Reliability of the Test of Integrated Language and Literacy Skills (TILLS).

BACKGROUND: As new standardized tests become commercially available, it is critical that clinicians have access to the information about a test's psychometric properties, including aspects of reliability. AIMS: The purpose of the three studies reported in this article was to investigate the reliability of a new test, the Test of Integrated Language and Literacy Skills (TILLS), with consideration of both internal and external sources of measurement error. METHODS & PROCEDURES: The TILLS was administered to children aged 6;0-18;11 years. The participants varied in terms of their language and literacy skills and included children with typical language development as well as those diagnosed with language or learning disability. The sample of children also varied in terms of their racial and socioeconomic backgrounds. Study 1 (N = 1056) assessed the internal consistency of TILLS calculating the coefficient omega for each subtest. Study 2 (N = 103) and Study 3 (N = 39) used the intra-class correlation coefficients to report on test-retest and inter-rater reliability respectively. OUTCOMES & RESULTS: The results indicate strong internal consistency and inter-rater reliability for all subtests of TILLS. The test-retest reliability was strong for all but one subtest, for which the intra-class correlation coefficient was in the acceptable range. CONCLUSION & IMPLICATIONS: This article provides clinicians with essential scientific information that supports the internal and external reliability of a new test of oral and written language skills, the TILLS. Information about reliability is critical for guiding the selection of an appropriate diagnostic tool amongst a number of options.

Comparison of prosthetic mobility and balance in transfemoral amputees with bone-anchored prosthesis vs. socket prosthesis.

BACKGROUND: The literature comparing bone-anchored prosthesis (BAP) with socket prosthesis (SP) consistently reports improvement in physical health and quality of life using primarily patient-reported outcome measures (PROMs). OBJECTIVE: To determine the differences in mobility and balance using performance-based outcome measures and PROMs in people with transfemoral amputations (TFAs) fitted with BAP vs. SP. STUDY DESIGN: Causal comparative. METHODS: Two groups of people with TFAs were recruited: one using a BAP (N = 11; mean age ± standard deviation, 44 ± 14.9 years; mean residual limb length as a percentage of the intact femur, 68% ± 15.9) and another group using a SP (N = 11; mean age ± standard deviation, 49.6 ± 16.0 years; mean residual limb length as a percentage of the intact femur, 81% ± 13.9), and completed the 10-meter walk test, component timed-up-and-go, Prosthetic Limb Users Survey of Mobility™ 12-item, and Activities-specific Balance Confidence Scale. RESULTS: There were no statistically significant differences between the BAP and SP groups in temporal spatial gait parameters and prosthetic mobility as measured by the 10-meter walk test and component timed-up-and-go, yet large effect sizes were found for several variables. In addition, Activities-specific Balance Confidence Scale and Prosthetic Limb Users Survey of Mobility™ scores were not statistically different between the BAP and SP groups, yet a large effect sizes were found for both variables. CONCLUSIONS: This study found that people with TFA who use a BAP can demonstrate similar temporal spatial gait parameters and prosthetic mobility, as well as self-perceived balance confidence and prosthetic mobility as SP users. Therefore, suggesting that the osseointegration reconstruction surgical procedure provides an alternative option for a specific population with TFA who cannot wear nor have limitations with a SP. Future research with a larger sample and other performance-based outcome measures and PROMs of prosthetic mobility and balance would further determine the differences between the prosthetic options.

The Relationship Between Pedagogy and Changes in Students' Learning Styles in Physician Assistant Education.

INTRODUCTION: The purpose of this study was to examine the relationship between instructional pedagogy and changes in physician assistant (PA) students' learning styles during a 2-year master's program. METHODS: Two parallel curricular tracks were established in the didactic year, one using problem-based learning (PBL) and the other lecture-based learning (LBL) for 6 years. Kolb's Learning Style Inventory (LSI) was administered to both groups at matriculation and at the end of the first and second years. Multivariate analyses, including logarithmic transformations of LSI data because of its ipsative nature, were conducted to evaluate differences and changes in students' learning style. RESULTS: A majority of students changed learning styles during the program. Despite considerable movement within and between learning styles, the percentage distribution of LBL students' learning styles changed little during the program, whereas there was a significant increase in PBL students having a Convergent learning style after 2 years. PBL students preferred more transformation than prehension in information processing than LBL students. About a third of LBL students, compared to a fifth of PBL students, had reverted to close to their matriculation learning style by the end of the clinical year. DISCUSSION: Primary care physicians and PAs tend to have a Convergent learning style. Little movement towards this learning style was seen with LBL students, whereas a significant increase in the number of PBL students had adopted this learning style by the end of the program.

The Dimensionality of Language and Literacy in the School-Age Years.

PURPOSE: This was an investigation of the dimensionality of oral and written language to test the hypothesis that a two-factor model with sound/word and sentence/discourse language levels would best fit language and literacy data for a population-based sample in the school-age years. METHOD: A stratified secondary data set of 1,500 participants was drawn randomly from a larger nationally representative U.S. data set (N = 1,853) gathered during standardization of the Test of Integrated Language and Literacy Skills. A sample of 254 students with prior diagnoses of language and literacy disorders (LLD) was drawn from the full data set. Confirmatory factor analysis was used to compare the hypothesized two-factor model with other theoretically possible models. RESULTS: The hypothesized two-factor language-levels model had an acceptable-to-good fit to the full data set, as did the three-factor model, with verbal memory added. High interfactor correlation between verbal memory and sentence/discourse constructs, as well as a preference for parsimony, led to the acceptance of the two-factor model as best. This language-levels model had a good fit to the data at ages 8-11 years, and an excellent fit at ages 12-18 years, but only a poor fit for ages 6-7 years (yet still better than other two-factor or unitary models). It had a reasonable fit for students with LLD, although the three-factor model fit their data slightly better. CONCLUSIONS: Oral and written language abilities during the school-age years are best explained by a two-factor model with sound/word and sentence/discourse language levels and memory as a contributing factor. Implications for identifying and treating language and literacy disorders as multidimensional rather than categorical are discussed.

Neurocognitive functioning in preschool-age children with type 1 diabetes mellitus.

Neurocognitive functioning may be compromised in children with type 1 diabetes mellitus (T1DM). The factor most consistently implicated in the long-term neurocognitive functioning of children with T1DM is age of onset. The pediatric literature suggests that glycemic extremes may have an effect on the neurocognitive functioning of children, but findings are mixed. The purpose of this study was to compare the neurocognitive functioning of young children with T1DM diagnosed before 6 yr of age and healthy children (i.e., without chronic illness). Additionally, in the children with T1DM, we examined the relationship between their neurocognitive functioning and glycemic control. Sixty-eight (36 with T1DM and 32 without chronic illness) preschool-age children (M age = 4.4 yr ) were recruited and administered a battery of instruments to measure cognitive, language, and fine motor skills. Children with T1DM performed similar to the healthy controls and both groups' skills fell in the average range. Among children with diabetes, poor glycemic control [higher hemoglobin A1c (HbA1c)] was related to lower general cognitive abilities (r = -0.44,p < 0.04), slower fine motor speed (r = -0.64,p < 0.02), and lower receptive language scores (r = -0.39,p < 0.04). Such findings indicate that young children with T1DM already demonstrate some negative neurocognitive effects in association with chronic hyperglycemia.

Exploring emergency physician-hospitalist handoff interactions: development of the Handoff Communication Assessment.

STUDY OBJECTIVE: We develop and evaluate the Handoff Communication Assessment, using actual handoffs of patient transfers from emergency department to inpatient care. METHODS: This was an observational qualitative study. We derived a Handoff Communication Assessment tool, using categories from discourse coding described in physician-patient communication, previous handoff research in medicine, health communication, and health systems engineering and pilot data from 3 physician-hospitalist handoffs. The resulting tool consists of 2 typologies, content and language form. We applied the tool to a convenience sample of 15 emergency physician-to-hospitalist handoffs occurring at a community teaching hospital. Using discourse analysis, we assigned utterances into categories and determined the frequency of utterances in each category and by physician role. RESULTS: The tool contains 11 content categories reflecting topics of patient presentation, assessment, and professional environment and 11 language form categories representing information-seeking, information-giving, and information-verifying behaviors. The Handoff Communication Assessment showed good interrater reliability for content (kappa=0.71) and language form (kappa=0.84). We analyzed 742 utterances, which provided the following preliminary findings: emergency physicians talked more during handoffs (67.7% of all utterances) compared with hospitalists (32.3% of all utterances). Content focused on patient presentation (43.6%), professional environment (36%), and assessment (20.3%). Form was mostly information-giving (90.7%) with periodic information-seeking utterances (8.8%) and rarely information-verifying utterances (0.4%). Questions accounted for less than 10% of all utterances. CONCLUSION: We were able to develop and use the Handoff Communication Assessment to analyze content and structure of handoff communication between emergency physicians and hospitalists at a single center. In this preliminary application of the tool, we found that emergency physician-to-hospitalist handoffs primarily consist of information giving and are not geared toward question-and-answer events. This critical exchange may benefit from ongoing analysis and reformulation.

The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation.

OBJECTIVE: The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test. METHODS: This was a cross-sectional study with a convenience sample of 130 community ambulators with unilateral LLA. Classification of VSI was determined based on a time-based pass/fail mCTSIB performance. Participants were classified as having normal sensory integration (NSI) if they could balance for 30 seconds in every mCTSIB condition. Participants who failed condition 4 exclusively were classified as IVSI. Prosthetic mobility, as measured by the cTUG, was compared between NSI and IVSI groups. RESULTS: Of the 130 participants, 29 (22%) were classified as IVSI and 95 (73%) were classified as having NSI. Prosthetic mobility significantly differed between IVSI and NSI groups, with IVSI participants performing all components of the cTUG significantly slower. Medium to large effect sizes were found between groups during cTUG. CONCLUSIONS: These results suggest that 1 in 5 community ambulators with LLA have IVSI, with associated limitations in balance confidence and prosthetic mobility. IMPACT: The ability to integrate vestibular information was found to have a strong relationship with prosthetic mobility in active community ambulators with LLA, especially with performing a 180-degree step turn. Physical therapists can use the mCTSIB to classify sensory integration during prosthetic rehabilitation and develop an appropriate balance intervention. LAY SUMMARY: Active adults with LLA can use information from their senses to maintain their standing balance. Adults with LLA who have difficulty balancing on foam with closed eyes were slower to get in and out of a chair, walk, and perform a 180-degree step turn.

Is Student Stress Related to Personality or Learning Environment in a Physician Assistant Program?

PURPOSE: The purpose of this research was to study the impact of students' personalities and 2 different learning environments-lecture-based learning (LBL) and problem-based learning (PBL)-on the stress perceived by 5 cohorts of physician assistant (PA) students. METHODS: Students rated their stress related to family obligations, financial concerns, schoolwork, relocation, and overall stress on 6 occasions over the course of the 2-year program. Personalities of students were assessed using the California Psychological Inventory 7 months into the program. Students' expectations and observations of their learning environments were measured using the PA School Learning Environment Survey at the beginning and end of the didactic year. RESULTS: Personalities of LBL and PBL students were very similar, but LBL students who scored higher on the Independence concept were less stressed about their schoolwork. The LBL students, in general, were more discontented with their learning environment, but this finding was not related to higher schoolwork-related stress. In contrast, PBL students' personalities were not related to stress, and PBL students also rated some dimensions of their learning environment higher than they had expected. However, those PBL students who rated the PBL environment less favorably also reported higher schoolwork-related stress. CONCLUSIONS: High stress perceived by LBL students was related to some personality concepts but not to the students' learning environment, despite their overall disappointment with that environment. The PBL students were more stressed by schoolwork, although their stress was not related to personality. Problem-based learning students, except for those most highly stressed, tended to rate their learning environment more favorably.

A Comparison of Students' Perceptions of Stress in Parallel Problem-Based and Lecture-Based Curricula.

PURPOSE: A 6-year longitudinal study was conducted to compare the perceived stress experienced during a 2-year master's physician assistant program by 5 cohorts of students enrolled in either problem-based learning (PBL) or lecture-based learning (LBL) curricular tracks. The association of perceived stress with academic achievement was also assessed. METHODS: Students rated their stress levels on visual analog scales in relation to family obligations, financial concerns, schoolwork, and relocation and overall on 6 occasions throughout the program. A mixed model analysis of variance examined the students' perceived level of stress by curriculum and over time. Regression analysis further examined school work-related stress after controlling for other stressors and possible lag effect of stress from the previous time point. RESULTS: Students reported that overall stress increased throughout the didactic year followed by a decline in the clinical year with statistically significant curricular (PBL versus LBL) and time differences. PBL students also reported significantly more stress resulting from school work than LBL students at some time points. Moreover, when the other measured stressors and possible lag effects were controlled, significant differences between PBL and LBL students' perceived stress related to school work persisted at the 8- and 12-month measurement points. Increased stress in both curricula was associated with higher achievement in overall and individual organ system examination scores. CONCLUSION: Physician assistant programs that embrace a PBL pedagogy to prepare students to think clinically may need to provide students with additional support through the didactic curriculum.

Parent-reported asthma in Puerto Rican children.

We conducted a survey to determine parent-reported asthma prevalence, morbidity, and healthcare utilization among 3527 children attending public schools (n = 2849) and private schools (n = 678) in San Juan, Puerto Rico. Schools were randomly selected from each of 12 geographic regions of the San Juan metropolitan area. Parents of children age 4-7 years old completed a 12-item questionnaire on asthma diagnosis, respiratory symptoms and morbidity, and healthcare utilization. Parents of children in public schools and private schools reported similar rates of a physician having previously diagnosed asthma in their children (43.2% vs. 39.4%); however, significantly more children in public schools were reported to still have asthma at the time of the survey (32.6% vs. 23.7%). Children attending public schools vs. private schools were reported to have missed significantly more school and to have had more hospitalizations and emergency department visits. Among children reported to still have asthma, significantly more children visited an emergency department, were hospitalized, and missed more school days due to respiratory symptoms in the past year. The high prevalence of parent-reported asthma, respiratory symptoms, and healthcare utilization among Puerto Rican children in San Juan calls for further studies using objective methods for ascertaining asthma and asthma-related morbidity. Differences in healthcare utilization between children attending public vs. private schools suggest that socioeconomic factors play a role in asthma management in Puerto Rico.

A comparison of student knowledge acquisition by organ system and skills in parallel problem-based and lecture-based curricula.

PURPOSE: A 5-year longitudinal study was conducted of students' acquisition of knowledge by organ system and skill development between two curricular tracks: problem-based learning (PBL) and lecture-based learning (LBL). Analysis of these data is reported. METHODS: A comprehensive examination was administered to all students enrolled in the LBL and PBL curricular tracks on five occasions: 0, 4, 8, 12, and 24 months. The organ-system and skills subtest scores from these comprehensive examinations and the Physician Assistant National Certifying Exam were compared. RESULTS: Organ-system subtests: Of the 12 organ-system subtests measured, there was a statistically significant difference between the LBL and PBL curricula in the mean test scores for one subtest (psychiatric). In addition, there were significant differences in all organ-system subtests by time, and finally there was a curriculum by time interaction in 10 of 12 subtests. Skills subtests: There were statistically significant differences in the mean test scores for one of seven subtests (applying scientific concepts), as well as significant differences in all skills subtests by time and a curriculum by time interaction in six of seven subtests. CONCLUSIONS: Statistical differences observed could mostly be explained by differences in knowledge on program entry or in time of exposure to curricular content. The importance of clinical training was evidenced in some organ systems, particularly reproductive and psychiatric. More uniform learning appears to occur in skills education, and there is evidence that the PBL model provides a sound grounding in the application of basic science.

The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate.

OBJECTIVES: To describe the development of the Amputee Mobility Predictor (AMP) instrument designed to measure ambulatory potential of lower-limb amputees with (AMPPRO) and without (AMPnoPRO) the use of a prosthesis, and to test its reliability and validity. DESIGN: Measurement study using known groups method and concurrence with existing measures. SETTING: Academic medical center. PARTICIPANTS: A convenience sample of 191 lower-limb amputee subjects who had completed prosthetic training, 24 in the reliability study (mean age +/- standard deviation, 68.3+/-17.9y, range, 28-99y) and 167 in the validity study (mean age, 54.8+/-18.6y; range, 18-100y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Intra- and interrater reliability; construct validity by known groups method; concurrent validity by comparisons with 6-minute walk test, Comorbidity Index, age, and time since amputation; predictive validity by comparison with 6-minute walk test after controlling for other factors. RESULTS: Interrater reliability was.99 for subjects tested with and without their prosthesis; intrarater reliability was.96 and.97. Both the AMPnoPRO (P<.0001) and the AMPPRO scores (P<.0001) distinguished among the 4 Medicare functional classification levels. The AMP correlated strongly with 6-minute walk scores (AMPnoPRO r=.69, P<.0001; AMPPRO r=.82, P<.0001) and the amputee activity survey (AMPnoPRO r=.67, P<.0001; AMPPRO r=.77, P<.0001), and negatively correlated with age (AMPnoPRO r=-.69, P<.0001; AMPPRO r=.56, P<.0001) and comorbidity (AMPnoPRO r=-.43, P<.0001; AMPPRO r=.38, P<.0001). CONCLUSION: The AMP with and without a prosthesis are reliable and valid measures for the assessment of functional ambulation in lower-limb amputee subjects.