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Nick Reaves and Matthew Krauter have written a fine review, in this journal, (1) of my recent book Religious Liberty in a Polarized Age. (2) I am grateful for the [...]

Specifications grading is a relatively recent approach to assessing student learning. In this approach, students make progress toward completion of a course by demonstrating mastery of specific skills or material. The assessment tools are short, frequent exercises that can be attempted multiple times until mastered. This contrasts with the traditional, exam-based assessment of student learning. There are multiple benefits to the specifications grading-based strategy, including reduced test anxiety, better knowledge retention, and increased flexibility. In this study, specifications grading was implemented into an upper-level biochemistry course at a private, liberal arts university. The student cohort consisted almost exclusively of junior and senior biochemistry, biology, and chemistry majors. Students earned points for demonstrating mastery on each of 12 short quizzes in addition to points earned from laboratory exercises and on the cumulative final exam. Student attitudes were assessed using three surveys that were administered at the beginning, middle, and end of the course. The survey results indicated that the students had overall favorable opinions of the specifications grading approach and its use in this course. A comparison of student performance on the quizzes to their performance on the final exam showed that the students learned and retained the course material. Combining the survey and performance data, we demonstrated that the students' perceptions of their learning correlated well with their performances on the specifications grading tools. Together, these results indicated that specifications grading is an effective approach to assessing student learning and to maintaining student enthusiasm in an upper-level biochemistry course.

Using multiple versions of an assessment has the potential to introduce item environment effects. These types of effects result in version dependent item characteristics (i.e., difficulty and discrimination). Methods to detect such effects and resulting implications are important for all levels of assessment where multiple forms of an assessment are created. This report describes a novel method for identifying items that do and do not display form dependence. The first two steps identify form dependent items using a differential item functioning (DIF) analysis of item parameters estimated by Item Response Theory. The method is illustrated using items that appeared in four forms (two trial and two released versions) of a first semester general chemistry examination. Eighteen of fifty-six items were identified as having item parameters that were form dependent. Thirteen of those items displayed a form dependence consistent with reasons previously identified in the literature: preceding item difficulty, content priming, and a combination of preceding item difficulty and content priming. The remaining five items had form dependence that did not align reasons reported in the literature. An analysis was done to determine if all possible instances of predicted form dependence could be found. Several instances where form dependence could have been found, based on the preceding item difficulty or content priming, were identified, and those items did not display form dependence. We identify and rationalize form dependence for thirteen of the eighteen items flagged; however, we are unable to predict form dependence for items.

Abstract Background HIV treatment programs in Africa have implemented centralized testing for routine viral load monitoring (VLM), which may result in specimen processing delays inhibiting timely return of viral load results. Decentralized, point-of-care (PoC) VLM is a promising tool for expediting HIV clinical decision-making but remains unavailable in most African settings. We qualitatively explored the perceived feasibility and appropriateness of PoC VLM to address gaps along the viral load monitoring continuum in rural Uganda. Methods Between May and September 2022, we conducted 15 in-depth interviews with HIV clinicians (facility in-charges, clinical officers, nurses, counselors) and six focus group discussions with 47 peer health workers from three south-central Ugandan districts. Topics explored centralized VLM implementation and opportunities/challenges to optimizing routine VLM implementation with PoC testing platforms. We explored perspectives on PoC VLM suitability and feasibility using iterative thematic analysis. Applying the Framework Method, we then mapped salient constraints and enablers of PoC VLM to constructs from the Consolidated Framework for Implementation Research. Results Clinicians and peers alike emphasized centralized viral load monitoring’s resource-intensiveness and susceptibility to procedural/infrastructural bottlenecks (e.g., supply stockouts, testing backlogs, community tracing of clients with delayed VLM results), inhibiting timely clinical decision-making. Participants reacted enthusiastically to the prospect of PoC VLM, anticipating accelerated turnarounds in specimen processing, shorter and/or fewer client encounters with treatment services, and streamlined efficiencies in HIV care provision (including expedited VLM-driven clinical decision-making). Anticipated constraints to PoC VLM implementation included human resource requirements for processing large quantities of specimens (especially when machinery require repair), procurement and maintenance costs, training needs in the existing health workforce for operating point-of-care technology, and insufficient space in lower-tier health facilities to accommodate installation of new laboratory equipment. Conclusions Anticipated implementation challenges, primarily clustering around resource requirements, did not diminish enthusiasm for PoC VLM monitoring among rural Ugandan clinicians and peer health workers, who perceived PoC platforms as potential solutions to existing inefficiencies within the centralized VLM ecosystem. Prioritizing PoC VLM rollout in facilities with available resources for optimal implementation (e.g., adequate physical and fiscal infrastructure, capacity to manage high specimen volumes) could help overcome anticipated barriers to decentralizing viral load monitoring.

Abstract Achieving precise and controllable hierarchical self-assembly of functional nanoclusters within crystal lattices to create distinct architectures is of immense significance, yet it creates considerable challenges. Here we successfully synthesized a silver nanowheel Ag40, along with its optically pure enantiomers S-/R-Ag40. Each species possesses an internal nanospace and exhibits host-guest interactions. These structures are constructed from primary building blocks (Ag9). By manipulating the surface anions and guest molecules, the nanowheels function as secondary building blocks, spontaneously organizing into complex double- and triple-helical crystalline superstructures or one-dimensional chains {Ag41} n through conformational matching and diverse noncovalent interactions. Moreover, we demonstrate that the water-mediated complex specifically assembled with uridine monophosphate nucleotides, resulting in chiral assemblies of Ag40 that exhibit chiroptical activity for specific recognition. Our findings provide insights into the efficient construction of assemblies with hollow frameworks and propose strategies for superstructure engineering by manipulating surface motifs.

Abstract Red mud is a by-product from alumina industry. Global production of red mud was around 369 million tons in 2023, and India contributed over 6% of total. Landfilling of red mud may leach out heavy metals to soil and water, which could have negative consequences for the ecosystem. Incorporating the red mud in a geopolymer matrix is a safe option. This paper aims to analyse the environmental impact of the 1.0 m3 red mud containing geopolymer paving blocks using GaBi (Indian extension database) software. The data used for the analysis was generated from the studies conducted in continuous geopolymer pilot plant (10 tons/day). The analysis shows the major contributions from alkali activators and electricity. Red mud paving blocks exhibit global warming potential (275 kg CO2 eq.), human toxicity (51.7 kg DCB eq.), and terrestrial ecotoxicity potential (0.441 kg DCB eq.). Red mud blocks have similar acidification (1.65 kg SO2 eq.) and abiotic depletion potential (fossil) (3080 MJ) on comparison with cement paving blocks. Red mud geopolymer paving blocks offer a sustainable alternative with the reduced environmental footprint compared to conventional methods.

Background: The workload of musculoskeletal radiologists has come under pressure. Our objective was to estimate the reading times of common musculoskeletal MRI examinations. Methods: A total of 144 radiologists were asked to estimate reading times (including interpretation and reporting) for MRI of the shoulder, elbow, wrist, hip, knee, and ankle. Multivariate linear regression analyses were performed. Results: Reported median reading times with interquartile range (IQR) for the shoulder, elbow, wrist, hip, knee, and ankle were 10 (IQR 6–14), 10 (IQR 6–14), 11 (IQR 7.5–14.5), 10 (IQR 6.6–13.4), 8 (IQR 4.6–11.4), and 10 (IQR 6.5–13.5) min, respectively. Radiologists aged 35–44 years reported shorter reading times for the shoulder (β coefficient [β] = B-3.412, p = 0.041), hip (β = −3.596, p = 0.023), and knee (β = −3.541, p = 0.013) than radiologists aged 45–54 years. Radiologists not working in an academic/teaching hospital reported shorter reading times for the hip (β = −3.611, p = 0.025) and knee (β = −3.038, p = 0.035). Female radiologists indicated longer reading times for all joints (β of 2.592 to 5.186, p ≤ 0.034). Radiologists without musculoskeletal fellowship training indicated longer reading times for the shoulder (β = 4.604, p = 0.005), elbow (β = 3.989, p = 0.038), wrist (β = 4.543, p = 0.014), and hip (β = 2.380, p = 0.119). Radiologists with p ≤ 0.045), and radiologists with 5–10 years of post-residency experience reported longer reading time for the knee (β = 3.660, p = 0.045) than those with >10 years of post-residency experience. Conclusions: There is substantial variation among radiologists in reported reading times for common musculoskeletal MRI examinations. Several radiologist-related determinants appear to be associated with reading speed, including age, gender, hospital type, training, and experience.

Abstract Ecosystem services such as pollination and biocontrol may be severely affected by emerging nano/micro-plastics (NMP) pollution. Here, we synthesize the little-known effects of NMP on pollinators and biocontrol agents on the organismal, farm and landscape scale. Ingested NMP trigger organismal changes from gene expression, organ damage to behavior modifications. At the farm and landscape level, NMP will likely amplify synergistic effects with other threats such as pathogens, and may alter floral resource distributions in high NMP concentration areas. Understanding exposure pathways of NMP on pollinators and biocontrol agents is critical to evaluate future risks for agricultural ecosystems and food security.

Abstract Background Inadequate collaboration in healthcare can lead to medical errors, highlighting the importance of interdisciplinary teamwork training. Virtual reality (VR) simulation-based training presents a promising, cost-effective approach. This study evaluates the effectiveness of the Team Emergency Assessment Measure (TEAM) for assessing healthcare student teams in VR environments to improve training methodologies. Methods Forty-two medical and nursing students participated in a VR-based neurological emergency scenario as part of an interprofessional team training program. Their performances were assessed using a modified TEAM tool by two trained coders. Reliability, internal consistency, and concurrent validity of the tool were evaluated using intraclass correlation coefficients (ICC) and Cronbach’s alpha. Results Rater agreement on TEAM’s leadership, teamwork, and task management domains was high, with ICC values between 0.75 and 0.90. Leadership demonstrated strong internal consistency (Cronbach’s alpha = 0.90), while teamwork and task management showed moderate to acceptable consistency (alpha = 0.78 and 0.72, respectively). Overall, the TEAM tool exhibited high internal consistency (alpha = 0.89) and strong concurrent validity with significant correlations to global performance ratings. Conclusion The TEAM tool proved to be a reliable and valid instrument for evaluating team dynamics in VR-based training scenarios. This study highlights VR’s potential in enhancing medical education, especially in remote or distanced learning contexts. It demonstrates a dependable approach for team performance assessment, adding value to VR-based medical training. These findings pave the way for more effective, accessible interdisciplinary team assessments, contributing significantly to the advancement of medical education.

Abstract Background Cervical cancer continues to threaten women’s health, especially in low-resource settings. Regular follow-up after screening and treatment is an effective strategy for monitoring treatment outcomes. Consequently, understanding the factors contributing to patient non-attendance of scheduled follow-up visits is vital to providing high-quality care, reducing morbidity and mortality, and unnecessary healthcare costs in low-resource settings. Methods A descriptive qualitative study was done among healthcare providers and patients who attended the cervical cancer screening clinic at Mbarara Regional Referral Hospital in southwestern Uganda. In-depth interviews were conducted using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim, and thematically analysed in line with the social-ecological model to identify barriers and facilitators. Results We conducted 23 in-depth interviews with 5 healthcare providers and 18 patients. Health system barriers included long waiting time at the facility, long turnaround time for laboratory results, congestion and lack of privacy affecting counselling, and healthcare provider training gaps. The most important interpersonal barrier among married women was lacking support from male partners. Individual-level barriers were lack of money for transport, fear of painful procedures, emotional distress, and illiteracy. Inadequate and inaccurate information was a cross-cutting barrier across the individual, interpersonal, and community levels of the socio-ecological model. The facilitators were social support, positive self-perception, and patient counselling. Conclusions Our study revealed barriers to retention in care after cervical cancer screening, including lack of partner support, financial and educational constraints, and inadequate information. It also found facilitators that included social support, positive self-perception, and effective counselling.

Abstract Background UKA is a well-established treatment option for anteromedial osteoarthritis of the knee, resulting in superior functional outcomes but also higher revision rates than TKA. This study aimed to compare the outcomes of UKA, TKA, UKA converted to TKA using identical standard implants and revised TKA to support clinical decision-making. Methods In this study, we retrospectively examined 116 patients who underwent UKA, 77 patients who received TKA, 28 patients whose UKA was converted to TKA using identical standard implants, and 21 patients who had a one-stage revision of TKA. The mean age at operation was 66.5 years (39–90 years), with a mean BMI of 28.8 kg/m2 (17.4–58.8) and a mean follow-up period of four years (0.9–9.9 years). We assessed various PROMs, including Oxford Knee Score, UCLA score, KSS score, and a modified WOMAC-Score as well as patient satisfaction and ability to resume daily activities, work, and sports. Results The highest patient satisfaction was seen in the UKA. All scores were significantly higher for UKA than for TKA, converted UKA, and revised TKA. None of the scores showed a significant inferiority of converted UKA to TKA. In the case of revision, two scores showed significantly better results for converted UKA than for revised TKA. Conclusions Our results indicated that patients initially treated with UKA did not have significantly worse functional outcomes after conversion to TKA, given the use of identical standard implants. This highlights the effectiveness of UKA as a therapeutic option with outcomes superior to those of primary TKA and the importance of a bone-sparing procedure. Conversely, revision TKA is linked to poorer functional outcomes compared to both primary arthroplasties.

Abstract The Sustainable Development Goal 8, “Decent Work and Economic Growth,” (SDG8) has crucial significance for developing nations as they grapple with the dual challenges of fostering economic growth and addressing climate change, as they are often hindered by financial constraints in advancing low-carbon transitions. Centered on SDG 8, particularly in developing countries, this paper takes Indonesia as a case study to delineate challenges and propose insights for an optimal green growth strategy. Challenges encompass fostering enduring, inclusive, and sustainable economic growth while meeting the heightened demand for electricity arising from economic priorities and strategies. The Government of Indonesia envisions low-carbon transition activities that create a substantial and dynamic workforce while preserving natural resources and the environment. The government wishes to leverage international green finance opportunities to mobilize economically stimulating capital while concurrently strengthening domestic investment capacities for future needs. In conclusion, this paper not only analyzes current challenges but also outlines prospective pathways to achieve sustainability.