Supporting validity: steps to contextualise applications for technology and assessment, for learning.

In the paper, the authors offer perspectives on the uses of technology and assessment, that support learning. The perspectives are viewed through validity (from the field of assessment) as a framework and they discuss four aspects of an interconnected technology, learning and assessment space that represent theory informed, authentic practice. The four are: 1) integrated coherence for learning, assessment and technology; 2) responsibilities for equity, diversity, inclusion and wellbeing; 3) sustainability; and 4) balancing resources in global contexts. The authors propose steps and considerations for medical and health professions educators who need to contextualise applications for technology, learning and assessment, for positive impact for learners, faculty, institutions and patient care.

A Horizon Scan to Support Chemical Pollution-Related Policymaking for Sustainable and Climate-Resilient Economies.

While chemicals are vital to modern society through materials, agriculture, textiles, new technology, medicines, and consumer goods, their use is not without risks. Unfortunately, our resources seem inadequate to address the breadth of chemical challenges to the environment and human health. Therefore, it is important we use our intelligence and knowledge wisely to prepare for what lies ahead. The present study used a Delphi-style approach to horizon-scan future chemical threats that need to be considered in the setting of chemicals and environmental policy, which involved a multidisciplinary, multisectoral, and multinational panel of 25 scientists and practitioners (mainly from the United Kingdom, Europe, and other industrialized nations) in a three-stage process. Fifteen issues were shortlisted (from a nominated list of 48), considered by the panel to hold global relevance. The issues span from the need for new chemical manufacturing (including transitioning to non-fossil-fuel feedstocks); challenges from novel materials, food imports, landfills, and tire wear; and opportunities from artificial intelligence, greater data transparency, and the weight-of-evidence approach. The 15 issues can be divided into three classes: new perspectives on historic but insufficiently appreciated chemicals/issues, new or relatively new products and their associated industries, and thinking through approaches we can use to meet these challenges. Chemicals are one threat among many that influence the environment and human health, and interlinkages with wider issues such as climate change and how we mitigate these were clear in this exercise. The horizon scan highlights the value of thinking broadly and consulting widely, considering systems approaches to ensure that interventions appreciate synergies and avoid harmful trade-offs in other areas. We recommend further collaboration between researchers, industry, regulators, and policymakers to perform horizon scanning to inform policymaking, to develop our ability to meet these challenges, and especially to extend the approach to consider also concerns from countries with developing economies. Environ Toxicol Chem 2023;42:1212-1228. © 2023 Crown copyright and The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland.

Technology enhanced assessment: Ottawa consensus statement and recommendations.

INTRODUCTION: In 2011, a consensus report was produced on technology-enhanced assessment (TEA), its good practices, and future perspectives. Since then, technological advances have enabled innovative practices and tools that have revolutionised how learners are assessed. In this updated consensus, we bring together the potential of technology and the ultimate goals of assessment on learner attainment, faculty development, and improved healthcare practices. METHODS: As a material for the report, we used the scholarly publications on TEA in both HPE and general higher education, feedback from 2020 Ottawa Conference workshops, and scholarly publications on assessment technology practices during the Covid-19 pandemic. RESULTS AND CONCLUSION: The group identified areas of consensus that remained to be resolved and issues that arose in the evolution of TEA. We adopted a three-stage approach (readiness to adopt technology, application of assessment technology, and evaluation/dissemination). The application stage adopted an assessment 'lifecycle' approach and targeted five key foci: (1) Advancing authenticity of assessment, (2) Engaging learners with assessment, (3) Enhancing design and scheduling, (4) Optimising assessment delivery and recording learner achievement, and (5) Tracking learner progress and faculty activity and thereby supporting longitudinal learning and continuous assessment.

Performance assessment: Consensus statement and recommendations from the 2020 Ottawa Conference.

INTRODUCTION: In 2011 the Consensus Statement on Performance Assessment was published in Medical Teacher. That paper was commissioned by AMEE (Association for Medical Education in Europe) as part of the series of Consensus Statements following the 2010 Ottawa Conference. In 2019, it was recommended that a working group be reconvened to review and consider developments in performance assessment since the 2011 publication. METHODS: Following review of the original recommendations in the 2011 paper and shifts in the field across the past 10 years, the group identified areas of consensus and yet to be resolved issues for performance assessment. RESULTS AND DISCUSSION: This paper addresses developments in performance assessment since 2011, reiterates relevant aspects of the 2011 paper, and summarises contemporary best practice recommendations for OSCEs and WBAs, fit-for-purpose methods for performance assessment in the health professions.

Understanding and developing procedures for video-based assessment in medical education.

INTRODUCTION: Novel uses of video aim to enhance assessment in health-professionals education. Whilst these uses presume equivalence between video and live scoring, some research suggests that poorly understood variations could challenge validity. We aimed to understand examiners' and students' interaction with video whilst developing procedures to promote its optimal use. METHODS: Using design-based research we developed theory and procedures for video use in assessment, iteratively adapting conditions across simulated OSCE stations. We explored examiners' and students' perceptions using think-aloud, interviews and focus group. Data were analysed using constructivist grounded-theory methods. RESULTS: Video-based assessment produced detachment and reduced volitional control for examiners. Examiners ability to make valid video-based judgements was mediated by the interaction of station content and specifically selected filming parameters. Examiners displayed several judgemental tendencies which helped them manage videos' limitations but could also bias judgements in some circumstances. Students rarely found carefully-placed cameras intrusive and considered filming acceptable if adequately justified. DISCUSSION: Successful use of video-based assessment relies on balancing the need to ensure station-specific information adequacy; avoiding disruptive intrusion; and the degree of justification provided by video's educational purpose. Video has the potential to enhance assessment validity and students' learning when an appropriate balance is achieved.

Problematic Risk Adjustment in National Healthcare Safety Network Measures.

This article reviews the risk-adjustment models underpinning the National Healthcare Safety Network (NHSN) standardized infection ratios. After first describing the models, the authors focus on hospital intensive care unit (ICU) designation as a variable employed across the various risk models. The risk-adjusted frequency with which ICU services are reported in Medicare fee-for-service claims data was compared as a proxy for determining whether reporting of ICU days is similar across hospitals. Extreme variation was found in the reporting of ICU utilization among admissions for congestive heart failure, ranging from 25% in the lowest admission hospital quartile to 95% in the highest. The across-hospital variation in reported ICU utilization was found to be unrelated to patient severity. Given that such extreme variation appears in a designation of ICU versus non-ICU utilization, the NHSN risk-adjustment models' dependence on nursing unit designation should be a cause for concern.

Rethinking Aid Allocation: Analysis of Official Development Spending on Modern Pollution Reduction.

Background: Modern pollution - pollution attributable to industrialization and urbanization - is responsible for nearly 6 million deaths per year, more than all the deaths from HIV, malaria, and tuberculosis combined; yet it receives comparatively little attention in the international development agenda [1]. Objective/Methods: This study attempts to highlight the funding disparity between select key threats to global health by quantifying the levels of international official development aid (ODA) allocated to reducing pollution's negative impact on human health using a new metric - dollars spent per death caused by health threat. Findings: Using only reported ODA spending for 2016, we calculate an average investment of $14/death for modern pollution, compared with $1,250/death for malaria, $190/death for tuberculosis, and $165/death for HIV/AIDS. Conclusions: Although there are substantive limitations to this analysis, results are sufficient to galvanize action to better monitor and track investments in modern pollution reduction. Donor countries have failed to respond to this urgent public health crisis. Given the severity of its public health burden, there is a critical need for funding to be allocated specifically to pollution reduction.

Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors.

BACKGROUND: The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals. OBJECTIVES: We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease-Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden-both current and projected. METHODS: We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment. DISCUSSION: A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure-risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD's current methods do not fully account for lead's impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk-outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD's estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496.

Measuring avian specialization.

Measuring the extent to which a species is specialized is a major challenge in ecology, with important repercussions for fundamental research as well as for applied ecology and conservation. Here, we develop a multidimensional index of specialization based on five sets of ecological characteristics of breeding bird species. We used two recent databases of species traits of European birds based on foraging ecology, habitat, and breeding characteristics. The indices of specialization were calculated by applying the Gini coefficient, an index of inequality. The Gini coefficient is a measure of statistical dispersion on a scale between 0 and 1, reflecting a gradient from low to high specialization, respectively. Finally, we tested the strength of the phylogenetic signal of each specialization index to understand how the variance of such indices is shared throughout the phylogeny. The methods for constructing and evaluating a multidimensional index of bird specialization could also be applied to other taxa and regions, offering a simple but useful tool, particularly suited for global or biogeographic studies, as a contribution to comparative estimates of the degree of specialization of species.

Access to Affordable, High-Quality Health Insurance for Rural Residents and Its Impact on Their Health and on Rural Hospitals.

Access to rural health care is an ongoing challenge for those living in America's countryside. Hospital closures, a fragmented and dislocated care delivery system, disproportionate levels of chronic illness, and poverty combine to present significant obstacles to health reform. This article highlights the major challenges in rural health care and specifies financial and delivery policy options that can strengthen rural health care. In particular, this article suggests a return to a prepaid approach within the umbrella organizational framework of what we term "rural convening entities." These entities would serve as the control of telehealth hubs for the communities they serve.

Changes in area and number of nature reserves in China.

Nature reserves (NR) are the cornerstone of biodiversity conservation. Over the past 60 years, the rapid expansion of NRs in China, one of the world's megadiverse countries, has played a critical role in slowing biodiversity loss. We examined the changes in the number and area of China's NRs from 1956 to 2014 and analyzed the effect of economic development on the expansion of China's NRs from 2005 to 2014 with linear models. Despite a continuing increase in the number of NRs, the total area of China's NRs decreased by 3% from 2007 to 2014. This loss resulted from downsizing and degazettement of existing NRs and a slowdown in the establishment of new ones. Nature reserves in regions with rapid economic development exhibited a greater decrease in area, suggesting that downsizing and degazettement of NRs are closely related to the intensifying competition between economic growth and conservation. For example, boundary adjustments to national NRs, the most strictly protected NRs, along the coast of China's Yellow Sea, a global biodiversity hotspot with a fast-growing economy, resulted in the loss of one-third of the total area. One of the most important ecosystems in these NRs, tidal wetlands, decreased by 27.8% because of boundary adjustments and by 25.2% because of land reclamation. Our results suggest conservation achievement, in terms of both area and quality, are declining at least in some regions in the Chinese NR estate. Although the designation of protected areas that are primarily managed for sustainable use has increased rapidly in recent years in China, we propose that NRs with biodiversity conservation as their main function should not be replaced or weakened.

Cambios en la Superficie y el Número de Reservas Naturales en China Resumen Las reservas naturales (RN) son la piedra angular de la conservación de la biodiversidad. Durante los últimos 60 años, la rápida expansión de las RN en China, uno de los países megadiversos, ha jugado un papel crítico en la reducción de la pérdida de biodiversidad. Examinamos los cambios en el número y superficie de las RN en China de 1956 a 2014 y analizamos el efecto del desarrollo económico en la expansión de las RN en China de 2005 a 2014 mediante modelos lineales. A pesar del incremento continuo en el número de RN, la superficie total de RN en China decreció en 3% de 2007 a 2014. Esta pérdida resultó de la reducción y cambio de registro de RN existentes y una desaceleración en el establecimiento de RN nuevas. Las reservas naturales en regiones con desarrollo económico rápido presentaron una mayor disminución en la superficie, lo que sugiere que la reducción y cambio de registro de RN están relacionados cercanamente con la intensificación de la competencia entre crecimiento económico y conservación. Por ejemplo, ajustes en los límites de RN nacionales, las RN más estrictamente protegidas, a lo largo de la costa del Mar Amarillo, un sitio de importancia para la biodiversidad global con una economía en rápido crecimiento, resultó en la pérdida de un tercio de la superficie total. Uno de los ecosistemas más importantes en estas RN, humedales mareales, decreció en 27.8% debido a ajustes en los límites y en 25.2% debido a la reclamación de tierras. Nuestros resultados sugieren que los logros de conservación, en términos tanto de área como de calidad, están declinando en las RN de China. Aunque la designación de áreas protegidas administradas primariamente para un uso sustentable ha incrementado rápidamente en años recientes en China, proponemos que las RN cuya principal función es la conservación de la biodiversidad no deben ser reemplazadas o debilitadas.

Assessment of the prevalence of lead-based paint exposure risk in Jakarta, Indonesia.

While lead-based paint has been banned for use in residential settings in most high-income countries, it remains commonly available in many low- and middle-income countries (LMICs). Despite its continued availability, little is known about the specific exposure risk posed by lead-based paint in LMICs. To address this knowledge gap, an assessment of home and preschool dust and paint was carried out in Greater Jakarta, Indonesia. A team of investigators used field portable X-ray Fluorescence (pXRF) to measure 1574 painted surfaces for the presence of lead (mg/cm2) and collected 222 surface dust wipe samples for lead loading (µg/m2) from 103 homes and 19 preschools across 13 different neighborhoods of Jakarta. The assessment found that 2.7% (n = 42) of pXRF measurements and 0.05% (n = 1) of dust wipe samples exceeded the commonly applied USEPA guideline values for paint (1 mg/cm2) and dust (floors: 431 µg/m2; window sills: 2691 µg/m2). Thus, contrary to expectations the locations analyzed in Greater Jakarta showed that exposure risk to lead-based paint appears low. Further study is required in other settings to confirm the findings here. Precautionary measures, such as the proposed ban on lead-based paint, should be taken to prevent the significant social and economic costs associated with lead exposure.

A meta-analysis of blood lead levels in India and the attributable burden of disease.

Multiple studies in India have found elevated blood lead levels (BLLs) in target populations. However the data have not yet been evaluated to understand population-wide exposure levels. We used arithmetic mean blood lead data published from 2010 to 2018 on Indian populations to calculate the average BLLs for multiple subgroups. We then calculated the attributable disease burden in IQ decrement and Disability Adjusted Life Years (DALYs). Our Pubmed search yielded 1066 articles. Of these, 31 studies representing the BLLs of 5472 people in 9 states met our study criteria. Evaluating these, we found a mean BLL of 6.86 µg/dL (95% CI: 4.38-9.35) in children and 7.52 µg/dL (95% CI: 5.28-9.76) in non-occupationally exposed adults. We calculated that these exposures resulted in 4.9 million DALYs (95% CI: 3.9-5.6) in the states we evaluated. Population-wide BLLs in India remain elevated despite regulatory action to eliminate leaded petrol, the most significant historical source. The estimated attributable disease burden is larger than previously calculated, particularly with regard to associated intellectual disability outcomes in children. Larger population-wide BLL studies are required to inform future calculations. Policy responses need to be developed to mitigate the worst exposures.

Crowdfunding biodiversity conservation.

Raising funds is critical for conserving biodiversity and hence so is scrutinizing emerging financial mechanisms that may help achieve this goal. Anecdotal evidence indicates crowdfunding is being used to support activities needed for biodiversity conservation, yet its magnitude and allocation remain largely unknown. To help address this knowledge gap, we conducted a global analysis based on conservation-focused projects extracted from crowdfunding platforms. For each project, we determined the funds raised, date, country of implementation, proponent characteristics, activity type, biodiversity realm, and target taxa. We identified 72 relevant platforms and 577 conservation-focused projects that raised $4,790,634 since 2009. Although proponents were based in 38 countries, projects were delivered across 80 countries, indicating a potential mechanism of resource mobilization. Proponents were affiliated with nongovernmental organizations (35%) or universities (30%) or were freelancers (26%). Most projects were for research (40%), persuasion (31%), and on-the-ground actions (21%). Projects were more focused on species (57.7%) and terrestrial ecosystems (20.3%), and less focused on marine (8.8%) and freshwater ecosystems (3.6%). Projects focused on 208 species, including a disproportionate number of threatened birds and mammals. Crowdfunding for biodiversity conservation is a global phenomenon and there is potential for expansion, despite possible pitfalls (e.g., uncertainty about effectiveness). Opportunities to advance conservation through crowdfunding arise from its capacity to mobilize funds spatially and increase steadily over time, inclusion of overlooked species, adoption by multiple actors, and funding of activities beyond research. Our findings pave the way for further research on key questions, such as campaign success rates, effectiveness of conservation actions, and drivers of crowdfunding adoption. Even though crowdfunding capital raised has been modest relative to other conservation-finance mechanisms, its contribution goes beyond funding research and providing capital. Embraced with due care, crowdfunding could become an important financial mechanism for biodiversity conservation.