The University of Texas at Tyler

Advancing technology has made detecting fetal abnormalities in the first and second trimesters a reality. Few families are prepared for the difficult decisions that must be made if their unborn children are diagnosed with a life-limiting condition. Expectant parents are compelled to make decisions on the basis of limited options. A systematic review of the literature is presented with an aim to inform clinicians of parental experiences and outcomes after diagnosis of a fetal anomaly. The review focused on patients given a diagnosis for fetal anomalies for the 40-year period from 1970 to 2010 by using the key words such as fetal anomaly, congenital malformations, pregnancy termination, perinatal palliative care, and perinatal hospice. Regardless of the option taken, women often experienced intense grief reactions. Both giving birth to a child with a life-limiting condition and termination of pregnancy for fetal anomaly can be emotionally traumatic life events, both associated with psychological morbidity. Nonaggressive obstetric management, allowing natural birth without life-sustaining therapeutics, is an option for families. Couples presented with a coordinated perinatal palliative care model may opt to continue their pregnancy. Families who experienced perinatal hospice/palliative care report positive feedback, but more research is needed to explore the psychological outcomes of this choice.

This study aimed to determine the effects of a flipped classroom (i.e., reversal of time allotment for lecture and homework) and innovative learning activities on academic success and the satisfaction of nursing students. A quasi-experimental design was used to compare three approaches to learning: traditional lecture only (LO), lecture and lecture capture back-up (LLC), and the flipped classroom approach of lecture capture with innovative classroom activities (LCI). Examination scores were higher for the flipped classroom LCI group (M = 81.89, SD = 5.02) than for both the LLC group (M = 80.70, SD = 4.25), p = 0.003, and the LO group (M = 79.79, SD = 4.51), p < 0.001. Students were less satisfied with the flipped classroom method than with either of the other methods (p < 0.001). Blending new teaching technologies with interactive classroom activities can result in improved learning but not necessarily improved student satisfaction.

Microorganisms are vital in mediating the earth’s biogeochemical cycles; yet, despite our rapidly increasing ability to explore complex environmental microbial communities, the relationship between microbial community structure and ecosystem processes remains poorly understood. Here, we address a fundamental and unanswered question in microbial ecology: ‘When do we need to understand microbial community structure to accurately predict function?’ We present a statistical analysis investigating the value of environmental data and microbial community structure independently and in combination for explaining rates of carbon and nitrogen cycling processes within 82 global datasets. Environmental variables were the strongest predictors of process rates but left 44% of variation unexplained on average, suggesting the potential for microbial data to increase model accuracy. Although only 29% of our datasets were significantly improved by adding information on microbial community structure, we observed improvement in models of processes mediated by narrow phylogenetic guilds via functional gene data, and conversely, improvement in models of facultative microbial processes via community diversity metrics. Our results also suggest that microbial diversity can strengthen predictions of respiration rates beyond microbial biomass parameters, as 53% of models were improved by incorporating both sets of predictors compared to 35% by microbial biomass alone. Our analysis represents the first comprehensive analysis of research examining links between microbial community structure and ecosystem function. Taken together, our results indicate that a greater understanding of microbial communities informed by ecological principles may enhance our ability to predict ecosystem process rates relative to assessments based on environmental variables and microbial physiology.

STUDY DESIGN: This prospective study evaluated the diagnostic utility of historically accepted sacroiliac joint tests. A multidisciplinary expert panel recommended 12 of the "best" sacroiliac joint tests to be evaluated against a criterion standard of unequivocal gain relief after an intra-articular injection of local anesthetic into the sacroiliac joint. OBJECTIVES: To identify a single sacroiliac joint test or ensemble of test that are sufficiently useful in diagnosing sacroiliac joint disorders to be clinically valuable. SUMMARY OF BACKGROUND DATA: No previous research has been done to evaluate any physical test of sacroiliac joint pain against an accepted criterion standard. METHODS: Historical data was obtained, and the 12 tests were performed by two examiners on 85 patients who subsequently underwent sacroiliac joint blocks. Ninety percent or more relief was considered a positive response, and less then 90% relief was considered a negative response. RESULTS: There were 45 positive and 40 negative responses. No historical feature, none of the 12 sacroiliac joint tests, and no ensemble of these 12 tests demonstrated worthwhile diagnostic value. CONCLUSION: Sacroiliac joint pain is resistant to identification by the historical and physical examination data from tests evaluated in this study.

One of the main assumptions in Clarke's classic channel model is isotropic scattering, i.e., uniform distribution for the angle of arrival (AOA) of multipath components at the mobile station. However, in many mobile radio channels we encounter nonisotropic scattering, which strongly affects the correlation function and power spectrum of the complex envelope at the mobile receiver. We propose the use of the versatile von Mises (1918) angular distribution, which includes and/or closely approximates important distributions like uniform, impulse, cardioid, Gaussian, and wrapped Gaussian, for modeling the nonuniform AOAs at the mobile. Based on this distribution, the associated correlation function and. power spectrum of the complex envelope at the mobile receiver are derived. The utility of the new results is demonstrated by comparison with the correlation function estimates of measured data.

With the flattening of the global economy in the 21st century, the teaching of Science, Technology, Engineering, and Mathematics (STEM) has taken on new importance as economic competition has become truly global. STEM education has evolved into a meta-discipline, an integrated effort that removes the traditional barriers between these subjects, and instead focuses on innovation and the applied process of designing solutions to complex contextual problems using current tools and technologies. Engaging students in high quality STEM education requires programs to include rigorous curriculum, instruction, and assessment, integrate technology and engineering into the science and mathematics curriculum, and also promote scientific inquiry and the engineering design process. All students must be a part of the STEM vision, and all teachers must be provided with the proper professional development opportunities preparing them to guide all their students toward acquiring STEM literacy. By focusing on student engagement, educators from institutions of higher education and K-12 schools can work together to develop pedagogical models that provide rigorous, well-rounded education and outstanding STEM instruction. This paper defines the necessary attributes of STEM programs designed to engage all students, describes a number of model programs focused on student engagement, and discusses assessments in progress.

This study's premise is that firms that can lower their costs and enhance their differentiation through the effective management of their human resources have a competitive advantage. Using data fr...

Abstract Anger at unfair treatment has been called moral outrage. However, moral outrage—anger at the violation of a moral standard—should be distinguished from personal anger at being harmed and empathic anger at seeing another for whom one cares harmed. Across a preliminary experiment and a main experiment, both designed to manipulate the appraisal conditions for these three forms of anger, we found evidence of personal anger and empathic anger, but little evidence of moral outrage. Participants perceived unfair treatment of another, even another for whom they had not been induced to feel empathy, to be as unfair as participants perceived unfair treatment of themselves. But the appraisal conditions that evoked anger were unfair treatment of self and unfair treatment of a cared‐for other, not unfairness per se . In the absence of empathic concern, unfair treatment of another evoked little anger. Possible implications for understanding moral emotion and moral motivation are suggested. Copyright © 2007 John Wiley &amp; Sons, Ltd.

Each chapter begins with and concludes with Summary, Tables, Figures, and Special Interest Topics. 1. Introduction to Educational Assessment. The Language of Assessment. Assumptions of Educational Assessment. Participants in the Assessment Process. Common Application of Educational Assessments. What Teachers Need to Know About Assessment. Educational Assessment in the 21st Century. 2. The Basic Mathematics of Measurement. The Role of Mathematics in Assessment. Scales of Measurement. The Description of Test Scores. Correlation Coefficients. 3. The Meaning of Test Scores. Norm-Referenced & Criterion-Referenced Score Interpretations. Norm-Referenced, Criterion-Referenced, or Both? Qualitative Description of Scores. 4. Reliability for Teachers. Errors of Measurement. Methods of Estimating Reliability. The Standard Error of Measurement. Reliability: Practical Strategies for Teachers. 5. for Teachers. of Validity versus of Types of Evidence. Validity: Practical Strategies for Teachers. 6. Item Analysis for Teachers. Item Difficulty Index (or Item Difficulty Level). Item Discrimination. Distracter Analysis. Item Analysis: Practical Strategies for Teachers. Using Item Analysis to Improve Items. Item Analysis and Performance Assessments. Qualitative Item Analysis. Using Item Analysis to Improve Classroom Instruction. 7. The Initial Steps in Developing a Classroom Test: Deciding What to Test and How to Test It. Characteristics of Educational Objectives. Taxonomy of Educational Objectives. Behavioral versus Nonbehavioral Educational Objectives. Writing Educational Objectives. Developing a Table of Specifications. Implementing the Table of Specifications and Developing an Assessment. Preparing your Students and Administering the Assessment. 8. The Development and Use of Selected-Response Items. Multiple-choice Items. True-False Items. Matching Items. 9. The Development and Use of Constructed-Response Items. Oral Testing: The Oral Essay as a Precursor of Constructed-Response Items. Essay Items. Short-Answer Items. A Final Note: Constructed-Response versus Selected-Response Items. 10. Performance Assessments & Portfolios. Introduction - What Are Performance Assessments? Guidelines for Developing Effective Performance Assessments. Strengths & Weaknesses of Performance Assessments. Portfolios. Guidelines for Developing Portfolio Assessments. Strengths & Weaknesses of Portfolios. 11. Assigning Grades on the Basis of Classroom Assessments. Feedback and Evaluation. Reporting Student Progress: Which Symbols to Use. The Basis for Assigning Grades. Frame of Reference. Combining Grades Into a Composite. Informing Students of Grading System. Parent Conferences. 12. Standardized Achievement Tests in the Era of High-Stakes Assessment. Group Administered Achievement Tests. Individual Achievement Tests. Selecting an Achievement Battery. 13. The Use of Aptitude Tests in the Schools. A Brief History of Intelligence Tests. The Use of Aptitude and Intelligence Tests in the Schools. Aptitude and Intelligence Tests. College Admission Tests. 14. Assessment of Behavior and Personality. Assessing Behavior and Personality. Behavior Rating Scales. Self-Report Measures. Projective Techniques. 15. Assessment Accommodations for Students with Disabilities. Major Legislation that Impact the Assessment of Students with Disabilities. Individuals with Disabilities Education Act (IDEA). Section 504. The Rationale for Accommodations. When are Accommodations Not Appropriate or Necessary? Strategies for Accommodations. Determining What Accommodations to Provide. Reporting Results of Modified Assessments. 16. The Problem of Bias in Educational Assessment. What Do We Mean By Bias? Past and Present Concerns: A Brief Look. The Controversy over Bias in Testing: Its Origin, What it is, and What it is Not. Cultural Bias and the Nature of Psychological Testing. Objections to the Use of Educational Tests with Minorities. The Problem of Definition in the Study of Bias. Culture Free Tests, Cultural Loading, and Cultural Bias. Inappropriate Indicators of Bias: Mean Differences & Equivalent Distributions. Bias in Test Content. Bias in Other Internal Features of Tests. Bias in Predictive and in Relation to Variables External to the Test. 17. Best Practices in Educational Assessment. Guidelines for Developing Assessments. Guidelines for Published Assessments. Guidelines for Administering Assessments. Guidelines for Scoring Assessments. Guidelines for Interpreting, Using, and Communicating Assessment Results. Responsibilities of Test Takers. Appendices. Appendix A: Student Evaluation (JCSEE, 2003). Appendix B: Code of Professional Responsibilities in Educational Measurement (NCME, 1995). Appendix C: Code of Fair Testing Practices in Education (JCTP, 1988). Appendix D: Joint Committee on Testing Practices Rights and Responsibilities of Test Takers: Guidelines and Expectations. Appendix E: Standards for Teacher Competence in Educational Assessment of Students. Appendix F: Table showing the proportion of scores below any given point in a distribution by specifying standard deviation units. Appendix G: Answers to Chapter Practice Problems.

The aim of this study is to clarify the concept of exercise using Walker and Avant concept analysis method. The author offers a definition of exercise, including its distinction from physical activity and how the two terms are not the same and should not be used interchangeably. In the traditional concept analysis format will be used. Exercise is a subcategory of physical activity that is planned, structured, repetitive, and purposefully focused on improvement or maintenance of one or more components of physical fitness. Physical activity is any bodily movement produced by skeletal muscles that require energy expenditure. Sample cases are provided. A clear definition of exercise allows health care providers to speak to patients about improving their physical activity, particularly given that physical inactivity is a leading but very modifiable risk factor for a wide range of diseases. One of the urgent goals of nursing should be getting people to become more active. This means communicating in clear terms with patients. Sometimes that will mean exercise, and sometimes that will mean simply moving more daily. Researchers of behavior change need to be precise in their definitions and the methods need to be provided in detail to be useful and reproducible.

BACKGROUND: Behavioral problems may affect individuals with dementia, increasing the cost and burden of care. Pet therapy has been known to be emotionally beneficial for many years. Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets. Robotic pet therapy offers an alternative to traditional pet therapy. OBJECTIVE: The study rigorously assesses the effectiveness of the PARO robotic pet, an FDA approved biofeedback device, in treating dementia-related symptoms. METHODS: A randomized block design with repeated measurements guided the study. Before and after measures included reliable, valid tools such as: RAID, CSDD, GDS, pulse rate, pulse oximetry, and GSR. Participants interacted with the PARO robotic pet, and the control group received standard activity programs. Five urban secure dementia units comprised the setting. RESULTS: 61 patients, with 77% females, average 83.4 years in age, were randomized into control and treatment groups. Compared to the control group, RAID, CSDD, GSR, and pulse oximetry were increased in the treatment group, while pulse rate, pain medication, and psychoactive medication use were decreased. The changes in GSR, pulse oximetry, and pulse rate over time were plotted for both groups. The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate, while GSR had several weeks when changes were similar between groups. CONCLUSIONS: Treatment with the PARO robot decreased stress and anxiety in the treatment group and resulted in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia.

Abstract Structural equation modeling, often referred to as SEM, is a well‐established, covariance‐based multivariate method used in Human Resource Development (HRD) quantitative research. In some research contexts, however, the rigorous assumptions associated with covariance‐based SEM (CB‐SEM) limit applications of the method. An emergent complementary SEM approach, partial least squares structural equation modeling (PLS‐SEM), is a variance‐based SEM method that provides valid solutions and overcomes several limitations associated with CB‐SEM. Despite PLS‐SEM's increasing popularity in many social sciences disciplines, the method has yet to gain traction in the field of HRD. An accessible overview of the method, including potential advantages for HRD research and extant methodological advancements, is provided in this article with the goal of encouraging productive dialogue in the field of HRD surrounding the PLS‐SEM approach. We present an emergent analytical tool for quantitative HRD research, offer practical guidelines for researchers to consider when selecting a SEM method, and clarify assessment stages and up‐to‐date evaluation criteria through an illustrative example.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To determine the face validity of lumbar medial branch blocks. SUMMARY OF BACKGROUND DATA: Lumbar medial branch blocks have been used increasingly to diagnose zygapophysial joint pain. The course and relations of the medial branches of the dorsal rami have been demonstrated in previous anatomic studies. What is not known is whether blocks of the medial branches anesthetize these nerves exclusively or whether they anesthetize other structures that are potential sources of pain. METHODS: In a cadaveric study, the branches of the dorsal rami were exposed. Spinal needles were placed over the nerves, and plain radiographs were taken to demonstrate the precise radiographic locations of the nerves. In the second phase of the study, healthy volunteers underwent injections of radiographic contrast over the nerves, and plain radiographs and computed tomographic images were taken. Injections were performed using different rates of injection and in two positions for each nerve. RESULTS: Radiographic contrast incorporated the medial branches of the dorsal rami in every injection. When injections were performed using the upper position, aberrant flow of contrast medium was demonstrated with extension into the epidural space or intervertebral foramina. When a position lower on the transverse process was selected, aberrant flow was very uncommon. Eight percent of injections were found to be intravenous. CONCLUSIONS: When the appropriate technique is used, medial branch blocks are target specific. To guard against false-negative responses due to intravenous up-take, contrast medium must be used before the injection of local anaesthetic.

The purpose of this article is to analyze how the concept of quality of life (QOL) is currently being defined and used within health care. An on-line search of the phrase QOL in Medline, Cinahl, Psyc-Info, Eric, and Social Science Abstract provided a list of 16,021 articles published between 1993 and 1998. A convenience sample of 65 research and theoretical articles from the 1990s was examined to determine current usage and definitions of the concept of QOL across disciplines. Analysis was conducted, and a definition of the concept QOL, based on the analysis, is offered.

PURPOSE: This article is a descriptive analysis of rural nurses' perceived readiness to manage disaster situations. DESIGN AND METHODS: The 58-item Disaster Readiness Questionnaire was used to survey hospital-based nurses from rural communities in Texas during the summer of 2011. The data were collected by emailing a link through the various hospital intranet sites, resulting in a sample size of 620 nurses. RESULTS: Findings revealed that most nurses are not confident in their abilities to respond to major disaster events. The nurses who were confident were more likely to have had actual prior experience in disasters or shelters. Self-regulation of behavior (motivation) was a significant predictor of perceived nurse competence to manage disasters only in regard to the nurse's willingness to assume the risk of involvement in a disaster situation. Healthcare climate (job satisfaction) was not a determinant of disaster preparedness. CONCLUSIONS: Global increases in natural and human-induced disasters have called attention to the part that health providers play in mitigation and recovery. Since nurses are involved in planning, mitigation, response, and recovery aspects of disasters, they should actively seek opportunities to participate in actual disaster events, mock drills, and further educational opportunities specific to disaster preparedness. Administrators must support and encourage disaster preparedness education of nurses to promote hospital readiness to provide community care delivery in the event of a disaster situation. CLINICAL RELEVANCE: Nursing comprises the largest healthcare workforce, and yet there is very little research examining nurses' readiness for disaster.

America's older adult population is increasing at a dramatic rate due to better health care, technology, and improved living conditions. However, as individuals 65 years and older begin to live longer and experience multiple life changes, there is a larger incidence of social isolation leading to loneliness, depression, and a general decline in health. This mixed-method study aimed to explore whether information and communication technologies, specifically iPads, improved the lives of older adults. Our findings suggest that the use of technology increased knowledge, elicited closer family ties, and led to a greater overall connection to society.

Abstract Why does empathy promote prosocial behavior? Previous research suggests that empathically aroused individuals help those in need, even when physical escape from the need situation is easy, and this evidence has been used to support the claim that empathy evokes an altruistic motive. However, existing research has not addressed the possibility that empathically aroused participants help because ease of physical escape fails to provide adequate psychological escape from awareness of the victim's suffering and the aversive empathic arousal such awareness produces. The two experiments reported here examined this issue by directly manipulating empathic arousal and the perceived ease of psychological escape among potential helpers. In both experiments, higher rates of helping were observed among empathically aroused participants, even under conditions of easy psychological escape. The findings of both experiments suggest that empathy evokes an altruistic motive to reduce the victim's suffering rather than an egoistic aversive‐arousal reduction motive. In addition, the results of Experiment 1 suggest that concern for psychological escape from the suffering of others may constitute an important independent prosocial motive in need of future study. Copyright © 2008 John Wiley &amp; Sons, Ltd.

BACKGROUND: Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. METHODS: Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS <226) and above basic (HLS ≥226). Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. RESULTS: The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05). The extrapolated national estimates show that the annual costs for prescription alone for adults with LHL possibly associated with basic and below basic health literacy could potentially reach about $172 billion. CONCLUSION: Health literacy is inversely associated with healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare utilization and expendituresspending more on prescriptions compared to individuals with above basic HLL. Public health strategies promoting appropriate education among individuals with LHL may help to improve health outcomes and reduce unnecessary healthcare visits and costs.

The problem and the solution . The workforce of the 21st century is in a continual state of flux. This has created a need by human resource development scholars and practitioners to continue to review best practices in developing a workforce with the latest technology, knowledge, and expertise. Revisiting traditional training models and processes is important as a means of moving forward. Although there are many system models, almost all are based on the generic analysis, design, develop, implement, and evaluate (ADDIE) model that evolved from instructional systems research following World War II. The purposes of this article are to (a) reacquaint the profession with the background and basic concepts of the traditional ADDIE model and (b) compare the original and revised ADDIE models. Subsequent articles in this volume deal with issues and advancements surrounding ADDIE and the ADDIE phases.

PURPOSE: To identify major problems that obscure understanding of quality of life; to differentiate quality of life from other closely related concepts, and to offer a definition of quality of life. Quality of life is a term frequently used, but seldom defined, in nursing research. Multiple interpretations and measures make evaluating research difficult. The need to clarify concepts, develop nursing theory, and enhance communication is significant. Concept clarification is also essential for research instrument development and evaluation. ORGANIZING CONSTRUCT AND SCOPE: Concept analysis as proposed by Walker and Avant. Preconceived theories were avoided to keep the analysis as unbiased as possible. The analyst considered many descriptions of quality of life, but eventually included only those in the scientific literature. SOURCES: CINAHL, Medline, Psych-Info, ERIC, Social Science Abstracts, and reference lists from published articles in nursing, medicine, psychology, and sociology were used. Twenty-seven theory-based articles and book chapters published since 1989 and a convenience sample of 88 research articles published in 1997 were used. This sample was selected from 16,480 articles published 1993 to 1998. METHODS: Concept clarification comparisons to identify the major attributes of several closely related concepts, including well-being, satisfaction with life, and functional status. Major attributes were validated by a panel of cohorts who met weekly for five consecutive weeks for the purpose of analyzing various concepts. FINDINGS: Quality of life is comprised of subjective indicators such as well-being and satisfaction with life and objective indicators, such as functional status. Continued dialog and research is necessary to distinguish between the concepts of health and quality of life. CONCLUSIONS: A model showing the relationships among quality of life, well-being, functional status, and satisfaction with life is provided and a definition of quality of life is offered. Researchers and authors should include the definition of quality of life used in their work. Instruments should reflect the theoretic definition used. Care should be taken to clarify if functional status, well-being, satisfaction with life are the concepts under consideration as reflecting a part of overall quality of life.