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To prevent mistakes in psychological assessment, the precision of test norms is important. This can be achieved by drawing a large normative sample and using regression-based norming. Based on that norming method, a procedure for sample size planning to make inference on Z-scores and percentile rank scores is proposed. Sampling variance formulas for these norm statistics are derived and used to obtain the optimal design, that is, the optimal predictor distribution, for the normative sample, thereby maximizing precision of estimation. This is done under five regression models with a quantitative and a categorical predictor, differing in whether they allow for interaction and nonlinearity. Efficient robust designs are given in case of uncertainty about the regression model. Furthermore, formulas are provided to compute the normative sample size such that individuals' positions relative to the derived norms can be assessed with prespecified power and precision. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives In elite figure skaters, to determine if there was a difference in volumetric bone mineral density and bone strength between 1) figure skaters and population-based normative data, 2) single or pair skaters and ice dancers, and 3) the landing and takeoff legs. Design Cross-sectional. Methods Figure skaters had their non-dominant distal radius and bilateral tibia scanned using high-resolution peripheral quantitative computed tomography. Volumetric bone mineral density was determined at the total, cortical and trabecular compartments, and finite element analysis estimated bone strength. Normative data was used to compare the total bone mineral density of figure skaters to a population-based cohort. Independent t-tests compared differences between skating discipline, and paired t-tests compared skeletal parameters for the landing and takeoff leg. Results Twenty elite skaters (mean age 22 ± 6.2; female = 11, male = 9) completed scans. Compared with the general population, the mean percentile rank for skaters' total volumetric bone mineral density was below normal at the radius (27th percentile) and normal at the tibia (54th percentile). Single or pair skaters had more robust bone in the landing compared with their takeoff leg. Specifically, the landing leg had higher total bone mineral density (2.8%) and trabecular bone mineral density (6.5%), and superior bone strength (8.5%) than the takeoff leg (p Conclusions Volumetric bone mineral density and strength differences in figure skaters were discipline dependent. Side-to-side differences were observed in single and pair skaters where the landing leg is denser, larger and stronger than the takeoff leg.

OBJECTIVE This study examines the role of electronic learning platforms for medical knowledge acquisition in orthopedic surgery residency training. This study hypothesizes that all methods of medical knowledge acquisition will achieve similar levels of improvement in medical knowledge as measured by change in orthopedic in-training examination (OITE) percentile scores. Our secondary hypothesis is that residents will equally value all study resources for usefulness in acquisition of medical knowledge, preparation for the OITE, and preparation for surgical practice. DESIGN 9 ACGME accredited orthopedic surgery programs participated with 95% survey completion rate. Survey ranked sources of medical knowledge acquisition and study habits for OITE preparation. Survey results were compared to OITE percentile rank scores. PARTICIPANTS 386 orthopedic surgery residents SETTING 9 ACGME accredited orthopaedic surgery residency programs RESULTS 82% of participants were utilizing online learning resources (Orthobullets, ResStudy, or JBJS Clinical Classroom) as primary sources of learning. All primary resources showed a primary positive change in OITE score from 2018 to 2019. No specific primary source improved performance more than any other sources. JBJS clinical classroom rated highest for improved medical knowledge and becoming a better surgeon while journal reading was rated highest for OITE preparation. Orthopedic surgery residents’ expectation for OITE performance on the 2019 examination was a statistically significant predictor of their change (decrease, stay the same, improve) in OITE percentile scores (p CONCLUSIONS Our results showed that no specific preferred study source outperformed other sources. Significantly 82% of residents listed an online learning platform as their primary source which is a significant shift over the last decade. Further investigation into effectiveness of methodologies for electronic learning platforms in medical knowledge acquisition and in improving surgical competency is warranted.

Using proprietary data from a major fund data provider, we analyze the screening activity of investment consultants (ICs). We find that ICs frequently shortlist funds using threshold screens clustered at $500MM for AUM, 0% for benchmark-adjusted return, and quartiles for return percentile rank screens. Funds just above the $500MM AUM threshold get 14%–18% more page views and 5–9 pp greater flows over the next year compared to similar funds just below the threshold. Our results are consistent with ICs using a two-stage consider-then-choose decision-making process and cognitive reference numbers in selecting screening thresholds. (JEL G41, G11, G14, G29) Received January 8, 2021; editorial decision September 3, 2021. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.

Objective To develop a valid and reliable instrument for measuring attitudes toward osteopathic medicine. Methods Participants included 5,669 first-year students from 33 U.S. colleges of osteopathic medicine, who completed an online survey at the beginning of the 2019-2020 academic year. Using data from the nationwide Project in Osteopathic Medical Education and Empathy, we developed a 13-item instrument: Attitudes Toward Osteopathic Medicine Scale (ATOMS) and demonstrated the validity and reliability of its scores. The social desirability response bias was controlled in statistical analyses. Results The corrected item-total score correlations were all positive and statistically significant, and the effect sizes of item discrimination indices were large. Cronbach's coefficient alpha reliability was 0.83. Construct validity, corroborating face and content validity of the ATOMS, was supported by three components, emerged from factor analysis: "Perspectives on Osteopathic Medicine," "Osteopathic Diagnosis and Treatment," and "Holistic-Integrative Care." Correlations between ATOMS scores and scores of cognitive empathy, emotional empathy; orientation toward interprofessional collaboration; lifelong learning; and burnout were statistically significant in the expected direction, providing validity evidence for the ATOMS. Using the method of contrasted groups, significant differences in the ATOMS scores were found by gender, ethnicity, academic background, and career interest in the expected direction, supporting the validity of the ATOMS scores. National norms were developed to assess individual scores alongside national percentile ranks. Conclusions The ATOMS, developed in a nationwide study, supported by strong psychometric evidence for measuring orientation toward osteopathic medicine, has implications for the assessment of osteopathic medical education, patient outcomes, and admission decisions.

Several authors of late have contributed significantly towards developing mathematical models for selecting the best possible team from a host of players in different team sports, including cricket. The performance of cricketers on the different skill sets of the game, such as batting, bowling, and fielding, is considered for selecting optimum teams. Most of these mathematical models are divided into two parts. The first part tells about a method that can quantify the performance of cricketers, and the second part tells about a method that can select a squad of players from a more extensive collection of players based on the value of their performance, taking into consideration the different constraints of team selection and expertise of players. The teams formed through different methods cannot be made to play against each other, so there is no direct way to find out which method delivers the best team. Also, no competition between optimum teams obtained through different methods was ever performed in the absence of objective methodology for such comparison. This paper attempts to compare different team selection methods and identify the best mathematical model for team selection in cricket using the fantasy league scoring system.

Background The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. Methods This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. Results Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. Conclusions Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

BACKGROUND: Several U.S. hospitals had surges in COVID-19 caseload, but their effect on COVID-19 survival rates remains unclear, especially independent of temporal changes in survival. OBJECTIVE: To determine the association between hospitals' severity-weighted COVID-19 caseload and COVID-19 mortality risk and identify effect modifiers of this relationship. DESIGN: Retrospective cohort study. (ClinicalTrials.gov: NCT04688372). SETTING: 558 U.S. hospitals in the Premier Healthcare Database. PARTICIPANTS: Adult COVID-19-coded inpatients admitted from March to August 2020 with discharge dispositions by October 2020. MEASUREMENTS: Each hospital-month was stratified by percentile rank on a surge index (a severity-weighted measure of COVID-19 caseload relative to pre-COVID-19 bed capacity). The effect of surge index on risk-adjusted odds ratio (aOR) of in-hospital mortality or discharge to hospice was calculated using hierarchical modeling; interaction by surge attributes was assessed. RESULTS: Of 144 116 inpatients with COVID-19 at 558 U.S. hospitals, 78 144 (54.2%) were admitted to hospitals in the top surge index decile. Overall, 25 344 (17.6%) died; crude COVID-19 mortality decreased over time across all surge index strata. However, compared with nonsurging (

Objectives: To Review the benefit of the GAST questionnaire (Tilston, S. 2003. Assessing the quality of life in adult cochlear implant users. MSc dissertation. London: City University.) to measure hearing related quality of life for adults pre and post-cochlear implantation. To develop a scoring methodology as to what score constitutes a significantly 'good' or 'poor' change to better target rehabilitation to those most in need.Design: The GAST Questionnaire was developed using a robust cycle of validation and reliability analyses using the Statistical Package for the Social Sciences (Norusis, M. 1993. SPSS for windows: professional statistics. release 6.0. Chicago: SPSS Inc.). The scoring methodology was developed by dividing 83 patient full data sets into quintiles for the delta of quality of life improvement and the 9-12 month post-implantation GAST score.Results: The GAST questionnaire design was deemed robust. The scoring methodology used led to the 20th percentile score highlighting individuals requiring further support and the 80th percentiles for those suitable for partial booking.Conclusion: The GAST questionnaire is a useful way of identifying the patients in need of support as well as to measure patient reported quality of life improvements following cochlear implantation.

Purpose Skin cancer is the most common, yet oftentimes preventable, cancer type in the United States. Exposure to ultraviolet radiation from sunlight is the most prominent environmental risk factor for skin cancer. Besides environmental exposure, demographic characteristics such as race, age, and socioeconomic status may make some groups more vulnerable. An exploratory spatial clustering method is described for identifying clusters of vulnerability to skin cancer incidence and mortality based on composite indices, which combine data from environmental and demographic risk factors. Methods Based on county-level ultraviolet data and demographic risk factors, two vulnerability indices for skin cancer were generated using an additive percentile rank approach. With these indices, univariate local Moran's I spatial autocorrelation identified significant clusters, or hotspots, of neighboring counties with high overall vulnerability indices. Clusters were identified separately for skin cancer incidence and mortality. Results Counties with high vulnerabilities were spatially distributed across the United States in a pattern that generally increased to the South and West. Clusters of counties with high skin cancer incidence vulnerability were mostly observed in Utah and Colorado, even with highly conservative levels of significance. Meanwhile, clusters for skin cancer mortality vulnerability were observed in southern Alabama and west Florida as well as across north Alabama, north Georgia and up through the Tennessee-North Carolina area. Conclusions Future skin cancer research and screening initiatives may use these innovative composite vulnerability indices and identified clusters to better target resources based on anticipated risk from underlying demographic and environmental factors.

Objective To determine the association between medical knowledge relevant to radiology practice (as measured by the Dutch radiology progress test [DRPT]) and clinical productivity during radiology residency. Methods This study analyzed the results of 6 DRPTs and time period–matched clinical production points of radiology residents affiliated to a tertiary care academic medical center between 2013 and 2016. The Spearman correlation analysis was performed to determine the association between DRPT percentile scores and average daily clinical production points. Linear regression analyses were performed to determine the association of DRPT percentile scores with average daily clinical production points, adjusted for age and gender of the radiology resident, and postgraduate year. Results Eighty-four DRPTs with time period–matched clinical production points were included. These 84 DRPTs were made by 29 radiology residents (18 males and 11 females) with a median age of 31 years (range: 26–38 years). The Spearman correlation coefficient between DRPT percentile scores and average daily clinical production points was 0.550 (95% confidence interval: 0.381–0.694) (p < 0.001), indicating a significant moderate positive association. On multivariate analysis, average daily clinical production points (β coefficient of 0.035, p = 0.003), female gender of the radiology resident (β coefficient of 12.690, p = 0.001), and postgraduate year (β coefficient of 10.179, p < 0.001) were significantly associated with DRPT percentile scores. These three independent variables achieved an adjusted R2 of 0.527. Conclusion Clinical productivity is independently associated with medical knowledge relevant to radiology practice during radiology residency. These findings indicate that clinical productivity of a resident could be a potentially relevant metric in a radiology training program. Key Points • There is a significant moderate correlation between medical knowledge relevant to radiology practice and clinical productivity during radiology residency. • Medical knowledge relevant to radiology practice remains independently associated with clinical productivity during radiology residency after adjustment for postgraduate year and gender. • Clinical productivity of a resident may be regarded as a potentially relevant metric in a radiology training program.

Motivation MHC-peptide binding prediction has been widely used for understanding the immune response of individuals or populations, each carrying different MHC molecules as well as for the development of immunotherapeutics. The results from MHC-peptide binding prediction tools are mostly reported as a predicted binding affinity (IC50) and the percentile rank score, and global thresholds e.g. IC50 value < 500 nM or percentile rank < 2% are generally recommended for distinguishing binding peptides from non-binding peptides. However, it is difficult to evaluate statistically the probability of an individual peptide binding prediction to be true or false solely considering predicted scores. Therefore, statistics describing the overall global false discovery rate (FDR) and local FDR, also called posterior error probability (PEP) are required to give statistical context to the natively produced scores. Result We have developed an algorithm and code implementation, called MHCVision, for estimation of FDR and PEP values for the predicted results of MHC-peptide binding prediction from the NetMHCpan tool. MHCVision performs parameter estimation using a modified expectation maximization framework for a two-component beta mixture model, representing the distribution of true and false scores of the predicted dataset. We can then estimate the PEP of an individual peptide’s predicted score, and conversely the probability that it is true. We demonstrate that the use of global FDR and PEP estimation can provide a better trade-off between sensitivity and precision over using currently recommended thresholds from tools. Availability and implementation https://github.com/PGB-LIV/MHCVision. Supplementary information Supplementary data are available at Bioinformatics online.

Background United States Medical Licensing Examination Step 1 (STEP 1) and Step 2 (STEP 2) scores are used in the selection of surgery residents. The American Board of Surgery In-Training Examination (ABSITE) is employed to assess resident knowledge. We sought to determine whether both STEP 1 and/or STEP 2 were predictive of ABSITE performance. Methods We performed a 10-year retrospective analysis of all PGY levels comparing STEP 1 and 2 scores with raw ABSITE scores and percentile rank. Additionally, we analyzed STEP 1 and 2 scores for the likelihood of scoring above the 20th percentile on the ABSITE. Results When STEP 1 and STEP 2 scores were evaluated separately, both were independent predictors of ABSITE performance. However, when STEP 1 and STEP 2 scores were evaluated together, only STEP 1 scores were predictive of ABSITE performance. Finally, only STEP 1 scores were predictive of scoring above the 20th percentile. Conclusion STEP 1 scores are a better predictor of ABSITE performance than STEP 2.

Diseases such as malaria, dengue, Zika and chikungunya remain endemic in many countries. Setting and deploying traps to capture the host/vector species are fundamental to understand their density and distributions. Human effort to manage the trap data accurately and timely is an exhaustive endeavour when the study area expands and period prolongs. One stop mobile app to manage and monitor the process of targeted species trapping, from field to laboratory level is still scarce. Toward this end, we developed a new mobile app named "PesTrapp" to acquire the vector density index based on the mobile updates of ovitraps and species information in field and laboratory. This study aimed to highlight the mobile app's development and design, elucidate the practical user experiences of using the app and evaluate the preliminary user assessment of the mobile app. The mobile app was developed using mobile framework and database. User evaluation of the mobile app was based on the adjusted Mobile App Rating Scale and Standardized User Experience Percentile Rank Questionnaire. The process flows of system design and detailed screen layouts were described. The user experiences with and without the app in a project to study Aedes surveillance in six study sites in Selangor, Malaysia were elucidated. The overall mean user evaluation score of the mobile app was 4.0 out of 5 (SD=0.6), reflects its acceptability of the users. The PesTrapp, a one-stop solution, is anticipated to improve the entomological surveillance work processes. This new mobile app can contribute as a tool in the vector control countermeasure strategies.

Purpose Previous studies of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) interview version suggested a second-order model, with a general disability factor and six factors on a lower level. The goal of this study is to investigate if we can find support for a similar higher-order factor structure of the 36-item self-report version of the WHODAS 2.0 in a Dutch psychiatric outpatient sample. We aim to give special attention to the differences between the non-working group sample and the working group sample. Additionally, we intend to provide preliminary norms for clinical interpretation of the WHODAS 2.0 scores in psychiatric settings. Methods Patients seeking specialized ambulatory treatment, primarily for depressive or anxiety symptoms, completed the WHODAS 2.0 as part of the initial interview. The total sample consisted of 770 patients with a mean age of 37.5 years (SD = 13.3) of whom 280 were males and 490 were females. Several factorial compositions (i.e., one unidimensional model and two second-order models) were modeled using confirmatory factor analysis (CFA). Descriptive statistics, model-fit statistics, reliability of the (sub)scales, and preliminary norms for interpreting test scores are reported. Results For the non-working group, the second-order model with a general disability factor and six factors on a lower level, provided an adequate fit. Whereas, for the working group, the second-order model with a general disability factor and seven factors on a lower level seemed more appropriate. The WHODAS 2.0 36-item self-report form showed adequate levels of reliability. Percentile ranks and normalized T-scores are provided to aid clinical evaluations. Conclusion Our results lend support for a factorial structure of the WHODAS 2.0 36-item self-report version that is comparable to the interview version. While we conjecture that a seven-factor solution might give a better reflection of item content and item variance, further research is needed to assess the clinical relevance of such a model. At this point, we recommend using the second-order structure with six factors that matches past findings of the interview form.

Monetary rewards granted on a per-publication basis to individual authors are an important policy instrument to stimulate scientific research. An inconsistent feature of many article reward schemes is that they use journal-level citation metrics. In this paper we assess the actual article-level citation impact of about 10,000 articles whose authors received financial rewards within the Romanian Program for Rewarding Research Results (PR3), an exemplary money-per-publication program that uses journal metrics to allocate rewards. We present PR3, offer a comprehensive empirical analysis of its results and a scientometric critique of its methodology. We first use a reference dataset of 1.9 million articles to compare the impact of each rewarded article from five consecutive PR3 editions to the impact of all the other articles published in the same journal and year. To determine the wider global impact of PR3 papers we then further benchmark their citation performance against the worldwide field baselines and percentile rank classes from the Clarivate Analytics Essential Science Indicators. We find that within their journals PR3 articles span the full range of citation impact almost uniformly. In the larger context of global broad fields of science almost two thirds of the rewarded papers are below the world average in their field and more than a third lie below the world median. Although desired by policymakers to exemplify excellence many PR3 articles are characterized by a rather commonplace individual citation performance and have not achieved the impact presumed and rewarded after publication based on journal metrics. Furthermore, identical rewards have been offered to articles with markedly different impact. Direct monetary incentives for articles may support productivity but they cannot guarantee impact.

Background: Informant-based measures are effective screening tools for cognitive impairment. The Alzheimer’s Questionnaire (AQ) is a subjective, informant-based measure that detects amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) with high sensitivity and specificity and has been shown to predict amyloid burden. Objective: To determine whether informant-based report of cognitive decline correlates with hippocampal volume changes in MCI and AD. Methods: Retrospective chart review of 139 clinically referred patients with clinical diagnoses of aMCI or mild dementia due to AD was conducted. Diagnostic status (clinical diagnosis made by a neurologist), NeuroQuant measured MRI brain with percentile rank hippocampal volume, Montreal Cognitive Assessment (MoCA) total, AQ-Total score, and demographic variables were extracted from medical records. Spearman correlation was used to assess the relationship between hippocampal volume and AQ-Total. The AQ was used to assign diagnostic status. Thus, the relationship between the AQ and diagnostic status was excluded. Results: The sample include 88 female and 51 male participants. The mean age was 74.37±9.45, mean MOCA was 22.65±4.18, mean education was 14.80±3.35, and mean AQ score was 10.54±5.22. Hippocampal volume and the AQ correlation was r = –0.33 [95%CI –0.47 to –0.17], p

Background Excessive media usage affects children’s health. This study investigated associations between children’s and mother’s media use, parent–child interactions, and early-childhood development outcomes. Methods Two hundred and ninety-six healthy 2–5-year-old preschoolers (52.4% male, mean age = 3.5 years) and 224 mothers from the LIFE Child cohort study were analyzed. Screen times and parent–child interactions were assessed using standardized parental questionnaires. Developmental skills were investigated using the standardized development test ET 6-6-R. Results High screen times in children (>1 h/day) were significantly associated with lower percentile ranks in cognition (b = −10.96, p b = −12.88, p b = −7.80, p = 0.05). High screen times in mothers (>5 h/day) were significantly associated with high media use by children (OR = 3.86, p b = 0.41, p = 0.05), cognition (b = 0.57, p b = 0.48, p = 0.02), and social–emotional outcomes (b = 0.80, p Conclusions Public health strategies should seek to educate caregivers as competent mediators for their children’s media habits, with focus on the need for children to have frequent parent–child interactions. Impact High media usage in children is related to poorer cognition, language, and social–emotional skills. More frequent parent–child interactions are associated with better body motor, cognition, language, and social–emotional skills in children. High level of media use in mothers is not directly related to children’s development outcomes but is directly related to high media usage of children. Public health strategies should seek to raise media awareness and management in both parents and children.

Occupational safety and health (OSH) inspection is an essential element of OSH regulatory enforcement programs. The effectiveness of regulated OSH inspections is dependent on many factors of which proper planning and scheduling of inspections, and optimum utilization of inspectors are extremely important. In spite of this, there is no published scheduling model to solve the problem of regulated safety inspections. Absence of such models negatively affected the performance of safety inspectorates in many countries which is manifested by low portion of firms being inspected over long periods of time. For these, there is urgent need to introduce new scheduling models to solve such problem that has distinctive characteristics compared to the scheduling problems in other fields. The current paper presents a novel hybrid macro and micro scheduling approach that is based on Probability Integral Transform (PIT) and a modified Bin Packing algorithm that address the Inspector Utilization Problem with Firm Inspection Sharing (IUPFISh). The PIT-IUPFISh model consists of uniform long-term macro scheduling of firms for inspection using PIT approach coupled with short-term micro scheduling of firm inspection using the IUPFISh algorithm to determine the daily scheduling of the firms and inspectors so that maximum utilization of inspectors is achieved. A case study was presented to show the application of the proposed model. The results indicate that the application of the proposed model can improve OSH inspectorate performance through improved planning and scheduling as well as maximizing effective utilization of manpower.

The moderating effects of motivation, social control, and self-regulation in predicting academic achievement were examined in Grades 11–12 for 3,281 seventh through nine graders. Standardized assessments of college readiness and student self-reported measures of psychosocial factors were used in the study. The results showed that females in Grades 7–9 scored higher than males for motivation and self-regulation. In predicting later achievement in Grades 11–12, motivation and social control moderated prior achievement, whereas self-regulation moderated both sex and prior achievement. Particularly among female students, effects of self-regulation were positive for high-achieving females (percentile rank ≥95) and negative for low-achieving females (percentile rank ≤5) in predicting achievement in Grades 11–12. The phenomenon known as the “Matthew Effect” and implications for classroom teachers and educational policymakers are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Background To determine objective resident characteristics that correlate with Ophthalmic Knowledge Assessment Program (OKAP) performance, as well as to correlate OKAP performance with Accreditation Council for Graduate Medical Education (ACGME) milestone assessments, written qualifying examination (WQE) scores, and oral board pass rates. Methods Review of administrative records at an ACGME-accredited ophthalmology residency training program at an urban, tertiary academic medical center. Results The study included data from a total of 50 resident physicians who completed training from 2012 to 2018. Mean (standard deviation) OKAP percentile performance was 60.90 (27.51), 60.46 (28.12), and 60.55 (27.43) for Years 1, 2, and 3 examinations, respectively. There were no statistically significant differences based on sex, marital status, having children, MD/PhD degree, other additional degree, number of publications, number of first author publications, or grades on medical school medicine and surgery rotations. OKAP percentile scores were significantly associated with United States Medical Licensing Examination (USMLE) Step 1 scores (linear regression coefficient 0.88 [0.54–1.18], p = 0.008). Finally, continuous OKAP scores were significantly correlated with WQE (r s = 0.292, p = 0.049) and oral board (r s = 0.49, p = 0.001) scores. Conclusion Higher OKAP performance is correlated with passage of both WQE and oral board examinations during the first attempt. USMLE Step 1 score is the preresidency academic factor with the strongest association with success on the OKAP examination. Programs can utilize this information to identify those who may benefit from additional OKAP, WQE, and oral board preparation assistance.

Background Birth by caesarean section has been shown to alter the composition of the early infant gut microbiota and postulated to influence cognitive outcomes via the gut-brain axis. Aims To determine whether birth by caesarean section is associated with secondary school educational achievement. Methods Whole-population administrative data were used from anonymised individual level linkage of birth records to educational and health information from the New Zealand Integrated Data Infrastructure (IDI). Participants were 111 843 children born between 1 January 1996 and 31 December 1998 for whom mode of delivery information was available from International Classification of Diseases 9th edition codes in maternal records. The National Certificate of Educational Achievement (NCEA) is the main secondary school qualification undertaken by New Zealand students. Multivariable linear regression models were used to examine the association between mode of delivery and educational achievement. A family fixed effect analysis compared educational achievement outcomes in sibling pairs where one sibling was delivered by caesarean section and one delivered vaginally. Results After adjustment for potential confounders, there was no significant association between mode of delivery and achievement of university entrance (odds ratio = 0.98, 95% CI: 0.94-1.02). NCEA percentile scores were lower in caesarean born infants (Estimate = -0.37, 95% CI: -0.69 to -0.06)). However, in the fixed effect sibling analysis caesarean section was no longer significantly associated with NCEA percentile scores. Conclusions We find that caesarean section is not related to educational outcomes, suggesting that even if the infant gut microbiota is altered in caesarean section, it does not appear to have a measurable impact on adolescent academic achievement.

PURPOSE: This study’s aim was to use a representative sample of the US pediatric population to estimate percentiles for several PROMIS pediatric measures: Anger, Anxiety, Depressive Symptoms, Family Relationships, Fatigue, Global Health, Life Satisfaction, Meaning and Purpose, Pain Behavior, Pain Interference, Physical Activity, Physical Function Mobility, Physical Function Upper Extremity, Physical Stress Experiences, Positive Affect, Psychological Stress Experiences, Sleep Disturbance, Sleep Impairment, and Peer Relationships. METHODS: We used two separate, nationally representative samples of parents and children aged 5–17 years drawn in different years from the GfK Knowledge Panel, a dual-frame online probability panel. RESULTS: All measures that were developed using a representative sample had a median at or near the expected value of 50. For the other measures, the 50th percentile was often 10 points or more from 50. Several domains had high floors or low ceilings. No domain’s percentiles completely corresponded to the percentiles associated with a normal distribution with a mean of 50 and standard deviation of 10. CONCLUSIONS: This work allows users to interpret a child’s self-reported quality of life relative to children in the US general population. When attempting to evaluate whether a child falls above or below other children in the US, one should use the values presented in this study. In addition, we recommend that users should focus on whether a child’s score falls into one of a few broad severity groups rather than on specific percentile scores.

Background Little information on gross motor function of congenital Zika syndrome (CZS) children is available. Objectives To evaluate gross motor function in CZS children aged up to 3 years, and its associated factors and changes in a minimum interval of 6 months. Methods One hundred children with CZS and cerebral palsy (36 with confirmed and 64 with presumed CZS) were evaluated with the Gross Motor Function Classification System (GMFCS) and Gross Motor Function Measure (GMFM-88/GMFM-66). Forty-six were reevaluated. Wilcoxon tests, Wilcoxon tests for paired samples, percentile scores, and score changes were performed. Results Clinical and socioeconomic characteristics (except maternal age), GMFM scores and GMFCS classification of confirmed and probable cases, which were analyzed together, were similar. The mean age was 25.6 months (±5.5); the median GMFM-88 score was 8.0 (5.4–10.8); and the median GMFM-66 score was 20.5 (14.8–23.1); 89% were classified as GMFCS level V. Low economic class, microcephaly at birth, epilepsy, and brain parenchymal volume loss were associated with low GMFM-66 scores. The median GMFM-66 percentile score was 40 (20–55). On the second assessment, the GMFM-66 scores in two GMFCS level I children and one GMFCS level IV child improved significantly. In one GMFCS level III child, one GMFCS level IV child, and the group of GMFCS level V children, no significant changes were observed. Conclusions Almost all CZS children had severe cerebral palsy; in the third year of life, most presented no improvement in gross motor function and were likely approaching their maximal gross motor function potential.

ObjectiveUntreated vision problems are associated with poor school performance. Whether providing glasses alone improves performance, however, remains unknown. We sought to test whether receiving glasses was associated with improved school performance for low-income minority students in Los Angeles.MethodsFrom 2017 to 2018, we analyzed achievement marks in mathematics and language arts from 406 first to fifth grade students attending 24 public elementary schools who received glasses through a free school-based vision program between February and May 2014, and 23,393 of their nonparticipating same-school, same-grade peers. We calculated students' percentile rank during each grading period in 1 year before and 2 years since they received glasses. Multilevel linear regressions tested whether percentile rank differed from baseline at each subsequent grading period. Models accounted for clustering at the school level and controlled for gender, grade level, and baseline class rank. Interaction terms tested whether associations differed by gender and class rank.ResultsStudents increased 4.5 percentile points (P=.02) in language arts in the second year after receiving glasses. There was no change in math achievement overall; however, those with baseline performance in the bottom tercile had an immediate and sustained improvement of 10 to 24 percentile points from baseline (interaction term P < .001). Class rank for behavior marks decreased during the fourth grading period after receiving glasses but subsequently returned to baseline. There were no significant changes in work habits and no variation in results by gender.ConclusionsEnsuring access to vision care may be a simple, scalable strategy to improve language arts performance for low-income minority children.

Background: Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations.Purpose: To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile.Methods: The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents’ Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6–18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling.Results: Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated.Conclusion: Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.

In a recent paper ( https://doi.org/10.1007/s11192-020-03386-9 ) we proposed a model to estimate the citations of an article in a database (Scopus/Web of Science) in which it is not indexed using the percentile rank of the database (Web of Science/Scopus) in which it is indexed. In this study we supplement the previous work with three advances: (1) by using 15 different research fields, corresponding to over 1 million papers, since we previously used only four fields; (2) by measuring the agreement between the percentile ranks in both databases using Lin’s concordance correlation coefficient, since this coefficient has not been used previously to measure this agreement, but as a test with a sample of 15,400 papers to compare the actual and estimated number of citations; and (3) by using a robust data cleaning procedure. The results revealed a substantial concordance between percentile ranks of papers indexed in these two databases in all the research fields studied, and that this concordance is even stronger for high percentile values. This level of concordance suggests that we can consider the percentile of a paper in a database in which it is not indexed as being equal to the percentile of this paper in a database in which it is indexed. In other words, we increased the reliability of our previous conclusions that the percentile rank can be used as a citation database-normalization. The results of this study contribute to improve the use of citation counts in bibliometric studies, and to calculate research indicators when we need to use both bibliographic databases.

Childhood was the key period for the development of fundamental movement skills, the acquisition of which had a definite bearing on a child's overall development, including such areas as cognition, interpersonal relationships, social behavior, and environmental awareness. The main purpose of this study was on the development of the norm of fundamental movement skills for children aged three to seven. In the method, we measured the development of such skills amongst 1,029 children in Taiwan aged 3–7 using the Test of Gross Motor Development-2 (TGMD-2). The results indicated that the fundamental movement skills increase with age. With a percentile rank of 50 in the overall fundamental movement skills, the mean score of the eight age groups, boys performed better than girls in the seven age groups. In conclusion, compared to the United States, Taiwanese five through seven-year-olds lag far behind their American counterparts in locomotor and object control skills, and this situation needed to be addressed by education authorities in Taiwan. Based on the findings of this study, for preschool teachers, most are women with little or no training in FMS education. The curriculum of preschool teachers' training at the universities should incorporate FMS into the PE course, and it is important to ensure that each pre-service preschool teacher has the ability to design a series of 30-60 minutes of dynamic, age-appropriate and fun vigorous exercise.

Introdução: O desenvolvimento motor do bebê tem influências cognitivas, socioemocionais e ambientais.Objetivo: verificar se existe associação dos escores do desenvolvimento motor grosso com as habilidades socioemocionais de bebês em seu primeiro trimestre de vida.Método: Estudo transversal, composto por 20 bebês provenientes de um hospital público de Porto Alegre, RS. Para a avaliação dos fatores de risco sociodemográficos foi utilizado um questionário elaborado pelas pesquisadoras. A Bayley III foi utilizada para avaliar o desenvolvimento motor grosso e habilidades socioemocionais.Resultados: Houve associação positiva estatisticamente significativa entre os escores brutos de motor grosso e socioemocional (r=0,665; p=0,001), como também nos escores bruto de motor grosso com os escores composto e percentil da socioemocional (r=0,571; p=0,008 e r=0,588; p=0,006, respectivamente). Houve associação positiva estatisticamente significativa entre idade gestacional (p=0,028), idade do bebê (p=0,003) e peso ao nascer (p=0,024) com o escore bruto motor grosso.Conclusão: Houve associação significativa positiva nos escores do desenvolvimento motor grosso e habilidades socioemocionais.

The current investigation reports on percentile normative values of college-aged men and women (18-25 years) for the YMCA bench press endurance test (YMCA-BPT). Previously reported normative values did not include the sample size or population specific information. Participants in this investigation were healthy, men and women who completed a standardized warm-up and then underwent the procedures for the YMCA-BPT. Demographic data are reported along with YMCA-BPT scores including averages of 34.18±12.51 for men, 25.26±10.20 for women and 29.69±12.26 for the combined group (repetitions±standard, respectively). Percentile scores by gender are also reported.

Introduction Although circumstantial evidence suggests children with tic disorders (TD) experience challenges in handwriting which may be attributed to their tics, few studies have systematically investigated handwriting performance among children with TD. This study examined the relationship between handwriting deficits and TD using a causal comparative research design. Methods Thirty-four children with TD completed the Test of Handwriting Skills-Revised (THS-R). The overall percentile ranks of the THS-R were analysed to determine if children with TD have lower scores compared to the test's normative values. Writing speed, letter reversals, touching letters and case errors were also evaluated. Results Data revealed the median percentile rank of the THS-R for the participants was significantly lower than the median percentile score of the THS-R for the normative sample. Close to 80% (n = 27) of writing samples were scored below 50th percentile. More than one-third (35.3%, n = 12) of the writing samples were scored greater than one standard deviation below the normative mean on the THS-R. Of the four ancillary scores, 82.4% (n = 28) of the participants' writing samples scored below 50th percentile (in the categories of watch or test further) on case errors and 67.6% (n = 23) scored below 50th percentile on writing speed. Conclusion Findings suggested that children with TD took longer to complete the writing task, and committed more case substitution errors than the normative sample of the THS-R and were likely to exhibit handwriting deficits.

Percentiles are statistics pointing to the standing of a paper’s citation impact relative to other papers in a given citation distribution. Percentile Ranks (PRs) often play an important role in evaluating the impact of researchers, institutions, and similar lines of study. Because PRs are so important for the assessment of scholarly impact, and because citations differ greatly across time and fields, various percentile approaches have been proposed to time- and field-normalize citations. Unfortunately, current popular methods often face significant problems in time- and field-normalization, including when papers are assigned to multiple fields or have been published by more than one unit (e.g., researchers or countries). They also face problems for estimating citation counts for pre-defined PRs (e.g., the 90th PR). We offer a series of guidelines and procedures that, we argue, address these problems and others and provide a superior means to make the use of percentile methods more accurate and informative. In particular, we introduce two approaches, CP-IN and CP-EX, that should be preferred in bibliometric studies because they consider the complete citation distribution and can be accurately interpreted. Both approaches are based on cumulative frequencies in percentages (CPs). The paper further shows how bar graphs and beamplots can present PRs in a more meaningful and accurate manner.

This is a case review of a male adult, GO, with nonverbal low functioning autism in his twenties. Previous psycho-educational assessment indicated that GO had a nonverbal IQ (NVIQ) of 73 within the borderline range, an adaptive behavior composite score at the extremely low percentile rank, and poor executive functioning (EF) capability with majority of the EF components falling in the performance range from borderline problem to problematic range. His family has expressed their concern if GO would be able to take care of himself when they are too old or no longer around to care for him. This short paper is an attempt to review all the previous assessment results and to find out if GO could be helped to improve in his daily living skills in order to lead a more independent life in the future.

Background/Objectives: The Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy Phase 2 (CALERIE) study showed that individuals who are non-obese were able to undergo significant calorie restriction (CR), yet the time course changes in adherence, weight, and appetite are unknown. This analysis aimed to investigate the time course changes in adherence, body weight, and appetite during the CALERIE study. Subjects/Methods: Overall, 143 participants (body mass index: 21.9–28.0 kg/m2) were randomized to a CR group that aimed to achieve 25% CR for 2 years. Throughout the intervention, body weight was measured, and appetite was assessed through visual analogue scales. Algorithms were utilized with body weight measurements to calculate adherence percentile score. Participants targeted an adherence percentile score of 50, though being between 80 (lowest acceptable adherence) and 10 (highest acceptable adherence) was adequate. Polynomial regression analyses were used to assess time course changes. Results: Polynomials indicated that adherence percentile score increased above 50 after approximately week 20, although adherence remained acceptable (adherence percentile score less than 80) (R2 = 0.89; P < 0.001). Weight loss occurred until approximately week 60 and then plateaued (R2 ≥ 0.92; P < 0.001). Hunger and thirst increased (R2 ≥ 0.30; P < 0.001), but the total increase in scale scores were less than 10 mm throughout the intervention. Conclusions: In individuals who are non-obese, adherence to 25% CR declines after 20 weeks, but two years of CR that stimulates a meaningful reduction in weight, promotes aging-related benefits and negligibly affects appetite is viable.

BACKGROUND The American Board of Surgery In-training Examination (ABSITE) is an important marker of medical knowledge. It is unclear what factors predict or improve these scores. We evaluated demographics, United States Medical Licensing Examination (USMLE) step 1 and 2 scores, and surgical rotations during the intern year to determine if there were any correlations with the ABSITE performance. METHODS This was a multicenter retrospective review during a 6-y period, investigating the correlation and association of demographics, USMLE scores, and types of rotations on the ABSITE percentile score of interns. Demographics included age, gender, race/ethnicity, U.S. versus international/foreign medical graduate for stratified analyses. Descriptive analysis was performed with ANOVA, correlation was evaluated with 95% confidence interval, and significance was defined as P

Objective Objectively determining orthopedic resident competence remains difficult and lacks standardization across residency programs. We sought to develop a scoring system to measure resident educational activity to stratify participation and performance in particular aspects of training and the effect of these measures on board certification. Design A weighted scoring system (Average Resident Score, ARS) was developed using the number of logged cases, clinic notes dictated, OITE PGY percentile, case minimums met, and scholarly activity completed each academic year (AY), with clinical activity being more heavily weighted. The Resident Effectiveness Score (RES), a z-score showing the number of standard deviations from the mean, was determined using the ARS. The RES effect on the Accreditation Council for Graduate Medical Education (ACGME) Milestones and American Board of Orthopedic Surgery (ABOS) Part 1 percentile score was determined using a Spearman correlation. Setting Large academic orthopedic residency. Participants Thirty one orthopedic residents graduating between 2011 and 2016 were included. Results The RES did not differ between classes in the same AY, nor change significantly for individual residents during their training. Milestone z-scores increased as residents progressed in their education. The RES correlated with each Milestone competency subscore. The PGY5 OITE score and achieving ACGME minimums correlated with passing ABOS Part 1 (28/31 1st time pass), but the RES did not predict passing the board examination. Conclusions This study demonstrates a scoring system encompassing multiple facets of resident education to track resident activity and progress. The RES can be tailored to an individual program's goals and aims and help program directors identify residents not maximizing educational opportunities compared to their peers. Monitoring this score may allow tailoring of educational efforts to individual resident needs. This RES may also allow residents to measure their performance and educational accomplishments and adjust their focus to obtain competence and board certification.

A proper knowledge and understanding of wind-wave characteristics and its variability on basin, regional and local scales have profound importance and practical applications in marine related activities, ocean engineering, and coastal zone management. The present study deals with the comparison of synoptic annual trends derived from space borne measurements (1992–2016), ERA-5 (1992–2018), and NCEP WWIII global run (1997–2018), monthly and seasonal wave climatology, characteristics of the annual cycle in regional basins and monthly trends of wind-wave climate on a pentad scale. Evaluation of wind-wave characteristics was performed for sub-divided domains of the IO. Further, the wave heights were segregated into percentile ranks (from 99th to 10th) by which a detailed analysis was carried out at the regional scale. Analysis of monthly and seasonal climatology signifies that the highest wave activity is observed in the extra tropical South Indian Ocean (ETSI) and the least in the Bay of Bengal. Higher percentile waves (99th, 95th, and 90th) in the ETSI are observed to be active for more than 6 months in a year. In the Arabian Sea, the maximum occurrence of 99th percentile waves (about 65%) is prominent during the month of July. An apparent pentad variation has been identified in the ETSI from 1997 to 2016 whereas, decadal variability in the north Indian Ocean (NIO) and Tropical South Indian Ocean for the lower percentile significant wave heights (25th and 10th percentiles). During the period 2007–2011, the IO experienced a considerable decreasing wave activity in all the sectors. The observed trends in annual maximum significant wave height for the ETSI and the annual mean significant wave height for the NIO are found increasing at a rate of 3.3 cm/year and 0.27 cm/year, respectively.

Tests and batteries used in the evaluation of language impairments are overly complex and often ineffective (too difficult) in the assessment of post-stroke patients affected by severe aphasia (global aphasia). The present study reports details on the construction and standardization of a new Italian battery of tasks, specifically designed to assess severe lexical disorders in acquired aphasia (Battery for the Assessment of Severe Acquired Lexical Damage in Italian, BASALDI). The battery is composed of a common set of 64 stimuli (concrete nouns), belonging to both living and non-living categories, and consists of four lexical tasks assessing picture naming, repetition, reading aloud, and oral comprehension. The item selection was based on word frequency, word length, and phonological-articulatory complexity, namely the presence of continuant vs. plosive phones, a variable that may interact with word production in case of severe language damage. Standardization (naming agreement) of a new set of 64 colored images and normative data on Italian healthy subjects pooled across homogenous subgroups for age, gender, and education are reported. Finally, for the four tasks, percentile ranks and z-scores were calculated from a pool of 92 left brain-damaged patients affected by aphasia of different types and severity. The battery allows a fine investigation of lexical disorders, being suitable for diagnostic assessment of mild-to-moderate and severe aphasic lexical deficits, detection of changes over time, and possible dissociations between tasks.

The effects of complex Korean medicine treatment including acupotomy, on irritable bowel syndrome (IBS) are reported in this case study. A 54-year-old woman with diarrheal symptoms that alternatively improved and worsened for many years and worsening abdominal pain visited the emergency room and was diagnosed with IBS; she was admitted for approximately 2 weeks at the Acupuncture and Moxibustion Department of National Medical Center (NMC). Numerical rating scale (NRS), irritable bowel syndrome?quality of life (IBS-QOL), and gastrointestinal symptom rating scale (GSRS) scores were evaluated on the day of hospitalization, midway through the hospitalization period, and on the day of discharge. Abdominal pain was measured daily using NRS, and the score decreased from 8 at admission to 0 at discharge. The IBS-QOL percentile score improved from 42 points to 100 points. The total GSRS score also improved, from 30 points to 2 points. These results suggest that complex Korean medicine treatment with acupotomy, is useful for treating internal diseases, such as IBS, as well as musculoskeletal disorders.

Study objective Malpractice fear is a commonly cited cause for defensive medicine, but it is unclear whether being named in a malpractice claim changes physician practice patterns. We study whether there are changes in commonly used measures of emergency physician practice after being named in a malpractice claim. Methods We performed a retrospective difference-in-differences study comparing practice patterns of emergency physicians named in a malpractice claim and unnamed matched controls working contemporaneously in the same emergency departments (EDs), using data from a national emergency medicine management group (59 EDs in 11 US states from 2010 to 2015). We studied aggregate measures of care intensity (hospital admission rate and relative value units/visit), studied care speed (relative value units/hour and discharged patients' length of stay), and assessed patient experience (monthly physician Press Ganey percentile rank). Results A total of 65 emergency physicians named in at least 1 malpractice claim and 140 matched controls met inclusion criteria. After the malpractice claim filing date, there were no significant changes in measures of care intensity or speed. However, named emergency physicians' patient experience scores improved immediately after the malpractice claim filing date and showed sustained improvements by 6.52 Press Ganey percentile ranks (95% confidence interval 0.67 to 12.38), with the increase most prominent among those involved in the 46 failure-to-diagnose claims (10.52; 95% confidence interval 3.72 to 17.32). Conclusion We observed a temporal improvement in patient satisfaction scores for emergency physicians in this sample after their being named in a malpractice claim relative to matched controls. Measures of care intensity and speed did not significantly change.

OBJECTIVE This study seeks to evaluate the psychological and academic effects of grading a medical school simulation course. This study also seeks to evaluate whether a student's class rank affects these results and whether the academic effects of a simulation course persist long-term. DESIGN Two separate medical school classes were evaluated. The first class participated in an ungraded surgery simulation course with only formative feedback. The second class participated in a tier-graded course. Qualitative assessment of both courses included daily standardized and self-reported stress surveys, student feedback surveys at the end of the course, and student feedback surveys at the end of the surgery clerkship. Quantitative assessment included pre and postcourse examinations, NBME Surgery Subject Assessment percentile ranks, and COMLEX 2 surgery subscores. Qualitative and quantitative assessments were compared between classes as a whole and between students in the upper and lower half of each class. Results were analyzed using a Student two-tailed t test. SETTING Rocky Vista University College of Osteopathic Medicine Institute of Simulation, Parker, Colorado. PARTICIPANTS One hundred forty-eight students from the Rocky Vista University College of Osteopathic Medicine Class of 2017 and one hundred fifty-one students from the Rocky Vista University College of Osteopathic Medicine Class of 2018. RESULTS Daily standardized stress surveys indicated some increase in stress for students in the graded course, especially for students in the upper half of the graded class. All students adapted to stress significantly by the end of each course, but upper-half students adapted more significantly. Students' self-reported stress levels demonstrated a significant decrease during the ungraded course, but a slight increase during the graded course. Students' self-reported confidence levels rose significantly during the ungraded course, but less significantly during the graded course. Student feedback surveys demonstrated a positive student perception of both courses, but, when stratified, some responses were significantly different between students in the upper and lower half of each class, with upper-half students generally giving a higher rating to the graded course. Clinical knowledge examination scores and improvement in scores within the course were significantly higher for the graded course, with no significant differences between students in the upper and lower half of each class. Students' mean NBME Surgery Subject Assessment percentile rank did not differ significantly between the two classes, but were significantly higher than for previous classes who had not participated in a simulation course. Mean NBME Surgery Subject Assessment percentile rank and COMLEX 2 mean surgery subscore were significantly higher for students in the upper half than for students in the lower half of each class. COMLEX 2 mean surgery subscore did not differ significantly between classes who had participated in a simulation course and previous classes who had not. Students in the upper half of each class in this study performed significantly better than students in the lower half of each class on the mean COMLEX 2 surgery subscore. CONCLUSIONS This study reaches the following conclusions: (1) objective stress level measurements did not correlate with students' self-reported stress levels; (2) grading a simulation course raises objective stress levels in higher-performing students more than in lower-performing students, but higher-performing students demonstrate the ability to effectively adapt to the increased levels of stress and achieve significant increases in confidence; (3) higher performing students generally demonstrate a greater sense of satisfaction with the simulation course experience when the course is graded; (4) higher-performing and lower-performing students within a class perform in a similar fashion on examinations within the intensely structured environment of a simulation course, whether the course is graded or not; (5) grading a course stimulates all students to perform better on examinations within the course; (6) this higher level of performance and similarity of performance between higher and lower-performing students does not continue when students are not in a structured environment, and students stratify into disparate performance groups in accordance with their class rank; and (7) students exposed to a surgical simulation course perform better on NBME surgery subject examinations than students who have not participated in a simulation course, but this increased level of performance does not extend long-term to national board exams.

Background: Physician denial of patient requests is associated with lower patient satisfaction. Our objective was to explore factors that influence physician request denial and patient satisfaction after request denial. Methods: Cross-sectional observational study of 1141 adult patients seen during 1319 outpatient visits with 56 primary care physicians. We measured patients9 postvisit self-report of requests and request fulfillment, visit satisfaction, sociodemographics, health status, symptom burden, life satisfaction, medical skepticism, and whether patients saw their usual physician and a faculty or resident physician. We used mixed-effects regression analyses to identify predictors of request denial and visit satisfaction among patients who had a request denied. Results: Patients made at least 1 request at 867 visits (65.7%) with at least 1 denied request reported at 182 visits (21.0%). Patients who saw their usual physician were less likely to report a request denial (adjusted Odds Ratio [aOR], 0.61; 95% CI, 0.42 to 0.88), and patients with the highest symptom burden (aOR, 2.21; 95% CI, 1.38 to 3.55) or greater medical skepticism (aOR, 1.35; 95% CI, 1.03 to 1.78) were more likely to report request denials. After request denials, patients seeing their usual physicians reported significantly greater visit satisfaction compared with not seeing their usual physician (adjusted percentile rank in visit satisfaction: 12.4%; 95% CI, 3.5% to 21.2%). Conclusions: Approximately one fifth of visits in primary care have a denied request. Having an office visit with one9s usual physician is associated with reduced likelihood of request denial and may mitigate the adverse impacts of request denial on patient visit satisfaction.

Purpose This study explores the effect of glaucomatous visual field defects on several neuropsychological tests that are often used in research and in clinical settings. Methods Nineteen glaucoma patients and nineteen healthy participants, which are current drivers and older than 65 years old were included. All participants completed the Montreal Cognitive Assessment (MoCA), the Trail Making Test (TMT), the Benton Visual Retention Test (BVRT), the Snellgrove Maze Task (SMT) and the Digit Span Test (DST). All participants were also tested on contrast sensitivity and near and far visual acuity. For the glaucoma patients, visual field tests were downloaded from hospital servers. Results On the MoCA test, glaucoma patients scored lower than the healthy group, but not significantly. On the MoCA-Blind, the difference was statistically significant. Glaucoma patients also had lower percentile scores on the TMT, with a significant difference in the TMT-A, but this difference largely disappeared in the calculated TMT B-A index, which isolates the cognitive component. The BVRT and SMT showed no significant differences between both groups. In the only non-visual test, the DST, glaucoma patients outperformed the healthy group. Glaucoma severity did not influence results, except for the BVRT on which the moderate/severe group has better scores. Conclusion Using visual items might lead to conclusions about cognition when it should be one about vision. Therefore, careful selection of tests is needed when examining cognition in glaucoma patients.

Social determinants of health (SDOH) impact patient outcomes in trauma. Census data are often used to account for SDOH; however, there is no consensus on which variables are most important. Social vulnerability indices offer the advantage of combining multiple constructs into a single variable. Our objective was to determine if incorporation of SDOH in patient-level risk-adjusted outcome modeling improved predictive performance.We evaluated two social vulnerability indices at the zip code level: Distressed Community Index (DCI) and National Risk Index (NRI). Individual variable combinations from Agency for Healthcare Research and Quality's SDOH data set were used for comparison. Patients were obtained from the Pennsylvania Trauma Outcomes Study 2000 to 2020. These measures were added to a validated base mortality prediction model with comparison of area under the curve and Bayesian information criterion. We performed center benchmarking using risk-standardized mortality ratios to evaluate change in rank and outlier status based on SDOH. Geospatial analysis identified geographic variation and autocorrelation.There were 449,541 patients included. The DCI and NRI were associated with an increase in mortality (adjusted odds ratio, 1.02; 95% confidence interval, 1.01-1.03 per 10% percentile rank increase; p0.01, respectively). The DCI, NRI, and seven Agency for Healthcare Research and Quality variables also improved base model fit but discrimination was similar. Two thirds of centers changed mortality ranking when accounting for SDOH compared with the base model alone. Outlier status changed in 7% of centers, most representing an improvement from worse-than-expected to nonoutlier or nonoutlier to better-than-expected. There was significant geographic variation and autocorrelation of the DCI and NRI (DCI; Moran's I 0.62, p = 0.01; NRI; Moran's I 0.34, p = 0.01).Social determinants of health are associated with an individual patient's risk of mortality after injury. Accounting for SDOH may be important in risk adjustment for trauma center benchmarking.Prognostic/Epidemiologic, level IV.

Judging value of scholarly outputs quantitatively remains a difficult but unavoidable challenge. Most of the proposed solutions suffer from three fundamental shortcomings: they involve (i) the concept of journal, in one way or another, (ii) calculating arithmetic averages from extremely skewed distributions, and (iii) binning data by calendar year. Here, we introduce a new metric Co-citation Percentile Rank (CPR), that relates the current citation rate of the target output taken at resolution of days since first citable, to the distribution of current citation rates of outputs in its co-citation set, as its percentile rank in that set. We explore some of its properties with an example dataset of all scholarly outputs from University of Jyväskylä spanning multiple years and disciplines. We also demonstrate how CPR can be efficiently implemented with Dimensions database API, and provide a publicly available web resource JYUcite, allowing anyone to retrieve CPR value for any output that has a DOI and is indexed in the Dimensions database. Finally, we discuss how CPR remedies failures of the Relative Citation Ratio (RCR), and remaining issues in situations where CPR too could potentially lead to biased judgement of value.

Objectives: This study aims to establish reference data for nondemented adults between 80 and 84 years of age based on the German version of the Consortium to Establish a Registry for Alzheimer’s disease Neuropsychological (CERAD-NP) test battery and to assess the possible influence of hearing and vision impairments on CERAD-NP performance. Methods: Two hundred one volunteers were examined with the German CERAD-NP test battery, and 18 test scores were calculated from the data. The sample included 99 men (49%), the mean age was 81.8 years (SD = 1.3), and the mean years of education were 13.9 (SD = 3.1). Percentiles for continuous and percentile ranks for discrete test scores were calculated separately for four norm groups. The groups were classified according to gender and education. Multiple regression analysis was used to predict cognitive performance from visual acuity and hearing ability. Results: The normative data obtained were consistent with other findings from younger and older age groups. Worse visual acuity predicted slower performance in the Trail Making Test (TMT). None of the other CERAD-NP tests were correlated to sensory functions. Conclusions: Using age-appropriate reference data, such as that established here for the 80–84 year age group can help to improve the detection of cognitive decline and prevent biases that arise when old-old adults are compared to younger old adults. Visual acuity should be considered an influencing factor on TMT performance.

Graduation from a genetic counseling graduate program accredited by the Accreditation Council of Genetic Counseling and certification obtained by passing the American Board of Genetic Counseling (ABGC) certification examination are increasingly required to practice as a genetic counselor in the USA. Despite the ABGC certification examination serving as a gateway to the genetic counseling career, there have been no research studies to date that have examined what variables are associated with examination performance. Therefore, the Association of Genetic Counseling Program Directors established a Task Force to assess whether trainee demographics, Grade point average (GPA) and Graduate Record Exam (GRE®) percentile scores are associated with passing the ABGC certification examination on the first attempt. We surveyed accredited genetic counseling graduate programs in North America and gathered demographic data, admissions variables, and certification examination outcome data for 1,494 trainees from 24 training programs, representing approximately 60.5% of matriculants between 2007 and 2016. Univariable analysis was performed to assess associations between admissions variables and categorical outcome (pass vs. fail) on the certification examination using Wilcoxon rank-sum or Fisher's exact test. Variables significantly associated with the categorical board outcome were then entered in a stepwise model selection procedure. In stepwise logistic regression, trainees with higher GPA (OR = 3.41; 95% CI = 1.99, 5.83), higher verbal (OR = 1.02; 95% CI = 1.01, 1.03) and quantitative (OR = 1.02; 95% CI = 1.01, 1.03) GRE® scores, female trainees (OR = 2.95; 95% CI = 1.70, 5.12), and White trainees (OR 3.37; 95% CI = 2.14, 5.30) had higher odds of passing the certification examination on the first attempt. As programs move to a holistic approach to graduate admissions in order to improve access to the genetic counseling profession, our results may influence programs to provide additional preparation for the certification examination for all trainees. In addition, genetic counseling professional organizations should continue to work together to assess and eliminate outcome disparities in admissions, training, and certification processes.

ObjectiveTo describe normative values for blood pressure (BP) response to maximal exercise in children/adolescents undergoing a treadmill stress test.MethodsFrom a retrospective analysis of medical records, patients who had undergone a Bruce protocol exercise stress test, with (1) normal cardiovascular system and (2) a body mass index percentile rank below 95% were included for analysis. Sex, age, height, weight, resting and peak heart rate, resting and peak systolic blood pressure (SBP), test duration, stage of Bruce protocol at termination, reason for undergoing the test and reason for termination of test were collected. Percentiles for exercise-induced changes in SBP were constructed by age and height for each sex with the use of quantile regression models.Results648 patients with a median age of 12.4 years (range 6–18 years) were included. Typical indications for stress testing were investigation of potential rhythm abnormalities, syncope/dizziness and chest pain and were deemed healthy by an overseeing cardiologist. Mean test duration was 12.6±2.2 min. Reference percentiles for change in SBP by sex, age and height are presented.ConclusionThe presented reference percentiles for the change in SBP for normal children and adolescents will have utility for detecting abnormally high or low BP responses to exercise in these age groups.

Purpose Anger and irritability are common and impairing symptoms in children. The PROMIS Anger scales assess self- and parent-reported irritable and angry mood over the past 7 days. The aim of this study was to evaluate the psychometric properties of the German version of the PROMIS Parent Proxy Short Form v1.0—Anger and to provide normative data. Methods To evaluate the psychometric properties, data from the study ADOPT Epidemiology were used. In this study, the PROMIS Anger Scale was administered to a population-based sample of n = 8746 parents of children aged 8–12 years. Psychometric analyses were carried out including the investigation of distribution characteristics, factor structure, model fit, internal consistency, and congruent validity. Normative data were calculated as percentile ranks and T-scores. Results The PROMIS Anger Scale demonstrated good psychometric properties, including satisfactory distribution characteristics, unidimensionality, good internal consistency as well as congruent validity. German normative data for the PROMIS Anger Scale are presented. Conclusion Based on first psychometric analyses, the German version of the PROMIS Anger Scale can be recommended for use in research and practice; however, further investigations using clinical data are needed. The normative data will allow researchers and clinicians an interpretation of the test scores in future applications.