Flow with an intelligent tutor: A latent variable modeling approach to tracking flow during artificial tutoring.

Increasing use of intelligent tutoring systems in education calls for analytic methods that can unravel students' learning behaviors. In this study, we explore a latent variable modeling approach for tracking learning flow during computer-interactive artificial tutoring. The study considers three models that give discrete profiles of a latent process: the (i) latent class model, (ii) latent transition model, and (iii) hidden Markov model. We illustrate application of each model using example log data from Cognitive Tutor Algebra I and suggest analytic procedures of drawing learning flow. Through experimental application, we show that the models can reveal substantive information about students' learning behaviors and have potential utility for describing the learning flow. The models differed in the assumptions and data constraints but yielded consistent findings on the flow states and interaction modalities. Based on our experiential analyses, we discuss strengths and limitations of the models and illuminate areas of future development.

Evidence-Based Practice Knowledge Retention Among Nurse Practitioner Students.

ABSTRACT: The mastery of clinical scholarship and analytic methods for evidence-based practice (EBP) is a published essential for nurse practitioner (NP) education; however, retention of EBP-related knowledge during NP education remains unknown. We assessed EBP knowledge during a first-semester research course and again during the last semester using an item response model. We found that changes depended on the exam item, with performance dropping on a third of the items. Our findings suggest a need to integrate EBP concepts across curricula (e.g., feedback loops in courses other than the research course) to retain these essential skills.

Self-Management Model fails to Predict Quality of Life for People Living with Dual Diagnosis of HIV and Diabetes.

The objective of this study was to test a self-management model for self-management in people living with HIV and type 2 diabetes (PLWH + T2DM). We conducted a predictive, longitudinal study of data from a national research cohort of PLWH using lag analysis to test short- and long-term health outcomes for PLWH + T2DM. We used a dataset from the Center for AIDS Research (CFAR) Network of Integrated Clinic Systems (CNICS), a nation-wide research network of 8 clinics that serves PLWH. Patient-reported outcomes, collected at clinic visit, included depression, adherence, CD4 cell count, and health-related quality of life (HRQoL). We computed summary statistics to describe the sample. Using lag analysis, we then modeled the three variables of adherence, CD4 count, and HRQoL as a function of their predecessors in our conceptual model. In the final model, an increase of in medication adherence corresponded to a small increase in HRQoL. An increase in CD4 count corresponded to a small increase in HRQoL. An increase in lagged depression was associated with a small decrease in HRQoL. The model was not sufficient to predict short- or long-term outcomes in PLWH + T2DM. Although depression had a moderate impact, the final model was not clinically significant. For people with a dual diagnosis of HIV and T2DM, variables other than those traditionally addressed in self-management interventions may be more important.

RESUMEN: El objetivo de este estudio era evaluar un modelo de autocontrol para el autocontrol en aquellas personas que viven con VIH y diabetes de tipo 2 (PLWH + T2DM). Llevamos a cabo un estudio predictivo y longitudinal de la información proveniente de un estudio nacional de una población base de PLWH usando un análisis de retraso para evaluar los resultados en la salud a corto y largo plazo para PLWH + T2DM. Utilizamos un conjunto de datos del Center for AIDS Research [Instituto para la Investigación del SIDA] (CFAR) Network of Integrated Clinic Systems [Red de Sistemas de Clínicas Integradas] (CNICS), una red de investigación nacional que cuenta con ocho clínicas al servicio de PLWH. Los resultados que los pacientes reportaron, recolectados en una visita médica, incluyen depresión, adherencia, conteo de células CD4 y la calidad de vida relacionado con la salud (HRQoL). Calculamos el resumen estadístico para describir la muestra. Utilizando análisis de retraso, modelamos luego las tres variables de adherencia, conteo de células CD4 y el HRQoL como función de su antecesor en nuestro modelo conceptual. En el modelo final, un aumento en la adherencia al medicamento correspondió a un aumento en el HRQoL. Un aumento en el conteo de células CD4 correspondió a un aumento en el HRQoL. Se asoció un aumento de depresión retardada con una disminución en el HRQoL. El modelo no fue suficiente como para predecir resultados a corto o largo plazo en PLWH + T2DM. A pesar de que la depresión tenía un impacto moderado, el modelo final no fue clínicamente significativo. Para aquellas personas con un diagnóstico doble de VIH y T2DM, otras variables, además de las que se abordan tradicionalmente en las intervenciones de autocontrol, podrían ser más importantes.

Moderator Effects in Intervention Studies.

BACKGROUND: Although nursing intervention studies typically focus on testing hypothesized differences between intervention and control groups, moderator variables can reveal for whom or under what circumstances an intervention may be most effective. OBJECTIVES: The aim of the study was to explain and illustrate moderator effects using data from a nursing intervention study to improve cognitive abilities in those with a chronic health condition. METHODS: The sample consisted of 178 individuals with multiple sclerosis participating in an experimental study of a cognitive intervention. General linear models were used for analyses. Interaction terms were created to represent moderator effects on three outcomes: self-reported cognitive abilities, use of memory strategies, and verbal memory performance. RESULTS: The Charlson comorbidity index significantly moderated the intervention effect on self-perceived cognitive abilities. Years of education significantly moderated the intervention effect on use of memory strategies. Scores on a general self-efficacy measure significantly moderated the intervention effect on the Controlled Verbal Learning Test-Second Edition. DISCUSSION: These analyses highlight the key role that moderator effects can play in nursing research. Although random assignment to groups can control potentially biasing effects of extraneous differences among individuals in intervention and control groups, those very differences may suggest fruitful avenues for hypothesis generating research about what works best for whom in intervention studies.

Using polytomous latent class analysis to compare patterns of substance use and co-occurring health-risk behaviors between students in alternative and mainstream high schools.

INTRODUCTION: Alternative high school (AHS) students, an understudied and underserved population, experience educational, social, and health disparities relative to students in mainstream high schools. Disparities in single types of substance use are particularly high, yet no known studies have compared patterns of substance use or relationships between these patterns and other health-risk behaviors between AHS and mainstream high schools. METHODS: Using data from the Texas Alternative School Health Survey (n = 515; mean age 17.1 years, 49% male, 59% Hispanic, 23% White, 15% Black) and the Texas Youth Risk Behavior Survey (n = 2,113; mean age 16 years, 47% male, 64% Hispanic, 22% White, 7% Black), we used latent class analyses to compare patterns of substance use in AHSs and mainstream high schools. We used latent class regression to examine relationships between patterns of substance use and involvement in other health-risk behaviors in each school setting. RESULTS: Students in AHSs and mainstream high schools had similar patterns of substance use, and youth in higher risk categories engaged in higher levels of other health-risk behaviors. A substantially greater proportion of AHS students, however, fell into the moderate and high use categories, in support of continuing disparities for AHS students. CONCLUSIONS: Additional support is needed in AHSs to address the prevalence of high-risk patterns of substance use and associated health-risk behaviors. For example, ongoing public health surveillance is needed in AHSs, just as is done in mainstream high schools, to monitor trends in substance use and impact of policies and interventions.

Depression among Mexican-origin mothers: Exploring the immigrant paradox.

OBJECTIVES: Residential time in the United States appears to be a risk factor for mental health problems among Latinos, according to studies of the immigrant paradox, or a pattern of findings documenting better health for immigrants relative to U.S.-born Latinos. The present study used an acculturative stress model to examine the immigrant paradox with a sample of Mexican-origin mothers. METHOD: Mothers [N = 175; age = 33.52 (10.75)], who were foreign- or U.S.-born, were categorized as more acculturated or less acculturated based on cluster analyses using demographic and language proficiency variables. The association between acculturative status and depressive symptoms approximately 9 months later was tested with two models: with both cultural stressors (i.e., perceived discrimination, acculturative stress) and cultural assets (i.e., familismo, ethnic identity) as mediators, and with the effects of cultural stressors moderated by cultural assets. RESULTS: Data provide some support for the validity of the mediation model. Less acculturated mothers reported (a) a stronger ethnic identity, which appears to have protected them from later depression, and (b) stronger familismo, which increased risk for later depression. In addition, discrimination was negatively related to later depression. CONCLUSIONS: We found support for the mediating role of cultural assets in the link between acculturation and depression, but some associations were in unexpected directions. These findings highlight the complexities of preserving core cultural characteristics among Mexican-origin mothers living in the United States, and the need to consider the context in which cultural processes unfold. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Maternal depression and acculturative stress impacts on Mexican-origin children through authoritarian parenting.

Depression and acculturative stress are common among Latina mothers, yet little is known about how these variables are related to parenting practices and in turn, to the mental health functioning of their young children. The present study used a sample of Mexican-origin mothers of 3- to 6-year-old children (N = 175) to test a model of maternal depression and acculturative stress as predictors of child internalizing and externalizing problems, mediated by authoritarian and authoritative parenting practices. Results showed that maternal depressive symptoms and acculturative stress were associated with child internalizing, but not externalizing, problems. Only authoritarian practices mediated these associations. Results highlight the importance of considering sociocultural context in the study of child mental health in Mexican-origin populations.

The role of cognitive rehabilitation in people with type 2 diabetes: A study protocol for a randomized controlled trial.

Today, the prevalence of cognitive dysfunction and the prevalence of diabetes are increasing. Research shows that diabetes increases cognitive impairment risk, and cognitive impairment makes diabetes self-management more challenging. Diabetes self-management, essential to good glycemic control, requires patients to assimilate knowledge about their complex disease and to engage in activities such as glucose self-monitoring and the management of their medications. To test a comprehensive cognitive rehabilitation intervention-the Memory, Attention, and Problem-Solving Skills for Persons with Diabetes (MAPSS-DM) program. Our central hypothesis is that participants who take part in the MAPSS-DM intervention will have improved memory and executive function, increased use of compensatory cognitive skills, and improved self-management. We will also explore the role of glucose variability in those changes. This is a randomized controlled trial. Sixty-six participants with cognitive concerns and type 2 diabetes will be assigned to either the full MAPSS-DM intervention or an active control. Participants will use continuous glucose monitoring pre- and post-intervention to identify changes in glycemic variability. All participants will also be evaluated systematically via questionnaires and neuropsychological tests at three timepoints: baseline, immediately post-intervention, and 3 months post-intervention. This study will fill an important gap by addressing cognitive function in the management of diabetes. Diabetes is related to accelerated cognitive aging, cognitive deficits are related to poorer self-management, and improvements in cognitive performance as a result of cognitive rehabilitation can translate into improved performance in everyday life and, potentially, diabetes self-management. The results of the proposed study will therefore potentially inform strategies to support cognitive function and diabetes self-management, as well as offer new mechanistic insights into cognitive function through the use of continuous glucose monitoring. Trial registration: This study has been registered at ClinicalTrials.gov (NCT04831775).

The Impacts of Three Educational Technologies on Algebraic Understanding in the Context of COVID-19.

The current study investigated the effectiveness of three distinct educational technologies-two game-based applications (From Here to There and DragonBox 12+) and two modes of online problem sets in ASSISTments (an Immediate Feedback condition and an Active Control condition with no immediate feedback) on Grade 7 students' algebraic knowledge. More than 3,600 Grade 7 students across nine in-person and one virtual schools within the same district were randomly assigned to one of the four conditions. Students received nine 30-minute intervention sessions from September 2020 to March 2021. Hierarchical linear modeling analyses of the final analytic sample (N = 1,850) showed significantly higher posttest scores for students who used From Here to There and DragonBox 12+ compared to the Active Control condition. No significant difference was found for the Immediate Feedback condition. The findings have implications for understanding how game-based applications can affect algebraic understanding, even within pandemic pressures on learning.

Promoting Healthy Attitudes and Behaviors in Youth Who Experience Homelessness: Results of a Longitudinal Intervention Study.

PURPOSE: The aim of this study is to determine the effectiveness of a brief intervention to promote responsible substance use and safe sex behaviors in youths experiencing homelessness (YEH). METHODS: Design: A Solomon four-group (double randomized controlled trial) longitudinal design with repeated measures (3- and 6-month follow-ups) was used in drop-in centers for YEH in Austin, Texas and Columbus, Ohio from which 602 youths, 18-24 years-old (M = 21 ± 1.8), 50% white; 69.9% heterosexual were recruited. A manualized one-on-one intervention consisted of six modules delivered via laptop computers. Modules focused on communication, goal-setting, substance use refusal, safe sex behaviors, enhanced psychological capital (hope, optimism, resilience, self-efficacy, gratitude), and life satisfaction. Valid and reliable measures of hope, optimism, future time perspective, resilience, social connectedness, gratitude, condom intention, self-efficacy for safe sex, safe sex behaviors, self-efficacy for substance use refusal, and life satisfaction were used to collect data for which three hypotheses were tested, using intent to treat, with multi-level modeling (R). RESULTS: The analysis showed partial support for all hypotheses: (1) post-test outcomes were greater than pretests; (2) intervention group outcomes were greater than control group measures; and (3) significant effects for pretesting. YEH in Ohio completed significantly more sessions than YEH in Texas (p = .001), but took significantly longer to complete all six sessions (p = .001). DISCUSSION: This brief intervention had significant effects on YEH to promote healthy attitudes and behaviors that merit further testing in larger samples.

A Cross-Sectional Exploration of Cytokine-Symptom Networks in Breast Cancer Survivors Using Network Analysis.

PURPOSE: The purpose of this study is to (a) visualize the symptom-cytokine networks (perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, sleep quality, and 13 cytokines) and (b) explore centrality metrics of symptom-cytokine networks in breast cancer survivors who completed chemotherapy treatment. METHODS: Cross-sectional analysis of data collected from 66 breast cancer survivors who were on average three years post chemotherapy completion. Perceived stress, fatigue, loneliness, perceived cognitive impairment, daytime sleepiness, and sleep quality were measured with self-report instruments, and a panel of 13 cytokines was measured from serum using multiplex assays. Symptoms and cytokines were simultaneously evaluated with correlations, network analysis, and community analysis. RESULTS: Network analysis revealed the nodes with the greatest degree and closeness were interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-13, and perceived cognitive impairment. Node betweenness was highest for perceived cognitive impairment and interleukin-2. Community analysis revealed two separate communities of nodes within the network (symptoms and the cytokines). Several edges connected the two communities including perceived cognitive impairment, stress, fatigue, depression, interleukin-2, granulocyte-macrophage colony-stimulating factor, interleukin-8, interleukin-13, and interleukin-10. Partial correlation analyses revealed significant negative relationships between interleukin-2 and fatigue, loneliness, stress, and perceived cognitive impairment (rs = -.27 to -.37, ps < .05) and a significant negative relationship between perceived cognitive impairment and granulocyte-macrophage colony-stimulating factor (r = -.34, p < .01). CONCLUSIONS: Our analyses support that perceived cognitive impairment, stress, loneliness, depressive symptoms, and fatigue co-occur and extend the literature by suggesting that interleukin-2 may contribute to the underlying mechanistic pathway of these co-occurring symptoms. Our findings add to a growing body of literature that is shifting to study symptoms as they co-occur, or cluster, rather than individual symptoms.

Valuing Joyful Teaching Moments: Nursing Faculty Experiences in Texas.

Purpose: Studies of joyful experiences in teaching nursing and related implications are lacking in the literature. The concept of joy seems undervalued yet critical to the theoretical basis for improving holistic faculty experiences and potentially affecting students and patients. The purpose of this study is to give voice to instances of joyful teaching identified by nursing faculty and to consider related implications, including advancing holistic nursing education. Design: In this sequential exploratory multimethod study, faculty discussed joyful teaching, responded to survey questions, and completed a Likert-type measure of outcomes. Eleven faculty were interviewed; interviews were digitally recorded and professionally transcribed. Interviews were coded using qualitative content analysis; quantitative data provided frequency counts. Findings: Four main themes emerged: "aha" moments, faculty validation, witnessing transformation, and planting seeds. Faculty shared experiences with peers, students, or both, and occasionally with others. Three outcome themes of joy were identified: transcendence, meaning, and activity. The most frequently reported significance of joy was hope and resilience. Conclusions: Joyful experiences belong in the literature and can inform holistic practice. Our results suggest that joyful moments support faculty and that students and patients may also benefit from this emotion, even though it has been undervalued in nursing research.

The Influence of Discrimination and Coping Style on Blood Pressure Among Black/African American Women in the InterGEN Study.

Purpose: Although research has explored the effects of racism on mental health, few studies have investigated the effects of racism on physical health. In this study, we examined the influence of racial discrimination and race-related stress and coping on blood pressure within a cohort of Black/African American women. Methods: This was a secondary data analysis of 226 Black/African American women from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study. Experiences of racial discrimination and coping, measured by the Experiences of Discrimination scale and the Race-Related Events Scale, were analyzed in relation to systolic blood pressure (SBP) and diastolic blood pressure (DBP). Multiple linear regression was used to explore the interaction effect of coping and discrimination on blood pressure for both scales. Results: Age and elevated body mass index were associated with increased SBP and DBP, and low income was associated with increased DBP. Among individuals who reported no personal experience of discrimination, more active coping strategies were associated with higher DBP. There was no evidence of a relationship between type of coping strategies used and blood pressure among individuals who did report experiences of discrimination. Conclusion: Differences in coping strategy in response to racism were not found to have a significant moderating effect on DBP in Black/African American women.

Examining the mutual relations between language and mathematics: A meta-analysis.

This study presents a meta-analysis of the relation between language and mathematics. A moderate relation between language and mathematics was found in 344 studies with 393 independent samples and more than 360,000 participants, r = .42, 95% CI [.40, .44]. Moderation and partial correlation analyses revealed the following: (a) more complicated language and mathematics skills were associated with stronger relations between language and mathematics; after partialing out working memory and intelligence, rapid automatized naming showed the strongest relation to numerical knowledge; (b) the relation between language and mathematics was stronger among native language speakers than among second-language learners, but this difference was not found after partialing out working memory and intelligence; (c) working memory and intelligence together explained over 50% of the variance in the relation between language and mathematics and explained more variance in such relations involving complex mathematics skills; (d) language and mathematics predicted the development of one another even after controlling for initial performance. These findings suggest that we may use language as a medium to communicate, represent, and retrieve mathematics knowledge as well as to facilitate working memory and reasoning during mathematics performance and learning. With development, the use of language to retrieve mathematics knowledge may be more important for foundational mathematics skills, which in turn further strengthens linguistic thought processes for performing more advanced mathematics tasks. Such use of language may boost the mutual effects of cognition and mathematics across development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Scientific Networks on Data Landscapes: Question Difficulty, Epistemic Success, and Convergence.

A scientific community can be modeled as a collection of epistemic agents attempting to answer questions, in part by communicating about their hypotheses and results. We can treat the pathways of scientific communication as a network. When we do, it becomes clear that the interaction between the structure of the network and the nature of the question under investigation affects epistemic desiderata, including accuracy and speed to community consensus. Here we build on previous work, both our own and others', in order to get a firmer grasp on precisely which features of scientific communities interact with which features of scientific questions in order to influence epistemic outcomes. Here we introduce a measure on the landscape meant to capture some aspects of the difficulty of answering an empirical question. We then investigate both how different communication networks affect whether the community finds the best answer and the time it takes for the community to reach consensus on an answer. We measure these two epistemic desiderata on a continuum of networks sampled from the Watts-Strogatz spectrum. It turns out that finding the best answer and reaching consensus exhibit radically different patterns. The time it takes for a community to reach a consensus in these models roughly tracks mean path length in the network. Whether a scientific community finds the best answer, on the other hand, tracks neither mean path length nor clustering coefficient.