Academic Groups Research Articles

XanthoMoClo─A Robust Modular Cloning Genetic Toolkit for the Genera Xanthobacter and Roseixanthobacter.

Interest in Xanthobacter species is increasing due to their unique metabolic capabilities. They can grow in both heterotrophic and fully autotrophic environments, including carbon dioxide, dinitrogen gas, and hydrogen as the sole carbon, nitrogen, and energy sources, respectively. Academic and industrial groups looking to leverage these metabolic properties are already using Xanthobacter strains for the sustainable production of food and commodities. However, only a handful of genetic parts and protocols exist in scattered genetic backgrounds, and there is an unmet need for reliable genetic engineering tools to manipulate Xanthobacter species. Here, we developed XanthoMoClo, a robust modular cloning genetic toolkit for Xanthobacter and Roseixanthobacter species and strains, providing extensive tools to transform them, manipulate their metabolism, and express genes of interest. The toolkit contains plasmid parts, such as replication origins, antibiotic selection markers, fluorescent proteins, constitutive and inducible promoters, a standardized framework to incorporate novel components into the toolkit, and a conjugation donor to transform Xanthobacter and Roseixanthobacter strains easily with no or minimal optimization. We validated these plasmid components in depth in three of the most commonly studied Xanthobacter strains: X. versatilis Py2, X. autotrophicus GZ29, and X. flavus GJ10, as well as in R. finlandensis VTT E-85241. Finally, we demonstrate robust toolkit functionality across 21 different species of Xanthobacter and Roseixanthobacter, comprising 23 strains in total. The XanthoMoClo genetic toolkit is available to the research community (through AddGene) and will help accelerate the genetic engineering of Xanthobacter to further their applications in sustainability and bioremediation efforts.

Development and validation of practice-based multimedia assisted item: a mixed-method study

BackgroundThe rapid development of information and technology and the spread of COVID-19 have made online learning and assessment more prevalent. In this context, the potential of multimedia-assisted items to provide an alternative method of learning and evaluation is significant. These items can better reflect authentic clinical situations and enhance higher cognitive skills. This study aims to develop and validate multimedia-assisted items that reflect clinical authenticity.MethodsA mixed-method design with qualitative and quantitative approaches was adopted. The study was conducted in two phases: development and validation. Thirty-six multimedia-assisted items were developed using videos, audio files, photos, and pictures. Preliminary testing ensured item comprehensibility and usability. In the validation phase, a mock test was administered to 136 nursing students, with 105 completing the survey. Quantitative analysis included calculating item difficulty, discrimination, and reliability and examining evidence based on relation with another variable through correlations with clinical reasoning scores and differences in test scores based on perceived academic achievement. Qualitative analysis involved thematic analysis of interviews with 10 participants to explore their experiences and validate the response process.ResultsThe average total score was 18.1 out of 36, with item difficulty averaging 0.51, item discrimination 0.31, and reliability (Cronbach’s alpha) 0.64. While no significant correlation was found between mock test scores and clinical reasoning scores, a significant difference was observed between high and low-perceived academic achievement groups. Participants expressed that the multimedia-assisted items were more relevant to nursing practice than paper-based items, integrating theoretical knowledge and clinical practicum experience, enhancing understanding, and stimulating active participation in clinical practicum.ConclusionsMultimedia-assisted items have been verified as an effective strategy for education and for assessing nursing students’ comprehensive competencies.MAIs are adequate for evaluating nursing students' competencies in theory and practice, suggesting that MAIs can enhance newly graduated nurses' competencies and improve online assessments in nursing education.

Genomic prostate score and treatment selection in favourable intermediate-risk prostate cancer.

To assess the factors associated with the use of active surveillance (AS) in NCCN favourable intermediate-risk (FIR) prostate cancer (PCa) patients who received the 17-gene Genomic Prostate Score (GPS) assay. Contemporary data were collected from academic and large community group practices across the United States. Eligible patients had localized PCa classified as FIR per NCCN guidelines and received a GPS report between May 2017 and April 2019. Higher GPS results (scale: 0-100) were associated with a higher risk of adverse outcomes. The proportion of patients selecting AS was calculated with 95% confidence intervals. Uni-and multivariable logistic regression analyses were performed to determine the association between AS selection and relevant covariates. There were 324 eligible patients (Gleason Score 3+4, 79%; PSA 10-20 ng/ml, 19%; clinical stage T2b-T2c, 2%; median percent positive cores, 16.7%; median GPS result, 26). The distribution of GPS results was 0-19 (23%), 20-40 (60%), and 41-100 (16%). Overall, 31% (95% CI 26%, 36%) selected AS: 58% (46%, 69%) with GPS 0-19, 27% (21%, 33%) with GPS 20-40, and 6% (1%, 16%) with GPS 41-100. In univariable models, the Gleason score, percent positive cores, PSA, and GPS results were significantly associated with AS selection. In a multivariable model, the percent positive cores and the GPS result remained significantly associated with AS selection. AS persistence was 91% (82%, 95%) at 12 months. The GPS result and percent positive cores appear associated with AS use after controlling for relevant clinical variables in NCCN FIR prostate cancer patients.

МОДУЛЬ АНАЛІЗУ ОПИТУВАНЬ ЗДОБУВАЧІВ МАЛОКОМПЛЕКТНИХ ГРУП У СИСТЕМІ KSU24

Feedback is one of the most effective tools for quality control in education, used by higher education institutions in Ukraine and around the world. It enables the collection of information regarding students' perception of educational materials and facilitates analysis of learning outcomes for a better understanding of the current effectiveness of a specific discipline or educational component within an academic program, with the goal of improving the quality of the discipline and, thus, the overall academic program. Feedback can relate to an entire discipline, a specific semester, the module in which the discipline is taught, or even an individual class session. A wide range of mathematical methods and models, as well as ready-made software libraries, allow for qualitative analysis of feedback results, with most requiring an adequate amount of information for processing. However, in Ukrainian higher education institutions, including Kherson State University, there are academic groups in certain specialties where the number of students is insufficient for applying most analytical methods, especially at the master’s level or higher, or in elective disciplines. To obtain information on learning effectiveness in these groups, equivalent to that in groups with a sufficient number of students, specialized analysis methods are needed. The article describes methods for analyzing feedback results in the form of surveys within the KSU24 system, allowing for consideration of relatively small student groups. It discusses approaches for the software implementation of relevant algorithmic methods and necessary architectural solutions for building a survey module within the KSU24 system. A key functional requirement of this module is ensuring anonymity in the process, as integrity among participants is critically important for obtaining high-quality feedback, especially when processing a limited number of results.

Supporting academic development during curriculum change: a co-operative inquiry of identity and engagement

ABSTRACT This paper investigates the impact of institution-wide curriculum reform on a multi-disciplinary group of teaching-focused academics. Using the participatory action research method of co-operative inquiry, the study contributes several insights for supporting academic development during curriculum change. It highlights that teaching-focused academics place high value on student engagement as both a driver and consequence of their teaching during curriculum reforms. The inquiry also demonstrates how shifting perceptions of student engagement can precipitate concomitant shifts in academic teaching identities. We conclude that collaborative reflection is invaluable for developing identity, enhancing agency and assisting academics to navigate the complexities of curriculum reform.

Economic Burden of Imaging and Interventions in Endourology: A Worldwide Cost Analysis from European Association of Urology Young Academic Urology Endourology and Urolithiasis Working Party.

Background and Objective: The cost of imaging and interventions in the surgical field varies between countries and sometimes within different regions of the same country. Procedural cost takes into account equipment, consumables, operating room, surgical, anesthetic and nursing teams, radiology, medications, and hospital stay. Health care systems therefore face an incredible burden related to investigations and surgical procedures. The aim of this study was to collect costs of imaging and interventions for kidney calculi across different hospitals and health care systems in the world. Methods: An online shared Google spreadsheet was created by the European Association of Urology Young Academic Urology urolithiasis group. The survey consisted of the cost of four radiological imaging (ultrasound of the urinary tract [USS], plain X-ray radiography of the abdomen including kidneys, ureter, and bladder [XRKUB], noncontrast-enhanced computerized tomography [CTKUB], and contrast-enhanced CT with urographic phase [CTU]) and seven interventions (endoscopic laser treatment of renal stones, ureteroscopic treatment or extraction of ureteral stones, percutaneous nephrolithotomy (PCNL), insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy). A chosen representative from each country collected and collated the data, and this was converted to Euros (€). Key Findings and Limitations: Data were collected from 32 countries, which include Turkey, Armenia, Nepal, Uzbekistan, Brazil, Chile, Qatar, Peru, Israel, Singapore, Thailand, Colombia, Argentina, Saudi Arabia, Asia, North America, 15 countries from the European continent, and the United States. The mean cost of USS, XRKUB, CTKUB, and CTU was 51.3 € (range: 2-160 €), 27.1 € (range: 2.5-187 €), 105.8 € (range: 19-405 €), and 171.5 € (range: 19-674 €), respectively. Similarly, the cost of endoscopic laser treatment of renal stones, ureteroscopic treatment/extraction of ureteral stones, PCNL, insertion of ureteral stent, diagnostic ureteroscopy, and cystolitholapaxy was 1942.6 € (range: 100-7887 €), 1626.8 € (range: 80-9787 €), 2884.6 € (range: 110-12642 €), 631 € (range: 110-2787 €), 861.6 € (range: 3-2667 €), and 876 € (range: 19-3457 €), respectively. Wide differences in cost between countries were found within the study. Conclusions and Clinical Implications: This study highlights the significant economic impact of kidney stone management on health care systems worldwide. There seem to be significant disparities between costs, and this study shows the social and economic inequalities in health care access, which can differ significantly between private and public health care. These results can aid policymakers to address these disparities and perhaps to learn from other health care providers.

Immersion in Discomfort: At the Intersection of Worldviews Toward Co‐Governing With Integrity

In the drive to embrace more inclusive, equitable, and respectful approaches to research, academics are increasingly encouraged to engage with diverse and alternate knowledges, including with First Nations and Indigenous Communities. Yet for those working at the intersection of different worldviews—known as the “cultural interface”—the experience can be accompanied by feelings of discomfort. We recognise discomfort as a personal, inner emotion of vulnerability that alerts us to unspoken, difficult conversations; to challenged beliefs and assumptions; and to the limits of our own knowledge. As a group of academics working at the cultural interface, we identify common themes across our collective experiences of discomfort, including fragility and guilt, helplessness, fear, ignorance, shame, challenged conceptions of time, and finally connection and relationality. By openly discussing and confronting our experiences of discomfort, we demonstrate that immersion in discomfort is a journey that provides opportunities for learning, understanding, and fostering co‐governing partnerships with integrity.

Perceptions and experiences with academic group work in online and in-person classroom contexts: Perspectives across levels of undergraduate study

Group work is a commonly used and highly regarded learning tool in tertiary education. While previous research has examined collaboration within higher education contexts, no study has investigated student preferences and experiences across different years of study. This is essential for a better understanding of how to effectively integrate collaborative learning into the undergraduate curriculum. The present study surveyed first year, second year and senior (3rd and 4th year) undergraduate students (n = 100 per group) to gather insights regarding their experiences with collaborative learning as a function of year of study and in both in-person and online contexts. Overall, preferences regarding group composition (e.g., group size) and experiences regarding group work (e.g., efficiency, motivation, satisfaction, stress) were consistent across the year of study. However, notable shifts in experiences were observed, particularly from first to second year, with respect to instructor-related variables (i.e., group formation strategies, leadership opportunities) and student-related variables (i.e., perceived difficulty producing assignments, level of collaboration in groups, learning experiences and enjoyment). Some differences were also observed between in-person and online contexts. Implications for future studies and instructional design are discussed.

Dukungan Sosial Teman Sebaya pada Regulasi Diri Mahasiswa yang Sedang Mengerjakan Skripsi

Completing a final thesis is one of the requirements for students to obtain a bachelor's degree. However, during the process, students often face various challenges that require good self-regulation to complete their thesis within the designated timeframe. This study aims to examine the relationship between peer social support and self-regulation among students working on their thesis. This research employs a quantitative correlational method with purposive sampling as the data collection technique. The participants in this study were students aged 19–25 years, enrolled in semesters 7–12, and currently writing their thesis. Data analysis was conducted using the Spearman Rho correlation test, yielding a p-value of 0.00 (p < 0.05), indicating that the hypothesis was accepted. These findings suggest a significant relationship between peer social support and self-regulation in students working on their thesis. Based on the results, it is recommended that students actively build and utilize peer social support to enhance their self-regulation in overcoming academic challenges. Furthermore, educational institutions should consider providing academic mentoring programs or study groups to help students develop better self-regulation skills, enabling them to navigate obstacles during the thesis-writing process more effectively.

A Bibliometric Analysis of Research on the Sources and Formation Processes of Forest Soil Organic Matter Under Climate Change

Forest soil organic matter (SOM) is a critical component of forest ecosystems and plays a vital role in the global carbon (C) cycle. Global climate change profoundly affects forest SOM dynamics, particularly its sources and formation processes, which are crucial initial stages of the forest soil C cycle. Therefore, understanding these processes and the impacts of climate change is essential for developing effective forest management strategies and climate policies. In this study, VOSviewer 1.6.18 was used to conduct a bibliometric analysis of research published from 1975 to 2024, retrieved from the Web of Science (WoS) Core Collection database, focusing on the sources and formation processes of forest SOM under climate change. The analysis covers annual publication trends, author co-occurrence networks, publication distributions by country and region, keyword clustering, and evolving keyword trends, integrating both quantitative results and a literature review to provide an understanding of the research progress in the field. The results highlight continuous growth in research publications, which can be categorized into four stages: initial emergence, sustained exploration, rapid development, and deep expansion. A solid theoretical foundation and good research strength have been established, driven by prominent academic groups led by researchers such as Jari Liski, as well as leading countries, including the United States and China. The research progress is divided into four topics: the sources of forest SOM; the formation processes of forest SOM; the impacts of climate change; and measurement methods and model-based analysis techniques, which mainly elaborate upon plant-, microbial-, and soil fauna-derived aspects. Research hotspots have evolved from basic C and nitrogen (N) cycles to in-depth studies involving microbial mechanisms and multiparameter climate change interactive effects. This study provides an overview of the research progress and hotspots in the field, offering basic knowledge and theoretical support for potential future research and climate change mitigation strategies.

Expanding the Paediatric Urology Peer Review Pipeline: A Novel Panel and Facilitated Peer Mentorship Program

ABSTRACTThe modern peer review process relies on review by independent experts; however, it is threatened by time constraints and increasing review demands placed on a limited number of involved individuals. To expand the pool of reviewers in paediatric urology, a joint effort was undertaken by the Journal of Urology and Journal of Paediatric Urology via a mentorship program occurring at the 2022 Paediatric Urology Fall Congress. The objective was to increase participants' knowledge and comfort with the review process. Our experience could serve as a pilot for other academic groups looking to expand their peer review pool. Overall, 39 individuals attended the program. An increase in comfort with performing a journal review was noted by 14/23 respondents (61%), with an average increase of 1.2 points on a 10‐point Likert scale. The average rating of satisfaction with the journal review program on a 10‐point scale was 9.7, with 77% (23/30) rating the program 10/10. When asked for specific elements of the program that participants particularly liked, the most common responses were networking with senior mentors in a small group setting and the panel discussion led by editors describing specifics of what they are looking for in a review. Previous programs with goals similar to ours have required more long‐term commitment from both mentors and mentees in developing their skills as peer reviewers. Our program benefited from a short‐term commitment at a large national conference. Long term results will need to be collected moving forward. However, initial feedback was positive and participants describe increased comfort and knowledge in the review process. Our program evaluation was limited by lack of validated surveys and a lack of longitudinal data on future completion of reviews. This pilot program inspired enthusiasm and increased interest in the peer review process among young paediatric urologists. This program could serve as a model for improving recruitment of peer reviewers and could impact reviewer quality.

The Relationship Between Academic Performance and Delinquent Behavior: Focusing on Strains Among Students With Unsatisfactory Academic Performance

While many studies suggest that poor academic performance predicts delinquency, others have argued that the relationship between academic performance and delinquency can be marginal, null, or even spurious. This study examines the relationship between academic performance and delinquent behavior among Korean youth within the general strain framework, utilizing data from the Korean Child and Youth Panel Survey. Using a sample of 2,378 students from 95 randomly selected schools in Korea, the KCYP survey examined students’ perceptions and experiences regarding relationships with parents, teachers, and peers, as well as their engagement in various delinquent behaviors. Group-based trajectory modeling identified two academic trajectory groups: consistently low academic grades and declining academic performance. Two dichotomous variables representing these academic trajectory groups were included in the negative binomial regression models. After accounting for the effects of other strain-related and social/self-control variables, the effects of low academic performance on delinquent behavior become spurious while a decline in academic performance is a consistent predictor of delinquent behavior across all models.

Leisure Activity Patterns of an Academic Environmental Group of Szczecin University Students—An Interdepartmental Analysis

The objective of this study was to verify the leisure time activity (LTA) patterns among students of three university courses (including students in their first, second, and third year of their bachelor’s degree)—Physical Education (PE) vs. Sports Diagnostics (SD) vs. Tourism and Recreation (TaR)—at the University of Szczecin and their possible correlations with the faculty of the studying youth. The study involved a total of 219 respondents: 96 were studying TaR, 93 were studying PE, and 31 were studying SD. The research was based on the following questionnaires: the International Physical Activity Questionnaire (IPAQ) and a questionnaire created by the authors which covered the type of leisure time activity (LTA) with emphasis on leisure-time physical activity (LTPA) and its type, frequency, and whether students sought companionship while engaging in such activities. The data obtained were developed using statistical methods such as analysis of structure and correspondence analysis. Several research questions were put forward in the study. Surprisingly, TaR students were characterized by a greater variety of sports activities than the PE or SD students. The TaR students had also undertaken long trips more often than the PE students. No difference in the frequency of long trips was found between students from either course. Regardless of the type of university course studied, no significant differences were found between the genders in terms of spending free time alone vs. in the company of family/friends.

Content validity of the Handwriting Assessment Battery (HAB-v6) for use with adults with acquired brain injury (ABI): An international Delphi study.

Occupational therapists are responsible for assessing adult handwriting following stroke and other acquired brain injuries. The Handwriting Assessment Battery (HAB) was developed for use as a diagnostic assessment tool and outcome measure. The current study aimed to investigate the content validity of version six of the Handwriting Assessment Battery (HAB-v6). A three round, online-Delphi study was conducted with an international group of expert clinicians and academics experienced in adult handwriting assessment and/or retraining. In round one, participants rated the importance of HAB-v6 domains and the six subtests and recommended modifications to administration and/or scoring procedures. In rounds two and three, participants were re-presented with several HAB-v6 domains where consensus was not reached and rated the importance of suggested modifications from round one. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using content analysis. Consumers and community members were not involved in this study. Fifteen participants from the United States of America, the United Kingdom, Canada, Israel, and Australia completed round one of the Delphi, 11 participants completed round two, and 15 participants completed round three. In round one, high consensus (>70% participant agreement) was achieved regarding the importance of 5/6 subtests of the HAB-v6; suggestions were made to modify three subtests and add new subtests. In round two, high consensus (>70% agreement) was achieved on three proposed revisions: adding two subtests and modifying instructions for the copying subtest. In round three, low consensus regarding inclusion of the dots drawing subtest remained. Based on the Delphi process, the content of five of six subtests of the HAB-v6 are valid for use by occupational therapists and others to measure adult handwriting performance, with the exception of the dots subtest, where consensus was not reached.

한국의 교원양성정책 변화 분석: 역사적 제도주의 관점으로

This study employs a historical institutionalist lens to analyze the evolution of teacher education policies in South Korea. By focusing on path dependency, the research examines the development and transformation of teacher education policy frameworks. A comprehensive approach was adopted, integrating three levels of analysis: structure (socioeconomic and political contexts), institutions (policies and legislation), and actors (government and academia). The findings indicate that, since the 1960s, successive governments have adjusted teacher education policies in response to changing social and political contexts. Initially, the focus was on quantitative expansion to address teacher shortages, which later shifted toward enhancing the quality and professional expertise of teachers. The study highlights the dominant role of the government and the Ministry of Education in policy formation, complemented by the supportive contributions of academic and related stakeholder groups. To establish and implement effective teacher education policies in the future, it is imperative to embrace continuous innovation and flexibility to meet the evolving demands of society and education. Furthermore, the policy design process should incorporate diverse stakeholder participation and an integrated approach. This research aims to contribute to a deeper understanding of the historical context of teacher education policies and to inform their future improvement and advancement.

Algorithmic-authors in academia: blurring the boundaries of human and machine knowledge production

ABSTRACT The emergence of large language models (LLMs) that generate human-like texts has raised questions about the boundaries between human-authored and machine-generated outputs. This article examines how LLMs are re-shaping academic knowledge production through the emergence of the Algorithmic-Author. Drawing on Foucault's Author-Function and the Social Construction of Technology approach, we analyze how academic groups negotiate LLMs' roles in scholarly work. Based on 25 semi-structured interviews with academics across career stages and disciplines, we identify two dominant technological frames: the Library of Babel, portraying LLMs as universal knowledge repositories leading to tecnomorphic views of human thinking, and the Superposition, presenting LLMs as dynamic, interactive agents described in anthropomorphic terms. These frames manifest differently across academia, shaping both formal writing conventions and informal social norms. Our findings suggest the Algorithmic-Author functions not merely as a writing tool but as a mechanism standardizing academic practices while creating new positions within knowledge production.

Here and elsewhere, together: how emerging blended synchronous learning approaches and perceptions can inform teaching guidance and support

ABSTRACT Blended synchronous learning, or BSL, emerged in the early 2000s to signify scenarios where remote students and in-the-room students participate in activities together at the same time. The recent proliferation of hybrid teaching provides an opportunity to redefine this teaching model and reassess its potential for contributing to teaching quality. Likewise, the urgent upskilling of staff cohorts to teach in modes like BSL during the pandemic has highlighted the potential role of academic developers in this realm. Semi-structured interviews with 12 teaching staff within a built environments faculty in Australia explored their experience teaching BSL for the first time, and their perception of support from the authors’ academic development group. Their on-the-ground reflections offer implications for supporting high-quality hybrid teaching at scale and justify consideration for long-term investment in BSL across the sector.

Ambient Ionization Mass Spectrometry for Fatty Acids Composition Investigation of Natural Lipids: A Multidisciplinary Workshop.

Teaching mass spectrometry essentials is usually connected with one of the basic courses for undergrads. Thus, specific previous knowledge is required from students. However, the necessity of teaching mass spectrometry essentials to students of different academic specializations and multidisciplinary groups can arise in every academic group. A specific workshop is needed to address such a demand. The presented workshop consisted of several thematic parts: assembling an ambient ionization ion source using improvised materials, preparing biological samples for analysis, data acquisition, and interpretation of data to solve a simple problem from the real world. The first part of the work consisted of assembling an ambient ionization setup and obtaining mass spectra of substances from standard solutions, natural mixtures, and biological fluids such as saliva. The second half of the workshop consists of analyzing the composition of fatty acids of natural and artificial fats using the same ion source. The identification of oils is a simple model problem that makes the workshop attractive for attendees with different backgrounds. The workshop provides students with practical skills that are highly valuable in fundamental and applied mass spectrometry. Students familiarize themselves with the basic concepts, instrument use, and mass spectra interpretation. They achieve basic hands-on experience in experimentation procedures and the practice of using mass spectrometry to solve problems related to real life.

Giving the outrage a name – how researchers are challenging employment conditions under the hashtags #IchBinHanna and #IchBinReyhan

ABSTRACT Outraged by the release of a ministerial video in which short-term employment contracts in German academia were lauded through the embodiment of fictitious doctoral researcher Hanna, thousands of researchers rallied behind the hashtags #IchBinHanna & #IchBinReyhan to vent their frustrations about precarious academic employment in Germany. The emerging connective action attracted a comparatively large number of researchers in a short period of time, stayed active for over two years, elicited reactions from policymakers and the media, and influenced current legislative developments in Germany. We analyse the discourse of over 45,000 tweets related to the movement from its onset in June 2021 to March 2023. Using a mixed-methods approach that combines machine-learning, corpus-linguistic, and qualitative analysis methods, we aim to distil the factors that led to the movement’s considerable success. The fast growth of the movement was likely driven by the use of an easy-to-personalise action frame and the large variety of discussion topics, facilitating the involvement of different groups of academics across career levels and employment conditions. Our analysis of the linguistic characteristics of the discourse reveals largely positive, constructive, and active exchanges, in which many of the most salient keywords are lexical verbs. Our analyses offer an explanation for the continued involvement of many activists and the successful translation of solutions developed by the movement to news reports and proposed law amendments, despite an absence of coordination by any formal organisation.

Sensitivity and Specificity of a Signaling Question for Surveillance of Cognitive Functioning in Pediatric Sickle Cell Disease.

Sickle cell disease (SCD) confers neurological risks that contribute to cognitive and academic difficulties. Clinical guidelines state that cognition should be monitored using signaling questions. However, evidence is lacking regarding the extent to which signaling questions accurately identify children with cognitive issues. Caregivers of youth with SCD between ages 7 and 16years (n = 89) responded to a signaling question about their child's academic performance: "How would you rate your child's academic performance relative to their peers?" Response choices included below grade level, on grade level, or above grade level. Youth with SCD completed the Wechsler Intelligence Scale of Intelligence, Fifth Edition to assess cognitive functioning. Most children were described by caregivers as being on grade level (67%), followed by below grade level (21%), and above grade level (11%). Cognitive testing revealed that 36% of participants had a low IQ (≤85; i.e., ≥1 SD below the mean), 60% had an IQ within normal limits (86-114; i.e., <1 SD below or above the mean), and 4% had a high IQ (≥115; i.e., ≥1 SD above the mean). Academic performance grouping was significantly associated with differences across cognitive domains (all p<0.001). Cognitive functioning varied by academic grouping for younger (ages 7-11; all p≤0.002) but not older children (ages 12-16; all p≥0.05). The signaling question's sensitivity for identifying those with cognitive difficulties was low (42%-54%); specificity, negative predictive value, and positive predictive value estimates were acceptable (87%-93%, 74%-84%, and 53%-79%, respectively). Asking caregivers of children with SCD to report on academic performance is a simple method of monitoring cognition. Children rated as below grade level should be referred for cognitive screening or evaluation. However, this question will likely result in a high rate of false negatives, and additional questions may be necessary to determine when to refer patients without obvious academic concerns.