI, BDI), (f) lack of correspondence between items and DSM criteria (e.g., CBCL - 1991 version, CDI, BDI, CES - D, (g) a factor structure that lacks clarity across studies (e.g., PSPCSAYC, CASI; although the factor structure is often difficult to assess in studies of pediatric populations, given the small sample sizes), (h) low inter-rater reliability for interview and
observational methods (e.g., CGAS), (i) low correlations between respondents
such as child, parent, teacher [e.g., BASC, PSPCSAYC, CSI, FSSC - R, SCARED, Connors Ratings Scales - Revised (CRS - R)-RSB-, (j) the inclusion of somatic or physical symptom items on mental health subscales (e.g., CBCL), which is a problem when conducting studies of children with pediatric physical conditions because physical symptoms may be a feature of the condition rather than an indicator of a mental health problem, (k) high correlations with
measures of social desirability, which is particularly problematic for the self - related rating scales and for child - report scales more generally, and (l) content validity problems (e.g., the RCMAS is a
measure of anxiety, but contains items that tap mood, attention, peer interactions, and impulsivity).
Increasingly, in complex public health evaluation research, there are questions about whether all relevant benefits can be captured in a single summary outcome
measure such as QALY or unit of «effectiveness» or net benefit approach17 which is why the use of a cost - consequence analysis (CCA) framework is being recommended for
such economic evaluations.18 Other outcomes from the trial
such as the Parent — Infant Relationship Global Assessment Scale (an
observational measure that is independently rated blind to group allocation) will be included in the CCA so that all costs and outcomes from the trial can be displayed transparently for decision - makers to consider trade - offs themselves.