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Learning communities are often associated with higher student engagement and academic achievement. Few studies to date, however, have examined the impacts of these practices among international students. To address this gap, the following questions led the current study: “To what degree is participation in learning communities associated with international students’ (1) engagement in educationally beneficial activities, (2) learning outcomes (e.g., general, practical, and professional development), and (3) overall satisfaction with their institutional environment and educational experience?” Drawing on student development theory, we designed a path analysis using a structural equation modelling to assess both the direct and the indirect effects. The results suggest that while students’ participation in learning communities positively correlates to student learning gains and satisfaction, the student engagement indicators are the significant mediating predictors for both outcomes, thus recommending that institutions interested in assessing the impacts of learning communities should determine not only the direct effects but also the indirect effects of these practices. Our results also show differences in participation patterns among international student subgroups. Institutions should be aware of such differences and make efforts to scale high impact practices like learning communities to provide opportunities for more students to become involved in these educationally purposeful activities. The findings call for future research aimed at identifying the environmental and individual conditions that are most conducive to the cultivation of these practices for international students.

Objective Black children are disproportionately affected by atopic diseases (i.e., atopic dermatitis, allergic rhinitis, asthma, and food allergies), with health disparities present in early life. Studies in White samples suggest that maternal stress confers risk for offspring atopy, yet little is known about these relationships in Black populations. This study seeks to (a) examine the relationship between self-reported and physiological indicators of maternal stress and offspring atopy and (b) explore warm and responsive caregiving as a potential protective factor in Black Americans. Methods A sample of 179 Black mother–child dyads of varying socioeconomic status participated in a prospective longitudinal study. Mothers completed self-reports of childhood trauma, prenatal stress, postnatal stress, and physician diagnosis of offspring atopy; provided blood samples to assess physiological responses to chronic stress exposure; and participated in a behavioral task with their infant. Results Maternal self-reports of childhood trauma, prenatal stress, and postnatal stress were not associated with offspring diagnosis of atopy by 2–3 years of age. Mothers who produced a smaller inflammatory response during pregnancy were more likely to have an offspring with atopy by 2–3 years of age. Warm and responsive parenting demonstrated a protective effect; the positive association between maternal stress and offspring atopy was less apparent in cases of mother–child interactions characterized by high levels warm and responsive parenting. Conclusion Failure to replicate previous findings suggests that the maternal stress–offspring atopy relationship is complex. Future studies must examine the unique stressors in Black Americans, as well as caregiving as a potential protective factor.

Background: Low levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the low physiologic range, surrogate markers for reduced liver metabolic function, are associated with cerebral hypometabolism, impairment in neurotransmitter production and synaptic maintenance, and a higher prevalence of dementia. It is unknown whether a prospective association exists between low liver enzyme levels and incident dementia. Objective: To determine whether low levels of ALT and AST are associated with higher risk of incident dementia. Methods: Plasma ALT and AST were measured on 10,100 study participants (mean age 63.2 years, 55% female, 22% black) in 1996–1998. Dementia was ascertained from comprehensive neuropsychological assessments, annual contact, and medical record surveillance. Cox proportional hazards regression was used to estimate the association. Results: During a median follow-up of 18.3 years (maximum 21.9 years), 1,857 individuals developed dementia. Adjusted for demographic factors, incidence rates of dementia were higher at the lower levels of ALT and AST. Compared to the second quintile, ALT values

Nondaily smoking is increasing in the United States and common among Hispanic/Latino smokers. We characterized factors related to longitudinal smoking transitions in Hispanic/Latino nondaily smokers.The Hispanic Community Health Study/Study of Latinos is a population-based cohort study of Hispanics/Latinos aged 18-74 years. Multinomial logistic regression assessed the baseline factors (2008-2011) associated with follow-up smoking status (2014-2017) in nondaily smokers (n = 573), accounting for complex survey design.After ∼6 years, 41% of nondaily smokers became former smokers, 22% became daily smokers, and 37% remained nondaily smokers. Factors related to follow-up smoking status were number of days smoked in the previous month, household smokers, education, income, and insurance. Those smoking 16 or more of the last 30 days had increased risk of becoming a daily smoker [vs. 4 days; relative risk ratio (RRR) = 5.65, 95% confidence interval (95% CI) = 1.96-16.33]. Greater education was inversely associated with transitioning to daily smoking [high school vs.ninth grade: RRR (95% CI) = 0.30 (0.09-0.95)]. Living with smokers was associated with decreased likelihood of quitting [RRR (95% CI) = 0.45 (0.24-0.86)]. Having insurance was associated with quitting [RRR (95% CI) = 2.11 (1.18-3.76)] and becoming a daily smoker [RRR (95% CI) = 3.00 (1.39-6.48)].Many Hispanic/Latino nondaily smokers became daily smokers, which may increase their risk of adverse health outcomes. Addressing different smoking patterns in primary care may be useful to prevent smoking-related diseases.

Holland’s theory of vocational choice is a powerful framework for studying academic environments and student development in college. This study tests Holland’s third proposition that students flourish in academic environments (i.e., majors) that are congruent with their personality types. In addition, we examine the extent to which student characteristics influence person-environment fit. Findings indicated that student characteristics and personality type were significantly related to person-environment fit. Moreover, person-environment fit is positively related to self-reported grades. However, person-environment was not significantly related to either perceived learning gains or satisfaction with college.

Institutional graduation rates occupy a prominent place in institutional research and public policy. Graduation rates are used in the College Scorecard, state performance funding initiatives, and potentially affect a significant proportion of public institutions revenues. Despite their widespread use, research suggests that institutional graduation rates are most strongly related to students’ entering characteristics and stable institutional characteristics, but are only weakly related to characteristics institutions can directly control. One set of institutional characteristics that appears to be related to graduation rates are expenditures for instruction, academic support, student services, and institutional support. However, inconsistencies in research findings raise the possibility that estimates of the effects of expenditures on graduation rates may be biased due to omitted variables (i.e., unobserved heterogeneity). The present research uses within-/between-effects panel data models with IPEDS panel data to account for omitted variable bias and examine the effects of institutional characteristics, cohort characteristics, and institutional expenditures on graduation rates.

Introduction: Age-related homeostatic dysregulation (Dm), characterized by multi-biomarker composite measures, has shown promise as a rate-of-aging metric. We tested the association of midlife Dm and its change over ~20 years of follow-up with later life physical function. Methods: We studied 4617 ARIC cohort participants (mean age 54.8 years, 58% female, 20% Black) who completed in-person examinations from 1990-92 (baseline) through 2011-13. Dm quantifies the multivariate statistical deviation of 15 physiology-motivated biomarkers from the distribution in a healthy sample at baseline. Midlife Dm was grouped by quartiles (higher quartiles indicating greater homeostatic dysregulation) and temporal change in Dm was quantified continuously. Physical function was assessed in 2011-13 and included measures from the Short Physical Performance Battery (SPPB) including repeated chair stands, balance, 4-meter walk and grip strength. Associations were quantified using linear regression and ordinal logistic regression as applicable, adjusting for age, sex, race, and education. Results: A graded association was observed between midlife Dm and physical functional performance in late life (Table). Compared to the 1 st quartile of midlife Dm, the odds ratio of a lower SPPB score in late life was 1.19 (95%CI 1.04, 1.35) for the 2 nd quartile, 1.63 (1.41, 1.90) for the 3 rd quartile, and 3.14 (2.60, 3.79) for the 4 th quartile. Similar associations were observed for each of SPPB components and grip strength, either modeled ordinally or continuously. Each standard deviation increase in 10-year Dm change was associated with ~2-3 times the odds of having a poorer physical functional performance. Conclusions: Greater homeostatic dysregulation at midlife and increases in dysregulation during follow-up were associated with poorer physical function in late life. Insights into the factors that lead to progression of multisystem deterioration during midlife may highlight opportunities to preserve functional abilities in late life.

Introduction: Studies have found that smaller brain volumes, cerebral infarcts, and white matter abnormalities are associated with dementia and mild cognitive impairment. However, these studies have been limited by short follow-up precluding a strong establishment of temporality. Therefore, it is unknown whether brain imaging findings are preceded by long-term changes in cognition. We sought to address this gap by examining brain imaging and two decades of cognitive changes in and a large, representative population-based cohort of older adults of black and white race. Hypothesis: We hypothesized that 22-year declines in global cognitive factor scores (GCFS) would be associated with a pattern of smaller total brain and temporal lobe meta region of interest (likely to be affected by Alzheimer’s disease) volumes, larger white matter hyperintensity volumes, and greater odds of ≥1 lacunar infarct and elevated brain β-amyloid deposition. Methods: ARIC participants with brain imaging data, complete cognitive factor score, and not missing key covariates were included. GCFS were collected at three visits across 22 years (1990-2013), and brain MRI and florbetapir PET imaging were collected in 2011-13; PET in subset of n=327. Mixed effects models with random intercepts and slopes predicted individual change in GCFS. Outcomes of interest were total brain volume (cc), temporal lobe meta region volume, log 2 (white matter hyperintensity volume), ≥1 lacunar infarct, and elevated brain β-amyloid deposition (SUVR >1.2). Multivariable linear and logistic regression was used to relate outcomes to GCFS slopes after adjusting for confounders, including vascular risk factors. As appropriate, models were also adjusted for total intracranial volume. Results: Among 1957 with complete brain MRI imaging, 1830 were included in the study, 60% (n=1096) women and 26% (n=480) black. At the first visit, the mean (SD) baseline age was 55 (5.2) yrs. The mean (SD) observed GCFS at the three visits were 0.16 (0.79), 0.05 (0.75), and -0.78 (0.86). After adjustment, a 1-SD larger decline in GCFS was significantly associated with a smaller brain volume by 1.6% [95%CI: 1.3, 1.8] relative to mean brain volume, a smaller temporal lobe meta region volume by 2.4% [2.1, 2.8] relative to the mean volume, a 15% [11, 19] larger volume of white matter hyperintensities, 1.3-fold [1.2, 1.4] higher odds of having ≥1 lacune, and 1.8-fold [1.4, 2.4] higher odds of elevated brain β-amyloid deposition. Associations remained significant after further adjustment for first or last GCFS. Conclusions: Greater declines in long-term cognitive functioning were significantly associated with smaller brain volumes and dementia-related brain characteristics and were independent of last visit GCFS. This suggests long-term changes in cognition may precede late-life brain morphology and outperform cross-sectional cognitive measures.

Background: Central artery stiffness is a predictor of cardiovascular risk and mortality among individuals with diabetes. Few studies examined whether the duration of diabetes relates to arterial stiffening and its rate of progression. Objective: To examine the association of diabetes duration from midlife to older adulthood with arterial stiffness and its 5-year change. Methods: Diabetes (defined by fasting glycemia level >126 mg/dl or use of glucose lowering agents or self-reported) was ascertained at visit 1 (1988-1990), on repeated examinations and on telephone follow-up calls of 2,155 ARIC cohort members (58% women, 20% black, mean age 74 years), as well as time since ascertainment of diabetes. Carotid femoral pulse wave velocity (cfPWV), a measure of central artery stiffness, was obtained at cohort visits 5 (2011-13) and 6 or 7 (2016-19). Associations of duration of diabetes with visit 5 cfPWV and the 5-year cfPWV change from visit 5 to visit 6 or 7 were evaluated by multivariable linear regression adjusted for demographic factors. Results: Among study participants with diabetes ascertained from midlife to older adulthood (n=639 (29%)), the mean cfPWV at visit 5 was 78.6, 95%CI (52.9, 104.4) cm/s greater than those without diabetes. Over a mean of 4.9 (SD 3) years of follow-up, cfPWV increased by a median 137 cm/s. The 5-year change in cfPWV was 40.5, 95%CI (12.3, 68.8) cm/s greater among those with diabetes, as compared to those without diabetes. The mean diabetes duration was 8.1(SD 6.8) years for participants with diabetes. After adjusting for demographic factors, we observed a positive association of diabetes duration with the 5-year change in cfPWV in older adulthood (Figure). Conclusion: Duration of diabetes was associated with a greater rate of progression of central arterial stiffness in older adults.

Background: Cerebral microbleeds (CMBs) are associated with cognitive decline, but their importance outside of clinical cerebral amyloid angiopathy is less well understood, as are the mechanisms of their impact on cognition. In a community-based dementia-free cohort, we evaluate cross-sectional associations between CMB patterns and cerebral amyloid β (Aβ) deposition, measured by florbetapir PET. Methods: ARIC-PET recruited nondemented individuals from 3 US sites. Participants completed 3T brain MRI with T2*GRE (with CMBs read for presence, frequency, location (lobar vs subcortical), and pattern, as well as florbetapir (Aβ) PET (global cortical standardized uptake value ratio >1.2 as a positive scan). Multivariable (see Table) logistic regression models of Aβ+ scans evaluated CMB presence, frequency, location, and pattern, in separate models. Effect modification by sex, race, APOE status, and cognition (normal vs mild cognitive impairment) was evaluated. Results: Nearly 25% of the 322 individuals included had CMBs. No significant associations were found between CMBs (presence or number) and Aβ positivity, but a pattern of isolated lobar CMBs or superficial siderosis was associated with over a 4-fold higher odds of elevated Aβ vs having no CMBs, without a similar elevated risk in those with isolated subcortical CMBs or mixed subcortical + either lobar CMBs or superficial siderosis. Although no significant interactions were found, a mixed pattern was nonsignificantly protective (OR estimates 0.4-0.6) and lobar only CMBs had a (nonsignificantly) higher risk (OR up to 6.4) of Aβ for three subgroups: women (vs men); Blacks (vs whites), APOE ε4 noncarriers (vs carriers), and cognitively normal (vs MCI). Conclusions: A lobar-only pattern of CMBs is most strongly associated with brain Aβ, with no elevated risk for a mixed CMB pattern. Further study is needed to understand differences in these CMB patterns and their meaning across distinct demographic subgroups.

Background: Ischemic Stroke (IS) is associated with an increased risk of dementia, but the relative contribution of IS severity or recurrence to cognition is not known. We aimed to determine the risk of dementia after incident IS and how it varies by stroke severity and recurrence in the Atherosclerosis Risk in Communities (ARIC) study. Methods: 15,405 ARIC participants free of stroke and dementia at baseline (1987-9) were followed for IS and dementia through 2019. Incident and recurrent IS were classified by expert review of hospital records, with stroke severity by the National Institutes of Health Stroke Scale (NIHSS) classified as NIHSS≤5, 6-10, 11-15, ≥16. Dementia cases were adjudicated through expert review of in-person evaluations, informant interviews, phone assessments, hospitalization code or death certificates. Poisson regression models with robust error variance were used to estimate dementia incidence in participants with and without IS, and associations between time-dependent IS incidence (excluding dementia in the first year after stroke), frequency and severity, and dementia were studied with Cox proportional hazards models, adjusting for demographics, APOE ε4 and vascular risk factors . Results: 1151 IS (970 incident) and 2807 dementia cases were identified. NIHSS was available for 877 IS (76%). Adjusted incidence rates (95% CI) of dementia per 100 person-years were 0.45 (0.42-0.49) in participants without IS vs. 1.33 (1.15-1.55) in those with IS. Compared to no IS, risk of dementia (adjusted HR, 95% CI) increased with IS number and severity from 1.71 (1.47-1.99) for participants with one IS to 6.68 (3.58-12.46) for those with ≥3 events, and from 1.64 (1.36-1.98) for NIHSS≤5 to 4.43 (1.84-10.68) for NIHSS≥16 ( Table ). Conclusion: Risk of dementia is significantly increased after stroke, independent of vascular risk factors. These data suggest a dose-response relationship between number of stroke events and stroke severity, and risk of dementia.

In recent years, more than half of all drug overdose deaths in United States involved an opioid. To address this epidemic, antecedents to opioid misuse must be identified and empirically validated. The objective of the current investigation was to examine whether illicit drug use was prospectively associated with nonprescription opioid use among adolescents from a vulnerable population with a greater prevalence of substance abuse. A population-based cohort study of 1060 adolescents from 29 alternative high schools in southern California was conducted over a two-year period. A total of 929 adolescents (mean age 17.5 years, 49.9% female, 76.4% Hispanic) who had not experimented with nonprescription opioids at the baseline assessment were included in the analytic sample. The outcome was self-reported use of nonprescription opioids within two years. The predictors tested were illicit drug use, illicit drug use excluding marijuana, and the use of nonmedical marijuana. Covariates included age, sex, ethnicity, socioeconomic status, parental education, weekly income, sensation seeking, stress, anxiety, depression, and the use of alcohol and nicotine products. Multilevel, covariate-adjusted logistic regression models indicated that the odds of experimentation with nonprescription opioids was greater among adolescents who had used illicit drugs or illicit drugs excluding marijuana. Nonmedical marijuana use alone was a statistically significant predictor in unadjusted but not covariate-adjusted models. While prior studies have examined the progression from nicotine, alcohol, and marijuana use to nonprescription opioid use, the present findings emphasize the importance of illicit drug use as a detectable and empirically supported risk factor for future opioid misuse.

Introduction: Low levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) among older adults are associated with mortality, and reportedly with lower cognitive performance, biomarkers of neurodegeneration, and dementia. We tested the associations of liver enzymes with cognition in ARIC-NCS. Methods: We studied 3191 participants (mean age 79 years, 59% female, 23% black) free of chronic liver disease and cirrhosis, and with AST:ALT ratio ≤2 at visit in 2016-2017. Serum ALT and AST were examined continuously and by quintiles, with the 3 rd quintile as the distribution-based modal reference range. Cognitive status (normal, mild cognitive impairment [MCI], dementia) was ascertained by an expert adjudication panel. A composite global cognition score was estimated from memory, executive function, and language tests. We used demographic and ApoE4 adjusted multinomial logistic and linear regressions. Results: Participants were classified as cognitively unimpaired (2375), MCI (602) or dementia (214). Lower levels of ALT and AST, and a higher AST:ALT ratio were associated with higher prevalence of dementia and lower global cognition scores ( Figure ). The prevalence odds ratio of dementia and MCI for the 1 st quintile, vs 3 rd quintile of ALT, were 1.73 (95% CI:1.06-2.81) and 1.27 (0.92-1.76), respectively. The corresponding estimates for AST were 1.71 (1.03-2.84) and 1.17 (0.87-1.59). Global cognition scores were lower in the 1 st vs 3 rd quintiles of ALT and AST by 0.13 (0.06-0.21) and 0.08 (0-0.15) standard deviation units, respectively. Additional adjustment for alcohol intake did not change the results. Conclusions: Liver hypometabolism is linked to reduced brain glucose metabolism, impaired production of neurotransmitters and synaptic maintenance, systemic insulin resistance and inflammation, while hepatic metabolite profiles are altered in dementia. Prospective assessments are warranted to characterize the role of hepatic metabolic dysfunction in cognitive impairment among older adults.

Background Since 1991, the Royal Australian College of General Practitioners’ (RACGP) Standards for General Practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017. Objective The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally. Method A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by the RACGP and led by an expert panel of GPs and representatives of stakeholder groups who were assisted and facilitated by a team from RACGP. Each draft was released for stakeholder feedback and tested twice before the final version was submitted for approval by the RACGP board. Results Four rounds of consultation and two rounds of piloting were carried out over 32 months. The Standards were redrafted after each round. One hundred and fifty-two individuals and 225 stakeholder groups participated in the development of the Standards. Twenty-three new indicators were recommended and grouped into three sections in a new modular structure that was different from the previous edition. Conclusion The Standards represent the consensus view of national stakeholders on the indicators of quality and safety in Australian general practice and primary care.

A Belmont Report for Health Data Just as indignities common in human-subjects research led to the articulation of ethical principles in the Belmont Report 40 years ago, contemporary concerns about ...

Background: A prolonged corrected QT (QTc) interval is a known risk factor for adverse cardiac events. Understanding the determinants and physiologic correlates of QTc is necessary for selecting proper strategies to reduce the risk of adverse events in high-risk patients. We sought to evaluate the role of arterial stiffness in heart failure as a determinant of QTc prolongation. Method: This was an observational study that recruited ambulatory heart failure patients (New York Heart Association Classes I–II) from an outpatient heart failure clinic. In the supine resting position, consented patients underwent noninvasive 12-lead electrocardiograph (ECG) and hemodynamic monitoring using BioZ Dx impedance cardiography. ECGs were evaluated by a reviewer blinded to clinical data, and QTc interval was automatically computed. Patients with pacing or bundle branch block (BBB) were analyzed separately. Strengths of associations were evaluated using Pearson’s r coefficients and multivariate linear regression. Results: The final sample ( N = 44) was 62 ± 13 years of age and 64% male with ejection fraction of 34% ± 12%. At univariate level, QTc interval moderately ( r > .50) correlated with cardiac output, left cardiac work index, systemic vascular resistance, and total arterial compliance in patients with intrinsically narrow QRS complexes. At the multivariate level, increasing systemic vascular resistance and decreasing total arterial compliance remained independent predictors of widening QTc interval in this group ( R2 = .54). No significant correlations were seen in patients with pacing or BBB. Conclusions: In the absence of conduction abnormalities, magnitude of arterial stiffness, an indirect measure of endothelial dysfunction, is associated with QTc interval prolongation.

Control over the orientation of metal nanorods is important for both fundamental and applied research. We show that gold nanorods (GNRs) can be aligned in a single direction by adsorbing positively charged GNRs onto a double-strand DNA-grafted substrate through electrostatic interaction. The ordered structure can be optimized by controlling the density of the positive charges on the surface of the GNRs. We found, in agreement with the results of theoretical simulation, that the resultant structure exhibits plasmonic properties that are dependent on the GNR orientation relative to the direction of an oscillating electric field. Our approach provides new insights into the polymer-assisted self-assembly of rod-shaped nanoparticles utilizing electrostatic interactions.

The present study examined the relationships between student engagement, represented by two versions of the National Survey of Student Engagement (NSSE) and self-reported gains in learning. The study drew on institutional-level data from participating institutions in 2011 and 2013. The objective of the research was to compare evidence of convergence and discrimination for the two versions of NSSE using canonical correlation analysis. Results indicated that both versions of NSSE provided clear evidence of convergence in that student engagement measures were significantly and positively related to perceived gains in learning. However, only the most recent version of NSSE provided strong evidence of discrimination (i.e., differential relationships between engagement measures and self-reported learning outcomes). Thus, the revised NSSE appears to offer substantial advantages for institutions interested in more nuanced understandings of the relationships between student engagement and perceived learning outcomes. Implications for educators, with goals of enhancing student learning, and for researchers, who often compare complex sets of data, are included.

Background There is an unmet need for a tool that helps to evaluate patients who are at risk of progressing from relapsing-remitting multiple sclerosis to secondary progressive multiple sclerosis (SPMS). A new tool supporting the evaluation of early signs suggestive of progression in multiple sclerosis (MS) has been developed. In the initial stage, concepts relevant to progression were identified using a mixed method approach involving regression on data from a real-world observational study and qualitative research with patients and physicians. The tool was drafted in a questionnaire format to assess these variables. Objective This study aimed to develop the scoring algorithm for the tool, using both quantitative and qualitative research methods. Methods The draft scoring algorithm was developed using two approaches: quantitative analysis of real-world data and qualitative analysis based on physician interviews and ranking and weighting exercises. Variables that were included in the draft tool and regarded as most clinically relevant were selected for inclusion in a multiple logistic regression. The analyses were run using physician-reported data and patient-reported data. Subsequently, a ranking and weighting exercise was conducted with 8 experienced neurologists as part of semistructured interviews. Physicians were presented with the variables included in the draft tool and were asked to rank them in order of strength of contribution to progression and assign a weight by providing a percentage of the overall contribution. Physicians were also asked to explain their ranking and weighting choices. Concordance between physicians was explored. Results Multiple logistic regression identified age, MS disease activity, and Expanded Disability Status Scale score as the most significant physician-reported predictors of progression to SPMS. Patient age, mobility, and self-care were identified as the strongest patient-reported predictors of progression to SPMS. In physician interviews, the variables ranked and weighted as most important were stability or worsening of symptoms, intermittent or persistent symptoms, and presence of ambulatory and cognitive symptoms. Across all physicians, the level of concordance was 0.278 (P Conclusions This study further confirms the need for a tool to provide a consistent, comprehensive approach across physicians to support the early evaluation of signs indicative of progression to SPMS. The novel and comprehensive approach to develop the draft scoring algorithm triangulates data obtained from ranking and weighting exercises, qualitative interviews, and a real-world observational study. Variables that go beyond the clinically most obvious impairment in lower limbs have been identified as relevant subtle/sensitive signs suggestive of progressive disease.

BACKGROUND Alzheimer's disease (AD) is one of the most costly conditions, both economically and regarding patient disability and dependency. The huge costs coupled with the predicted increase in prevalence worldwide are likely to challenge healthcare systems in the future. The classic version of the Alzheimer's Disease Assessment Scale-Cognition subscale (ADAS-Cog) is generally seen as the current gold standard primary outcome measure of cognitive symptom progression in dementia clinical trials. OBJECTIVE This study evaluated the relationship between ADAS-Cog scores as a measure of clinical progression and the healthcare resource utilization (HCRU)-measured burden of cognitive impairment in patients with mild cognitive impairment, AD, or suspected AD in the real world. METHODS A retrospective observational survey of physicians and their consulting patients with multiple ADAS-Cog scores. Regression models were constructed for HCRU variables (e.g., consultations, hospitalizations, caregiving requirements) with ADAS-Cog rate of change, baseline ADAS-Cog, and their interaction included as exposure variables. RESULTS 651 patient records were completed by 154 physicians. Approximately 70% of patients had mild to moderate dementia. In 56.7% of patients, clinical progression was maintained/stable from baseline. Mean change in ADAS-Cog (adjusted to 12 months) was 2.8 points and change scores increased with increasing dementia severity. Most HCRU variables increased significantly (p

Cadmium sulphide can be templated on λ-DNA molecules to form an aqueous dispersion of CdS/λ-DNA nanowires. Subsequent addition of ethylene glycol to 50% v/v is sufficient to formulate an ink suitable for printing using piezoelectric drop-on-demand technology. Printed droplet arrays show a coffee-ring morphology of individual deposits by fluorescence and Raman microscopy, but upon increasing the number of layers of printed material by repeated printing over each droplet, the dry deposit approaches closer to a disc shape. It is also possible to print parallel tracks by reducing the droplet separation in the array until neighbouring droplets overlap before they dry. The droplets coalesce to form a strip of width roughly equal to the diameter of the droplets. Evaporation-driven capillary flow sends the nanowires to the edges of the strip and when dry they form parallel tracks of CdS/λ-DNA nanowire bundles. Both droplets and tracks were printed onto Pt-on-glass interdigitated microelectrodes (10 μm width, 10 μm gap). The current-voltage characteristics of these two-terminal devices were approximately ohmic, but with some hysteresis. The conductance increased with temperature as a simple activated process with activation energies of 0.57 ± 0.02 eV (tracks) and 0.39 ± 0.02 eV (droplets). The impedance spectra of the printed films were consistent with hopping between CdS grains.

Our research on FORC diagrams has been supported over the years by the U.S. National Science Foundation, the UK Natural Environment Research Council, the European Union, the Royal Society of London, and the Australian Research Council (grant DP120103952).

Purpose Script concordance tests (SCTs) are assessments purported to measure one’s ability to interpret clinical data, a key component of the clinical diagnostic reasoning process. The aim of this research was to directly examine the construct validity/dimensionality of SCTs using factor analysis.

The potential for big data to advance our understanding of human disease has been particularly heralded in the field of genomics. Recent technological advances have accelerated the massive data generation capabilities of genomic research, which has allowed researchers to undertake larger scale genomic research, with significantly more participants, further spurring the generation of massive amounts of data. The advance of technology has also triggered a significant reduction in cost, allowing large-scale genomic research to be increasingly feasible, even for smaller research sites. The rise of genetic research has triggered the creation of many large-scale genomic repositories (LSGRs) some of which contain the genomic information of millions of research participants. While LSGRs have genuine potential, they also have raised a number of ethical concerns. Most prominently, commentators have raised questions about the privacy implications of LSGRs, given that all genomic data is theoretically re-identifiable. Privacy can be further threatened by the possibility of aggregation of data sets, which can give rise to unexpected, and potentially sensitive, information. Beyond privacy concerns, LSGRs also raise questions about participant autonomy, public trust in research, and justice. In this chapter, we explore these ethical challenges, with the goal of elucidating which ones require closer scrutiny and perhaps policy action. Our analysis suggests that caution is warranted before any major policies are implemented. Much attention has been directed at privacy concerns raised by LSGRs, but perhaps for the wrong reasons, and perhaps at the expense of other relevant concerns. We do not think that there is yet sufficient evidence to motivate enactment of major policy changes in order to safeguard welfare interests, although there might be some stronger reasons to worry about subjects’ non-welfare interests. We also believe that LSGRs raise genuine concerns about autonomy and justice. Big data research, and LSGRs in particular, have the potential to radically advance our understanding of human disease. While these new research resources raise important ethical concerns, any policies implemented concerning LSGRs should be carefully tailored to ensure that research is not unduly burdened.

Surveys play a prominent role in assessment and institutional research, and the NSSE College Student Report is one of the most popular surveys of enrolled undergraduates. Recent studies have raised questions about the validity of the NSSE survey. Although these studies have themselves been criticized, documenting the validity of an instrument requires an affirmative finding regarding the adequacy and appropriateness of score interpretation and use. Using national data from NSSE 2008, the present study found that the NSSE benchmarks provided dependable means for 50 or more students and were significantly related to important institutional outcomes such as retention and graduation rates.

Multilevel modeling provides several advantages over traditional ordinary least squares regression analysis; however, reporting results to stakeholders can be challenging. This chapter identifies some useful principles for reporting results.

This research examined the relationships among students’ academic majors, levels of engagement, and learning outcomes within the context of Holland’s person–environment theory of vocational and educational behavior. The study focused on the role of student engagement as a mediating agent in the relationships between academic majors and student learning. Drawing on data from a stratified random sample of 20,000 seniors who participated in the 2008 National Survey of Student Engagement, results revealed that students’ academic majors were significantly related to levels of engagement and learning outcomes. Student engagement was also significantly related to learning outcomes. Students’ academic majors generally were not indirectly related to learning outcomes through levels of engagement. An important exception to this result was found for students in Enterprising environments where indirect relationships among Enterprising disciplines and Enterprising learning outcomes were positive, statistically significant, and substantially larger than the direct relationship.

This study examined the contingent relationships between learning community participation and student engagement in educational activities inside and outside the classroom using data from the 2004 administration of the National Survey of Student Engagement (NSSE). Results indicated that learning community participation was positively and significantly related to student engagement, both for first-year students and seniors. For some types of engagement, relationships were significantly stronger for seniors than for first-year students. Analyses also revealed there was substantial variability across institutions in the magnitude of the relationships between learning community participation and first-year students’ levels of engagement. Although institutional characteristics accounted for some of the variability across institutions, a substantial amount of the variability in engagement–learning community relationships remained unexplained.

The widespread popularity of programs for first-year students is due, in large part, to studies showing that participation in first-year programs is significantly related to students’ academic success. Because students choose to participate in first-year programs, self-selection effects prevent researchers from making causal claims about the outcomes of those programs. The present research examined the effects on first-semester grades of students participating in themed learning communities at a research university in the Midwest. Results indicated that membership in themed learning communities was positively associated with higher grade point averages, even after controlling for entering ability, application date, gender, and first-generation/low-income status. However, when instrumental variables were introduced to account for self-selection, the effects of themed learning communities on grades were not statistically significant. The results have implications for campus leaders and assessment practitioners who are working to develop methods for understanding the effects of programs designed to enhance the undergraduate educational experiences on their campuses.

Calls for accountability in higher education are prompted in part by questions concerning whether colleges and universities use their resources effectively to promote student learning. Unfortunately, too little is known about whether money matters to desired outcomes of college. Using students’ responses to the 2004 administration of the National Survey of Student Engagement (NSSE) in concert with institutional data from the Integrated Postsecondary Education Data System (IPEDS) and the College Board, this study examined the relationships between educational expenditures, student engagement and selected student self-reported learning outcomes, controlling for student and institutional characteristics. Results indicated that expenditures were modestly related to student engagement and learning outcomes. However, the nature of these relationships differed, depending on the engagement/outcome measure and student year in school.

A suite of assessment tools, including measures of student engagement, powers a cycle of activities that create an institutional culture of planning and decision making based on evidence.

The effects of on- and off-campus living arrangements on students’ openness to diversity were examined using data from 502 first-time-college students at a major research university in the Midwest. Results indicated that living on campus was directly associated with significantly higher levels of openness to diversity than was living off campus. Living in a Freshman Interest Group was indirectly related to greater openness to diversity through students’ relationships with their peers. No significant indirect effects were found for living in a traditional residence hall or a sponsored learning community.

Hypnosis of preschool age children for anxiety reduction in dentistry - Hypnosis of preschool age children for anxiety reduction in dentistry. A non-verbal hypnotic induction technique for three year old children at their first dental visit rapidly reduces anxiety. The mind set is done via pre-mailed printed materials. The induction sequence is as follows: Adjust shoes and socks, examine fingers, measure height, assist arm levitation, and praise. The key is to allow the child to feel in control, while the dentist acts as a guide. Proceeding against a child’s will, destroys hard earned trust forever. Technical procedures require detailed progressive desensitization. Operator patience and painless techniques are most important. Key words: hypnosis, children, non-verbal, dentist, progressive, desensitization. Parole chiave: ipnosi, bambini, non-verbale, dentista, desensibilizzazione progressiva.

This study compares the explanatory power of the 2000 edition of Carnegie Classification, the 2005 revision of the classification, and selected variables underlying Carnegie’s expanded 2005 classification system using data from the National Survey of Student Engagement’s spring 2004 administration. Results indicate that the 2000 and 2005 classifications generally offer comparable explanatory power for measures of self-reported gains and student engagement, but the new variables from the 2005 system are more strongly related to cognitive outcomes and engagement than were the two categorical groupings. The variables most consistently related to outcomes and engagement are graduate-undergraduate coexistence, residential character of the campus, and arts and sciences share of undergraduate majors. Implications of the findings for research and assessment are discussed.

This chapter describes the ongoing development of a survey of students' workplace skills, civic engagement, and global awareness that colleges and universities can use to document their contributions to the public good.

This final chapter examines some of the factors that may influence whether colleges and universities are able to respond effectively to the renewed interest in accountability and suggests that institutional researchers have an important role to play in moving ahead constructively.

Affirmative action in college admissions is based on the premise that a diverse student body contributes to interactions among students from different backgrounds, which are in turn positively related to desirable outcomes of college. This study evaluates the merits of this rationale for affirmative action by examining the direct and indirect relationships between student-body diversity and students' gains in understanding people of other racial/ethnic backgrounds. Data from a nationally representative sample of 428 colleges and universities participating in the National Survey of Student Engagement (NSSE) indicated that student-body diversity was indirectly, but not directly, related to gains in understanding people from diverse backgrounds. Results supported the use of affirmative action in college admissions, indicating that student body diversity is directly related to greater interaction among diverse groups, but not the quality of interpersonal relations on campus. Diversity of the student body was indirectly related to gains in understanding diverse groups, acting through informal interactional diversity.

The few studies focusing on the relationships between higher education expenditures and student outcomes have produced contradictory results. This study hypothesized that the lack of consistent relationships is a function of the fact that the effects of expenditures on outcomes are mediated by student engagement. Furthermore, it is expected that the relationships between expenditures and outcomes are contingent on the characteristics of the students and institutions being studied. The present research examined the relationships between higher education expenditures and students’ engagement in educationally purposeful activities, after controlling for a variety of student and institutional characteristics. Using data from a nationally representative sample of colleges and universities, the findings indicated that the relationships between expenditures and student engagement are very complex. Relationships differed by institutional control, students’ year in school, and the type of engagement measure included in the analysis.

Because it focuses on the interactions between students and their environments, Holland’s theory of vocational choice provides a powerful framework for studying college experiences. The present study assessed the relative merits of psychological and sociological interpretations of Holland’s theory by examining the relationships among students’ expectations about college, their personality types, and their intended academic majors. Results indicated that both the psychological and sociological aspects of Holland’s theory aid in understanding students’ college expectations.

College and university administrators, as well as faculty members, are more likely to take responsibility for student learning if they believe that the assessment data represent their students and suggest specific actions for improvement. This study examined whether it is feasible to develop scalelets (i.e., focused measures, usually consisting of four or five items) that provide dependable metrics for assessing student learning at the college or department level. A generalizability analysis of 12 scalelets from the National Survey of Student Engagement (NSSE) indicated that the scalelets provided dependable measures of educational effectiveness with 25–50 respondents.

Holland’s theory of vocational preferences provides a powerful framework for studying students’ college experiences. A basic proposition of Holland’s theory is that individuals actively seek out and select environments that are congruent with their personality types. Although studies consistently support the self-selection proposition, they have not examined the processes underlying students’ selections. It seems reasonable to presume that many students select academic majors because they believe or expect that the academic environments will be congruent with their personalities. Using data from 631 entering students, this research examined the possibility that self-selection is related to students’ college expectations. Results provided support for the role of expectations in the selection of academic majors.

Almost half of the U.S. population will be racial/ethnic minorities by the year 2030 (Cortes, 1991). Colleges and universities are also becoming increasingly diverse and students of color are expected to comprise nearly two fifths of total undergraduate enrollment by 2015 (Carnevale & Fry, 2000). In several states, minority students already make up at least one third of the student body. For example, fall 2002 minority enrollments in the four most populous states—California, Texas, Florida, and New York—were 51%, 41%, 37%, and 32%, respectively (Chronicle of Higher Education, 2005). Faced with this dramatic demographic shift, leaders in the public and private sectors have called on colleges and universities to prepare students to function effectively in a diverse society (Association of American Colleges and Universities, 1995; Bikson & Law, 1994). Similar calls have come from within the academy by leaders such as Bowen and Bok (1998) and

Faculty and administrators are more likely to take responsibility for student learning and development if they believe that assessment data represent their students and identify specific actions for improvement. An earlier study found that NSSE scalelets provide dependable metrics for assessing student engagement at the university, college, and department levels. Building on the earlier study, the findings of the current research indicate that the NSSE scalelets have greater explanatory power and provide richer detail than the NSSE benchmarks.

The Carnegie classification system has served as a framework for research on colleges and universities for more than 30 years. Today, the system’s developers are exploring criteria that more effectively differentiate among institutions. One approach being considered is classifying institutions based on students’ educational experiences. This study explored whether it is possible to create a typology of institutions based on students’ experiences. Results indicated that such a typology could be created, and the types were somewhat independent of institutional mission (i.e., Carnegie classification)

College rankings and guidebooks have become big business. The prominent role played by rankings and guidebooks is problematic because the criteria used to evaluate institutions have little to do with the quality of education students receive. Designed as an alternative to college rankings, NSSE assesses student engagement in activities that contribute to learning and success during college. This study compared the NSSE scores for 14 AAU public research universities with their rankings by U.S. News and World Report.

Preclinical studies have identified numerous neuroprotective drugs that attenuate brain damage and improve functional outcome after cerebral ischemia. Despite this success in animal models, neuroprotective therapies in the clinical setting have been unsuccessful. Identification of biochemical markers common to preclinical and clinical cerebral ischemia will provide a more sensitive and objective measure of injury severity and outcome to facilitate clinical management and treatment. However, there are currently no effective biomarkers available for assessment of stroke. Nonerythroid alphaII-spectrin is a cytoskeletal protein that is cleaved by calpain and caspase-3 proteases to signature alphaII-spectrin breakdown products (alphaII-SBDPs) after cerebral ischemia in rodents. This investigation examined accumulation of calpain- and caspase-3-cleaved alphaII-SBDPs in cerebrospinal fluid (CSF) of rodents subjected to 2 hours of transient focal cerebral ischemia produced by middle cerebral artery occlusion (MCAO) followed by reperfusion. After MCAO injury, full-length alphaII-spectrin protein was decreased in brain tissue and increased in CSF from 24 to 72 hours after injury. Whereas alphaII-SBDPs were undetectable in sham-injured control animals, calpain but not caspase-3 specific alphaII-SBDPs were significantly increased in CSF after injury. However, caspase-3 alphaII-SBDPS were observed in CSF of some injured animals. These results indicate that alphaII-SBDPs detected in CSF after injury, particularly those mediated by calpain, may be useful diagnostic indicators of cerebral infarction that can provide important information about specific neurochemical events that have occurred in the brain after acute stroke.

Research involving 6,782 undergraduates (50% first-year students, 50% seniors, 16% fraternity/sorority members, and 58% females) at 15 AAU public research universities revealed that Greek affiliation had a weak positive relationship with engagement and gains in learning. The effects for Greek affiliation were stronger for seniors than first-year students.

Although institutional characteristics are assumed to influence student learning and intellectual development, this link has not been confirmed empirically. This study examined whether institutional mission, as represented by Carnegie classification, is related to student learning and development. After controlling for student background characteristics, no meaningful differences were found in students' perceptions of the college environment, levels of academic and social involvement, integration of information, or educational outcomes by Carnegie classification.