Evaluating Modes of Observations Using Hierarchical Signal Detection Rater Models.

Scoring of performance can be based on different modes of observation, which can include live and videotaped observations. Although live observations have been the traditional format of measuring examinee performance in education and in healthcare, videotaped observations provide educators and testing agencies the promise of unbiased and standardized evaluations, offering practical solutions to limitations of real-time scoring. This study proposes a measurement model taking into account different modes of observation, using an extension of the hierarchical rater model based on signal detection theory (HRM-SDT). A hierarchical rater model is motivated by the nested structure of scores assigned by raters - scores assigned by raters become indicators of performance quality, which in turn become indicators of examinee ability. This study extends the hierarchical structure of the scoring process to include modes of observation, which serves as an intermediary level between the latent categorical indicator of performance quality and examinee ability, forming a three-level HRM-SDT. Analyses based on real-world data showed differences in the quality of scores from live observations and videotaped recordings. Compared to the traditional HRM-SDT, the overall model fit improved when including modes of observation. Simulations using different sample sizes and conditions provide implications for uses of this model.

A social media microinfluencer intervention to reduce coronavirus disease 2019 vaccine hesitancy in underserved Tennessee communities: A protocol paper.

BACKGROUND: Central to effective public health policy and practice is the trust between the population served and the governmental body leading health efforts, but that trust has eroded in the years preceding the pandemic. Vaccine hesitancy among adults is also a growing concern across the United States. Recent data suggest that the trustworthiness of information about the coronavirus 2019 (COVID-19) vaccine was a larger concern than the vaccine's adverse effects or risks. OBJECTIVE: This study aims to describe the methods used to create a public health microinfluencer social media vaccine confidence campaign for the COVID-19 vaccine in underserved Tennessee communities. A secondary objective is to describe how the Social-Ecological Model (SEM) and Social Cognitive Theory may address vaccine hesitancy using community pharmacies. METHODS: In late 2020, 50 independent community pharmacies in underserved communities across Tennessee were involved in a public health project with the State of Tennessee Department of Health and the University of Tennessee Health Science Center College of Pharmacy. The project involved a 3-pronged, pharmacy-based COVID-19 vaccination outreach project, including (1) social media messaging (i.e., microinfluencer approach), (2) community partner collaboration, and (3) in-pharmacy promotion. Quantitative and qualitative data will assess the quality and effectiveness of the program. Social media outcomes will also be assessed to measure the impact of the microinfluencer social media training. RESULTS: Project implementation is planned for 6 months (January 2021 to June 2021) after an initial month of planning by the research team (December 2020) and preceding several months of assessment (July 2021 and beyond). CONCLUSIONS: Novel, theory-based approaches will be necessary to improve vaccine confidence. One approach to promoting public health, derived from the SEM, may be to use trusted microinfluencers on social media platforms, such as local community pharmacists and community leaders.

Simulation-Based Curricula for Enhanced Retention of Pediatric Resuscitation Skills: A Randomized Controlled Study.

INTRODUCTION: Resuscitation skills decay as early as 4 months after course acquisition. Gaps in research remain regarding ideal educational modalities, timing, and frequency of curricula required to optimize skills retention. Our objective was to evaluate the impact on retention of resuscitation skills 8 months after the Pediatric Advanced Life Support (PALS) course when reinforced by an adjunct simulation-based curriculum 4 months after PALS certification. We hypothesized there would be improved retention in the intervention group. METHODS: This is a partial, double-blind, randomized controlled study. First-year pediatric residents were randomized to an intervention or control group. The intervention group participated in a simulation-based curriculum grounded in principles of deliberate practice and debriefing. The control group received no intervention. T-tests were used to compare mean percent scores (M) from simulation-based assessments and multiple-choice tests immediately following the PALS course and after 8 months. RESULTS: Intervention group (n = 12) had overall improved retention of resuscitation skills at 8 months when compared with the control group (n = 12) (mean, 0.57 ± 0.05 vs 0.52 ± 0.06; P = 0.037). No significant difference existed between individual skills stations. The intervention group had greater retention of cognitive knowledge (mean, 0.78 ± 0.09 vs 0.68 ± 0.14; P = 0.049). Residents performed 61% of assessment items correctly immediately following the PALS course. CONCLUSIONS: Resuscitation skills acquisition from the PALS course and retention are suboptimal. These findings support the use of simulation-based curricula as course adjuncts to extend retention beyond 4 months.

Optically Active Flavaglines-Inspired Molecules by a Palladium-Catalyzed Decarboxylative Dearomative Asymmetric Allylic Alkylation.

With the aid of a class of newly discovered Trost-type bisphosphine ligands bearing a chiral cycloalkane framework, the Pd-catalyzed decarboxylative dearomative asymmetric allylic alkylation (AAA) of benzofurans was achieved with high efficiency [0.2-1.0 mol% Pd2(dba)3/L], good generality, and high enantioselectivity (>30 examples, 82-99% yield and 90-96% ee). Moreover, a diversity-oriented synthesis (DOS) of previously unreachable flavaglines is disclosed. It features a reliable and scalable sequence of the freshly developed Tsuji-Trost-Stoltz AAA, a Wacker-Grubbs-Stoltz oxidation, an intra-benzoin condensation, and a conjugate addition, which allows the efficient construction of the challenging and compact cyclopenta[b]benzofuran scaffold with contiguous stereocenters. This strategy offers a new avenue for developing flavagline-based drugs.

Rater Model Using Signal Detection Theory for Latent Differential Rater Functioning.

Differential rater functioning (DRF) occurs when raters show evidence of exercising differential severity or leniency when scoring examinees within different subgroups. Previous studies of DRF have examined rater bias using manifest variables (e.g., use of covariates) to determine the subgroups. These manifest variables include gender and the ethnicity of the examinee. For example, a rater may score males more severely. Ideally, each rater's severity should be invariant across subgroups. This study examines DRF in the context of latent subgroups that classify possible sources of DRF based on raters' scoring behavior rather than manifest factors. An extension of the latent class signal detection theory (LC-SDT) model for identifying DRF is proposed and examined using real-world data and simulations. Results from real-world data show that the signal detection approach leads to an effective method to identify latent DRF. Simulations with varying sample sizes and conditions of rater precision were shown to recover parameters at an adequate level, supporting its use to identify latent DRF in large-scale data. These findings suggest that the DRF extension of the LC-SDT can be a useful model to examine characteristics of raters and add information that can aid rater training.

Inter-rater reliability and generalizability of patient note scores using a scoring rubric based on the USMLE Step-2 CS format.

Recent changes to the patient note (PN) format of the United States Medical Licensing Examination have challenged medical schools to improve the instruction and assessment of students taking the Step-2 clinical skills examination. The purpose of this study was to gather validity evidence regarding response process and internal structure, focusing on inter-rater reliability and generalizability, to determine whether a locally-developed PN scoring rubric and scoring guidelines could yield reproducible PN scores. A randomly selected subsample of historical data (post-encounter PN from 55 of 177 medical students) was rescored by six trained faculty raters in November-December 2014. Inter-rater reliability (% exact agreement and kappa) was calculated for five standardized patient cases administered in a local graduation competency examination. Generalizability studies were conducted to examine the overall reliability. Qualitative data were collected through surveys and a rater-debriefing meeting. The overall inter-rater reliability (weighted kappa) was .79 (Documentation = .63, Differential Diagnosis = .90, Justification = .48, and Workup = .54). The majority of score variance was due to case specificity (13 %) and case-task specificity (31 %), indicating differences in student performance by case and by case-task interactions. Variance associated with raters and its interactions were modest (<5 %). Raters felt that justification was the most difficult task to score and that having case and level-specific scoring guidelines during training was most helpful for calibration. The overall inter-rater reliability indicates high level of confidence in the consistency of note scores. Designs for scoring notes may optimize reliability by balancing the number of raters and cases.

Relationships Between Remote Learning Modalities and Nursing Students' Perceptions of Their Sleep Quality During the COVID-19 Pandemic.

BACKGROUND: The relationship between learning modalities and nursing students' sleep quality during the coronavirus disease (COVID-19) pandemic is unknown. PURPOSE: This study examined the relationships between remote learning and the sleep quality of nursing students during the COVID-19 pandemic. METHODS: Using a cross-sectional descriptive design, 890 nursing students were surveyed online to identify sleeping habits and learning modalities. RESULTS: There were no significant correlations between remote learning hours, self-reported sleep hours, and sleep quality. The asynchronous-only group reported better sleep quality than the in-person and online hybrid group after controlling for health conditions and grade point average. Students who reported that remote learning had impacted their sleep had poorer sleep quality. CONCLUSIONS: This study provides insight into how different learning modalities impact nursing students' sleep quality during the pandemic.

ß-Ecdysterone Enhanced Bone Regeneration Through the BMP-2/SMAD/RUNX2/Osterix Signaling Pathway.

Bone defects are a global public health problem. However, the available methods for inducing bone regeneration are limited. The application of traditional Chinese herbs for bone regeneration has gained popularity in recent years. ß-ecdysterone is a plant sterol similar to estrogen, that promotes protein synthesis in cells; however, its function in bone regeneration remains unclear. In this study, we investigated the function of ß-ecdysterone on osteoblast differentiation and bone regeneration in vitro and in vivo. MC3T3-E1 cells were used to test the function of ß-ecdysterone on osteoblast differentiation and bone regeneration in vitro. The results of the Cell Counting Kit-8 assay suggested that the proliferation of MC3T3-E1 cells was promoted by ß-ecdysterone. Furthermore, ß-ecdysterone influenced the expression of osteogenesis-related genes, and the bone regeneration capacity of MC3T3-E1 cells was detected by polymerase chain reaction, the alkaline phosphatase (ALP) test, and the alizarin red test. ß-ecdysterone could upregulate the expression of osteoblastic-related genes, and promoted ALP activity and the formation of calcium nodules. We also determined that ß-ecdysterone increased the mRNA and protein levels of components of the BMP-2/Smad/Runx2/Osterix pathway. DNA sequencing further confirmed these target effects. ß-ecdysterone promoted bone formation by enhancing gene expression of the BMP-2/Smad/Runx2/Osterix signaling pathway and by enrichment biological processes. For in vivo experiments, a femoral condyle defect model was constructed by drilling a bone defect measuring 3 mm in diameter and 4 mm in depth in the femoral condyle of 8-week-old Sprague Dawley male rats. This model was used to further assess the bone regenerative functions of ß-ecdysterone. The results of micro-computed tomography showed that ß-ecdysterone could accelerate bone regeneration, exhibiting higher bone volume, bone surface, and bone mineral density at each observation time point. Immunohistochemistry confirmed that the ß-ecdysterone also increased the expression of collagen, osteocalcin, and bone morphogenetic protein-2 in the experiment group at 4 and 8 weeks. In conclusion, ß-ecdysterone is a new bone regeneration regulator that can stimulate MC3T3-E1 cell proliferation and induce bone regeneration through the BMP-2/Smad/Runx2/Osterix pathway. This newly discovered function of ß-ecdysterone has revealed a new direction of osteogenic differentiation and has provided novel therapeutic strategies for treating bone defects.

Connexin 43 affects thoracic ossification of ligamentum flavum by regulating the p38 MAPK-RUNX2 signaling pathway.

This study aimed to investigate the role of connexin 43 (CX43) in thoracic ossification of ligamentum flavum (TOLF) based on the p38 mitogen-activated protein kinase (p38MAPK)-runt-related transcription factor 2 (RUNX2) pathway. Immunohistochemistry was used to detect CX43 expression in TOLF and non-TOLF patients, fibroblasts of TOLF were isolated and induced osteogenic differentiation, and CX43 expression was detected by western blot analysis (WB). In addition, si-CX43 was used to intervene CX43, and SB203580 was used to inhibit the p38MAPK. The expressions of bone differentiation marker protein were detected by WB, and the ossification ability was analyzed by alizarin red staining. The interaction between RUNX2 and CX43 was identified by dual-luciferase reporter assay. Results found that CX43 was highly expressed during TOLF, and si-CX43 could inhibit the expression of alkaline phosphatase (ALP) and osteopontin (OPN), as well as inhibit TOLF and the p38MAPK-RUNX2 pathway. In addition, SB203580 showed a synergistic effect with si-CX43 to further inhibit TOLF and the expression of RUNX2. The dual-luciferase reporter assay confirmed that RUNX2 could bind to the CX43 promoter. In conclusion, CX43 promotes TOLF, which may be mediated by p38MAPK-RUNX2, and RUNX2 binds to the CX43 promoter to form a positive feedback regulatory loop during TOLF.

Measuring Skill Growth and Evaluating Change: Unconditional and Conditional Approaches to Latent Growth Cognitive Diagnostic Models.

During the past decade, cognitive diagnostic models (CDMs) have become prevalent in providing diagnostic information for learning. Cognitive diagnostic models have generally focused on single cross-sectional time points. However, longitudinal assessments have been commonly used in education to assess students' learning progress as well as evaluating intervention effects. Thus, it becomes natural to identify longitudinal growth in skills profiles mastery, which can yield meaningful inferences on learning. This study proposes longitudinal CDMs that incorporate latent growth curve modeling and covariate extensions, with the aim to measure the growth of skills mastery and to evaluate attribute-level intervention effects over time. Using real-world data, this study demonstrates applications of unconditional and conditional latent growth CDMs. Simulation studies show stable parameter recovery and classification of latent classes for different sample sizes. These findings suggest that building on the well-established growth modeling frameworks, applications of covariate-based longitudinal CDM can help understand the effect of explanatory factors and intervention on the change of attribute mastery.

Explanatory Cognitive Diagnostic Models: Incorporating Latent and Observed Predictors.

Large-scale educational testing data often contain vast amounts of variables associated with information pertaining to test takers, schools, or access to educational resources-information that can help explain relationships between test taker performance and their learning environment. This study examines approaches to incorporate latent and observed explanatory variables as predictors for cognitive diagnostic models (CDMs). Methods to specify and simultaneously estimate observed and latent variables (estimated using item response theory) as predictors affecting attribute mastery were examined. Real-world data analyses were conducted to demonstrate the application using large-scale international testing data. Simulation studies were conducted to examine the recovery and classification for simultaneously estimating multiple latent (using dichotomous and polytomous items as indicators for the latent construct) and observed predictors for varying sample sizes and number of attributes. Results showed stable parameter recovery and consistency in attribute classification. Implications for latent predictors and attribute specifications are discussed.

[Mitochondrial 12S rRNA gene A827G in two pedigrees with nonsyndromic deafness].

OBJECTIVE: To investigate the relationship of associating mitochondrial DNA 12S rRNA gene mutations with non-syndromic and aminoglycoside-induced hearing loss happening to Chinese families. METHODS: The diagnosis was validated by hearing tests. Blood samples were collected from 20 family members (13 subjects from pedigree A and 7 from pedigree B) and 32 sporadic deafness cases. DNA was extracted from the leukocytes in blood samples. The gene fragments of mitochondrial DNA 12S rRNA, tRNA(Ser(UCN)) and GJB(2) were amplified by polymerase chain reaction (PCR). PCR products were analyzed by sequencing. RESULTS: The target gene fragments of all individuals were successfully amplified by PCR. The mitochondrial DNA 12S rRNA 827 A to G transition was detected from all maternal members including 12 patients with hearing loss, which was the homoplasmic mutation. Non-maternal members in two pedigrees did not carry this mutation. However, the tRNA(Ser(UCN)) A7445G, 12SrRNA A1555G and GJB2 gene mutations were not found from both the family members of two pedigrees and sporadic patients. One sporadic individual (1/32) who was diagnosed as aminoglycoside-induced hearing impairment carried A827G mutation too. CONCLUSION: It is confirmed that the mitochondrial DNA 12S rRNA gene is a hot spot for mutations associated with non-syndromic inherited hearing loss. The 12S rRNA nt827 A to G mutation may play a pivotal role in the pathogenesis of hearing impairment in two Chinese pedigrees.

Investigating the Impact of Item Parameter Drift for Item Response Theory Models with Mixture Distributions.

This study investigates the impact of item parameter drift (IPD) on parameter and ability estimation when the underlying measurement model fits a mixture distribution, thereby violating the item invariance property of unidimensional item response theory (IRT) models. An empirical study was conducted to demonstrate the occurrence of both IPD and an underlying mixture distribution using real-world data. Twenty-one trended anchor items from the 1999, 2003, and 2007 administrations of Trends in International Mathematics and Science Study (TIMSS) were analyzed using unidimensional and mixture IRT models. TIMSS treats trended anchor items as invariant over testing administrations and uses pre-calibrated item parameters based on unidimensional IRT. However, empirical results showed evidence of two latent subgroups with IPD. Results also showed changes in the distribution of examinee ability between latent classes over the three administrations. A simulation study was conducted to examine the impact of IPD on the estimation of ability and item parameters, when data have underlying mixture distributions. Simulations used data generated from a mixture IRT model and estimated using unidimensional IRT. Results showed that data reflecting IPD using mixture IRT model led to IPD in the unidimensional IRT model. Changes in the distribution of examinee ability also affected item parameters. Moreover, drift with respect to item discrimination and distribution of examinee ability affected estimates of examinee ability. These findings demonstrate the need to caution and evaluate IPD using a mixture IRT framework to understand its effects on item parameters and examinee ability.

Differential Weighting for Subcomponent Measures of Integrated Clinical Encounter Scores Based on the USMLE Step 2 CS Examination: Effects on Composite Score Reliability and Pass-Fail Decisions.

PURPOSE: Medical schools administer locally developed graduation competency examinations (GCEs) following the structure of the United States Medical Licensing Examination Step 2 Clinical Skills that combine standardized patient (SP)-based physical examination and the patient note (PN) to create integrated clinical encounter (ICE) scores. This study examines how different subcomponent scoring weights in a locally developed GCE affect composite score reliability and pass-fail decisions for ICE scores, contributing to internal structure and consequential validity evidence. METHOD: Data from two M4 cohorts (2014: n = 177; 2015: n = 182) were used. The reliability of SP encounter (history taking and physical examination), PN, and communication and interpersonal skills scores were estimated with generalizability studies. Composite score reliability was estimated for varying weight combinations. Faculty were surveyed for preferred weights on the SP encounter and PN scores. Composite scores based on Kane's method were compared with weighted mean scores. RESULTS: Faculty suggested weighting PNs higher (60%-70%) than the SP encounter scores (30%-40%). Statistically, composite score reliability was maximized when PN scores were weighted at 40% to 50%. Composite score reliability of ICE scores increased by up to 0.20 points when SP-history taking (SP-Hx) scores were included; excluding SP-Hx only increased composite score reliability by 0.09 points. Classification accuracy for pass-fail decisions between composite and weighted mean scores was 0.77; misclassification was < 5%. CONCLUSIONS: Medical schools and certification agencies should consider implications of assigning weights with respect to composite score reliability and consequences on pass-fail decisions.

[Study on the effect of qinggan jiangtang tablet in improving the insulin resistance in patients with multiple metabolic syndrome].

OBJECTIVE: To observe the effect of Qinggan Jiangtang tablet (QJT) in improving the insulin resistance (IR) in patients with multiple metabolic syndrome (MMS). METHODS: Adopting randomized controlled double-blinded method, 60 patients with MMS were divided equally into two groups. The treated group was treated by oral taking of QJT 3 tabs, twice a day and the control group treated by oral taking of Glucophage 3 tabs, twice a day, the therapeutic course for both groups was 1 month, and the observation lasted for 2 successive courses. RESULTS: After treatment, levels of blood glucose, fasting and postprandial blood glucose, C-peptide and IR were significantly reduced with markedly improvement of beta-cell function in both groups, the difference between the two groups showed no significance. Change of plasma level of free fatty acids before and after treatment in both groups was insignificant. CONCLUSION: QJT has the effects on reducing blood glucose, blood lipids, blood pressure and IR and improving function of beta cells.

[Nonsyndromic inherited hearing impairment caused by mtDNA double mutations of A1555G and 961 insC].

OBJECTIVE: To investigate the genotypes of mitochondrial DNA mutations of a large nonsyndromic inherited hearing impairment pedigree. METHODS: The diagnosis was validated by hearing test. Blood samples from the branch pedigree (33 members) and 6 sporadic patients were obtained. DNA was extracted from the leukocytes. The mitochondrial DNA target fragments were amplified by polymerase chain reaction(PCR). The 1555G, 3243G and 7445G mutations were detected by BsmA I, Apa I and Xba I restriction endonuclease digestion respectively. Some PCR products were analyzed by sequencing. RESULTS: Restriction endonuclease digestion identified that 17 patients from the pedigree carried 1555G mutation. All pedigree members, including patients and sporadic patients, did not have 3243G and 7445G mutation. In 6 patients of the pedigree DNA sequence analysis revealed double mutations, an A>G transition at position 1555 and a C insertion at position 961, whereas the unaffected relatives of the pedigree and sporadic patients did not have such mutations. None of them carried 3243G and 7445G mutation. CONCLUSION: Double mutations of A1555G and 961 insC in mitochondrial DNA 12S rRNA gene region may play a pivotal role in the pathogenesis of hearing loss in the large nonsyndromic inherited hearing impairment pedigree.

[Neurophysiological characteristics of infants and young children with auditory neuropathy].

OBJECTIVE: To analyze the neurophysiological characteristics of infants and young children with auditory neuropathy (AN) and explore their clinical significance. METHODS: Audiological measurements (acoustic immittance, EOAEs, ABR, CM, MLR and ERP) and peripheral neurological tests were conducted and evaluated in 13 infants and young children with AN. 6 AN patients received CT scan and/or MRI examination. RESULTS: All patients had type "A" tympanogram and normal CM. Normal EOAEs were elicited in 12 patients. 8 cases had normal MLR recording and 6 cases had normal ERP (P(300) and MMN). Peripheral neurological tests and CT and/or MRI showed normal results. CONCLUSION: The diagnosis of AN in infants and young children should focus on analyzing their neurophysiological characteristics. Combined use of EOAEs, ABR and CM was recommended for hearing screening on newborns with high risk factors.