Individual Test Research Articles

Team-based Learning (TBL) in Medical Education: Fostering Collaboration and Enhancing Learning Outcomes

ABSTRACT Background and Aim: Team-based learning (TBL) is an instructional strategy that has gained popularity in various educational settings, including anatomy courses. It is an active learning approach that encourages students to work collaboratively in small teams to solve problems, discuss concepts, and apply their knowledge. Therefore, the purpose of this study was to assess how well students engaged with and learned about anatomy through the medium of TBL. Materials and Methods: The current study was carried out for phase I MBBS students in the Department of Anatomy at KAHER’s J N Medical College, Belagavi. TBL sessions included 65 students. One week prior, students were provided pertinent reading materials for the gross anatomy topics that were chosen. The Pre-TBL test, which was composed of five MCQs based on case scenarios, was administered before the start of the session. Students completed the Individual Readiness Assurance Test (IRAT), which had ten multiple-choice questions (MCQs) at the start of the class. The students were then put into groups where they collaborated on the same MCQs, talked about the topics, and provided identical answers. This is called the Group Readiness Assurance Test (GRAT). A post-TBL test was given after the case scenario discussion to wrap up the session. This test’s questions were the same as those on the Pre-TBL. Results: The effect sizes provide insights into the magnitude of change observed between pre-TBL and post-TBL test scores. In this study, significant statistical differences were found between pre and post-TBL tests across all sessions [Table 1, P < 0.001], indicating larger effect sizes associated with more significant improvements in learning outcomes attributed to TBL. This aids in interpreting the statistical significance of the results. Conclusion: TBL can help students achieve academic success through teamwork. Study revealed that TBL is one of the most effective ways to teach anatomy and can complement traditional didactic lectures.

The Impact of Two-Stage Testing and Other Tutorial Co-Learning Activities on Cohort Cohesion and Learning Outcomes in a Large-Enrollment Undergraduate Course

Large enrollments in undergraduate courses pose several teaching and learning challenges that impact students’ learning experience and performance. Implementing co-learning activities in tutorials of large courses can help mitigate these challenges and improve the learning environment. One type of collaborative learning activity that has become increasingly popular is two-stage testing but there are limitations to how two-stage testing has been conducted. We undertook a study to elucidate whether our modified two-stage testing protocol and other co-learning activities performed in tutorials can enhance the learning experiences of undergraduate students and foster a sense of community in a large-enrollment research methods course. The specific aims of our study were to: 1) Assess whether co-learning activities including two stage testing in tutorials improves learning outcomes and fosters cohort cohesion in a large-enrollment junior undergraduate science course. 2) Evaluate the impact of our modified two-stage testing approach on student learning and long-term retention. To assess cohort cohesion students were asked to complete a survey and were invited to participate in focus groups. Results indicated that tutorials did foster cohort cohesion among students in the tutorial. The tutorial activities helped scale down the course size and connect with their peers. We tested our modified two-stage testing protocol by administering a two-stage test (an individual test consisting of short-answer questions followed by a group test that was comprised of a subset of the individual test questions that was completed during tutorials). Approximately three months after the individual test, a retention test was administered. Student grades were significantly higher in group tests compared to the individual tests. Interestingly, students on average scored 6.2% higher on the retention test questions that were from the group test, compared to questions that were only on the individual test. These results support the idea that group tests help improve student retention. Students reported tutorials and two-stage testing to be a positive learning experience.

Effects of exercise on autonomic cardiovascular control in individuals with chronic, motor-complete spinal cord injury: an exploratory randomised clinical trial.

Secondary analysis of a clinical trial. To assess the impact of 6 months of armcycle ergometry training (ACET), or body weight-supported treadmill training (BWSTT), on autonomic cardiovascular responses to a laboratory sit-up test (SUT) in individuals with chronic (≥1-year post-injury) spinal cord injury (SCI). Tertiary Rehabilitation Centre, Vancouver, Canada. Sixteen individuals with motor-complete (American Spinal Injury Association Impairment Scale A-B) SCI between the fourth cervical and sixth thoracic spinal cord segments, aged 39 ± 11 years, were assessed. Participants were randomized to receive 72 sessions of moderate-to-vigorous intensity ACET (n = 8) or passive BWSTT (n = 8). Changes in mean arterial pressure (finger plethysmography), hemodynamics (Modelflow® method), and heart rate/heart rate variability (HR/HRV; electrocardiography) were measured in response toa SUT before and after 6 months of exercise training. Spontaneous cardiovagal baroreflex sensitivity (cvBRS) was assessed using the sequence method. Neither ACET nor BWSTT impacted hemodynamic responses to SUT or the incidence of orthostatic hypotension (all P > 0.36). ACET increased HR (P < 0.01, ηp2 = 0.34) and high frequency (HF) power HRV responses (P < 0.01, ηp2 = 0.42) to SUT following 6 months of training while BWSTT did not. Consistent with this, cvBRS improved (P < 0.05, ηp2 = 0.16) only following ACET. Improvements in cvBRS were correlated with both the HR (r = 0.726, P < 0.0001) and HF power (r = -0.484, P < 0.01) responses to SUT. Six months of ACET, but not BWSTT, improved cardiovagal baroreflex control of HR but had no effect on BP responses to SUT in individuals with chronic, motor-complete SCI. Canadian Institutes of Health Research (CIHR) CLINICAL TRIAL REGISTRATION: NCT01718977.

Analysing Discrimination based on Genetic Information

This paper analyzes and critiques existing literature on discrimination based on genetic information collected during genetic tests of individuals and the legal issues attached therewith. Genetic variations, which can lower or raise disease risk, result from the inheritance of parental genes. Subjecting individuals to stigmatization based on their unique ancestry or genetic status raises legitimate concerns. The literature review reveals that the issue of discrimination based on genetic information has occurred in countries like the United States and Canada. Accordingly, concerns regarding new forms of discrimination arising from the collection of information during genetic testing have grown over the decades in the wake of technological advancements in biotechnology, health, and allied sciences, as several studies have revealed. On the contrary, more material sufficiency in India necessitates consulting data from various disciplines. A conceptual framework is proposed to examine the theoretical foundations of non-discrimination provisions, compare genetic information non-discrimination legislation in the United States and Canada to India, and evaluate the practicality of implementing such laws in India. The initial testing of this framework suggests that due to insufficient legislation, there may be a need for enforceable measures to mitigate genetic information-related discrimination in India. The research problem requires qualitative research to gain an in-depth comprehension of experiences, phenomena, and context. This paper makes two main contributions: establishing a comprehensive background to allow comparisons by scholars and policymakers on the matter and helping to further the debate on the subject to generate value-based research regarding the ethical, legal, and social impacts of genetic research and anti-discrimination laws.KEYWORDS: Non-discrimination, Genetics and law, Literature review, Genetic discrimination.

Competitive sorption of CH₄ and CO₂ on coals: Implications for carbon geo-storage

Geological carbon storage, particularly within coal seams, is recognized as a viable strategy for achieving net-zero emissions. However, following CO₂ injection into the coal seam, limited studies have addressed the competitive sorption dynamics of CH₄ and CO₂ on coal, despite the natural presence of CH₄ in these formations. In this work, sorption experiments were conducted using two types of coal: sub-bituminous coal and anthracite. Initially, pure CH4 and CO2 gases were employed to conduct individual sorption tests. Subsequently, the competitive sorption of CH4 and CO2 was evaluated using pre-mixed binary gas mixtures with varying CH4/CO2 ratios. Further, the displacement effect of CO2 on CH4 was investigated by injecting CO2 into coal samples that had been pre-adsorbed with CH4. The data reveal that, for both coals, the ideal selectivity calculated from pure gas measurements underestimates the corresponding values from real multicomponent systems. Anthracite demonstrates a higher selectivity for CO₂ over CH₄ during both adsorption and desorption processes when compared to the ideal selectivity calculated from pure gas sorption data. Conversely, the sub-bituminous coal initially shows lower selectivity for CO₂ than for CH₄ during adsorption, but this trend reverses and intensifies during desorption. If competitive sorption effects are neglected, coal selectivity for CO₂ over CH₄ under the examined conditions would be underestimated by a factor of 1.5 to 2.5. Due to the competitive sorption effects between CH₄ and CO₂, the Langmuir equilibrium constants for gas mixtures are influenced by compositional changes, leading to dynamic deviations from those observed under pure gas conditions. This finding contrasts with the traditional extended Langmuir model, which presumes that the equilibrium constants remain unchanged regardless of gas composition. In addition, the displacement study underscores the efficacy of CO2 in displacing CH4, with higher CO2 ratios intensifying displacement effects. The study highlights the substantial impact of real multicomponent scenarios on coal selectivity for CO₂ and CH₄, offering deeper insights into predicting competitive sorption behavior between CO₂ and CH₄ during CO₂-enhanced coalbed methane recovery and carbon storage processes.

Blood pressure behavior during exercise in patients with diastolic dysfunction and a hypertensive response to exercise.

A hypertensive response to exercise is a precursor leading to hypertension, which is a major risk factor for the development of heart failure and diastolic dysfunction. Herein, we aimed to assess blood pressure (BP) in patients with a hypertensive response to exercise and different degrees of diastolic dysfunction. Between January 2009 and December 2014, 373 patients with a hypertensive response to exercise (HRE) and echocardiographic data assessing diastolic function were enrolled at the University Hospital of Zurich. ANCOVA was used to assess the changes in BP response during exercise testing in individuals with different degrees of diastolic dysfunction. Normalization of systolic BP was blunted in patients with grade II and III diastolic dysfunction after 3 min of recovery in univariable [β (95%) - 9.2 (-13.8 to - 4.8) p<.001, -16.0 (-23.0 to 9.0) p<.001, respectively] and adjusted models. In fully adjusted models, when taking maximal effort into account, there were no differences with regard to systolic BP during exercise. Patients without diastolic dysfunction achieved higher heart rates (HRs) [both in absolute terms (p<.001) and as a percentage of the calculated maximum (p=.003)] and greater wattage (p<.001) at maximum exertion. The findings of this cross-sectional study suggest that exercise capacity is compromised in patients with diastolic dysfunction. A hypertensive response to exercise and the finding of a blunted BP recovery may help identify patients at risk of developing heart failure.

PENGEMBANGAN MEDIA PEMBELAJARAN BERBASIS ISPRING SUITE PADA MATERI BANGUN RUANG SISI DATAR

This research aims to develop ispring suite-based learning media on flat side space building materials reviewed from the aspects of feasibility, practicality and effectiveness. The research uses the R&amp;D method, namely (Research and Development), and uses the ADDIE learning design model (Analysis, Design, Development, Implementation and Evaluation). The media developed uses ispring suite software, which is software used to create interactive learning media in the form of material presentations, material videos, practice questions, and quizzes. The test subjects in this study used individual and small group trials. The individual trial was 3 students of class VIII Madrasah Tsanawiyah and for the small group trial, namely 13 students of class VIII Madrasah Tsanawiyah. The results of this study, according to the assessment of media experts and material experts, show that ispring suite-based learning media obtained criteria suitable for use with an average score of 4.1. The results of the trials conducted on individual trials and small group trials showed that the ispring suite-based learning media obtained very practical criteria with an average score of 4.3. The ispring suite-based learning media also obtained very effective criteria with an average N-gain score of 0.87 based on the results of individual trial tests and small group trial test results.

Evaluating Lactate and D-Dimer as Mortality Predictors of Paediatric Multiple Organ Dysfunction Syndrome: A Prospective Study in a Low-Middle Income Country.

Multiple Organ Dysfunction Syndrome (MODS) is a complex medical condition characterised by dysfunction across multiple organs. With limited information available on mortality prediction in the paediatric population, particularly in low-middle income countries, this study evaluates the mortality predicting capabilities of lactate, D-dimer, and their combination. This prospective study involved paediatric patients admitted to the paediatric intensive care unit (PICU) of the largest central children's hospital in the Mekong Delta region, Vietnam, from 2019 to 2021. The discriminative ability and calibration of both individual and combined tests were assessed using the receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow goodness-of-fit test. Among the patients studied, 63.1% did not survive. Lactate and D-dimer concentrations were significantly higher in the non-survivor group (P < 0.001). The area under the curve (AUC) values for lactate, D-dimer and the combined lactate-D-dimer test were 0.742, 0.775 and 0.804, respectively, with the combination showing the highest AUC value, though without statistical significance. Specific thresholds for lactate, D-dimer and the combination yielded sensitivities of 75.5%, 71.7%, and 66.0%, respectively. All three tests showed no statistically significant differences between observed and predicted mortality in the Hosmer-Lemeshow test (all P-values > 0.05). Lactate and D-dimer levels showed a significant association with mortality, along with good discrimination and calibration abilities. These results highlight the utility of lactate and D-dimer as effective predictors in paediatric MODS, particularly in resource-limited settings, and their role in improving patient outcomes.

On the Clinimetrics of the Montreal Cognitive Assessment: Cutoff Analysis in Patients with Mild Cognitive Impairment due to Alzheimer's Disease.

In the era of disease-modifying therapies, empowering the clinical neuropsychologist's toolkit for timely identification of mild cognitive impairment (MCI) is crucial. Here we examine the clinimetric properties of the Montreal Cognitive Assessment (MoCA) for the early diagnosis of MCI due to Alzheimer's disease (MCI-AD). Data from 48 patients with MCI-AD and 47 healthy controls were retrospectively analyzed. Raw MoCA scores were corrected according to the conventional Nasreddine's 1-point correction and demographic adjustments derived from three normative studies. Optimal cutoffs were determined while previously established cutoffs were diagnostically reevaluated. The original Nasreddine's cutoff of 26 and normative cutoffs (non-parametric outer tolerance limit on the 5th percentile of demographically-adjusted score distributions) were overly imbalanced in terms of Sensitivity (Se) and Specificity (Sp). The optimal cutoff for Nasreddine's adjustment showed adequate clinimetric properties (≤23.50, Se = 0.75, Sp = 0.70). However, the optimal cutoff for Santangelo's adjustment (≤22.85, Se = 0.65, Sp = 0.87) proved to be the most effective for both screening and diagnostic purposes according to Larner's metrics. The results of post-probability analyses revealed that an individual testing positive using Santangelo's adjustment combined with a cutoff of 22.85 would have 84% post-test probability of receiving a diagnosis of MCI-AD (LR+ = 5.06). We found a common (mal)practice of bypassing the applicability of normative cutoffs in diagnosis-oriented clinical practice. In this study, we identified optimal cutoffs for MoCA to be allocated in secondary care settings for supporting MCI-AD diagnosis. Methodological and psychometric issues are discussed.

Changes in the Johne’s disease situation in GB dairy herds over 10 years, as revealed by regular milk ELISA data

Effective management of cattle infected with Johne’s Disease (JD) is crucial to minimizing transmission and within-herd prevalence. Within Great Britain (GB), the voluntary National Johne’s Management Plan (NJMP) requires farmers and a certified vet to conduct a risk assessment to determine the herd risk, examine the herd JD status and formulate a management plan. Individual milk ELISA tests for JD antibodies are widely used to monitor infection. The JD Tracker application, available within the dairy data management software InterHerd+ and other web-based environments, is being used by farmers and veterinarians to facilitate the practical use of milk ELISA data to aid JD-related management decisions. The JD Tracker application uses a herd’s milk ELISA data to calculate a collection of ‘JD parameters’ that are indicative of the current JD status of the herd alongside contemporary and retrospective drivers linked to transmission and maintenance of infection. Herein, we use milk ELISA data from 154 regularly testing herds to review the temporal trends in JD parameters from 2013 to 2022. Since 2015, JD Tracker parameters have improved in these herds, most notably average test value (ATV) and within-herd prevalence (%Pos30). Trends in driver parameters suggest that farmers are progressively less likely to serve repeat test-positive (J5) cows and are more readily removing them. The data also reveal that the burden of JD is disproportionately greater in herds with higher ATV. In 2022, the 25 % of herds with the highest ATVs accounted for 42 % of positive tests and 42 % of repeat ELISA positive (J5) cows. Retrospectively, it is not possible to identify with certainty factors that directly contributed to the trends in JD parameters, but it is notable that the introduction of the NJMP was coincided with the improving JD situation. In 2019, participation in the NJMP or an equivalent scheme became mandatory for dairy farms to be compliant with the food and farms standards assurance scheme Red Tractor, with the result that JD management plans are now completed by 95 % of UK dairy farms. As far as we know, the UK is unique in its development of a tool (the JD Tracker) which adds utility to milk ELISA data using specifically designed JD parameters. Anticipated further work includes the development of a national database of JD testing herds and application of the JD Tracker at national scale to enable more comprehensive industry-level monitoring of JD within GB dairy farms.

Physics-informed transfer learning model for fatigue life prediction of IN718 alloy

To address the challenges posed by inadequate data and data utilization in multiple scenarios of fatigue loading, a Physics-informed Transfer Learning (PITL) model has been developed to predict the fatigue life of IN718 superalloy. Strain-controlled low-cycle fatigue tests were carried out at 400 °C with three distinct strain ratios, which were subsequently segmented for individual transfer learning tests. PITL models with significant engineering value were built by integrating transfer learning methodologies rooted in TrAdaBoost with a physics-based model that hinges on the principles of equivalent strain theory. The findings suggest that PITL models exhibit improved accuracy and greater robustness compared to both transfer learning and physics models.

Revisiting strain localization analysis for elastoplastic constitutive models in geomechanics

AbstractThe localization of deformations plays a crucial role in the failure of granular materials. Concerning classical continuum constitutive models, the localization of deformations is considered to be connected to the loss of ellipticity of the governing rate equilibrium equations, and entails mesh sensitivity in finite element simulations. While previous studies are often limited to strain localization analyses of individual tests, the focus of the present contribution lies on studying the localization properties in general constitutive states. For this purpose, a staggered optimization algorithm for determining the loss of ellipticity, considering both extreme values, minimum and maximum, of the determinant of the acoustic tensor, is proposed. Part of this algorithm representing a novel application of spherical Fibonacci lattices for discretizing the feasible domain of the associated optimization problem. In the presented localization study of the widely recognized modified Cam‐clay model, special attention is paid to determining the influence of the individual model parameters. Specifically, three factors favoring strain localization are found, namely (i) a low value of the ratio of the primary compression index and the recompression index, (ii) a large value of the critical state frictional constant, as well as (iii) a large value of Poisson's ratio. Moreover, a structural finite element study is performed, confirming the results of localization analyses at the constitutive level.

Concurrent de novo MACF1 mutation and inherited 16p13.11 microduplication in a preterm newborn with hypotonia, joint hyperlaxity and multiple congenital malformations: a case report

BackgroundThe MACF1 gene, found on chromosome 1p34.3, is vital for controlling cytoskeleton dynamics, cell movement, growth, and differentiation. It consists of 101 exons, spanning over 270 kb. The 16p13.11 microduplication syndrome results from the duplication of 16p13.11 chromosome copies and is associated with various neurodevelopmental and physiological abnormalities. Both MACF1 and 16p13.11 microduplication have significant impacts on neural development, potentially leading to nerve damage or neurological diseases. This study presents a unique case of a patient simultaneously experiencing a de novo MACF1 mutation and a hereditary 16p13.11 microduplication, which has not been reported previously.Case presentationIn this report, we describe a Chinese preterm newborn girl exhibiting the typical characteristics of 16.13.11 microduplication syndrome. These features include developmental delay, respiratory issues, feeding problems, muscle weakness, excessive joint movement, and multiple congenital abnormalities. Through whole-exome sequencing, we identified a disease-causing mutation in the MACF1 gene (c.15266T > C / p. Met5089Thr). Additionally, after microarray analysis, we confirmed the presence of a 16p13.11 microduplication (chr16:14,916,289 − 16,315,688), which was inherited from the mother.ConclusionsThe patient’s clinical presentation, marked by muscle weakness and multiple birth defects, may be attributed to both the de novo MACF1 mutation and the 16p13.11 duplication, which could have further amplified her severe symptoms. Genetic testing for individuals with complex clinical manifestations can offer valuable insights for diagnosis and serve as a reference for genetic counseling for both patients and their families.

A proactive/reactive mass screening approach with uncertain symptomatic cases.

We study the problem of mass screening of heterogeneous populations under limited testing budget. Mass screening is an essential tool that arises in various settings, e.g., the COVID-19 pandemic. The objective of mass screening is to classify the entire population as positive or negative for a disease as efficiently and accurately as possible. Under limited budget, testing facilities need to allocate a portion of the budget to target sub-populations (i.e., proactive screening) while reserving the remaining budget to screen for symptomatic cases (i.e., reactive screening). This paper addresses this decision problem by taking advantage of accessible population-level risk information to identify the optimal set of sub-populations for proactive/reactive screening. The framework also incorporates two widely used testing schemes: Individual and Dorfman group testing. By leveraging the special structure of the resulting bilinear optimization problem, we identify key structural properties, which in turn enable us to develop efficient solution schemes. Furthermore, we extend the model to accommodate customized testing schemes across different sub-populations and introduce a highly efficient heuristic solution algorithm for the generalized model. We conduct a comprehensive case study on COVID-19 in the US, utilizing geographically-based data. Numerical results demonstrate a significant improvement of up to 52% in total misclassifications compared to conventional screening strategies. In addition, our case study offers valuable managerial insights regarding the allocation of proactive/reactive measures and budget across diverse geographic regions.

Evaluation of the Effect of Age on the Contralateral Acoustic Reflex Suppression Test in Individuals With Normal Hearing.

The aim of this study is to investigate the age-related changes of the Contralateral Acoustic Reflex Suppression (CARS) test in individuals with normal hearing and to provide age-related normal values. The study included 66 individuals aged 18-65 years. The participants were divided into three age groups, respectively, 18-30 years, 31-45 years, and 46-65 years. Acoustic reflex threshold and acoustic reflex amplitude measurements were performed at frequencies of 500, 1000, and 2000 Hz in the presence and absence of suppressive noise from the contralateral ear. In the comparison of suppression amounts according to age groups, the highest suppression amount at all frequencies was observed in the 18-30 years age group. It is known that changes in the function of the efferent hearing system occur due to aging. In the CARS test, a decrease in the amount of suppression produced by the efferent system has been observed due to aging.

Diagnostic tests for the prediction of histological chorioamnionitis and funisitis in pregnant women with preterm premature rupture of membranes: A systematic review.

Infection of the amniotic cavity is an important driver and/or consequence of preterm prelabour rupture of membranes (PPROM). Prediction of infection is challenging, limiting guidance for interventions during the antenatal period. Infection typically triggers a host inflammatory response, and non-invasive indirect markers of the maternal or fetal inflammatory response have been reported in the context of PPROM and intra-amniotic infection. Some of these markers have also been tested in amniotic fluid (AF) samples. This study compared markers of the inflammatory response in women with PPROM against the outcome standard of histological chorioamnionitis (HCA) or funisitis (FUS). Searches were conducted for studies reporting diagnostic test sensitivity and specificity for proven HCA or FUS in pregnant women with PPROM after 20 weeks' gestation. Weighted mean pooled sensitivity (Se), specificity (Sp), positive predictive value, negative predictive value, diagnostic odds ratio and 95% confidence intervals were calculated for each of the selected diagnostic tests. Except ultrasonographic detection of fetal thymic involution, almost all index tests analysed showed relatively low sensitivity. Maternal white cell count, interleukin-6 (IL-6) and AF IL-6 had credible specificity. Testing of AF markers, while more consistent than serum markers, showed no clear diagnostic accuracy improvement. There is a clear lack of evidence for the reliability of any individual diagnostic test to assist in the detection of HCA or FUS in women with PPROM. Combining several markers into a predictive model for improved diagnosis may be worth investigating.

Handheld, Graphene Multiplexed Sensor for Wastewater-Based Epidemiology

Wastewater-based epidemiology (WBE) is emerging as a vital tool for early detection of the emergence of diseases without the need for individual testing and reporting. This is enabled via virus shedding through bodily waste, which can be present up to two days before symptoms appear in infected individuals, albeit at low levels. Current detection methods, such as HPLC-MS and PCR, are time-consuming and require specialized equipment with highly trained personnel. This drives up the cost and turnaround time while limiting the widespread implementation of WBE for local detection, especially in resource-limited settings. Therefore, a fast, cost-effective, multiplexing, and sensitive viral wastewater detection platform could help health officials effectively implement measures to mitigate the spread of diseases. Here, I will present our recently developed handheld, graphene-based multiplexed platform utilizing high-specificity aptamers for rapid, sensitive, and simultaneous detection of virus proteins for SARS-CoV-2, Influenza A, and RSV in wastewater to accurately assess infected individuals in municipal communities. In addition, the device allows normalizing to the population, contributing to the signal by simultaneously measuring the presence of virus proteins and caffeine in wastewater. These results will highlight the selectivity and specificity of the platform in wastewater as well as the limits of detection.

Parental report of vocabulary in 3- to 6-year-old Polish children: Reliable but not valid.

For over 30 years, parental reports have been used to study the vocabulary of children under 4 years of age. Research exploring parental checklists as a measure of vocabulary in older children is very limited. Typically, authors of parental checklists report the reliability of the developed tools but do not explore validity in terms of the agreement between parental assessments and the children's actual word knowledge. We aimed to explore the reliability and validity of a parental checklist for assessing vocabulary in children aged between 3 and 6 years. Furthermore, we aimed to evaluate the agreement between indirect (parental checklist) and direct (picture naming and picture recognition tasks) assessments of children's vocabulary. A group of 94 typically developing monolingual Polish-speaking children aged between 3 and 6 years were first directly tested onsite with picture naming and picture recognition tasks (Cross-Linguistic Lexical Tasks). Subsequently, the participants' parents completed an online checklist containing the same set of 128 items and marked all the words that they had ever heard in their child's spontaneous speech. The parental checklist demonstrated very high internal consistency. The scores of the parental checklist and vocabulary tasks were moderately correlated. We compared the total number of words marked by parents and the number of items correctly identified by children in the picture naming and picture recognition tasks. In picture naming, we found no difference between the children's scores and the number of words selected by parents. However, parents selected significantly fewer words than children correctly recognised in the picture recognition task. When data were analysed at the level of individual items (i.e., whether parents selected exactly the same items that children answered correctly), we found that the level of agreement was low. The level of agreement correlated negatively with the children's vocabulary; that is, the more words a child knew, the lower the agreement between the direct measure and the parental checklist. Parental checklists should be used with caution in children aged between 3 and 6 years, especially if the assessed children have a large vocabulary and if item analysis is planned. Such checklists may be of more use in younger children or in children with limited vocabulary. What is already known on the subject Parental checklists are commonly used to assess the vocabulary of children younger than 4 years of age. Previous research has indicated that parental checklists are reliable in terms of internal consistency and valid in terms of predictive and convergent validity. What this paper adds to the existing knowledge This study introduces a parental checklist designed for assessing the vocabulary of monolingual Polish-speaking children aged between 3 and 6 years. Statistical analyses reveal that while the parental checklist exhibits high reliability, and the scores on the checklist correlate with direct measures of vocabulary, the agreement between parental reports and direct vocabulary measures (i.e., validity) is notably low, particularly when examining individual test items. What are the clinical implications of this work? These findings underscore the importance of exercising caution when using parental vocabulary checklists with children aged between 3 and 6 years. These checklists can serve as a replacement for direct vocabulary tests only when the general/overall score is needed. However, when specific words are the subject of interest, parental reports may not be a valid measure.

Team-Based Learning as a Feasible, Acceptable, and Effective Educational Method for Internal Medicine Trainees - A Multi-phase Intervention and Cohort Comparison.

Team-based learning (TBL) is an active learning strategy gaining traction in medical education. However, studies demonstrating successful incorporation into Graduate Medical Education (GME) curricula are limited. To assess the feasibility, acceptability and efficacy of Infectious Disease (ID) TBL sessions within an Internal Medicine (IM) residency curriculum as part of a traditional 60-minute conference. We conducted a prospective cohort study of TBL implementation assessing acceptability and feasibility (Phase 1), and efficacy (Phase 2). Phase 1 included 101 IM residents and eight TBL naïve faculty. Phase 2 included aggregate cohort IM In-Training Exam (ITE) data before (2008-2013) and after (2014-2019) TBL implementation. Eight TBL sessions were delivered once or twice weekly during 60-minute noon conferences. We assessed feasibility by measuring individual Readiness Assurance Test (iRAT) completion rates and inclusion of TBL elements in each session; acceptability through attendance, perceived effectiveness rating and attitudes about TBL; efficacy by comparing ITE data for the overall ID content and specific TBL associated learning objectives. Seventy-five of 93 (80%) residents attended at least one session. All TBL elements were successfully incorporated each session. Of those surveyed, 86% rated the TBL sessions as facilitating their learning "very (4)" or "extremely (5)" well on a 5-point Likert scale (p<0.001). ITE mean percent correct scores of total ID content as well as TBL associated learning objective performance were both significantly higher for the post-TBL cohort among PGY-2 (76.2 vs 62.3; 76.2 vs 62.6) and PGY-3 (73 vs 64.5; 76.2 vs 64.5) IM residents (p<0.05; p<0.001 respectively). Implementing a complete TBL pedagogy within the traditional noontime conference hour in GME is feasible, acceptable to residents and faculty, and associated with improved learning efficacy demonstrated through improved ITE scores.

Phonemic processing is below expectations and linked to word-finding difficulty in multiple sclerosis

Background: Word-finding difficulty is prevalent but poorly understood in persons with relapsing-remitting multiple sclerosis (RRMS). Objective: The objective was to investigate our hypothesis that phonological processing ability is below expectations and related to word-finding difficulty in patients with RRMS. Method: Data were analyzed from patients with RRMS (n = 50) on patient-reported word-finding difficulty (PR-WFD) and objective performance on Wechsler Individual Achievement Test, Fourth Edition (WIAT-4) Phonemic Proficiency (PP; analysis of phonemes within words), Word Reading (WR; proxy of premorbid literacy and verbal ability), and Sentence Repetition (SR; auditory processing of word-level information). Results: Performance (mean (95% confidence interval)) was reliably lower than normative expectations for PP (−0.41 (−0.69, −0.13)) but not for WR (0.02 (−0.21, 0.25)) or SR (0.08 (−0.15, 0.31). Within-subjects performance was worse on PP than on both WR (t(49) = 4.00, p < 0.001, d = 0.47) and SR (t(49) =3.76, p < 0.001, d = 0.54). Worse PR-WFD was specifically related to lower PP (F2,47 = 6.24, p = 0.004, η2 = 0.21); worse PP performance at PR-WFD Often (n = 13; −1.16 (−1.49, −0.83)) than Sometimes (n = 17; −0.14 (−0.68, 0.41)) or Rarely (n = 20; −0.16 (−0.58, 0.27). PR-WFD was unrelated to WR or SR (ps > 0.25). Conclusion: Phonological processing was below expectations and specifically linked to word-finding difficulty in RRMS. Findings are consistent with early disease-related cortical changes within the posterior superior temporal/supramarginal region. Results inform our developing model of multiple sclerosis-related word-finding difficulty.