Answer Format Research Articles

Testimony of Professor Katharine Van Tassel, Patient Dumping Briefing, U.S. Commission on Civil Rights, Panel III: Scholars Panel

Chairman Castro and other esteemed members of the Commission, thank you for inviting me to submit this written statement on the very important issue of the effectiveness of the Emergency Medical Treatment and Labor Act in preventing the practice of patient dumping. Patient dumping refers to the situation where hospitals, states and/or localities prematurely discharge or transfer certain patients in need of emergency care, typically uninsured, mentally disabled, and minority individuals. My name is Katharine Van Tassel. I am a Professor of Law at the University of Akron School of Law where I am also the Director of the Public Health Law & Science Center and the Health Law Program. One of my main areas of research involves the legal standards that are used to measure healthcare quality, cost, and equal access. My Statement is directed to two of the four topics that the Commission has asked the panel of academics to speak upon: (1) what policies are in place to detect potential violations of the law; and, (2) whether hospital policies governed by the Act should be revised to ensure the protection of patient's rights. For your convenience, this Statement starts with an overview of its basic points in a two-page question and answer format.

P69 ‐ Development and evaluation of CARATKids, Control of Allergic Rhinitis and Asthma Test for children

Evaluation Prospective multicenter validation study. In a 2 visits program scheduled 3-5 weeks apart, questionnaires (including cACT) and VAS were filled by children with ARA and their caregivers. Physicians blinded for questionnaire results assessed children’s ARA status. Logistic regression and reliability analysis were used to select the questions to be included in CARATKids final version; and discriminative properties, reliability and validity were evaluated. Results Development A 17-item preliminary version with dichotomous (Yes/ No) answer format accompanied by illustrative drawings was produced.

Knowledge of Acne among Medical Students: Pretest and Posttest Assessment

Background. Acne vulgaris is a disorder of sebaceous glands mainly affecting the adolescent population. There are some misconceptions about acne not only in the general population but also among the medical students. Methods. Second year medical undergraduate students attending dermatology postings for the first time were included in the study. A questionnaire (in yes or no answer format) with 20 questions on acne, each carrying one mark, was to be answered by the students. The students were categorized into 4 grades based on the marks obtained: Grade I 90% marks and above, Grade II 75%–90%, Grade III 50%–74%, and Grade IV <50% marks obtained. Results. Of the 144 students of the batch, 95 (69.5%) completed both pretest and posttest questionnaires. The average pretest score was 14.1 and that of the posttest was 16.9. The percentage of improvement in mean score from pretest to posttest was 16.5. Fischer's exact test was applied to analyze the improvement in scores between pretest and posttests which is significant at P = 0.015 (P < 0.05). In the paired t-test the improvement in mean scores between pretest and posttest was significant at P < 0.001.

Mutual Recriminations: God and Israel in the Book of Malachi

ABSTRACTFrom the time that Pfeiffer’s work on the structure of the Book of Malachi was published, scholars have divided the Book into six oracles with a common question/answer answer format. Most scholars attempt to identify the genre of the oracles and their sitz im leben according to this struc-ture. However, scholars have overlooked one basic feature connected with this format in the Book of Malachi, a feature that has significant ramifications for the understanding of the book. Examining the content of the questions and answers, we discover that they fall into two different categories, one in which the prophet rebukes the people and the people attempt to justify their actions (in the second, third, and fifth oracles), and one in which the main accusation is made by the people against God, while God justifies Himself against the people’s accusations (in the first, fourth, and sixth oracles). Having made this distinction, we can understand more clearly the principle on which the whole book is based. The oracles of Malachi reflect a breach in the covenantal rela-tionship between God and the people that is expressed through mutual accu-sations. The prophet seeks to repair this breach through a message designed to renew and strengthen the people’s feeling that God is committed to the cove-nantal relationship with Israel.

Including Don't know answer options in brand image surveys improves data quality

How do respondents use the Don't know answer option in surveys? We investigate this question in the context of brand image measurement, using an experimental design with about 2,000 respondents and, for the first time, considering a range of commonly used answer formats. Results indicate that Don't know options are primarily used when respondents genuinely cannot answer the question, as opposed to representing a quick, low-effort option to complete a survey. Two practical conclusions arise from this study: (1) a Don't know option should be offered in cases where it is expected that some respondents may be unfamiliar with some brands under study; and (2) answer formats without a midpoint should be used in brand image studies because midpoints can either be falsely misinterpreted as an alternative to ticking the Don't know option, or used as an avenue for respondent satisficing.

A Simple Approach of Low Back Pain

Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to current clinical studies guidelines. Our objectives are to define LBP, to establish how to take a detailed history and how to physically examine it in order to enable physicians to make an appropriate differential diagnosis for LBP, and to identify relevant investigations and referrals of patients with LBP. The article first offers a quick description of inflammatory back pain then discusses the importance of screening red flag patients with LBP and the importance of its early detection. Finally, we summarize how to outline a primary plan for managing and treating LBP. The article is prepared in the format of question and answer to make it targeted and accessible.

Progress Testing for Medical Students at the University of Auckland: Results from the First Year of Assessments

Background Progress testing is a method of assessing longitudinal progress of students using a single best answer format pitched at the standard of a newly graduated doctor. Aim To evaluate the results of the first year of summative progress testing at the University of Auckland for Years 2 and 4 in 2013. SUBJECTS: Two cohorts of medical students from Years 2 and 4 of the Medical Program. Methods A survey was administered to all involved students. Open text feedback was also sought. Psychometric data were collected on test performance, and indices of reliability and validity were calculated. Results The three tests showed increased mean scores over time. Reliability of the assessments was uniformly high. There was good concurrent validity. Students believe that progress testing assists in integrating science with clinical knowledge and improve learning. Year 4 students reported improved knowledge retention and deeper understanding. Conclusion Progress testing has been successfully introduced into the Faculty for two separate year cohorts and results have met expectations. Other year cohorts will be added incrementally. Recommendation Key success factors for introducing progress testing are partnership with an experienced university, multiple and iterative briefings with staff and students as well as demonstrating the usefulness of progress testing by providing students with detailed feedback on performance.

Validity and reliability of the Mexican scale of sleep quality

Since 1988, Pittsburgh Sleep Quality Index has been used to evaluate sleep quality in healthy subjects and patients with sleep disorders and comorbidity; however have different faults concerned to items that ask about insomnia complaints caused by climatic issues, and PSQI have not categories of severity apart from good or bad sleep quality. The aim was to determine reliability and validity of the Mexican Scale of Sleep Quality (MSSQ). This was a prospective, psychometric research. In a consensus of experts were selected 18 items as a first version of the MSSQ. The MSSQ includes items related to nocturnal and diurnal symptoms; it was applied to 70 students in a pilot study in Xalapa city, Mexico. The first studied group was integrated by 35, male and female, between 18 and 24 years old; and 35 subjects older than 25 years. With these data we delete some items and corrected format of answers. In a second pilot study we applied the corrected scale to 60 participants between 18 and 50 years old. With the aim to determine the most adequate items we developed a logistic regression model, performed a exploratory factorial analysis (principal component analysis) and evaluate reliability with the Cronabch’s alpha test. In the MSSQ, the total lowest score is 0 (the best sleep quality) until 65 indicating the worst sleep quality. We propose the following 5 categories according the total score: Good Sleep Quality, and Bad Sleep Quality (BSQ) of mild, moderate, severe and extremely severe intensity. According to reliability, in the first pilot study we determined an acceptable but low Cronbach‘s alpha of 0.68, but with the second sample Cronbach‘s alpha was 0.81. Concerned to construct validity, with an exploratory factorial analysis we found that only three factors obtained an eigenvalue equal or more than one; and explains 61.7% of the variance. These three factors were named diurnal symptoms, sleep quality and nocturnal sleep duration. MSSQ has been developed with a consensus of experts, classical psychometrics procedures and mathematical models. With relatively two small samples of students the new scale obtained very acceptable psychometric values. We pretend to increase sample size, including patients with diagnosis of sleep disorders (using PSG records), and test concurrent validity performing correlations with another good accepted scales such as Epworth Sleepiness Scale, Athens Insomnia Scale and the SF-36. National council of science and technology, México, Veracruzana University and National Autonomous University of Mexico.

CFTC staff finalizes guidance on anti-disruptive trading practices

Purpose – The Dodd-Frank Act added a number of prohibited trading practices on futures markets and swap execution facilities. In May 2013, the CFTC issued guidance on how it intends to interpret these prohibitions. Persons trading on these facilities should understand the guidance and how it affects their trading activities. This article aims to focus on the issues. Design/methodology/approach – The article analyzes the prohibitions and the CFTC's related guidance using a question and answer format to make it accessible to affected market participants. Findings – The new trading prohibitions include spoofing, violating bids and offers, and recklessly disregarding an orderly close. Different standards of scienter (state of mind) apply to each. Intent is required to violate the anti “spoofing” provision; recklessness is required to violate the disregarding the orderly close provision, but no finding of intent is required for violating bids or offers. The CFTC will evaluate the facts and circumstances at the...

Analysis of use of a single best answer format in an undergraduate medical examination.

Examinations at the Faculty of Medicine of Mu'tah University are based on a single best answer multiple-choice questions (MCQs) format. However, the reliability of this examination format has not been determined. Objective: Using an examination of obstetrics and gynaecology as a model, this study aims to analyze the difficulty (facility) index, the discriminatory power and reliability of the examination format. Materials, Subjects and Methods: A prospective study on the psychometric performance was carried out for an undergraduate examination in obstetrics and gynaecology. The performance of the items was measured in terms of facility, discrimination and reliability. Two statistical tests were used to estimate the reliability of the exam: The Kuder-Richardson Formula 20 (KR-20) and the Cronbach alpha test. Results: The items scored well in facility with a significant portion (26%) achieving a positive point biserial of over 0.3 and a Cronbach alpha score of 0.947. However, 23% of the items had a negative point biserial and the Kuder-Richardson 20 (KR20) score was only 0.599. Conclusion: In order to improve the reliability of examinations, we recommend removing the items with negative point biserials and increasing the total number of items.

The Use of Likert Scales With Children

We investigated elementary school children's ability to use a variety of Likert response formats to respond to concrete and abstract items. 111 children, aged 6-13 years, responded to 2 physical tasks that required them to make objectively verifiable judgments, using a 5-point response format. Then, using 25 items, we ascertained the consistency between responses using a "gold standard" yes/no format and responses using 5-point Likert formats including numeric values, as well as word-based frequencies, similarities to self, and agreeability. All groups responded similarly to the physical tasks. For the 25 items, the use of numbers to signify agreement yielded low concordance with the yes/no answer format across age-groups. Formats based on words provided higher, but not perfect, concordance for all groups. Researchers and clinicians need to be aware of the limited understanding that children have of Likert response formats.

Explicit versus implicit social cognition testing in autism spectrum disorder

Although autism spectrum disorder is defined by reciprocal social-communication impairments, several studies have found no evidence for altered social cognition test performance. This study examined explicit (i.e. prompted) and implicit (i.e. spontaneous) variants of social cognition testing in autism spectrum disorder. A sample of 19 adolescents with autism spectrum disorder and 19 carefully matched typically developing controls completed the Dewey Story Test. ‘Explicit’ (multiple-choice answering format) and ‘implicit’ (free interview) measures of social cognition were obtained. Autism spectrum disorder participants did not differ from controls regarding explicit social cognition performance. However, the autism spectrum disorder group performed more poorly than controls on implicit social cognition performance in terms of spontaneous perspective taking and social awareness. Findings suggest that social cognition alterations in autism spectrum disorder are primarily implicit in nature and that an apparent absence of social cognition difficulties on certain tests using rather explicit testing formats does not necessarily mean social cognition typicality in autism spectrum disorder.

Comparing Diagnostic Performance and the Utility of Clinical Vignette-Based Assessment Under Testing Conditions Designed to Encourage Either Automatic or Analytic Thought

Although decades of research have yielded considerable insight into physicians' clinical reasoning processes, assessing these processes remains challenging; thus, the authors sought to compare diagnostic performance and the utility of clinical vignette-based assessment under testing conditions designed to encourage either automatic or analytic thought. This 2011-2012 multicenter randomized study of 393 clinicians (medical students, postgraduate trainees, and faculty) measured diagnostic accuracy on clinical vignettes under two conditions: one encouraged participants to give their first impression (FI), and the other led participants through a directed search (DS) for the correct diagnosis. The authors compared accuracy, feasibility, reliability, and relation to United States Medical Licensing Exam (USMLE) scores under each condition. A 2 (instructional condition) × 2 (vignette complexity) × 3 (experience level) analysis of variance revealed no difference in accuracy as a function of instructional condition (F[1,379] = 2.44, P = .12), but demonstrated the expected main effects of vignette complexity (F[1,379] = 965.2, P < .001) and experience (F[2,379] = 39.6, P < .001). Pearson correlations revealed greater associations between assessment scores and USMLE performance in the FI condition than in the DS condition (P < .001). Spearman-Brown calculations consistently indicated that alpha ≥ 0.75 could be achieved more efficiently under the FI condition relative to the DS condition. Instructions to trust one's first impres-sions result in similar performance when compared with instructions to consider clinical information in a systematic fashion, but have greater utility when used for the purposes of assessment.

Dynamic, Interactive Survey Questions Can Increase Survey Data Quality

ABSTRACT Survey research is critical to the development of knowledge and market insight in hospitality and tourism. Survey research quality depends on the willingness of respondents to participate, and this is decreasing. The recent development of dynamic, interactive online survey question formats may contribute to solving this problem by making surveys more engaging for respondents. To the best of the authors' knowledge, this is the first study which compares traditional and dynamic interactive answer formats using objective and subjective assessment criteria. Results indicate that using a simple dynamic, interactive question in a study on tourism and quality of life improved the objective quality of the data and made the survey experience easier and more fun for respondents, thus leading to higher quality data for users of market research on this topic. Given the wide variety of dynamic question formats, users of market research data need to, however, assess on a case-by-case basis if survey questions are merely more entertaining or whether they indeed increase the validity of data.

Treatment resistant depression in primary care: Co-constructing difficult encounters

Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients' atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings.

How risky? The impact of target person and answer format on risk assessment

The present research examined the influence of different risk perspectives by the use of four different target persons (who could be affected: abstract person, self, specific person, and specific others) and of four different questionnaire answer formats (rating, open percentage, open, and closed frequency) on risk assessments. It was assumed that subjects use two different systems in terms of probabilistic reasoning: a distributional approach for abstract targets leading to higher risk estimates and a singular approach for specific targets leading to lower risk assessments. According to unrealistic optimism (UO) research (showing higher risk assessments for an abstract person than for self), the assumption was that risk assessments for a specific (named) target lead to lower risk assessments compared to an abstract target. Further, common quantitative answer formats for assessing risk were compared to explore differences in risk estimates. The hypotheses were tested using data of a sample of 512 students from a Bavarian university. The frequently confirmed finding of UO could be replicated with both rating scale and open frequency scale, which appeared to be more sensitive compared to the other used scales. However, UO disappeared when the comparison target was specific. Further, risk assessments for an abstract target were highest within every answer format and lowest for specific targets. Furthermore, results revealed that the type of answer format has a moderating effect on the extent of the influence of risk perspective on risk assessments. Overall, this study gives evidence that both the chosen scale and the risk perspective strongly influence risk assessments. Results aim to contribute to the research fields of quantitative assessment of perceived risk. They suggest that probabilistic reasoning in regard to risk not only underlies motivational or cognitive ego-defensive mechanisms but is rather presumably caused by the use of different systems of inferential strategies.

The law on hate crime

PurposeThe purpose of this paper is to inform readers about the Law Commission's review of hate crime offences and provide information on key stages. At the time of writing the review is at consultation stage and people are being invited to participate in this process.Design/methodology/approachThe paper is structured in a question and answer format and provides an overview of existing hate crime offences and the stages of the Law Commission's review.FindingsThe consultation will consider the effect of the Law Commission's review of hate crime law on people with disabilities.Originality/valueThe author is a member of the Law Commission's criminal law team and answers questions on what's involved in the consultation process. The Law Commission wants to make sure that people who could be affected by any changes to the law on hate crime have their say.

AB0560 Performance characteristics of response scales of activity and function measures of ankylosing spondylitis in turkish: numerical rating scale vs visual analog scale

BackgroundBath ankylosing spondylitis disease activity index (BASDAI) (1) and Bath ankylosing spondylitis functional index (BASFI) (2) are frequently used self-reported measures of disease activity and function. Previously we showed the...

Taking a SecondLook™ at teaching histology – Development of a self‐evaluation iPad application

As today's generation of students gravitates more and more to electronic teaching resources that are interactive and provide efficient feedback, I developed an iPad app that allows students studying histology to test their knowledge before participating in quizzes and exams. This iPad app called “Michigan eHistology – A SecondLook™ Series” is based on 28 PowerPoint files that cover all aspects of human histology. In two surveys to which 289 Michigan M1 students, who used the SecondLook™ PowerPoint files, responded, 95.8% named this resource as one of the three most valuable learning resources available to them. The second most valued histology learning resource was attending the lectures in person, which was named by 34.9% of all respondents. Both SecondLook™ formats allow students to efficiently gauge their level of histology knowledge in a free question–answer format, with the iPad app version offering some additional performance enhancing features, like a progress indicator and slide randomizer (see http://www.med.umich.edu/lrc/secondlook/).Supported by a Teaching with Technology Institute award from the University of Michigan Center of Research on Learning and Teaching (CRLT)

How Simple Can it Get? Measuring Pain With NRS Items or Binary Items

In the postoperative setting, functional interference of pain is an important outcome parameter. It can be measured by numerical rating scales (NRS) and by binary items (yes/no). For implementation, dissemination, and practicability in clinical routine, not only psychometric characteristics but also patients' acceptance of assessment methods is important but has not been studied so far. To compare these 2 answer formats, the pain interference questions of the German initiative Quality Improvement in Postoperative Pain Management, a multicentric pain registry project, were used. Psychometric quality, clinical significance, and patients' preferences were analyzed in NRS and binary formats of pain interference assessments. Responses from 430 patients in 3 surgical disciplines (abdominal, orthopedic/trauma, and oromaxillofacial surgery) were examined. The results indicate a satisfactory reliability and validity of both answer formats. They achieve equal test-retest reliability (0.724 to 0.885) and construct validity (identifying significant differences between the 3 surgical disciplines). The binary "no interference" answer consistently corresponds to NRS values of 0 to 2. The means in 3 pain intensity measures differ significantly for the groups of patients with or without pain interference. Two third of the patients prefer to answer to binary items. Binary answer format was proven to be a practical alternative to the NRS format for a screening instrument. Comparison of binary answers with NRS answers can improve our understanding of the clinical relevance of patients' statements. Most patients prefer the use of the binary answer format.