An Iterative Scale Purification Procedure on lz for the Detection of Aberrant Responses.

Many person-fit statistics have been proposed to detect aberrant response behaviors (e.g., cheating, guessing). Among them, lz is one of the most widely used indices. The computation of lz assumes the item and person parameters are known. In reality, they often have to be estimated from data. The better the estimation, the better lz will perform. When aberrant behaviors occur, the person and item parameter estimations are inaccurate, which in turn degrade the performance of lz. In this study, an iterative procedure was developed to attain more accurate person parameter estimates for improved performance of lz. A series of simulations were conducted to evaluate the iterative procedure under two conditions of item parameters, known and unknown, and three aberrant response styles of difficulty-sharing cheating, random-sharing cheating, and random guessing. The results demonstrated the superiority of the iterative procedure over the non-iterative one in maintaining control of Type-I error rates and improving the power of detecting aberrant responses. The proposed procedure was applied to a high-stake intelligence test.

DUSP5 and PHLDA1 mutations in mature cystic teratomas of the ovary identified on whole-exome sequencing may explain teratoma characteristics.

BACKGROUND: Mature cystic teratomas of the ovary are the most common type of germ cell tumor, comprising 33% of ovarian tumors. Studying these tumors may result in a better understanding of their stepwise developmental processes and molecular bases and provide useful information for the development of tissue-engineering technologies. METHODS: In the present study, 9 mature cystic teratomas of the ovary were analyzed by whole-exome sequencing and the results were compared with the Catalogue of Somatic Mutations in Cancer and dbSNP databases. RESULTS: Mutations were validated in 15 genes with alterations in all 9 (100%) samples and changes in protein coding. The top 10 mutated genes were FLG, MUC17, MUC5B, RP1L1, NBPF1, GOLGA6L2, SLC29A3, SGK223, PTGFRN, and FAM186A. Moreover, 7 variants in exons with changes in protein coding are likely of importance in the development of mature cystic teratomas of the ovary, namely PTGFRN, DUSP5, MPP2, PHLDA1, PRR21, GOLGA6L2, and KRTAP4-2. CONCLUSIONS: These genetic alterations may play an important etiological role in teratoma formation. Moreover, novel mutations in DUSP5 and PHLDA1 genes found on whole-exome sequencing may help to explain the characteristics of teratomas.

Correlations between histological characterizations and methylation statuses of tumour suppressor genes in Wilms' tumours.

Wilms' tumour is a solid tumour that frequently occurs in children. Genetic changes in WT1 and epigenetic aberrations that affect imprinted control region 1 in WT2 loci are implicated in its aetiology. Moreover, tumour suppressor genes are frequently silenced by methylation in this tumour. In the present study, we analysed the methylation statuses of promoter regions of 24 tumour suppressor genes using a methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA)-based approach in 6 Wilms' tumours. Methylation of RASSF1 was specific to all 6 Wilms' tumours and was not observed in normal tissues. Moreover, methylated HIC1 was identified in stromal-type Wilms' tumours and methylated BRCA1 was identified in epithelial-type Wilms' tumours. Unmethylated CASP8, RARB, MLH1_167, APC and CDKN2A were found only in blastemal predominant-type Wilms' tumour. Our results indicated that methylation of RASSF1 may be a vital event in the tumorigenesis of Wilms' tumour, which informs its clinical and therapeutic management. In addition, mixed-type Wilms' tumours may be classified according to epithelial, stromal and blastemal components via MS-MLPA-based approach.

A new item response theory model for rater centrality using a hierarchical rater model approach.

Rater centrality, in which raters overuse middle scores for rating, is a common rater error which can affect test scores and subsequent decisions. Past studies on rater errors have focused on rater severity and inconsistency, neglecting rater centrality. This study proposes a new model within the hierarchical rater model framework to explicitly specify and directly estimate rater centrality in addition to rater severity and inconsistency. Simulations were conducted using the freeware JAGS to evaluate the parameter recovery of the new model and the consequences of ignoring rater centrality. The results revealed that the model had good parameter recovery with small bias, low root mean square errors, and high test score reliability, especially when a fully crossed linking design was used. Ignoring centrality yielded poor item difficulty estimates, person ability estimates, rater errors estimates, and underestimated reliability. We also showcase how the new model can be used, using an empirical example involving English essays in the Advanced Placement exam.

Psychometric evaluation of the WHOQOL-BREF, Taiwan version, across five kinds of Taiwanese cancer survivors: Rasch analysis and confirmatory factor analysis.

BACKGROUND: Quality of life (QoL) is important for clinicians to evaluate how cancer survivors judge their sense of well-being, and WHOQOL-BREF may be a good tool for clinical use. However, at least three issues remain unresolved: (1) the psychometric properties of the WHOQOL-BREF for cancer patients are insufficient; (2) the scoring method used for WHOQOL-BREF needs to be clarify; (3) whether different types of cancer patients interpret the WHOQOL-BREF similarly. METHODS: We recruited 1000 outpatients with head/neck cancer, 1000 with colorectal cancer, 965 with liver cancer, 1438 with lung cancer and 1299 with gynecologic cancers in a medical center. Data analyses included Rasch models, confirmatory factor analysis (CFA), and Pearson correlations. RESULTS: The mean WHOQOL-BREF domain scores were between 13.34 and 14.77 among all participants. CFA supported construct validity; Rasch models revealed that almost all items were embedded in their expected domains and were interpreted similarly across five types of cancer patients; all correlation coefficients between Rasch scores and original domain scores were above 0.9. CONCLUSION: The linear relationship between Rasch scores and domain scores suggested that the current calculations for domain scores were applicable and without serious bias. Clinical practitioners may regularly collect and record the WHOQOL-BREF domain scores into electronic health records.

Assessment of Differential Rater Functioning in Latent Classes with New Mixture Facets Models.

Multifaceted data are very common in the human sciences. For example, test takers' responses to essay items are marked by raters. If multifaceted data are analyzed with standard facets models, it is assumed there is no interaction between facets. In reality, an interaction between facets can occur, referred to as differential facet functioning. A special case of differential facet functioning is the interaction between ratees and raters, referred to as differential rater functioning (DRF). In existing DRF studies, the group membership of ratees is known, such as gender or ethnicity. However, DRF may occur when the group membership is unknown (latent) and thus has to be estimated from data. To solve this problem, in this study, we developed a new mixture facets model to assess DRF when the group membership is latent and we provided two empirical examples to demonstrate its applications. A series of simulations were also conducted to evaluate the performance of the new model in the DRF assessment in the Bayesian framework. Results supported the use of the mixture facets model because all parameters were recovered fairly well, and the more data there were, the better the parameter recovery.

Amplifications of EVX2 and HOXD9-HOXD13 on 2q31 in mature cystic teratomas of the ovary identified by array comparative genomic hybridization may explain teratoma characteristics in chondrogenesis and osteogenesis.

BACKGROUND: Teratomas are a common type of germ cell tumor. However, only a few reports on their genomic constitution have been published. The study of teratomas may provide a better understanding of their stepwise differentiation processes and molecular bases, which could prove useful for the development of tissue-engineering technologies. METHODS: In the present study, we analyzed the copy number aberrations of nine ovarian mature cystic teratomas using array comparative genomic hybridization in an attempt to reveal their genomic aberrations. RESULTS: The many chromosomal aberrations observed on array comparative genomic hybridization analysis reveal the complex genetics of this tumor. Amplifications and deletions of large DNA fragments were observed in some samples, while amplifications of EVX2 and HOXD9-HOXD13 on 2q31.1, NDUFV1 on 11q13.2, and RPL10, SNORA70, DNASE1L1, TAZ, ATP6AP1, and GDI1 on Xq28 were found in all nine mature cystic teratomas. CONCLUSIONS: Our results indicated that amplifications of these genes may play an important etiological role in teratoma formation. Moreover, amplifications of EVX2 and HOXD9-HOXD13 on 2q31.1, found on array comparative genomic hybridization, may help to explain the characteristics of teratomas in chondrogenesis and osteogenesis.

Quality of life in overweight and obese young Chinese children: a mixed-method study.

BACKGROUND: Obesity among young children in Hong Kong has become a public health problem. This study explored associations between Chinese parent reported children's quality of life (QoL), socio-demographics and young children's weight status from 27 preschool settings. METHODS: A mixed-method approach, including quantitative and qualitative tools, was employed for this cross-sectional study. Quantitative data were collected from 336 Chinese parents of children aged 2-7 years. Paediatric Quality of Life Inventory 4.0 (PedsQL, v 4.0) and a questionnaire about parents' socio-demographics were used. In-depth interviews with mothers, teachers and children from a larger sample were the basis of 10 case studies. Quantitative data were analysed using chi-square analysis, one-way ANOVA and logistic regression. Qualitative data were analysed according to a multi-level framework that established linkages with quantitative data. RESULTS: The children's Body Mass Index (BMI) ranged from 11.3 to 28.0 kg/m(2) and was classified into four weight groups. ANOVAs showed that the normal-weight children had significantly higher PedsQL scores in Physical Functioning than obese children (mean difference = 14.19, p < .0083) and significantly higher scores in School Functioning than overweight children (mean difference = 10.15, p < .0083). Results of logistic regression showed that relative to normal-weight children, obese children had a 2-5 times higher odds of showing problems in Physical, Social Functioning and School Performance. Overweight children had 2 times higher odds of problems in Social Functioning, and underweight children had a 2 times higher odds of problems in Physical Functioning. Children's age (χ(2) = 21.71, df = 3, p < 0.01), and housing (χ(2) = 33.00, df = 9, p < 0.01) were associated with their weight. The case studies further act as a supplement to the quantitative data that children showed emotional problems across different abnormal weight statues; and the association between children's weight status and well-being might be affected by multiple childcare arrangements and familial immigration status. CONCLUSIONS: This study is one of only a few studies that have examined parents', teachers' and young children's own perceptions of the children's quality of life across different weight statuses. The results are discussed in terms of their implications for intervention.

The validity of the Type D construct and its assessment in Taiwan.

BACKGROUND: Type D (distressed) personality, defined by negative affectivity and social inhibition, is related to cardiovascular outcomes. Little is known about Type D in non-Western cultures. We examined the validity of this construct and its assessment in Taiwanese patients with coronary artery disease (CAD) and adults from the general population. METHODS: CAD patients (N = 87) and adults from the general population (N = 421) completed the 14-item Type D Scale- Taiwanese version (DS14-T), State-Trait Anxiety Inventory, Beck Depression Inventory-II, and Chinese Hostility Inventory Short-Form. RESULTS: Based on the psychometric examination, item #3 of the original DS14, "I often talk to strangers" was replaced by "I don't like to have a lot of people around me" which comes from the "Withdrawal" facet of social inhibition of DS-24. The reliability of Type D assessment in Taiwan was good, with Cronbach's α for negative affectivity and social inhibition of .86 and .79. Factor analyses confirmed the two-factor model of the Type D construct. The prevalence rate of Type D personality in Taiwan was 20% in CAD patients and 16% in the general population. Negative affectivity was positively associated with anxiety, depression and hostility, and social inhibition was positively associated with suppressive hostility and negatively associated with expressive hostility after controlling for the total hostility. Furthermore, Taiwanese individuals with a Type D personality displayed elevated levels of anxiety, depression and hostility. CONCLUSIONS: The Type D construct and its assessment with the DS14-T is generalizable to an Asian setting, Taiwan. The DS14-T showed good psychometric properties, and the prevalence of Type D personality in Taiwan was similar to the prevalence rates in Western countries and Mainland China, and Type D was associated with anxiety, depression and hostility.

Assessing ChatGPT's capacity for clinical decision support in pediatrics: A comparative study with pediatricians using KIDMAP of Rasch analysis.

BACKGROUND: The application of large language models in clinical decision support (CDS) is an area that warrants further investigation. ChatGPT, a prominent large language models developed by OpenAI, has shown promising performance across various domains. However, there is limited research evaluating its use specifically in pediatric clinical decision-making. This study aimed to assess ChatGPT's potential as a CDS tool in pediatrics by evCDSaluating its performance on 8 common clinical symptom prompts. Study objectives were to answer the 2 research questions: the ChatGPT's overall grade in a range from A (high) to E (low) compared to a normal sample and the difference in assessment of ChatGPT between 2 pediatricians. METHODS: We compared ChatGPT's responses to 8 items related to clinical symptoms commonly encountered by pediatricians. Two pediatricians independently assessed the answers provided by ChatGPT in an open-ended format. The scoring system ranged from 0 to 100, which was then transformed into 5 ordinal categories. We simulated 300 virtual students with a normal distribution to provide scores on items based on Rasch rating scale model and their difficulties in a range between -2 to 2.5 logits. Two visual presentations (Wright map and KIDMAP) were generated to answer the 2 research questions outlined in the objectives of the study. RESULTS: The 2 pediatricians' assessments indicated that ChatGPT's overall performance corresponded to a grade of C in a range from A to E, with average scores of -0.89 logits and 0.90 logits (=log odds), respectively. The assessments revealed a significant difference in performance between the 2 pediatricians (P < .05), with scores of -0.89 (SE = 0.37) and 0.90 (SE = 0.41) in log odds units (logits in Rasch analysis). CONCLUSION: This study demonstrates the feasibility of utilizing ChatGPT as a CDS tool for patients presenting with common pediatric symptoms. The findings suggest that ChatGPT has the potential to enhance clinical workflow and aid in responsible clinical decision-making. Further exploration and refinement of ChatGPT's capabilities in pediatric care can potentially contribute to improved healthcare outcomes and patient management.

Intraclass reliability for assessing how well Taiwan constrained hospital-provided medical services using statistical process control chart techniques.

BACKGROUND: Few studies discuss the indicators used to assess the effect on cost containment in healthcare across hospitals in a single-payer national healthcare system with constrained medical resources. We present the intraclass correlation coefficient (ICC) to assess how well Taiwan constrained hospital-provided medical services in such a system. METHODS: A custom Excel-VBA routine to record the distances of standard deviations (SDs) from the central line (the mean over the previous 12 months) of a control chart was used to construct and scale annual medical expenditures sequentially from 2000 to 2009 for 421 hospitals in Taiwan to generate the ICC. The ICC was then used to evaluate Taiwan's year-based convergent power to remain unchanged in hospital-provided constrained medical services. A bubble chart of SDs for a specific month was generated to present the effects of using control charts in a national healthcare system. RESULTS: ICCs were generated for Taiwan's year-based convergent power to constrain its medical services from 2000 to 2009. All hospital groups showed a gradually well-controlled supply of services that decreased from 0.772 to 0.415. The bubble chart identified outlier hospitals that required investigation of possible excessive reimbursements in a specific time period. CONCLUSION: We recommend using the ICC to annually assess a nation's year-based convergent power to constrain medical services across hospitals. Using sequential control charts to regularly monitor hospital reimbursements is required to achieve financial control in a single-payer nationwide healthcare system.

Reducing the Misclassification Costs of Cognitive Diagnosis Computerized Adaptive Testing: Item Selection With Minimum Expected Risk.

Cognitive diagnosis computerized adaptive testing (CD-CAT) aims to identify each examinee's strengths and weaknesses on latent attributes for appropriate classification into an attribute profile. As the cost of a CD-CAT misclassification differs across user needs (e.g., remedial program vs. scholarship eligibilities), item selection can incorporate such costs to improve measurement efficiency. This study proposes such a method, minimum expected risk (MER), based on Bayesian decision theory. According to simulations, using MER to identify examinees with no mastery (MER-U0) or full mastery (MER-U1) showed greater classification accuracy and efficiency than other methods for these attribute profiles, especially for shorter tests or low quality item banks. For other attribute profiles, regardless of item quality or termination criterion, MER methods, modified posterior-weighted Kullback-Leibler information (MPWKL), posterior-weighted CDM discrimination index (PWCDI), and Shannon entropy (SHE) performed similarly and outperformed posterior-weighted attribute-level CDM discrimination index (PWACDI) in classification accuracy and test efficiency, especially on short tests. MER with a zero-one loss function, MER-U0, MER-U1, and PWACDI utilized item banks more effectively than the other methods. Overall, these results show the feasibility of using MER in CD-CAT to increase the accuracy for specific attribute profiles to address different user needs.

Computerized Adaptive Testing for Ipsative Tests with Multidimensional Pairwise-Comparison Items: Algorithm Development and Applications.

A computerized adaptive testing (CAT) solution for tests with multidimensional pairwise-comparison (MPC) items, aiming to measure career interest, value, and personality, is rare. This paper proposes new item selection and exposure control methods for CAT with dichotomous and polytomous MPC items and present simulation study results. The results show that the procedures are effective in selecting items and controlling within-person statement exposure with no loss of efficiency. Implications are discussed in two applications of the proposed CAT procedures: a work attitude test with dichotomous MPC items and a career interest assessment with polytomous MPC items.

Corrigendum: Methylation Statuses of H19DMR and KvDMR at WT2 in Wilms Tumors in Taiwan.

[This corrects the article DOI: 10.1007/s12253-020-00802-6.].

Rasch analysis of positive changes following adversity in cancer patients attending community support groups.

OBJECTIVE: This study assessed the 38-item Perceived Benefits Scale (PBS) by examining whether the items constructed a single latent trait and formed an interval scale. This would justify its use to measure the advantages of benefit-finding brought to patients with different cancers from participation in community-based cancer support groups. METHODS: A total of 300 patients were randomly recruited from a 1300-bed medical centre in Taiwan. The Rasch rating scale model was used to examine the model-data fit. Differential item functioning (DIF) analysis was conducted to verify construct equivalence across groups. Comparisons were made among demographic characteristics for various types of patient support groups. RESULTS: Of the 38 items on the PBS, 28 were applicable to cancer patients and were divided into two distinct unidimensional domains; both met the Rasch model's expectation to constitute a single construct. DIF was found between types of cancer patients, but not between genders. Positive changes following adversity were statistically significantly associated with and ascribed to the duration of patient attendance in community-based cancer support groups. CONCLUSION: The two domains verified by Rasch analysis can be used through Rasch-transformed measures to make further statistical inference when comparing positive changes following adversity within and between cancer groups. The psychometric properties of the PBS verified by Rasch modeling fit to the unidimensionality, but need a huge sample size to support its validity and reliability in future studies. Nonetheless, we should be cautious to make comparisons among types of cancer patients due to DIF exhibited in scale.

Origin of uterine teratoma differs from that of ovarian teratoma: a case of uterine mature cystic teratoma.

Mature cystic teratomas are usually found in the ovaries and rarely in the uterus. Most teratomas of the uterus are of cervical origin. There are only a handful of reports to date of uterine teratomas arising from uterine corpus. The teratomas of the ovaries and the cervix are thought to be of parthenogenetic origin from oocyte after the completion of the first division. However, the origin of a uterine teratoma has not been established by molecular methods. In this study, we report a 46-year-old woman with a teratoma within uterine corpus. Computed tomography scanning and histological studies after tumor resection confirmed the diagnosis of teratoma. The DNA profiles of normal uterine tissue and teratoma tissue were compared using short tandem repeats analysis and showed that the teratoma did not originate from the parthenogenetic process. Our results suggest that the origin of this uterine teratoma is most likely pluripotential stem cell of uterus or primordial germ cell before meiosis I.

A web-based computerized adaptive testing (CAT) to assess patient perception in hospitalization.

BACKGROUND: Many hospitals have adopted mobile nursing carts that can be easily rolled up to a patient's bedside to access charts and help nurses perform their rounds. However, few papers have reported data regarding the use of wireless computers on wheels (COW) at patients' bedsides to collect questionnaire-based information of their perception of hospitalization on discharge from the hospital. OBJECTIVE: The purpose of this study was to evaluate the relative efficiency of computerized adaptive testing (CAT) and the precision of CAT-based measures of perceptions of hospitalized patients, as compared with those of nonadaptive testing (NAT). An Excel module of our CAT multicategory assessment is provided as an example. METHOD: A total of 200 patients who were discharged from the hospital responded to the CAT-based 18-item inpatient perception questionnaire on COW. The numbers of question administrated were recorded and the responses were calibrated using the Rasch model. They were compared with those from NAT to show the advantage of CAT over NAT. RESULTS: Patient measures derived from CAT and NAT were highly correlated (r = 0.98) and their measurement precisions were not statistically different (P = .14). CAT required fewer questions than NAT (an efficiency gain of 42%), suggesting a reduced burden for patients. There were no significant differences between groups in terms of gender and other demographic characteristics. CONCLUSIONS: CAT-based administration of surveys of patient perception substantially reduced patient burden without compromising the precision of measuring patients' perceptions of hospitalization. The Excel module of animation-CAT on the wireless COW that we developed is recommended for use in hospitals.

The allele frequency of two single nucleotide polymorphisms in the von Hippel-Lindau (VHL) tumor suppressor gene in the Taiwanese population.

BACKGROUND: The von Hippel-Lindau (VHL) tumor suppressor gene located on chromosome 3p25-26 is implicated in VHL disease. Two informative single nucleotide polymorphisms are at positions 19 and 1149 on the nucleotide sequence from Gene Bank NM_000551. In this study we examined the allele frequencies at these two loci in the Taiwanese population and compared the results to those from European ethnic populations. METHODS: The allele frequency was examined in 616 healthy individuals including 301 university students and 315 neonates. Both A/G polymorphisms were investigated using restriction fragment length polymorphism analysis created by restriction enzymes, BsaJ I and Acc I. RESULTS: Among these subjects, the allele frequencies at 19 SNP and 1149 SNP for variant G were 0.130 and 0.133, respectively. And these results were significant differences from those of the Caucasian populations. In addition, 90% of the tested subjects had identical genotypes at these two loci suggesting the existence of nonrandom association of alleles. CONCLUSION: We found that the G allele frequency at these two loci in the Taiwanese population is much lower than that in people from Western countries. This phenomenon may be attributed to ethnic effects.

The Q-Matrix Anchored Mixture Rasch Model.

Mixture item response theory (IRT) models include a mixture of latent subpopulations such that there are qualitative differences between subgroups but within each subpopulation the measure model based on a continuous latent variable holds. Under this modeling framework, students can be characterized by both their location on a continuous latent variable and by their latent class membership according to Students' responses. It is important to identify anchor items for constructing a common scale between latent classes beforehand under the mixture IRT framework. Then, all model parameters across latent classes can be estimated on the common scale. In the study, we proposed Q-matrix anchored mixture Rasch model (QAMRM), including a Q-matrix and the traditional mixture Rasch model. The Q-matrix in QAMRM can use class invariant items to place all model parameter estimates from different latent classes on a common scale regardless of the ability distribution. A simulation study was conducted, and it was found that the estimated parameters of the QAMRM recovered fairly well. A real dataset from the Certificate of Proficiency in English was analyzed with the QAMRM, LCDM. It was found the QAMRM outperformed the LCDM in terms of model fit indices.

Genetic Analysis Reveals the Important Role of the APC Gene in Clear Cell Renal Cell Carcinoma.

BACKGROUND/AIM: Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. The aim of this study was to elucidate the molecular pathogenesis of sporadic RCC in Taiwan. MATERIALS AND METHODS: Fifteen patients with RCC were screened for mutations in the von Hippel-Lindau (VHL) gene by PCR and Sanger sequencing. The methylation status of promoters of 24 tumor suppressor genes by methylation sensitive multiplex ligation-dependent probe amplification analysis was also determined. RESULTS: Inactivation of the VHL gene was observed in 5 cases: three missense somatic mutations, one promoter methylation, and one small deletion. In RCCs, methylation was most frequently observed in APC (100%), CDKN2B (92.9%), CASP8, MLH1_167, and KLLN (85.7.4%), but not in FHIT, MLH1_463, DAPK1, or HIC1 (0%). CONCLUSION: In addition to VHL inactivation, promoter methylation of APC may be a universal pathognomonic event in the tumorigenesis of RCC and a candidate diagnostic and therapeutic biomarker.