PROFILE AND LEARNING CURVE OF BRAZILIAN SURGEONS REGARDING SHOULDER ARTHROSCOPY

Amid growing concerns over declining national numeracy proficiency, learning applications play a pivotal role in enhancing learners' performance in numeracy. This study evaluated the effectiveness of the “Math Games: Math for Kids” learning application in improving the numeracy skills of Grade 3 pupils at Banica Elementary School during the School Year 2024–2025. Specifically, it aimed to determine the learners’ proficiency levels in numeracy before and after the intervention, assess whether a significant difference existed between the pretest and posttest results, and measure the intervention’s effect size. The study employed a quasi-experimental, single-group pretest-posttest design involving 26 Grade 3 pupils who scored below the proficient level in the Enhanced Regional Unified Numeracy Test (ERUNT). A 45-item standardized numeracy test covering addition, subtraction, and multiplication was administered before and after a four-week intervention using the learning app. Data were analyzed using the mean, paired sample t-test at a 0.05 significance level, and Cohen’s d to determine the effect size. Results showed that the pupils' proficiency level in numeracy before the intervention was “low proficient.” After the intervention, it improved to “proficient.” Statistical analysis revealed a significant difference in the pretest and posttest results, favoring the posttest scores. Moreover, Cohen’s d indicated a very large effect size, suggesting that the “Math Games: Math for Kids” app had a substantial positive impact on learners' numeracy skills. These findings highlight the app’s effectiveness as a digital learning tool for strengthening foundational math competencies in young learners.

The purpose of the study aims to examine the roles of vocabulary and syntactical knowledge on L2 reading comprehension when learners' English proficiency levels were concerned. More specifically, the study investigates to what extent vocabulary and syntactic knowledge contributes to L2 reading comprehension regardless of learners' proficiency levels and whether lexical and syntactic knowledge makes differential contributions to L2 reading comprehension depending on learners' proficiency levels. To this end, 337(male: 153, female: 183) students attending two universities in Korea participated in this study. The participants took the tests in the same order: (1) a vocabulary levels test; (2) a vocabulary test; (3) a grammar test 1; (4) a grammar test 2; (5) a reading comprehension test; and (6) a recall task. A series of multiple regression analyses were conducted with SPSS 18.0 to mainly examine the research questions that set up. The results demonstrate that syntactic knowledge plays a stronger role than lexical knowledge regardless of the reading tasks. In addition, the study found that lexical and grammatical knowledge makes differential contributions in accordance with the participants’ proficiency levels. That is, grammatical knowledge, particularly grammar test 1, was shown to be a stronger predictor for high and intermediate proficient groups in performing both reading tasks. On the contrary, lexical knowledge was a stronger predictor for low proficient level students in both reading tasks. Implications are also discussed.

The study developed and utilized language instructional material (LIM), which focused on using biblical texts and passages to explore the relationship between pupils’ reading and speaking proficiency levels. A quasi-experimental research design was used to gather significant results from the denominational schools. Study showed that Grade 6 pupils significantly improved their language proficiency after undergoing to intervention. Reading proficiency increased from basic to on their grade level and speaking proficiency from good to proficient level. LIM has brought positive significant change on the proficiency level of the pupils, however there is a pressing need to improve their figurative language and listening comprehension skills since there skills show the lowest increase.

The objective of this study is to elucidate the perspective of students' tolerance of ambiguity to enhance proficiency in English as a secondary language. The aptitude to tolerate ambiguity, commonly referred to as AT, plays a crucial role in the process of language acquisition. It pertains to an individual's aptitude to manage and adapt to unfamiliar and uncertain aspects of the target language being learned. This skill is precious in comprehending and interpreting new information more effectively and flexibly. By cultivating AT, language learners can augment their overall proficiency, ultimately achieving greater fluency and mastery of the language they are studying. The interpretation of an ambiguous piece of language reflects the level of tolerance or intolerance of a language learner, as well as their capacity to endure the structure of the language and its impact on their emotional perception of progress. To illuminate the concern, a group of 110 students, consisting of 26 at the preparatory level, 50 at the proficient level, and 34 at the master's level in the English department at Jizan University, responded to a questionnaire comprising 12 items. The questionnaire focused on the Second Language Tolerance of Ambiguity Scale (SLTAS), modified by Erten and Topkaya in 2009. To feature a circumstantial perspective, A comprehensive assessment was conducted on students across various levels to evaluate students' capacity to tolerate ambiguity. It is evident from the study results that students must acquire the necessary skills to navigate and comprehend language structures that may be unclear or open to interpretation because of their high ambiguity tolerance. Additionally, findings indicate no significant difference exists in levels of ambiguity tolerance among students categorized by proficiency as preparatory, proficient, or master. Furthermore, four open-ended questions were executed to limited introductory, proficient and master levels, each aiming to measure the coherence between the statistical findings and data interpretation. The outcomes derived from the open-ended inquiries aligned with the most recently scrutinized studies.

Teachers performance can have a significant impact on the proficiency levels of their pupils. The study aimed to determine the (1) teachers performance (2) pupils level of English Proficiency and (3) relationship of teachers performance towards pupils English proficiency. The respondents were the selected thirty-eight (38) teachers and ninety-one (91) pupils from schools in Legislative I District in the Division of Cagayan de Oro City Year 2021-2022. The researcher used Universal Sampling Method that is, all the teachers as well as their pupils that were included in the conduct of 2022 the Regional Achievement Test (RAT) were taken as respondents of this study with the total of one hundred twenty-nine (129). It employed a descriptive correctional method of research. Data were gathered through the process of documentary analysis. Statistical treatments such as mean, standard deviation, and Pearson Product Moment Correlation Coefficient were used in presenting and analyzing of data. Results showed that the majority of the teachers Level of Performance is at Very Satisfactory Level while the majority of the pupils level of English proficiency was at a nearly proficient level. A significant moderate positive relationship between the teachers performance and pupils proficiency was also registered. The researcher recommends that the teachers may continue in enhancing their knowledge and skills in teaching to have much better strategies and performance that will also benefit the pupils proficiency.

To describe patterns of clinical Spanish use by pediatric residents, and to compare self-assessment of language proficiency against an objective language test. In 2010, the authors e-mailed a survey to all 247 pediatric residents at three institutions, inviting those with any level of Spanish language ability to participate. Participants completed a survey reporting Spanish proficiency, interpreter use, and comfort using Spanish in a range of clinical scenarios. Clinical scenarios were grouped and analyzed by degree of complexity. Self-reported Spanish proficiency was compared with tested proficiency, as measured by a 20-minute telephone assessment of general language ability. Scores were categorized as "not proficient," "proficient," and "highly proficient." Of the 247 residents, 78 (32%) participated, self-reporting a range of Spanish skills; 23% of those reported spoken proficiency ("proficient" or "fluent"). Participants at all levels of proficiency reported using Spanish without interpretation, including 63% of those who were not proficient. The majority (56%) of nonproficient residents reported comfort using Spanish in straightforward clinical scenarios, and 10% reported comfort in clinical scenarios with legal implications. Self-reported proficiency had a positive predictive value of 67% for testing at a proficient level and 22% for testing at a highly proficient level. Regardless of level of Spanish proficiency, pediatric residents provide clinical care to patients in Spanish. Self-reported Spanish proficiency does not reliably predict tested ability, especially when using stringent criteria to define proficiency. Provider language "credentialing" is an important step in implementing a policy to improve care for limited English proficiency patients.

Teaching and research are central aspects of university scholars’ work. To provide a high quality of teaching and research, scholars are required to continually learn and develop professionally. Only recently have some empirical studies that focused on academics’ motivations and emotions attempted to explain key outcomes related to their research, teaching, and professional development. This study adopted a self-determination lens to explore academics’ motivation to learn foreign languages, an area that has hardly been scrutinized due to an assumption that academics are highly motivated. The sample consisted of 593 academics (330 women) from nine public and one non-public higher education institutions in Krakow, Poland. The participants also self-rated their level of proficiency in English, French, German, Spanish, and Russian. The results from the Polish version of the Language Learning Orientations Scale—intrinsic motivation, extrinsic motivation, amotivation (LLOS-IEA) (Noels et al., 2000) showed that these university academics were characterized by both intrinsic motivation and the most internalized form of extrinsic motivation (identified regulation). These have been considered to be optimal forms of motivation with positive outcomes. Statistically significant differences were found between scholars’ motivation to learn languages and age, gender, and job seniority. The analysis performed for English indicated that scholars rated themselves as having a proficient level (C1) in reading and an independent level (B2) in writing skills.

The Level of Evidence Pyramid: Indicating Levels of Evidence in Plastic and Reconstructive Surgery Articles

A New Year

### A. Organization of Committee and Evidence Review The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines was formed to make recommendations regarding the diagnosis and treatment of patients with known or suspected cardiovascular disease. Ischemic heart disease is the single leading cause of death in the United States. The most common manifestation of this disease is chronic stable angina. Recognizing the importance of the management of this common entity and the absence of national clinical practice guidelines in this area, the task force formed the Committee on Management of Patients With Chronic Stable Angina to develop guidelines for the management of stable angina. Because this problem is frequently encountered in the practice of internal medicine, the task force invited the American College of Physicians–American Society of Internal Medicine (ACP–ASIM) to serve as a partner in this effort by identifying 3 general internists to serve on the committee. The guidelines are arbitrarily divided into 4 sections: diagnosis, risk stratification, treatment, and patient follow-up. Experienced clinicians will quickly recognize that the distinctions between these sections may be arbitrary and unrealistic for individual patients. However, for most clinical decision making, these divisions are helpful and facilitate the presentation and analysis of the available evidence. Detailed evidence was developed whenever possible. The weight of the evidence was ranked highest (A) if the data were derived from multiple randomized clinical trials involving large numbers of patients and intermediate (B) if the data were derived from a limited number of randomized trials involving small numbers of patients or careful analyses of nonrandomized studies or observational regis-tries. A low rank (C) was given when expert consensus was the primary basis for the recommendation. The customary ACC/AHA classifications I, II, and III are used in tables that summarize both the evidence and expert opinion and provide final recommendations for both patient …

The relationship between reading skills in earlier grades and achieving Proficiency on the National Assessment of Educational Progress (NAEP) grade 8 reading assessment was examined by establishing a statistical link between NAEP and the Early Childhood Longitudinal Study (ECLS) grade 8 reading assessments using data from a common sample that took both assessments. The link allowed a comparison between NAEP grade 8 achievement levels in reading and the finer grain and developmentally descriptive ECLS reading proficiency levels. Reading skills students need to master in earlier grades to later reach NAEP’s Proficient level at grade 8 were identified. Results showed that, in terms of ECLS reading proficiency levels, to have about a 50% chance of reaching Proficient in NAEP’s grade 8 reading assessment students need to be at level 5 (reading words in context) or higher by spring term of first grade, at level 7 (extrapolation) or higher by spring term of third grade or at level 8 (evaluation) or higher by spring term of fifth grade.

The objective of this study is to evaluate the effect of Brazilian elementary schools on the chances of their students achieving at different levels of mathematics proficiency. Since student proficiency is classified at three levels – Insufficient, Basic and Proficient – the chosen model of analysis was the hierarchical multinomial model. The explicit use of proficiency levels, which have a clear normative and pedagogical interpretation, allows the findings to be expressed in language more relevant to schools and educational policy. The main findings are: the infrastructure factor (quality of the school buildings, library, computers, etc.) is related mainly to the effect of the school on the chances of their students being at the Basic level; only one pedagogical factor (homework) is related to the chances of students being at the Proficient level. The findings suggest that Brazilian schools need to undergo interventions of a different kind for their students to succeed.

Education laws in the U.S. hold schools accountable for including students with intellectual disability on statewide reading assessments. Students with intellectual disability have been taking general or alternate reading assessments over the past two decades. However, very little attention has been given to the results of these assessments. The purpose of this study was to examine reading outcomes of students with intellectual disability on statewide general and alternate assessments in a Midwestern state in the U.S. We also examined whether students with intellectual disability's reading outcomes varied across traditional and innovative school types. Results from descriptive analyses showed that a very low percentage of students with intellectual disability performed at the proficient level or above on 5th and 8th grades reading assessments. Also, students with intellectual disability's reading proficiency levels did not significantly differ across school types. Implications of these results are discussed and recommendations for future research are provided.

Items on test score scales located at and below the Proficient cut score define the content area knowledge and skills required to achieve proficiency. Alternately, examinees who perform at the Proficient level on a test can be expected to be able to demonstrate that they have mastered most of the knowledge and skills represented by the items at and below the Proficient cut score. It is important that these items define intended knowledge and skills, especially increasing levels of knowledge and skills, on tests that are intended to portray achievement growth across grade levels. Previous studies show that coherent definitions of growth occur often as a result of good fortune rather than by design. In this paper, we use grades 3, 4, and 5 mathematics tests from a state assessment program to examine how well (a) descriptors for Proficient performance define achievement growth across grades, and (b) the knowledge and skill demands of test items that define Proficient performance at each grade level may or may not define achievement growth coherently. Our purpose is to demonstrate (a) the results of one state assessment program's first attempt to train item writers to hit assigned proficiency level targets, and (b) how those efforts support and undermine coherent inferences about what it means to achieve Proficient performance from one grade to the next. Item writers' accuracy in hitting proficiency level targets and resulting inferences about achievement growth are mixed but promising.

Adapted texts play a pivotal role in the dissemination of English as a global language, particularly for learners with diverse proficiency levels. The significance of adapted texts in the context of foreign language instruction is considerable. They are regarded as an invaluable for attaining a proficient level of target language. Such materials assist learners in comprehending cultural nuances and idiomatic expressions, particularly for those who are constrained in their linguistic abilities. Additionally, adapted texts facilitate cultural exchange by furnishing information and divergent perspectives. This study examines methods for rendering Kazakh texts more comprehensible to contemporary audiences. Kazakh is a Turkic language with substantial literary tradition, yet numerous historical and cultural texts remain inaccessible due to linguistic evolution and evolving cultural references. Furthermore, the article presents a comprehensive enumeration of adaptation techniques, exemplified by the adaptation of Kazakh authentic literary works and traditional fairy tales through the utilization of prevalent adaptation techniques employed in the adaptation of English-language texts. This study aims to address this gap by examining the most effective methods for adapting Kazakh texts. This study’s primary focus is on vocabulary, grammar and cultural references, which are essential elements in the process of adaptation. A variety of approaches were analyzed, including simplification, denotative explication, and amplification, as well as other methods such as addition, deletion, reordering, and so forth. The suitability of these approaches for different addresses and desired outcomes were determined. Keywords: adaptation, text, authentic, simplification, amplification, denotative explication, the Kazakh language