Assessing the Prevalence of Cannabis Use Through a Survey About Criminal Activity Versus One About Alcohol, Tobacco, and Other Drugs

Background: The prevalence of cannabis use in the United Kingdom might be underestimated using the Crime Survey of England and Wales. The current study examined whether responding to questions about their cannabis use as part of a crime survey would be less likely to report that they use cannabis compared to those responding to the same questions that are part of a survey about health. Methods: Participants were randomized to be told that the items about cannabis use came from a crime survey versus from a health survey. In addition, the sample was recruited using a representative online sampling method and compared to published rates of self-reported cannabis use collected as part of the Crime Survey for England and Wales. Results: There was no significant difference (p > 0.05) in the proportion endorsing cannabis use between those told the items came from a crime survey versus a health survey. However, self-reported rates of cannabis use collected as part of the online panel (51.3% ever use; 11.9% past year; age range 18-64 years) appeared higher than those reported based on results from the Crime Survey for England and Wales (37.2% ever and 5.8% past year; age range 18-59 years). Conclusion: The current study did not find evidence that manipulating whether participants were told that the items asking about cannabis use came from a survey asking about criminal activity versus one about health had an impact on self-reported cannabis use. However, as prevalence estimates generated by the Crime Survey of England and Wales do appear to be an underestimate of actual levels of cannabis use in the United Kingdom, further research is merited on this topic.

Evaluating methods of detecting and determining the type of urinary incontinence in adults after stroke: A systematic review

INTRODUCTION

Urinary incontinence (UI) affects over half of people with stroke. It is unclear which methods are accurate in assessing presence and type of UI to inform clinical management. Diagnosis of UI based on inaccurate methods may lead to unnecessary interventions. The aims of this systematic review were to identify, for adults with stroke, clinically accurate methods to determine the presence of UI and type of UI.

METHOD

We searched seven electronic databases and additional conference proceedings. To be included, studies had to be primary research comparing two or more methods, or use a reference test.

RESULTS

We identified 3846 studies with eight eligible for inclusion. We identified 11 assessment methods within the eight studies. Only five studies had sufficient comparator data for synthesis. Due to heterogeneity of data, results on the following methods were narratively synthesized: Core Lower Urinary Tract Symptom Score (CLSS), clinical history and physical examination, Barthel Activities of Daily Living Index, International Consultation Incontinence Questionnaire Short Form (ICiQ-SF) and urodynamic studies (UDS). Most studies were small and of low to medium quality. All reported differences in sensitivity, and none compared the same assessment methods.

CONCLUSION

Current evidence is insufficient to support recommendations on the most accurate UI assessment for adults with stroke. Further research is needed.

Progress Testing in UK Medical Education: Evaluating Its Impact and Potential

This comprehensive review critically examines the UK medical curriculum, with a particular focus on progress testing as an innovative assessment strategy. The curriculum, evolving from foundational sciences to practical applications, is encapsulated in the integrated curriculum model (ICM). This model adeptly combines theoretical knowledge with clinical practice, fostering cognitive, affective, and psychomotor skills among medical students. Central to this review is an exploration of progress testing. This method, grounded in constructivist learning theories, emphasises continuous assessment and professional development. Progress testing's regular, comprehensive examinations are instrumental in guiding students through the progressive stages of competence, as outlined in Miller's pyramid, from foundational knowledge to clinical proficiency. The review also addresses the broader impacts of progress testing on teaching approaches, student feedback, academic and pastoral support, and quality assurance. By aligning with the dynamic requirements of 21st-century medical training, progress testing not only nurtures well-rounded professionals but also ensures compliance with regulatory bodies like the General Medical Council. Its emphasis on continuous evaluation aligns with the practical realities of a medical career, driving curricular innovation and aligning with regulatory standards. The implementation of progress testing marks a significant advancement in medical education. Its continuous, holistic nature benefits both students and educators, nurturing a more engaged learning attitude and meeting evolving medical needs. The adoption of this assessment strategy is seen as pivotal in shaping competent medical professionals, ready to face the challenges of modern medical practice.

Exploring the Anemia Ecology: A New Approach to an Old Problem

Our ability to identify anemia and all its permutations demands an approach that integrates the key elements of a complex "ecology," which intertwines biology and mechanistic aspects of nutrients with both the health status and underlying factors-physical, economic, social, behavioral, demographic, and environmental. The complexity of anemia demands an ecologic approach that appreciates systems biology, translates sensitive and specific assessment methodologies and interventions, and ultimately improves clinical and public health outcomes. This series of technical papers on anemia by the U.S. Agency for International Development (USAID) Advancing Nutrition Anemia Task Force (ATF) is a first step in translating our ecologic approach to anemia with a view toward balancing research with its translation to effective programs, interventions, and policy. This introductory overview describes the components of our ecologic approach-linking the biology of anemia with its assessment and using the learning from that confluence to devise context-specific interventions. This introductory review briefly discusses the topics that underlie the biology and primary etiologies of anemia and presents a framework for public health assessment of anemia, leading to appropriate public health interventions. The other 3 manuscripts in the supplement provide the details of the arguments laid out in the introduction.

Regulatory considerations for medical imaging AI/ML devices in the United States: concepts and challenges

Purpose

To introduce developers to medical device regulatory processes and data considerations in artificial intelligence and machine learning (AI/ML) device submissions and to discuss ongoing AI/ML-related regulatory challenges and activities.

Approach

AI/ML technologies are being used in an increasing number of medical imaging devices, and the fast evolution of these technologies presents novel regulatory challenges. We provide AI/ML developers with an introduction to U.S. Food and Drug Administration (FDA) regulatory concepts, processes, and fundamental assessments for a wide range of medical imaging AI/ML device types.

Results

The device type for an AI/ML device and appropriate premarket regulatory pathway is based on the level of risk associated with the device and informed by both its technological characteristics and intended use. AI/ML device submissions contain a wide array of information and testing to facilitate the review process with the model description, data, nonclinical testing, and multi-reader multi-case testing being critical aspects of the AI/ML device review process for many AI/ML device submissions. The agency is also involved in AI/ML-related activities that support guidance document development, good machine learning practice development, AI/ML transparency, AI/ML regulatory research, and real-world performance assessment.

Conclusion

FDA's AI/ML regulatory and scientific efforts support the joint goals of ensuring patients have access to safe and effective AI/ML devices over the entire device lifecycle and stimulating medical AI/ML innovation.

[Updates on anosognosia in Alzheimer's disease]

Impaired awareness increases dependency of patients suffering from Alzheimer's Disease (AD) and caregivers' burden but remains insufficiently evaluated in clinical practice. The numerous conceptualisations of this symptomatology (anosognosia, denial, insight…) have only a slight impact on the three main assessment methodologies which are: the patient-caregiver discrepancy; the clinician rating of patients' awareness of illness; and the prediction of performance discrepancy methods. Nevertheless, most of evaluating tools are not validated yet, in particular regarding the clinician rating, leading to contrasted results. Most of recent studies reported positive correlations with apathy and AD severity, and negative relationships with depressive symptoms. Therefore, impaired awareness seems to be mainly influenced by patient's depression and apathy. We discuss these correlates and shared aspects of apathy and impaired awareness from neuroanatomical, clinical and conceptual viewpoints. We also highlight the relevance and limits of quantitative and qualitative assessment methods, in particular phenomenological.

A Systematic Review of Assessment Methods for Seafarers' Mental Health and Well-Being During the COVID-19 Pandemic

Seafarers spend more time at sea than on land, which makes them a hard-to-reach community. Since their mental health and well-being is usually addressed from a land-based perspective, dedicated and validated methods incorporating maritime specificities are lacking. During the COVID-19 pandemic, research into seafarers' mental health and well-being flourished. However, a systematic review of the literature to assess the type and appropriateness of assessment methods pertaining to the mental health and well-being of seafarers has yet to be undertaken. This study reviews 5 databases (ERIC, Scopus, PubMed, Google Scholar and EBSCO) to assess the methods used to examine seafarers' mental health and well-being during the pandemic. Peer-reviewed literature alongside grey literature that applied quantitative or qualitative instruments to measure seafarers' mental health and/or well-being, published in English between March 2020 and February 2023, was eligible for the review. Studies from all geographic regions and regardless of nationality, rank and ship type of the subjects were explored. Database searches produced 272 records. Five additional records were identified via other methods. We identified 27 studies suitable for review, including 24 published in peer-reviewed scientific journals and 3 reports and surveys produced by the industry or welfare organizations. Assessment methods used to measure seafarers' mental health and well-being vary significantly in the literature. The frequent use of ad hoc questionnaires limits the possibility to replicate and compare the studies due to various inconsistencies. Furthermore, several validation and reliability measures needed more solidity when applied to the seafaring population. Such inadequate measuring and a mix of assessment methods impacted the comparison of results and might inflate the risks of underreporting or overstating mental complaints.

Assessment of the knowledge of canalis sinuosus amongst dentists and dental students: An online-based cross-sectional study

INTRODUCTION

Canalis sinuosus (CS) is a neurovascular canal that corresponds to a small branch of the infraorbital canal. This study aimed at assessing the knowledge and detection performance of CS amongst dentists and dental students.

MATERIALS AND METHODS

Four-hundred and five dentists and dental students answered a questionnaire with three parts: 1. Socio-demographical; 2. Clinical cases with cone- beam computed tomography (CBCT) sections showing CS and 3. Previous knowledge about CS. The chi-squared test and Spearman's correlation test were used to compare results as appropriate. p-values below .05 were considered statistically significant.

RESULTS

Most participants did not identify CS in any CBCT. There was an association between the number of correct answers and dental specialties. Most individuals had not learned about CS previously. There was an association between past knowledge of CS and gender, highest academic degree, working environment, dental specialty and number of correct answers but not with age or experience in Dentistry.

CONCLUSION

This study suggests that most dentists are not aware about CS and do not know how to diagnose it. Previous knowledge about CS positively influenced its identification in CBCT.

Feasibility and reliability of the Functional Movement Screen battery in adults with intellectual disability

BACKGROUND

The feasibility and reliability of the Functional Movement Screen (FMS) battery for predicting injury risk have been widely studied in athletic, military, public service and healthy populations. However, scant research has been carried out in people with disabilities. This study aimed at identifying the feasibility and reliability of the FMS battery when administered to adults with intellectual disability (ID).

METHODS

Adults from a residential and day care centre over 18 years of age, diagnosed with ID and able to follow simple instructions, were included in the study. All participants with behavioural or health problems that prevented the completion of the FMS battery were excluded. All exercises were video recorded to assure proper scoring. Three assessors (one trained and two novices) scored each of the FMS subtests performed separately from the videos. Feasibility was based on completion rates. Reliability of the composite test scores was analysed using intraclass correlation coefficients (ICCs).

RESULTS

A total of 30 people with ID (mean age: 35.5 ± 7.12 years; 33.3% women) completed all assessments. The battery showed to be feasible, although difficulties when performing two of the subtests were observed among those with moderate and severe ID. Mean total scores from the three assessors ranged from 7.83 to 8.90. An inverse trend was observed indicating that the higher the ID level, the lower the total FMS score. Test-retest reliability was good for the trained assessor (ICC = 0.89) and mostly moderate for both novice assessors (ICC range: 0.60 to 0.76). Moderate to good inter-rater reliability was observed (ICC range: 0.65 to 0.80).

CONCLUSION

The FMS battery is a reliable tool that can be performed by people with ID, albeit with certain difficulties, especially in those with moderate to severe impairment. The battery does not seem to be useful for identifying people with ID at risk of suffering a sport injury. Adequately powered, well-designed studies are required to determine if the FMS battery is appropriate for identifying changes in functional performance in this population.

Objective sleep assessments for healthy people in environmental research: A literature review

To date, although many studies had focused on the impact of environmental factors on sleep, how to choose the proper assessment method for objective sleep quality was often ignored, especially for healthy subjects in bedroom environment. In order to provide methodological guidance for future research, this paper reviewed the assessments of objective sleep quality applied in environmental researches, compared them from the perspective of accuracy and interference, and statistically analyzed the impact of experimental type and subjects' information on method selection. The review results showed that, in contrast to polysomnography (PSG), the accuracy of actigraphy (ACT), respiratory monitoring-oxygen saturation monitoring (RM-OSM), and electrocardiograph (ECG) could reach up to 97%, 80.38%, and 79.95%, respectively. In terms of sleep staging, PSG and ECG performed the best, ACT the second, and RM-OSM the worst; as compared to single methods, mix methods were more accurate and better at sleep staging. PSG interfered with sleep a great deal, while ECG and ACT could be non-contact, and thus, the least interference with sleep was present. The type of experiment significantly influenced the choice of assessment method (p < 0.001), 85.3% of researchers chose PSG in laboratory study while 82.5% ACT in field study; moreover, PSG was often used in a relatively small number of young subjects, while ACT had a wide applicable population. In general, researchers need to pay more attention at selection of assessments in future studies, and this review can be used as a reliable reference for experimental design.

Digital Assessment Tools Using Animation Features to Quantify Alcohol Consumption: Systematic App Store and Literature Review

Background

Accurate and user-friendly assessment tools for quantifying alcohol consumption are a prerequisite for effective interventions to reduce alcohol-related harm. Digital assessment tools (DATs) that allow the description of consumed alcoholic drinks through animation features may facilitate more accurate reporting than conventional approaches.

Objective

This review aims to identify and characterize freely available DATs in English or Russian that use animation features to support the quantitative assessment of alcohol consumption (alcohol DATs) and determine the extent to which such tools have been scientifically evaluated in terms of feasibility, acceptability, and validity.

Methods

Systematic English and Russian searches were conducted in iOS and Android app stores and via the Google search engine. Information on the background and content of eligible DATs was obtained from app store descriptions, websites, and test completions. A systematic literature review was conducted in Embase, MEDLINE, PsycINFO, and Web of Science to identify English-language studies reporting the feasibility, acceptability, and validity of animation-using alcohol DATs. Where possible, the evaluated DATs were accessed and assessed. Owing to the high heterogeneity of study designs, results were synthesized narratively.

Results

We identified 22 eligible alcohol DATs in English, 3 (14%) of which were also available in Russian. More than 95% (21/22) of tools allowed the choice of a beverage type from a visually displayed selection. In addition, 36% (8/22) of tools enabled the choice of a drinking vessel. Only 9% (2/22) of tools allowed the simulated interactive pouring of a drink. For none of the tools published evaluation studies were identified in the literature review. The systematic literature review identified 5 exploratory studies evaluating the feasibility, acceptability, and validity of 4 animation-using alcohol DATs, 1 (25%) of which was available in the searched app stores. The evaluated tools reached moderate to high scores on user rating scales and showed fair to high convergent validity when compared with established assessment methods.

Conclusions

Animation-using alcohol DATs are available in app stores and on the web. However, they often use nondynamic features and lack scientific background information. Explorative study data suggest that such tools might enable the user-friendly and valid assessment of alcohol consumption and could thus serve as a building block in the reduction of alcohol-attributable health burden worldwide.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020172825; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172825

Effect of Dental Course Cycle on Anatomical Knowledge and Dental Carving Ability of Dental Students

This study assessed the effect of the course cycle on theoretical knowledge of dental morphology and the dental carving ability of dental students. Thirty-two dental students from the third semester (initial cycle) and 30 students from the eighth and tenth semesters of the dental course (end cycle) had their theoretical knowledge on dental morphology assessed using a questionnaire with ten closed questions. Their dental carving ability was also assessed using wax carvings in macro models of plaster (for the third [S3] and eight [S8] semesters) and natural-sized artificial teeth (for the tenth [S10] semester). The teeth chosen for the dental carving activity were #16 and #47. The scores were statistically analyzed using the t-test, Kruskal-Wallis test, and Mann-Whitney test (α = 0.05). Students from the initial cycle presented better theoretical knowledge than the other groups did (P < 0.007). No significant differences in carving score were found between the initial and end cycles (P > 0.05), although S10 students obtained a higher score for teeth #16 and #47 (P < 0.05). Natural-sized artificial teeth received a higher evaluation score in dental carvings than the macro models (P < 0.001). Within the limits of this study, it was possible to conclude that students from the initial cycle (S3) presented higher theoretical knowledge, whereas no difference in carving ability was observed between the initial and end cycles. The tenth semester (S10) students performed dental carvings with better quality. Furthermore, carvings in natural-sized artificial teeth presented better quality compared with the macro models.

Hand function development of children with hemiplegic cerebral palsy: A scoping review

PURPOSE

Hemiplegic cerebral palsy (hCP) typically impacts sensorimotor control of the hand, but comprehensive assessments of the hands of children with hCP are relatively rare. This scoping review summarizes the development of hand function for children with hCP.

METHODS

This scoping review focused on the development of hand function in children with hCP. Electronic databases (PubMed, PEDro, Web of Science, CINAHL, and SpringerLink) were searched to identify studies assessing hand function in children with hCP. The search was performed using keywords (e.g., "hemiplegia"). An iterative approach verified by two authors was used to select the studies. Articles which reported quantitative data for children with hCP on any items of a specified set of hand evaluations were included. Measures were sorted into three categories: quantitative neuromechanics, clinical assessments, and clinical functional evaluations.

RESULTS

Initial searches returned 1536 articles, 131 of which were included in the final review. Trends between assessment scores and age were examined for both hands.

CONCLUSION

While several studies have evaluated hand function in children with hCP, the majority relied on clinical scales, assessments, or qualitative descriptions. Further assessments of kinematics, kinetics, and muscle activation patterns are needed to identify the underlying impairment mechanisms that should be targeted for treatment.

[Reform and practical experience of bilingual course for "Environmental Biotechnology" with the development of "Emerging Engineering Education"]

The construction of "Emerging Engineering Education" aims at cultivating high-quality graduates capable of engineering practice, innovation and international competitiveness. Bilingual courses have become one of the effective means to cultivate qualified students with skills of both professional knowledge and international communication. However, the teaching effect of most bilingual courses is not very ideal. Based on analyzing common problems in the current bilingual teaching, we take the bilingual course of environmental biotechnology as an example, and discusses possible improvement strategies from the aspects of the construction of teaching mode, the establishment of quality control system, the selection of textbooks and the optimization of assessment methods. Moreover, we summarize experience and shortcomings on improving the lecturers' ability, students' learning enthusiasm and school's support. It is expected to provide useful reference for improving the effect of bilingual teaching in biotechnology-relevant courses.

A program to improve the assessment of a child for attention deficit hyperactivity disorder

PROBLEM

Due to the number of children diagnosed with attention deficit hyperactivity disorder (ADHD), increased risk of these children having comorbidities and/or an adverse childhood experience and insufficient documentation of the Diagnostic and Statistical manual of Mental Disorders, fifth edition (DSM-5) criteria for an ADHD diagnosis, an ADHD evaluation program was developed for a child presenting for an initial ADHD evaluation.

METHODS

A quantitative design method evaluated provider's documentation by the percentage of DSM-5 criteria met before and after the implementation of the ADHD program. Descriptive statistics evaluated the system change by the percentage of providers who utilized the ADHD template and the use of the unspecified ADHD International Statistical Classification of Diseases and Related Health Problems, 10th edition (ICD-10) code, F90.9 by the percentage of code use before and after implementation of the ADHD program.

FINDINGS

The two-tailed Mann-Whitney U test was significantly based on p < 0.001. Providers met 100% of the DSM-5 criteria after implementation of the ADHD program in the electronic health record, compared to 50% before implementation.

CONCLUSIONS

The ADHD program increased the provider's documentation and consistency to the DSM-5 criteria, decreasing the use of the unspecified ADHD ICD-10 code, allowing the provider to develop a more successful plan of care for children between the ages of 5 and 18.

[Thoughts on teaching reform of Biologicology]

With the rapid development of modern biotechnology, the cultivation of high-quality biotechnology talents has received more and more attention. The course of Biologicology is a core subject that students majoring in biology should master. However, Biologicology is a new subject, and its teaching content and teaching methods are at the exploratory stage. Based on the current teaching status and existing problems of the Biologicology course, we propose teaching reforms in terms of teaching content, teaching methods and assessment methods, to lay a firm foundation for the further teaching efficacy of Biologicology course and increasing students' interest in learning.

The Importance of Mental Models in Implementation Science

Implementation science is concerned with the study of adoption, implementation and maintenance of evidence-based interventions and use of implementation strategies to facilitate translation into practice. Ways to conceptualize and overcome challenges to implementing evidence-based practice may enhance the field of implementation science. The concept of mental models may be one way to view such challenges and to guide selection, use, and adaptation of implementation strategies to deliver evidence-based interventions. A mental model is an interrelated set of beliefs that shape how a person forms expectations for the future and understands the way the world works. Mental models can shape how an individual thinks about or understands how something or someone does, can, or should function in the world. Mental models may be sparse or detailed, may be shared among actors in implementation or not, and may be substantially tacit, that is, of limited accessibility to introspection. Actors' mental models can determine what information they are willing to accept and what changes they are willing to consider. We review the concepts of mental models and illustrate how they pertain to implementation of an example intervention, shared decision making. We then describe and illustrate potential methods for eliciting and analyzing mental models. Understanding the mental models of various actors in implementation can provide crucial information for understanding, anticipating, and overcoming implementation challenges. Successful implementation often requires changing actors' mental models or the way in which interventions or implementation strategies are presented or implemented. Accurate elicitation and understanding can guide strategies for doing so.

A Primer on Usability Assessment Approaches for Health-Related Applications of Virtual Reality

Health-related virtual reality (VR) applications for patient treatment, rehabilitation, and medical professional training are on the rise. However, there is little guidance on how to select and perform usability evaluations for VR health interventions compared to the supports that exist for other digital health technologies. The purpose of this viewpoint paper is to present an introductory summary of various usability testing approaches or methods that can be used for VR applications. Along with an overview of each, a list of resources is provided for readers to obtain additionally relevant information. Six categories of VR usability evaluations are described using a previously developed classification taxonomy specific to VR environments: (1) cognitive or task walkthrough, (2) graphical evaluation, (3) post hoc questionnaires or interviews, (4) physical performance evaluation, (5) user interface evaluation, and (6) heuristic evaluation. Given the growth of VR in health care, rigorous evaluation and usability testing is crucial in the development and implementation of novel VR interventions. The approaches outlined in this paper provide a starting point for conducting usability assessments for health-related VR applications; however, there is a need to also move beyond these to adopt those from the gaming industry, where assessments for both usability and user experience are routinely conducted.

Measurement, outcomes and interventions of cognitive function after breast cancer treatment: A narrative review

Cancer-related cognitive impairment (CRCI) is a common complaint in breast cancer patients, especially related to chemotherapy. It is characterized as cognitive disorders in areas of memory, attention and executive function, which can negatively affect patients' quality of life and their ability to work. While various assessment methods of CRCI cause highly diverse results in CRCI-related studies. Currently, it is not clear how cerebral structure and function change in breast cancer patients and underlying mechanisms of developing CRCI are still undefined. Intervention research is limited. This article reviews the results of CRCI-related studies and research progress and discusses the advantages and limits of various methods. Besides, the mechanisms and intervention strategies are reviewed.

A Comparative Analysis of Army Body Composition Standards for Women

The aim of this study was to compare body fat percentage (BF%) of women measured using the U.S. Army standard body composition assessment (ABC) and two common laboratory measures of body composition to evaluate the efficacy of ABC within this population. The BF% of 27 women (21.5 ± 1.8 years) was assessed using the 7-site skinfold, air plethysmography, and ABC measurements. The initial physical fitness test (IPFT) was used to determine if participants met the criteria required for admittance into basic combat training. A repeated measures ANOVA identified differences in BF% between the three assessment methods, (F (2, 52) = 22.83, p < .001, η2 p = .47). Pairwise comparisons revealed that mean BF% obtained using the ABC (29.3 ± 7.7 %) was significantly higher (p = .042) than BF% measured using air plethysmography (26.9 ± 8.4 %). ABC and air plethysmography measured BF% was significantly higher (both p < .001) than BF% obtained from skinfold assessment (22.2 ± 5.9 %). Of the 27 total participants, 4 (14.8%) passed IPFT but failed to meet the Army body composition standards using the ABC method. The primary findings of this study suggest that the overestimation of BF% by the ABC method could lead to an unnecessary delay in enlistment for women approaching the upper threshold of the Army's acceptable body composition standards. Alternative methods of assessing body composition in this population should be explored. However, skinfold assessment does not appear to be a suitable alternative to the ABC.

Methods Used to Assess Student Performance and Course Outcomes at the National Center of Excellence in Dairy Production Medicine Education for Veterinarians

Between 2012 and 2014, three cohorts of senior veterinary students participated in an 8-week dairy production medicine course created by the National Center of Excellence in Dairy Production Medicine Education for Veterinarians. One goal of this course is to better prepare veterinary students to serve the increasingly complex needs of the dairy industry. In this article, we describe the assessment methods and student performance outcomes of those first three cohorts. A combination of assessment methods was used, including pre- and post-testing; instructor observations and scores on individual and group projects, including a final integrative project; and peer evaluation. Student feedback, collected via anonymous survey, provided insight into students' perceptions about the course and their learning. Performance and feedback suggest that the course was successful in preparing students for careers using skills in dairy production medicine. Pre- and post-testing was conducted for most topic modules in the course. The mean (median) pre- and post-test scores were 47% (50% ) and 83% (88%), respectively. The mean improvement in score was significant (p < .002) for all modules and cohorts. Students indicated a moderate or high degree of confidence in performing dairy production medicine skills after each module. Of students in cohorts 1, 2, and 3, respectively, 55%, 75%, and 82% felt they could provide dairy production medicine services (e.g., records analysis, problem investigation, protocol and standard operating procedure design) either alone or with some mentoring, immediately after graduation. In addition, assessment results and student feedback enabled timely course modifications during these first three cohorts.

Measures of preoperative anxiety

The evaluation of treatment from the patient's perspective (Patient Reported Outcomes, PROs) currently remains one of the most vibrant and dynamically developing fields of research. Among PROs, patient self-assessment of various symptoms, including one's psychological state, is of great importance. Anxiety is one of the most frequently observed psychological reactions among patients awaiting various surgeries, and may occur even in up to 80% of patients scheduled for high-risk surgical procedures. An increased level of preoperative anxiety has been proved to be related to negative consequences, both psychological and somatic, and affecting, in consequence, anaesthesia, postoperative care and treatment, along with the rehabilitation process. It is also considered as a risk factor for mortality in patients after surgeries. Planning of necessary educational, pharmacological and psychological interventions should be preceded by the evaluation of anxiety level which should be considered a routine element of preoperative care. The assessment of anxiety intensity may be performed using psychometric scales. Various factors should be taken into consideration while choosing the scale, including its reliability and accuracy, the aim of the assessment, the patient's age and clinical state, as well as the type of surgery being planned. In the current article, we present standardised and reliable methods which may be used in the evaluation of preoperative anxiety among patients scheduled for surgery, namely: the State-Trait Anxiety Inventory (STAI); the Hospital Anxiety and Depression Scale (HADS); the Amsterdam Preoperative Anxiety and Information Scale (APAIS); and the Visual Analogue Scale (VAS). A detailed description of the scales, including their main advantages and limitations, as well as their usefulness in both clinical evaluation of various patients' groups and scientific research are presented.

Agreement of different methods for assessment of progesterone concentrations in beef cattle serum

Progesterone (P4) is responsible for the main reproduction processes. Concentration of P4 varies widely among different determination methods, and interpretation of these values may be difficult. The objective of the current study was to assess the agreement of three different enzyme immunoassays (ELISA) in relation to radioimmunoassay (RIA) of P4 concentration assessment of beef cow serum samples. Samples were collected randomly considering high (pregnant cows) and low (non-pregnant cows) P4 concentrations. Depending on the P4 assessment method, four groups were created as follows: Group 1 - direct samples assessed by ELISA, Group 2 - extracted samples assessed by ELISA, Group 3 - samples assessed by automated ELISA, and Group 4 - samples assessed by RIA. The mean progesterone concentration was 4.50 ng/mL, 1.24 ng/mL, 4.07 ng/mL and 4.39 ng/mL from Group 1 to Group 4, respectively. The mean difference (MD) between Group 1, Group 2 and Group 3 individually compared with Group 4 was -0.10 ± 1.24 ng/mL, 3.15 ± 3.58 ng/mL and 0.33 ± 1.42 ng/mL, and the 95% confidence interval (CI) for the differences (s) was from -0.99 to 0.78 ng/mL, from 0.59 to 5.71 ng/mL, and from -0.69 to 1.34 ng/mL, respectively. The confidence interval for the lower and upper limit of the agreement ranged from -4.12 to -1.05 ng/mL and from 0.84 to 3.91 ng/mL between Group 1 and Group 4, from -8.45 to 0.42 ng/ mL and from 5.88 to 14.75 ng/mL between Group 2 and Group 4, from -4.29 to -0.76 ng/mL, and from 1.41 to 4.94 ng/mL between Group 3 and Group 4. Our findings show that the best agreement with RIA was observed for Group 1 and Group 3, while the agreement in the extraction method was least accurate.

Investigating the Probability of Response Bias in Owner-Perceived Pain Assessment in Dogs With Osteoarthritis

Owners' ability to recognize signs of chronic pain in dogs undergoing pharmacologic and nonpharmacologic pain interventions during a period of physical rehabilitation is not known. This study aimed to compare dogs with and without chronic pain, and to assess the relationship between explanatory factors, including the probability of owners' response bias induced by pharmacologic and nonpharmacologic pain intervention, and chronic pain in dogs with osteoarthritis (OA). Seventy-one dogs with OA were included in this observational study. Owner-perceived pain interference was measured by Canine Brief Pain Inventory (CBPI) and owner-perceived pain behavior was assessed using Helsinki Chronic Pain Index. A dichotomous variable of Helsinki Chronic Pain Index was used in regression analysis to investigate the association between chronic pain and explanatory factors (body condition, anti-inflammatory medication, animal physiotherapy consultation once or more and owners' perception of pain interfering). Seventy-five percent of the dogs had ongoing anti-inflammatory medication, 51% of were overweight and 45% had a physiotherapy consultation. Higher levels of overt pain behaviors were reported in items addressing activities. Body condition, physiotherapy consultation and medication were not associated with chronic pain. Odds ratio (OR) and 95% confidence intervals of OR for the CBPI were 1.74 (1.23-2.47) and significantly associated with chronic pain. The adjusted OR of the CBPI did not differ from the crude OR. Owner-perceived pain behavior was not confounded by the dogs' medication. Results indicated that CBPI was not mediated by the medication. The CBPI pain interference score was not associated with response bias and may be used as clinical outcome measure of chronic pain and pain-related disability in dogs with OA along a period of physical rehabilitation comprising pharmacologic and nonpharmacologic pain interventions.

Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018

BACKGROUND

Medical professionalism enhances doctor-patient relationships and advances patient-centric care. However, despite its pivotal role, the concept of medical professionalism remains diversely understood, taught and thus poorly assessed with Singapore lacking a linguistically sensitive, context specific and culturally appropriate assessment tool. A scoping review of assessments of professionalism in medicine was thus carried out to better guide its understanding.

METHODS

Arksey and O'Malley's (2005) approach to scoping reviews was used to identify appropriate publications featured in four databases published between 1 January 1990 and 31 December 2018. Seven members of the research team employed thematic analysis to evaluate the selected articles.

RESULTS

3799 abstracts were identified, 138 full-text articles reviewed and 74 studies included. The two themes identified were the context-specific nature of assessments and competency-based stages in medical professionalism.

CONCLUSIONS

Prevailing assessments of professionalism in medicine must contend with differences in setting, context and levels of professional development as these explicate variances found in existing assessment criteria and approaches. However, acknowledging the significance of context-specific competency-based stages in medical professionalism will allow the forwarding of guiding principles to aid the design of a culturally-sensitive and practical approach to assessing professionalism.

Quantitative Data From Rating Scales: An Epistemological and Methodological Enquiry

Rating scales are popular methods for generating quantitative data directly by persons rather than automated technologies. But scholars increasingly challenge their foundations. This article contributes epistemological and methodological analyses of the processes involved in person-generated quantification. They are crucial for measurement because data analyses can reveal information about study phenomena only if relevant properties were encoded systematically in the data. The Transdisciplinary Philosophy-of-Science Paradigm for Research on Individuals (TPS-Paradigm) is applied to explore psychological and social-science concepts of measurement and quantification, including representational measurement theory, psychometric theories and their precursors in psychophysics. These are compared to theories from metrology specifying object-dependence of measurement processes and subject-independence of outcomes as key criteria, which allow tracing data to the instances measured and the ways they were quantified. Separate histories notwithstanding, the article's basic premise is that general principles of scientific measurement and quantification should apply to all sciences. It elaborates principles by which these metrological criteria can be implemented also in psychology and social sciences, while considering their research objects' peculiarities. Application of these principles is illustrated by quantifications of individual-specific behaviors ('personality'). The demands rating methods impose on data-generating persons are deconstructed and compared with the demands involved in other quantitative methods (e.g., ethological observations). These analyses highlight problematic requirements for raters. Rating methods sufficiently specify neither the empirical study phenomena nor the symbolic systems used as data nor rules of assignment between them. Instead, pronounced individual differences in raters' interpretation and use of items and scales indicate considerable subjectivity in data generation. Together with recoding scale categories into numbers, this introduces a twofold break in the traceability of rating data, compromising interpretability of findings. These insights question common reliability and validity concepts for ratings and provide novel explanations for replicability problems. Specifically, rating methods standardize only data formats but not the actual data generation. Measurement requires data generation processes to be adapted to the study phenomena's properties and the measurement-executing persons' abilities and interpretations, rather than to numerical outcome formats facilitating statistical analyses. Researchers must finally investigate how people actually generate ratings to specify the representational systems underlying rating data.

The Dynamics of Creative Ideation: Introducing a New Assessment Paradigm

Despite six decades of creative cognition research, measures of creative ideation have heavily relied on divergent thinking tasks, which still suffer from conceptual, design, and psychometric shortcomings. These shortcomings have greatly impeded the accurate study of creative ideation, its dynamics, development, and integration as part of a comprehensive psychological assessment. After a brief overview of the historical and current anchoring of creative ideation measurement, overlooked challenges in its most common operationalization (i.e., divergent thinking tasks framework) are discussed. They include (1) the reliance on a single stimulus as a starting point of the creative ideation process (stimulus-dependency), (2) the analysis of response quality based on a varying number of observations across test-takers (fluency-dependency), and (3) the production of "static" cumulative performance indicators. Inspired from an emerging line of work from the field of cognitive neuroscience of creativity, this paper introduces a new assessment framework referred to as "Multi-Trial Creative Ideation" (MTCI). This framework shifts the current measurement paradigm by (1) offering a variety of stimuli presented in a well-defined set of ideation "trials," (2) reinterprets the concept of ideational fluency using a time-analysis of idea generation, and (3) captures individual dynamics in the ideation process (e.g., modeling the effort-time required to reach a response of maximal uncommonness) while controlling for stimulus-specific sources of variation. Advantages of the MTCI framework over the classic divergent thinking paradigm are discussed in light of current directions in the field of creativity research.

Use of Audio Computer-Assisted Self-Interviews to Gather Information on Risk Behaviors in a Population of Pregnant Adolescents

In a prospective study comparing the use of the Audio Computer-Assisted Self-Interview (ACASI) with a traditional clinical interview in 40 pregnant adolescents, there was significantly greater disclosure of violence with the ACASI method. Better identification of high-risk behaviors may help to optimize care and programing for pregnant adolescents.

Measuring Multiple Text Integration: A Review

Multiple text integration is an important skill in modern society, required in heterogeneous situations, across many disciplines and in daily life. It is a complex skill that builds on bottom-up and top-down processes (Britt and Rouet, 2012). As a complex skill it has been measured in the literature using different techniques. To date, the different ways in which researchers have defined and operationalized the term have not been reviewed. Therefore, the aim of this paper is to review how multiple text integration has been theoretically and empirically assessed. The current paper reviews which texts were typically used, which aspects of integration were assessed, and with which scoring rubrics. Finally, we propose that despite the diverse use of tasks, important features of multiple text integration are missing from current research.

Optimizing quality of dental carving by preclinical dental students through anatomy theory reinforcement

Knowledge of dental anatomy is of great importance in the practice of dentistry, especially in oral rehabilitation, because without this knowledge, professional practice is not possible. Dental carving plays a major role in training dental students as it develops their manual dexterity. This randomized controlled trial aimed to evaluate the influence of didactic-theoretical reinforcement on the theoretical and practical knowledge of dental anatomy of preclinical students by examining the quality of the anatomical restorations performed by these students before and after a didactic-theoretical reinforcement. For the evaluation of theoretical knowledge, a questionnaire with closed questions about dental anatomy was used. To evaluate the effect of didactic reinforcement on dental carvings, two groups of 15 preclinical students were assessed. Experimental group (G1) received a three-hour theoretical tutoring on dental anatomy, while the control group (G2) did not. The dental carving scores obtained by the two different groups were compared using Student's t-test. Cohen's d was used to estimate the effect sizes between groups. The frequency of correct answers given for each theoretical knowledge question was compared in each group using Fisher's exact test. T-test was also used to compare the means of the two groups' final scores of theoretical evaluations. To compare these final scores obtained in both carving and theoretical tests, a principal component analysis was performed with different items assessed in each test to obtain factor loading scores and a final weighted score, where factor loadings were considered for each item. Weighted scores were compared using t-test. Also, scores obtained during the head and neck course were assessed and compared using t-test. Spearman's correlation test was used to assess the correlation between scores obtained prior to the anatomy course and scores obtained in the dental carving exercise. The theoretical evaluation revealed no significant difference between the grades (mean ± SD) of G1 (85.1 ± 6.6%) and G2 (86.2 ± 9.1%) with the grades of a baseline test that was previously obtained when students submitted to the study (P = 0.725). Regarding the tooth carving assessment, the dental carving quality by students of G1 has significantly improved, except for tooth #23 (P = 0.096). Theoretical reinforcement of dental anatomy seems to improve the students' carving performance but does not enhance their knowledge about dental anatomy. Anat Sci Educ 11: 377-384. © 2017 American Association of Anatomists.

Influence of Er:YAG Laser on Objective and Subjective Parameters of Stress during Sealant Application in Children

BACKGROUND

Acceptance of lasers as alternatives and accessory tools to traditional methods in dental medicine has created an explosion of interest. Er:YAG laser is recommended for enamel conditioning. There is no study evaluating the anxiety in children during fissure sealing procedures when using Er:YAG laser compared to the routine application technique.

AIM

To evaluate the objective and subjective stress parameters in children during a preventive procedure when using Er:YAG laser for additional enamel conditioning before pit and fissure sealant application compared to the routine clinical application technique.

MATERIALS AND METHODS

The study included sixty-four 6-12-year-old children, divided into two equal treatment groups. A standardized fissure sealant application was performed, as in the intervention group before acid etching, the occlusal surfaces of teeth were conditioned with Er:YAG laser (2940 nm). During the procedure, objective and subjective stress parameters were recorded.

RESULTS

Significantly lower degree of dental anxiety was found at the end of the dental visit of the study group (p<0.001). During the professional cleaning of the tooth surface, the mean heart rate was low (95.55±14.29 bpm) within the physiological normal range. The objective and subjective stress parameters show no significant differences between the two subgroups during sealing procedure (p>0.05).

CONCLUSIONS

Application of Er:YAG laser during sealant application does not provoke anxiety and is well accepted by children in dental environment. Preventive procedures at the beginning of a dental visit decrease the initial levels of dental anxiety and contribute to an effective treatment process.

The impact of critical appraisal workshops on residents' evidence based medicine skills and knowledge

OBJECTIVE

To assess the impact of four evidence based medicine (EBM) critical appraisal education workshops in improving residents' EBM knowledge and skills.

METHODS

The eligible participants in the workshops were 88 residents-in-training, postgraduate years one through four, rotating through the outpatient internal medicine clinic. Four EBM workshops, consisting of 3 days each (30 minutes daily), were taught by our faculty. Topics covered included critical appraisal of randomized controlled trials, case-control and cohort studies, diagnosis studies, and systematic reviews.

RESULTS

As a program evaluation, anonymous pre-workshop and post-workshop tests were administered. Each of the four sets of tests showed improvement in scores: therapy from 58% to 77% (42% response rate), harm from 65% to 73% (38% response rate), diagnosis from 49% to 68% (49% response rate), and systematic review from 57% to 72% (30% response rate).

CONCLUSION

We found that teaching EBM in four short workshops improved EBM knowledge and critical appraisal skills related to the four topics.

Broad and Inconsistent Muscle Food Classification Is Problematic for Dietary Guidance in the U.S

Dietary recommendations regarding consumption of muscle foods, such as red meat, processed meat, poultry or fish, largely rely on current dietary intake assessment methods. This narrative review summarizes how U.S. intake values for various types of muscle foods are grouped and estimated via methods that include: (1) food frequency questionnaires; (2) food disappearance data from the U.S. Department of Agriculture Economic Research Service; and (3) dietary recall information from the National Health and Nutrition Examination Survey data. These reported methods inconsistently classify muscle foods into groups, such as those previously listed, which creates discrepancies in estimated intakes. Researchers who classify muscle foods into these groups do not consistently considered nutrient content, in turn leading to implications of scientific conclusions and dietary recommendations. Consequentially, these factors demonstrate a need for a more universal muscle food classification system. Further specification to this system would improve accuracy and precision in which researchers can classify muscle foods in nutrition research. Future multidisciplinary collaboration is needed to develop a new classification system via systematic review protocol of current literature.

Identifying Gifted Children: Congruence among Different IQ Measures

This study has two main aims: (1) analysing the relationship between intellectual capacities and levels of creativity in a sample of Spanish students from the third and sixth grades; and (2) examining the discrimination capacities and degree of congruence among different tests of intellectual ability that are commonly used to identify high-ability students. The study sample comprised 236 primary school students. Participants completed different tests of intellectual ability, which were based on both fluid and crystallized intelligence, as well as creativity. Results indicated that it is advisable to use varying tests in the assessment process, and a complementary measure (i.e., creativity) in order to create a multi-criteria means of detection that can more efficiently distinguish this population of students.

The mobile conjugate reinforcement paradigm in a lab setting

The mobile conjugate reinforcement task was administered to 4-month-old infants in a lab rather than a home setting where it is usually administered. Learning and retention patterns were comparable to those of infants tested in their homes, suggesting flexibility in where this task can be administered. These results pave the way for this task to be used with a broader range of infants for whom home visits are not practical or convenient (e.g., infants in child care). Developmental research conducted with a more diverse population of infants would facilitate our understanding of cognitive development very early in life.

Leisure riding horses: research topics versus the needs of stakeholders

Horses intended for leisure riding do not undergo any selection and most often retired sports horses or defective horses are chosen, as a low selling price determines their purchase by a leisure riding center. Unfortunately, horses bought at low prices usually have low utility value, are difficult to handle, require a special or individual approach and do not provide satisfaction in riding. However, neither modern horse breeding nor scientific research address the need to breed horses for leisure activities. There is no clear definition of a model leisure horse and criteria or information for its selection are not readily available in scientific publications. A wide spectrum of research methods may be used to evaluate various performance traits in horses intended for leisure activities. The fact that the population of recreational horses and their riders outnumber sporting horses should attract the special attention of scientific research. Their utility traits need to be determined with modern technology and methods in the same way they are for sporting horses. Such a system of evaluation would be very helpful for riders.

The Short Form Score for the Assessment and Quantification of Chronic Rheumatic Affections of the Hands in Daily Clinical Routines-Its Sensitivity to Change and Preliminary Patient Relevant Variation Values: A Pilot Study

OBJECTIVE

The SF-SACRAH was developed to assess the involvement of the hand in rheumatoid arthritis (RA) and hand osteoarthritis (HOA) patients in daily clinical routines. In this pilot study, its sensitivity to change will be assessed longitudinally, and preliminary thresholds for patient relevant changes are derived.

METHODS

Ninety-nine outpatients suffering from HOA (n = 55) or RA (n = 44) completed the SF-SACRAH once initially. After approximately 3 months, patients repeated the SF-SACRAH. At both visits, patients rated their satisfaction (PATSAT) with the state of their disease (1 = very good to 5 = unsatisfactory). For assessing its sensitivity to change, SF-SACRAH changes in patients with stable, improving, or worsening conditions according to PATSAT were calculated in HOA and RA patients. The respective medians and highest values were used to estimate patient relevant variation values. SF-SACRAH changes and positive or negative PATSAT changes in HOA as well as RA patients were analyzed by applying the Kruskal-Wallis test. In RA patients, the DAS28 was also calculated. Spearman's rho was calculated to correlate SF-SACRAH changes with the EULAR response criteria.

RESULTS

In HOA and RA patients, a statistically high correlation between PATSAT changes and SF-SACRAH values was revealed (p < 0.0001 in HOA and p < 0.01 in RA patients, respectively). The median changes in SF-SACRAH in patients with improving, stable, or worsening conditions according to PATSAT were HOA patients: PATSAT improving: ΔSF-SACRAH -1.6, PATSAT stable: ΔSF-SACRAH +0.8, PATSAT worsening: ΔSF-SACRAH +1.0; RA patients: PATSAT improving: ΔSF-SACRAH -0.9, PATSAT stable: ΔSF-SACRAH +0.2, PATSAT worsening: ΔSF-SACRAH +0.8. In RA patients, there is a moderate, but significant, correlation between DAS28 EULAR response criteria and SF-SACRAH changes (ΔDAS28 improving >0.6: ΔSF-SACRAH -0.4, ΔDAS28 <0.6: ΔSF-SACRAH +0.0, ΔDAS28 worsening >0.6: ΔSF-SACRAH +0.5; r = 0.433, p < 0.01).

CONCLUSION

The SF-SACRAH constitutes a reliable tool for the assessment of hand impairment in patients with chronic rheumatic diseases. It proved to be sensitive to change in this short-term evaluation in both HOA and RA patients. Additionally, preliminary patient variation values for improvement (-1.60) and deterioration (+1.0) could be derived.

Process and implementation of Audio Computer Assisted Self-Interviewing (ACASI) assessments in low resource settings: a case example from Zambia

BACKGROUND

Studies from low- and middle-income countries (LMIC) indicate that the use of audio computer-assisted self-interviewing (ACASI) is associated with more accurate reporting of sensitive behaviors (e.g. substance use and sexual risk behaviors) compared with interviewer-administered questionnaires. There is a lack of published information on the process of designing, developing, and implementing ACASI in LMIC. In this paper we describe our experience implementing an ACASI system for use with a population of orphans and vulnerable children in Zambia.

METHODS

A questionnaire of mental health, substance use, and HIV risk behaviors was converted into an ACASI system, tested in pilot and validity studies, and implemented for use in a randomized controlled trial. Successes, barriers, and challenges associated with each stage in the development and implementation of ACASI are described.

RESULTS

We were able to convert a lengthy and complex survey into an ACASI system that was feasible for use in Zambia. Lessons learned include the importance of: (1) piloting the written and electronic versions; (2) proper and extensive training for study assessors to use ACASI and for those doing voice recordings; and (3) attention to logistics such as appropriate space, internet, and power.

CONCLUSIONS

We found that ACASI was feasible and acceptable in Zambia with proper planning, training, and supervision. Given mounting evidence indicating that ACASI provides more accurate self-report data and immediate data download compared with interview-administered measures, it may be an effective and economical alternative for behavioral health research studies in LMIC.

Patterns of disclosure and antiretroviral treatment adherence in a South African mining workplace programme and implications for HIV prevention

Social and psychological barriers to the disclosure of one's seropositive HIV status to significant others and poor adherence to taking medications pose significant challenges to the scaling-up of access to antiretroviral treatment (ART) in the workplace. Such barriers are predictive of sub-optimal treatment outcomes and bedevil HIV-prevention interventions at a societal level. Against this background, this article explores the lived experiences of 19 HIV-positive male participants, between the ages of 33 and 57 years, who were enrolled in an ART programme managed at an occupational health clinic at a mining company in South Africa. The majority of these mineworkers had been aware of their HIV status for between 5 and 7 years. The study explored psychological and relational factors, as aspects of these participants lived experiences, which had a bearing on their adherence to their ART regimen and the disclosure choices that they made regarding their HIV status. In our sample, those participants who were adherent demonstrated higher levels of control and acceptance of their HIV infection and were more confident in their ability to manage their treatment, while the group who were non-adherent presented with lower levels of adherence motivation and self-efficacy, difficulties in maintaining a healthy lifestyle and significant challenges in maintaining control over their lives. While most of the men favoured disclosing their HIV status to their partners for the sake of treatment support, they were less sure about disclosing to family members and non-family members, respectively, because of their need to protect these persons and due to their fear of being stigmatised. It was evident that treatment adherence choices and behaviours were impacted by psychological and relational factors, including disclosure decisions. We conclude with a bivariate model for understanding the adherence behaviours that influenced different patterns of ART adherence among the sample, and offer recommendations for HIV-prevention and treatment interventions in a mining workplace.

Qualitative study of the influence of antidepressants on the psychological health of patients on antiretroviral therapy in Uganda

The study set out to explore how HIV-positive individuals conceptualise and describe depression and its manifestation in their lives, and how this may change over time in the context of antiretroviral therapy (ART) and antidepressant treatment. We conducted in-depth interviews using a semi-structured interview guide with 26 adult HIV-positive clients receiving ART in Uganda. We asked the participants to describe their depression and its impact on their general health, physical functioning and psychological wellbeing, as well as the influences of receiving ART or antidepressant treatment. Although depressive experience among the patients was largely described in terms of criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), some of the symptoms used to describe depression, such as 'thinking too much' or worrisome thoughts, did not fit into the DSM-IV criteria. The participants attributed their depression to news of the HIV diagnosis, a fear of dying, the potential socioeconomic consequences of their HIV infection on their family, ART side-effects and continued bad health. Their subjective reports indicated that the treatment of depression with antidepressants had made a positive impact on their general and psychological health. These findings highlight the need for models of HIV care that integrate mental health services and promote the diagnosis and treatment of depression in culturally sensitive ways so as to improve the quality of life and health outcomes for clients. However, keeping the particular study design in mind, these findings should be interpreted as preliminary.

Quality of life of people living with HIV/AIDS and on highly active antiretroviral therapy in Ethiopia

The Amharic version of the Short Form-36 Health Survey (SF-36) was used to measure quality of life among patients on highly active antiretroviral therapy (HAART) at selected governmental hospitals in central and southern Ethiopia. The study was cross-sectional and used SF-36-specific software for automatic scoring of the form's scales and dimensions. Pearson bivariate correlations showed moderate correlation between the SF-36 scales, ranging from 0.2673 between 'general health' and 'vitality,' to 0.8583 between 'role physical' and 'role emotional.' Cronbach's-αwas >0.70 for six out of eight multi-item scales, with values ranging from 0.6500 to 0.8860 for all scales, thus indicating good internal reliability of the Amharic version of the SF-36. The independent variables shown to positively affect mean scores were: duration of treatment, CD4 cell count, and adherence to doses of antiretrovirals. Participants treated for >12 months had higher mean scores for all domains than those who had been treated for ≤12 months. Likewise, those with a CD4 cell count >200 cells/mm(3) had better mean scores for all scales except 'social functioning' and 'mental health' than those with counts ≤200. Participants adhering to treatment (in the last 15 days, according to self-report) had better mean scores for all scales except 'role physical,' 'bodily pain' and 'vitality' in comparison to those who were not adherent. The findings suggest that the Amharic version of the SF-36 is a valid and reliable health survey instrument for use in Ethiopia to assess the quality of life of people living with HIV/AIDS on HAART.

The integrated anatomy practical paper: A robust assessment method for anatomy education today

Assessing anatomy in a way that tests higher cognitive domains and clinical application is not always straightforward. The old "spotter" examination has been criticized for only testing low level "identify" knowledge, whereas other assessment modalities such as multiple choice questions do not reflect the three dimensional and application nature of clinical anatomy. Medical curricula are frequently integrated and subject specific examinations do not reflect the case based, spiral, integrative nature of the curricula. The integrated anatomy practical paper (IAPP) is a hybrid of the old "spotter" and an objective structured clinical examination but it demonstrates how higher levels of taxonomy can be assessed, together with clinical features and integrates well with other disciplines. Importantly, the IAPP has shown to be reliable and practical to administer. Data gathered from the Bachelor of Medicine five-year program over two academic years for four IAPP examinations, each being 40 minutes with (K = 60 items) based on 440 students revealed consistently strong reliability coefficients (Cronbach alpha) of up to 0.923. Applying Blooms taxonomy to questions has shown a marked shift resulting in an increase in the complexity level being tested; between 2009 and 2013 a reduction of 26% in the number of low level "remember knowledge" domain questions was noted with up to an increase of 15% in "understanding" domain and 12% increase in the "applying" knowledge domain. Our findings highlight that it is possible to test, based in a laboratory, anatomy knowledge and application that is integrated and fit for practice.

Influence of age on postural sway during different dual-task conditions

Dual-task performance assessments of competing parallel tasks and postural outcomes are growing in importance for geriatricians, as it is associated with predicting fall risk in older adults. This study aims to evaluate the postural stability during different dual-task conditions including visual (SMBT), verbal (CBAT) and cognitive (MAT) tasks in comparison with the standard Romberg's open eyes position (OE). Furthermore, these conditions were investigated in a sample of young adults and a group of older healthy subjects to examine a potential interaction between type of secondary task and age status. To compare these groups across the four conditions, a within-between mixed model ANOVA was applied. Thus, a stabilometric platform has been used to measure center of pressure velocity (CoPV), sway area (SA), antero-posterior (AP) and medio-lateral (ML) oscillations as extents of postural sway. Tests of within-subjects effects indicated that different four conditions influenced the static balance for CoPV (p < 0.001), SA (p < 0.001). Post-hoc analyses indicated that CBAT task induced the worst balance condition on CoPV and resulted in significantly worse scores than OE (-11.4%; p < 0.05), SMBT (-17.8%; p < 0.01) and MAT (-17.8%; p < 0.01) conditions; the largest SA was found in OE, and it was statistically larger than SMBT (-27.0%; p < 0.01) and MAT (-23.1%; p < 0.01). The between-subjects analysis indicated a general lower balance control in the group of elderly subjects (CoPV p < 0.001, SA p < 0.002), while, the mixed model ANOVA did not detect any interaction effect between types of secondary task and groups in any parameters (CoPV p = 0.154, SA p = 0.125). Postural sway during dual-task assessments was also found to decrease with advancing age, however, no interactions between aging and types of secondary tasks were found. Overall, these results indicated that the secondary task which most influenced the length of sway path, as measured by postural stability was a simple verbal assignment.

Exploring the validity of assessment in anatomy: do images influence cognitive processes used in answering extended matching questions?

Assessment is an important aspect of medical education because it tests students' competence and motivates them to study. Various assessment methods, with and without images, are used in the study of anatomy. In this study, we investigated the use of extended matching questions (EMQs). To gain insight into the influence of images on the validity of test items, we focused on students' cognitive processes while they answered questions with and without images. Seventeen first-year medical students answered EMQs about gross anatomy, combined with either labeled images or answer lists, while thinking aloud. The participants' verbal reports were transcribed verbatim and then coded. Initial codes were based on a task analysis and were adapted into final codes during the coding process. Results showed that students used more cues from EMQs with images and visualized more often in EMQs with answer lists. Ready knowledge and verbal reasoning were used equally often in both conditions. In conclusion, EMQs with and without images elicit different results in this think aloud experiment, indicating different cognitive processes. They seem to measure different skills, making them valid for different testing purposes. The take-home message for anatomy teachers is that questions without images seem to test the quality of students' mental images while questions with images test their ability to interpret visual information. It makes sense to use both response formats in tests. Using images from clinical practice instead of anatomical drawings will help to improve test validity.

Ecological Momentary Assessment and Alcohol Use Disorder Treatment

The ability to capture real-time data on human behavior inexpensively, efficiently, and accurately holds promise to transform and broaden our understanding of many areas of health science. One approach to acquiring this type of real-time data is ecological momentary assessment (EMA).This method has been used to collect data in many domains of addiction research, including research on the treatment of alcohol use disorders (AUDs). Empirical evidence supports the hypothesis that use of EMA can improve the quality of AUD treatment research when compared with standard assessment methods because it provides more accurate reporting, allows investigators to examine the dynamic unfolding of the behavior change process at an individual level, and can be used to augment and improve clinical assessment and treatment. Overall, the existing literature provides strong support for the advantages of EMA when combined with standard assessment of addictive behaviors in general. Nevertheless, use of EMA in AUD treatment research thus far has been limited, especially in the area of research on mechanisms of behavior change. Existing research indicates, however, that EMA can be used to deliver tailored feed- back as a novel and potentially transformative approach to improving AUD treatment. This research area clearly warrants additional future efforts.

Trait anxiety and trait anger measured by ecological momentary assessment and their correspondence with traditional trait questionnaires

Ecological momentary assessments (EMA) of anxiety and anger/hostility were obtained every 25-30 minutes over two 24-hour periods, separated by a median of 6 months, from 165 employees at a university in the Northeast. We used a multilevel trait-state-error structural equation model to estimate: (1) the proportion of variance in EMA anxiety and anger/hostility attributable to stable trait-like individual differences; (2) the correspondence between these trait-like components of EMA anxiety and anger/hostility and traditional questionnaire measures of each construct; and (3) the test-retest correlation between two 24-hour averages obtained several months apart. After adjustment for measurement error, more than half the total variance in EMA reports of anxiety and anger/hostility is attributable to stable trait-like individual differences; however, the trait-like component of each construct is only modestly correlated with questionnaire measures of that construct. The 6-month "test-retest" correlations of latent variables representing the true 24-hour EMA average anxiety and average anger are quite high (r ≥ 0.83). This study represents the longest follow-up period over which EMA-based estimates of traits have been examined. The results suggest that although the trait component (individual differences) of EMA momentary ratings of anxiety and anger is larger than the state component, traditional self-report questionnaires of trait anxiety and anger correspond only weakly with EMA-defined traits.