Evidence-based Assessment Research Articles

Designing a Reflective Assessment with Universal Design for Learning Principles: Insights from a Speech and Language Therapy Programme

Reflection is a requirement of the regulatory bodies for trainee and practicing Allied Health Professionals, making authentic reflection on practice a typical form of assessment in Higher Education professional programmes. The pessimism of reflective assessments from authors, working in HE motivated the scoping and design of an evidence-based assessment for reflection on the BSc Speech and Language Therapy Programme at De Montfort University. This paper presents a tripartite of challenges relating to the assessment discourse for professional programmes within a neoliberal University. First, the tension between professional and academic education is highlighted, addressing key themes from the debate around whether reflection can be assessed and how. Second, this is contextualised by the Higher Education Institutional national and local measures and the implementation of ‘assessment of’ and ‘assessment for learning.’ Third, the challenges of social mobility are presented given the high-stake responsibility for equitable learning and assessment. The principles of Universal Design for Learning (UDL) are therefore explored in the context of widening participation. In response to the literature, practitioner reflections have influenced the design of an assessment which is pedagogically sound but inviting for students. This assessment is presented to demonstrate how reflective assignments may allow for creativity, individuality, and real-life value, whilst also providing a holistic judgement of students’ skills. UDL is implicit to the project and rightly aims to reduce barriers in the curriculum and the learning environment to promote inclusivity and support all students to achieve.

Comparing clinical trial population representativeness to real-world populations: an external validity analysis encompassing 43 895 trials and 5 685 738 individuals across 989 unique drugs and 286 conditions in England

Randomised controlled trials (RCTs) inform prescription guidelines, but stringent eligibility criteria exclude individuals with vulnerable characteristics, which we define as comorbidities, concomitant medication use, and vulnerabilities due to age. Poor external validity can result in inadequate treatment decision information. Our first aim was to quantify the extent of exclusion of individuals with vulnerable characteristics from RCTs for all prescription drugs. Our second aim was to quantify the prevalence of individuals with vulnerable characteristics from population electronic health records who are actively prescribed such drugs. In tandem, these two aims will allow us to assess the representativeness between RCT and real-world populations and identify vulnerable populations potentially at risk of inadequate treatment decision information. When a vulnerable population is highly excluded from RCTs but has a high prevalence of individuals actively being prescribed the same medication, there is likely to be a gap in treatment decision information. Our third aim was to investigate the use of real-world evidence in contributing towards quantifying missing treatment risk or benefit through an observational study. We extracted RCTs from ClinicalTrials.gov from its inception to April 28, 2021, and primary care records from the Clinical Practice Research Datalink Gold database from Jan 1, 1998, to Dec 31, 2020. We referred to the British National Formulary to classify prescription drugs into drug categories. We conducted descriptive analyses and quantified RCT exclusion and prevalence of individuals with vulnerable characteristics for comparison to identify populations without treatment decision information. Exclusion and prevalence were assessed separately for different age groups, individual clinical specialities, and for quantities of concomitant conditions by clinical specialities, where multimorbidity was defined as having two or more clinical specialties, and medications prescribed, where polypharmacy was defined as having five or more medications prescribed. Population trends of individuals with multimorbidity or polypharmacy were assessed separately by age group. We conducted an observational cohort study to validate the use of real-world evidence in contributing towards quantifying treatment risk or benefit for patients with dementia on anti-dementia drugs with and without a contraindicated clinical speciality. To do so, we identified the clinical specialities that anti-dementia drug RCTs highly excluded yet had corresponding high prevalence in the real-world population, forming the groups with highest risk of having scarce treatment decision information. Cox regression was used to assess if the risk of mortality outcomes differs between both groups. 43 895 RCTs from ClinicalTrials.gov and 5 685 738 million individuals from primary care records were used. We considered 989 unique drugs and 286 conditions across 13 drug-category cohorts. For the descriptive analyses, the median RCT exclusion proportion across 13 drug categories was 81·5% (IQR 76·7-85·5) for adolescents (aged <18 years), 26·3% (IQR 21·0-29·5) for individuals older than 60 years, 40·5% (IQR 33·7-43·0) for individuals older than 70 years, and 52·9% (IQR 47·1-56·0) for individuals older than 80 years. Multimorbidity had a median exclusion proportion of 91·1% (IQR 88·9-91·8) and median prevalence of 41·0% (IQR 34·9-46·0). Concomitant medication use had a median exclusion proportion of 52·5% (IQR 50·0-53·7) and a median prevalence of 94·3% (IQR 84·3-97·2), and polypharmacy had a median prevalence of 47·7% (IQR 38·0-56·1). Population trends show increasing multimorbidity with age and consistently high polypharmacy across age groups. Populations with cardiovascular or otorhinolaryngological comorbidities had the highest risk of having scarce treatment decision information. For the observational study, populations with cardiovascular or psychiatric comorbidities had highest risk of having scarce treatment decision information. Patients with dementia with an anti-dementia prescription and contraindicated cardiovascular condition had a higher risk of mortality (hazard ratio [HR] 1·20 [95% CI 1·13-1·28 ; p<0·0001]) compared with patients with dementia without a contraindicated cardiovascular condition. Patients with dementia with comorbid delirium (HR 1·25 [95% CI 1·06-1·48]; p<0·0088), intellectual disability (HR 2·72 [95% CI 1·53-4·81]; p=0·0006), and schizophrenia and schizotypal delusional disorders (HR 1·36 [95% CI 1·02-1·82]; p=0·036) had a higher risk of mortality compared with patients with dementia without these conditions. Overly stringent RCT exclusion criteria do not appropriately account for the heterogeneity of vulnerable characteristics observed in real-world populations. Treatment decision information is scarce for such individuals, which might affect health outcomes. We discuss the challenges facing the inclusivity of such individuals and highlight the strength of real-world evidence as an integrative solution in complementing RCTs and increasing the completeness of evidence-based medicine assessments in evaluating the effectiveness of treatment decisions. Wellcome Trust, National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, NIHR Great Ormond Street Hospital Biomedical Research Centre, Academy of Medical Sciences, and the University College London Overseas Research Scholarship.

Social Isolation: Levels of Response for Nurse Practitioners

Although social isolation occurs across the lifespan, this article focuses on the unique challenges faced by the older adult population. Older adults are particularly sensitive to the health risks of social isolation. High-risk groups within the older adult population are minorities, immigrants, LGBTQ+, and victims of elder abuse. Nurse practitioners have the education and are poised to assess and intervene appropriately on social isolation at the primary, secondary, and tertiary levels of care. This article provides evidence-based assessment tools and resources for the nurse practitioner to use in clinical practice.

Evidence-based Risk Assessment of Ecological Damage due to Groundwater Abstraction; the Case of Doñana Natural Space, Spain

Many regions of the world are facing mounting water stress as competition increases for this vital resource that may become scarcer under future climates. More water is being allocated to our needs for food, public supply, hydro-electric power and industrial goods to support growing populations and mounting life-style expectations. To achieve this, less water is often being retained for water-dependent ecosystems. Environmental protection agencies and conservation organisations have highlighted the resulting threat to freshwater biodiversity and associated ecosystem services that support human livelihoods and well-being. Careful assessments are therefore required to advise on the optimum allocation of water and to determine the risk of developments that require redistribution of water resources.Along the northern fringes of the Guadalquivir River delta and estuary in southern Spain about 40% of all jobs derive from agriculture. The production of olives, fruit trees, rice and berries is a major component of the local economy producing large exports, but it requires significant water from local rivers and the underlying aquifers. The economy is also reliant on tourism that brings many thousands of people to the area in the summer for which groundwater abstraction is augmented. The delta is the location of the Doñana wetland complex of lagoons, marshlands, fixed and mobile dunes that was designated as a Biosphere Reserve by UNESCO in 1980, as wetland of international importance (Ramsar Site) under the Convention on Wetlands in 1982 and as a World Heritage Site by UNESCO in 1994. Fears have been expressed that increasing human water use is putting the wetlands at risk of drying out, despite efforts by the river basin authority to limit abstraction to sustainable levels.This paper reports on a methodology that analyses best available eco-hydrological scientific knowledge together with information on the likely success of abstraction control measures to determine the risk to the wetland ecosystem of current and future planned water allocation. The method was applied to Doñana by the joint UNESCO/IUCN/Ramsar Reactive Monitoring mission to in 2020. The results are also provided in the paper, which raised many important scientific and related political, legal and social issues concerning the impacts of water withdrawals on the ecology of the wetlands. The methodology has wide application to environmental water allocation assessments.

PHYSIOTHERAPISTS’ CURRENT KNOWLEDGE AND CLINICAL USE OF TOOLS TO PREDICT, MONITOR, EVALUATE THE TREATMENT OUTCOME AND CLASSIFY PATIENTS WITH SCIATICA IN GREECE: AN ONLINE SURVEY

Purpose: The use of evidence-based assessment tools is important to differentiate, give prognosis and guide the therapeutic approaches in sciatica. We aimed to evaluate whether physiotherapists’ knowledge and clinical practice in Greece are aligned with up-to-date research recommendations in the assessment of sciatica. Methods: An online-survey was developed, validated and disseminated in registered physiotherapists in Greece. The survey designed to capture physiotherapists’ demographic characteristics, knowledge and use of patient-reported outcome measures (PROMs), classification systems and neurological tests in sciatica. Descriptive statistics were used to analyze the data. Results: 381 physiotherapists participated in the survey. Most of the participants reported that at least one or more of the proposed PROMs (85.5%), classification system (87%) or neurological tests (95%). 75.6% of responders use one or more PROMs during the management of patients with sciatica. Pain intensity evaluation tools are the most commonly used (35.9%) followed by disability or psychosocial evaluation scales (25.9% and 22.5%, respectively). 38.8% of participants use the McKenzie classification while almost 90% use common neurological examination tests (myotomes, sensory tests, reflexes, straight-leg-raise, slump and femoral slump test). No association was found between participants’ characteristics and number of assessment tools known or used. Conclusions: Our findings suggest that physiotherapy practice in Greece is aligned to research recommendations only in terms of delivering common neurological physical examination tests. The knowledge and clinical use of evidence-based tools to assess the treatment outcome and classify patients with sciatica is limited. Further training and organizational or peer support are required to improve the management of the condition.

Family Needs Checklist: Development of a Mobile Application for Parents with Children to Assess the Risk for Child Maltreatment.

Child maltreatment (CM) has been enormously studied. However, a preventive practice still requires comprehensive and effective instruments to assess the risks for CM in a family context. The aim of this study is to describe the development process of an evidence-based CM risk assessment instrument (Family Needs Checklist, FNC) for primary prevention online utilization. This article reports the development process of the checklist and its mobile application, consisting of a systematic literature review, identification of known risk factors using the content analysis method, and generation of the checklist, including a multidisciplinary group in the design and feedback. As a result, a comprehensive and compact checklist was developed to be used by parents or caregivers as a self-referral instrument with an option to be used with professionals as a basis for joint conversations. The FNC consists of parental, family-, and child-related risk factors. Based on the international evidence, the online application consists of knowledge about different CM types, information about risk factors and protective factors as well as recommendations and guidance to support services. The FNC is based on robust evidence on known risk factors causing CM in families. It can be used for primary prevention utilization in the general population.

The Evidence-based Periodontal Risk Assessment (PRA) Tool for Nonsurgical Periodontal Therapy in a Comprehensive Periodontal Management by Risk Assessment (PEMBRA)

In the management of periodontitis patients, periodontal risk assessment (PRA) tool is currently being applied during periodontal review (PR). However, an assessment of risk profiles during examination and diagnosis (E&amp;D) may and would effectively assess and diagnose patients’ periodontal conditions, provide personalised treatment planning, and render an enhanced patient care through periodontal management by risk assessment (PEMBRA). From a retrospective study on selected records of 81 patients treated for chronic periodontitis, the PRA profiles of the patients were evaluated during E&amp;D and two to three months after completion of nonsurgical periodontal therapy (NSPT) during PR. The results were analysed using SPSS version 24 for descriptive statistics. On E&amp;D, the patients presented with 25.9% localised and 74.1% generalised chronic periodontitis. Of these, 2.5% of low-risk patients on E&amp;D increased to 21% during PR signifying an improvement after the treatment. However, the medium-risk patients have a slight increase from 32% to 35%, and patients with a high risk of 62% were reduced to 43%. The improvement of the risk profiles for both low and high-risk groups was mostly contributed by the reduction in the plaque score, percentages of bleeding on probing (BOP), and probing pocket depth (PPD) ≥ 5 mm. This evidence-based evaluation of PRA tool during E&amp;D and PR is important for PEMBRA as it encouraged the clinicians to adopt periodontal management through basic periodontal examination, detailed periodontal charting, radiographic interpretation, tooth per tooth prognosis, diagnosis, and targeted NSPT.

The Royal Canadian Mounted Police (RCMP) Study: protocol for a prospective investigation of mental health risk and resilience factors

The Royal Canadian Mounted Police (RCMP), like all public safety personnel (PSP), are frequently exposed to potentially psychologically traumatic events that contribute to posttraumatic stress injuries (PTSI). Addressing PTSI is impeded by the limited available research. In this protocol paper, we describe the RCMP Study, part of the concerted efforts by the RCMP to reduce PTSI by improving access to evidence-based assessments, treatments and training as well as participant recruitment and RCMP Study developments to date. The RCMP Study has been designed to (1) develop, deploy and assess the impact of a system for ongoing annual, monthly and daily evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; (4) augment the RCMP Cadet Training Program with skills to proactively mitigate PTSI; and (5) assess the impact of the augmented training condition (ATC) versus the standard training condition (STC). Participants in the STC (n = 480) and ATC (n = 480) are assessed before and after training and annually for 5 years on their deployment date; they also complete brief monthly and daily surveys. The RCMP Study results are expected to benefit the mental health of all participants, RCMP and PSP by reducing PTSI among all who serve.

Counseling Across Cultures: A Half-Century Assessment

As the Special Issue of the Journal of Cross-Cultural Psychology celebrates the 50th anniversary of the International Association for Cross-Cultural Psychology (IACCP), this article aims to summarize and track the development of counseling and psychotherapy in cultural contexts over the past half-century. When the edited volume, Counseling Across Cultures (CAC) first appeared nearly half a century ago, it sent an innovative message that culture matters in counseling and psychotherapy. The CAC editors produced six more updated editions in the succeeding years by 2016. The CAC authors examined the cultural context of accurate assessment, meaningful understanding of culture-relevant concepts, and appropriate interventions in each of the seven editions. They have surveyed universal and cultural aspects of counseling and psychotherapy according to such themes as emic and etic approaches to models of mental health, therapeutic relationships and techniques, assessment and interventions, and training needs against the IACCP’s ever-growing academic and professional activities. Research on the cultural adaptation of specific psychotherapies for specific clients should enhance access to culturally sensitive and evidence-based assessments and interventions. The need for training in multicultural awareness is expected to accelerate in the age of rapid globalization. This article affirms the contribution of the foundation-building approaches of CAC and the need for developing the interface between cross-cultural psychology and related clinical and counseling fields.

Evidence-based clinical psychological assessment (EBCPA): Review of current state of the literature and best practices.

Evidence-based clinical psychological assessment (EBCPA): Review of current state of the literature and best practices.

State of the Art Physiotherapist-Led Approaches to Safe Aging in Place

IntroductionSafe aging in place (SAIP) is when an older adult can successfully and comfortably remain in their home despite increasing barriers, including falls. Various physical, medical, psychological, and psychosocial factors may individually or cumulatively impact an older adult’s ability to safely age in place. Physiotherapists should assess not only items traditionally considered within their scope of practice but should select efficient and effective outcome measures to quantify other domains of health. A comprehensive geriatric assessment (CGA) is an evidence-based clinical assessment which identifies medical, psychosocial, and functional limitations of an older person. The CGA is useful to dictate individualized exercise/intervention prescription to address identified areas of increased risk.Purpose and importance to practiceThe purpose of this Masterclass is to describe key screening, assessments, and interventions to facilitate SAIP and to provide overviews of currently available programming and care delivery models applicable to physiotherapist practice.There are a wide variety of outcome measures and interventions that vary in depth, validity, and reliability. Measures selected for inclusion in this Masterclass were chosen based upon their clinical utility with respect to time and resource constraints and ease of administration during a comprehensive assessment for SAIP in community-dwelling older adults. Measures recommended for assessing physical function were the Short Physical Performance Battery, the Timed-Up-and-Go, the 30 second chair rise test, and the Four Test Balance Scale. Additionally, measures from the heath domain (e.g., Functional Comorbidity Index) and the environmental domain (e.g., Home FAST) are recommended. Relative to interventions, the Otago Exercise Program, motivational interviewing, home modifications, and leveraging technology are recommended. Partnerships with community-facing organizations facilitate utilization of resources for sustainable SAIP. The Home-based Older Person Upstreaming Prevention Physical Therapy (HOP-UP-PT) program is one approach led by physiotherapists framed in the screening, assessments, and interventions discussed in this Masterclass with strong scientific grounding.ConclusionPrograms integrating both community and healthcare approaches have the strongest evidence for their utility; however, implementation for these preventative approaches are lagging behind the increased need due to the substantial population growth of those over 65 years.

Radiographic Contrast Media and the Kidney.

AKI is a potential complication of intravascular iodinated contrast exposure. Contrast-associated AKI, which typically manifests as small and transient decrements in kidney function that develop within several days of contrast administration, is associated with serious adverse outcomes, including progressive kidney dysfunction and death. However, a causal link between the small increases in serum creatinine that characteristically occur with contrast-associated AKI and serious adverse outcomes remains unproven. This is important given mounting evidence that clinically indicated, potentially lifesaving radiographic procedures are underutilized in patients with CKD. This has been hypothesized to be related to provider concern about precipitating contrast-associated AKI. Intravascular gadolinium-based contrast, an alternative to iodinated contrast that is administered with magnetic resonance imaging, has also been linked with potential serious adverse events, notably the development of nephrogenic systemic fibrosis in patients with severe impairment in kidney function. Patients hospitalized in the intensive care unit frequently have clinical indications for diagnostic and therapeutic procedures that involve the intravascular administration of contrast media. Accordingly, critical care providers and others treating critically ill patients should possess a sound understanding of the risk factors for and incidence of such outcomes, the ability to perform evidence-based risk-benefit assessments regarding intravascular contrast administration, and knowledge of empirical data on the prevention of these iatrogenic complications.

An evidence-based assessment of IMO's short-term measures for decarbonizing container shipping

The International Maritime Organization (IMO) has recently adopted short-term measures introducing technical standards for existing ships and a labeling system reflecting their operational carbon intensity. This paper investigates the relevant techno-economic implications from a shipowner's perspective and estimates the effect of six compliance options on six sample containerships. The study applies a new evidence-based bottom-up approach, and the results show that compliance, when possible, is not straightforward and costly. Engine power limitation is the most cost-effective option, but low power limits can lead to substantially increased sailing times (up to 793.92 h/year), which can be prohibitive. The option favors older ships with oversized engines as its effectiveness is mainly determined by the main engine load profile. In general, the effectiveness of the measures is not without limits, particularly concerning older ships and those that have already installed several options. Solutions such as market-based measures and alternative fuels, classed by IMO as medium- and long-term measures, must be considered soon.

The CURB65 score predicted 180-day mortality of non-small cell lung carcinoma patients with immune checkpoint inhibitor-associated pneumonitis: A pilot retrospective analysis.

IntroductionThe immune checkpoint inhibitor-associated pneumonitis (CIP) is a particularly worrisome and potentially lethal form of immune-related adverse events. An objective and evidence-based assessment tool for evaluating the severity of CIP is in urgent need. CURB65 (consciousness, urea nitrogen, respiratory rate, blood pressure, and age) is a potential candidate to meet the need.MethodsA retrospective study was conducted to explore preliminarily if CURB65 could predict the mortality in non-small cell lung carcinoma (NSCLC) patients with CIP.ResultsA total number of 28 NSCLC patients with CIP were included in the current study and classified into low-CURB65 group (n = 21) and high-CURB65 group (n = 7). Mortality after onset of CIP was consistently higher in the high-CURB65 group than in the low-CURB65 group (30-day: 57.1% vs. 0; 90-day: 71.4% vs. 4.76%; 180-day:71.4% vs. 14.29%). Two patients (9.5%) in the low-CURB65 group had severe CIP, and more than half of patients in the high-CURB65 group had severe CIP (p = 0.0008). The patients in the high-CURB65 group received more aggressive treatment. Both groups showed a predominant organizing pneumonia-like pattern on CT scan. CURB65 was moderately correlated with the American Society of Clinical Oncology (ASCO) grade of CIP, with a Pearson correlation coefficient R of 0.524.ConclusionCURB65 accurately stratified the risk of mortality in NSCLC patients with CIP. CURB65 might complement the ASCO grade in the assessment and prediction of mortality in these populations.

Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach

Chronic pain remains a serious healthcare challenge, particularly for older adults who suffer substantial disability and are susceptible to serious risks from pain medications and invasive procedures. Psychotherapy is a promising option for older adults with chronic pain, since it does not contribute to medical or surgical risks. However, standard psychotherapies for chronic pain, including cognitive-behavioral therapy (CBT), acceptance and commitment therapy, and mindfulness-based interventions, produce only modest and time-limited benefits for older adults. In this article, we describe a novel, evidence-based psychological assessment and treatment approach for older adults with chronic pain, including a detailed case example. The approach begins with reviewing patients’ pain, psychosocial, and medical histories to elicit evidence of a subtype of chronic pain called centralized (primary, nociplastic, or psychophysiologic) pain, which is highly influenced and may even be caused by life stress, emotions, and alterations in brain function. Patients then undertake a novel psychotherapy approach called emotional awareness and expression therapy (EAET) that aims to reduce or eliminate centralized pain by resolving trauma and emotional conflicts and learning healthy communication of adaptive emotions. Our published preliminary clinical trial (n = 53) indicated that EAET produced statistically significant and large effect size advantages over CBT in pain reduction and marginally greater improvements in pain interference than CBT for older adults with chronic musculoskeletal pain. Geriatric mental healthcare providers may learn this assessment and treatment approach to benefit many of their patients with chronic pain.

The state of information infrastructure for global climate governance

PurposeThe world is facing global challenges that require international collaboration. This study aims to describe and analyze how digital technologies are applied in global governance to respond to such critical challenges.Design/methodology/approachThe authors apply an interpretive case study of climate reporting to the United Nations Framework Convention on Climate Change (UNFCCC) as a case of digitalization in global governance. It includes interviews with officials in the Swedish public administration and the UNFCCC secretariat to cover national and international levels. The authors describe the reporting process and analyze the role of information systems through the lens of information infrastructures.Findings“Information infrastructure” is a valuable instrument to understand digitalization in global governance as a complex interplay between information systems, information, standards, organizations, people and social structures. The level of sophistication is, however, basic with a large potential for improvement – for instance in analytical and communicative services to support evidence-based decision-making and assessment of progress.Research limitations/implicationsThe data collection is limited to one governance process: reporting. Future studies should complement the findings by broadening the scope to other processes. The authors propose that digital global governance is dependent on an effective information infrastructure, and that the five design principles by Hanseth and Lyytinen (2016) offer guidance when developing this.Practical implicationsThe results indicate a large unutilized potential of digital technologies to improve progress assessment, communicate more effectively with stakeholders and identify new ways of visualizing data to support decision making in global climate policy.Social implicationsUse of digital technologies, as suggested in the article, could strengthen the implementation capability of climate goals, which is of urgent need.Originality/valueWhile most research in digital governance considers the national or municipal level, this study provides empirical insight and theorization of digital technologies in a global governance setting.

"Evidence-based assessment and treatment of children and adolescents who misuse fire": Correction.

"Evidence-based assessment and treatment of children and adolescents who misuse fire": Correction.

Evidence-based assessment of acupuncture skills using a newly developed simulation-based test

ObjectiveAcupuncture is an efficient treatment modality for many different training, but the technique can be challenging to master. Identification of the different acupuncture points can now be practiced in a standardized and patient-safe simulation-based environment. We aim to gather additional evidence regarding simulation-based training of acupuncture skills and hope that the simulation-based test developed and will be used for simulation-based mastery learning in future develop. MethodsThe aim of this study was to develop a test of acupuncture skills using the TCM (Traditional Chinese Medicine) Meridians & Acupoints Anatomy Teaching Platform and gather validity evidence using Messick's framework. Novice medical students without prior experience in acupuncture (n = 43), intermediate medical students who had finished the mandatory acupuncture course (n = 24), and skilled acupuncture doctors (n = 17) were included in the study. One-hundred and seven acupuncture points were presented to the participants in identical randomized order and they were asked to identify each point by touching the correct anatomical location on the simulator. The simulator automatically registered the accuracy of participants’ answers. ResultsThe reliability of the final test (66 acupuncture points) was at a high level with a Cronbach's alpha of 0.98 and only 16 acupuncture points were needed to ensure a reliability of 0.90. The test could discriminate significantly between all three groups and a credible pass/fail-score of 34 points was determined which resulted in eight out of 43 (19%) novices passing the test and only two out of 17 (12%) experienced failing the test. These consequences were statistically significant (P < 0.001). ConclusionBased on Messick's framework we demonstrated strong validity evidence for a newly developed simulation-based test of acupuncture points localization skills. The test can be used as an aid to decide when trainees are ready to progress to more advanced training and clinical practice. Compared with the traditional point-point test, the point-point evaluation of the simulator can be more objective and reduce the effort of teachers.

Is there an ideal curriculum and pedagogy to achieve an optimal One Health practitioner capable of contributing to the growing expectations for One Health?

The looming challenges of pandemic recovery, climate change emergencies, species extinction, and growing food insecurity are driving calls for more One Health to “do more.” To address these calls, it is reasonable to anticipate an explosion in One Health training programs. Many One Health educational efforts were originally designed in response to emerging zoonotic diseases. As the scope of practice of One Health grows, the breadth of knowledge, skills, and attitudes to be cultivated through education and training also grows. Many One Health programs created in the early days of One Health could not benefit from the experiences of years of applying One Health in practice that exist today. Few One Health programs have been systematically evaluated to see if or how their structure or curriculum empowers learners to be effective One Health researchers or practitioners. We invite authors to provide evidence-based assessments of the impacts of different means, methods, and targets for training and/or systematic assessments of educational theory to help answer the Question, “is there an ideal curriculum and pedagogy to achieve an optimal One Health practitioner capable of contributing to the growing expectations for One Health?”

Evaluating the Impact of Freeway Service Patrol on Incident Clearance Times: A Spatial Transferability Test

Freeway service patrol (FSPs) programs have been considered as an effective tool for traffic incident management in minimizing the adverse effects of traffic incidents. In this study, random parameters hazard-based duration modeling method was used to evaluate the impact of the newly implemented Alabama Service and Assistance Patrol (ASAP) program, using incident clearance time as a performance measure. It was determined that there is a statistically significant difference in the factors that influence incidents clearance times between incidents that occurred inside and outside the ASAP regions. A total of five variables (on-road, nighttime, peak hours, rain, and fire response present) were observed to have random effects along with ten fixed effects variables on incidents occurring inside the ASAP regions. On the other hand, incidents that occurred outside the ASAP regions were found to have three random effects variables (on-road, nighttime, and fire response present) and seven fixed effects variables. The estimation results indicate a significant association of incident clearance times to incident related variables such as involvement of CMVs, fatality, vehicle towing, seat belt indicated as involved, and on-road incidents that occurred both inside and outside the ASAP regions. The results also reveal that incident clearance times are influenced strongly by temporal variables (e.g., nighttime), traffic factors (e.g., AADT), and operational variables (e.g., fire response present) for incidents both inside and outside the ASAP area models. Overall, it was observed that the incident clearance times recorded in the regions where the ASAP program is in effect are significantly different. The findings of this study are expected to be useful for the state traffic incident management (TIM) agencies in developing and executing strategies to minimize incident clearance times. Ultimately, the study provides a data-driven evidence-based assessment of the ASAP program in the state.