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Interleaved practice combined with comparison prompts can better foster students' adaptive use of subtraction strategies compared to blocked practice. It has not been previously investigated whether all students benefit equally from these teaching approaches. While interleaving subtraction tasks prompts students' attention to the different task characteristics triggering the use of specific subtraction strategies, blocked practice does not support students in detecting these differences. Thus, low-prior-knowledge students would benefit from interleaving rather than blocking as it guides them through the learning-relevant comparison processes. Because these comparison processes are cognitively demanding, students' need for cognition (NFC) could influence the effectiveness of interleaved practice. The present study investigates the role of students' prior knowledge and NFC for the effectiveness of interleaved and blocked practice. To this end, 236 German third-graders were randomly assigned to either an interleaved or blocked condition. Over 14 lessons, both groups were taught to use four number-based strategies and the written algorithm for solving subtraction problems. The interleaved learners were prompted to compare the strategies, while the blocked learners compared the adaptivity of one strategy for different mathematical tasks. A quadratic growth curve model showed that prior knowledge had a positive influence on students' development of adaptivity in the blocked but not in the interleaved condition. Students' NFC had a positive impact in the interleaved condition, while it had no influence in the blocked condition. However, the effects of prior knowledge and NFC did not differ significantly between the two conditions. [ABSTRACT FROM AUTHOR]

Interleaved learning has been shown to be better for delayed memory performance than blocked learning. Nevertheless, people judge blocked learning to be more effective. In the present work, we tested different explanations for this metacognitive bias. Across three experiments, participants studied sequences of object-color associations for a final color-reproduction test. In Experiment 1, colors of a sequence were selected from one color category (blocked-study condition) or distinct color categories (interleaved-study condition). Participants gave higher judgements of learning (JOLs) for objects studied in the blocked condition, although performance was better for objects in the interleaved condition. In Experiment 2, participants' immediate memory performance after each sequence was additionally measured. JOLs were again higher for objects in the blocked condition, and they mimicked participants' immediate memory performance suggesting a link between participants' evaluations of the learning strategies and their immediate memory effects. In Experiment 3, the objects of one sequence were either grouped by category (blocked-study condition) or derived from distinct categories (interleaved-study condition). Neither JOLs, nor immediate performance was affected by this manipulation of blocked learning, speaking against the possibility that people prefer blocked learning because of habit only. We conclude that people overestimate the effectiveness of blocked learning due to the immediate memory boost caused by blocked learning and not due to their previously acquired habit to study in blocks. This study provides insights into how people evaluate the effectiveness of learning strategies and why these evaluations are not always accurate. [ABSTRACT FROM AUTHOR]

Until recently, physicians in the USA who were board-certified in a specialty needed to take a summative test every 6–10 years. However, the 24 Member Boards of the American Board of Medical Specialties are in the process of switching toward much more frequent assessments, which we refer to as longitudinal assessment. The goal of longitudinal assessments is to provide formative feedback to physicians to help them learn content they do not know as well as serve an evaluation for board certification. We present five articles collectively covering the science behind this change, the likely outcomes, and some open questions. This initial article introduces the context behind this change. This article also discusses various forms of lifelong learning opportunities that can help physicians stay current, including longitudinal assessment, and the pros and cons of each. [ABSTRACT FROM AUTHOR]

Natural category learning is important in science education. One strategy that has been empirically supported for enhancing category learning is testing, which facilitates not only the learning of previously studied information (backward testing effect) but also the learning of newly studied information (forward testing effect). However, in category learning, such benefits of testing have mostly been examined without explicit instructions. This is not aligned with a real educational practice where teachers often provide students with explicit instructions that highlight the diagnostic features of the category. Thus, we investigated the effect of interim testing and feature highlighting on rock category learning and whether the provision of feature highlighting further enhances testing benefits. The participants learned 12 rock categories, which were divided into two sections (Sections A and B). They studied a series of rock images with or without feature highlighting and were given an interim test or not on Section A before proceeding to Section B. After Section B, all the participants took a final test in which they had to classify both old and new rock images of the studied categories. Three experiments demonstrated the benefits of interim testing (compared to restudy) for both previously and newly studied categories. However, feature highlighting did not further enhance learning and sometimes even impeded learning. The findings suggest that providing more information is not always better than providing less information in natural category learning. [ABSTRACT FROM AUTHOR]

Desirable difficulties are learning conditions that are often experienced as effortful, but have a positive effect on learning results and transfer of knowledge and skills (Bjork & Bjork, 2011; Bjork, 1994). Learners often do not appreciate the beneficial effects of desirable difficulties, and the negative experiences of high effort and perceived low learning make them resistant to engage in desirable difficulties (Biwer et al., 2020a). This ultimately limits learning outcomes and academic achievement. With the increasing emphasis on self-regulation in education, characterized by higher learner agency and abundant choices in what, when, and how to study, the field of educational psychology is in need of theoretical and empirically testable assumptions that improve self-regulation in desirably difficult learning conditions with the aim to foster self-regulation abilities, learning outcomes, and academic achievement. Here, we present a framework that describes how to support self-regulation of effort when engaging in desirable difficulties: the “Start and Stick to Desirable Difficulties (S2D2)” framework. The framework builds on the Effort Monitoring and Regulation model (de Bruin et al., 2020). The aim of this framework is (1) to describe evidence for the central role of perceived effort and perceived learning in (dis)engagement in desirable difficulties, and (2) to review evidence on, and provide an agenda for research to improve learners’ self-regulated use of desirable difficulties to help them start and persist when learning feels tough, but is actually effective. [ABSTRACT FROM AUTHOR]

In higher education, many students make poor learning strategy decisions. This, in part, results from the counterintuitive nature of effective learning strategies: they enhance long-term learning but also cost high initial effort and appear to not improve learning (immediately). This mixed-method study investigated how students make learning strategy decisions in category learning, and whether students can be supported to make effective strategy decisions through a metacognitive prompt, designed to support accurate monitoring of effort and learning. Participants (N = 150) studied painting styles through blocked and interleaved practice, rated their perceived effort and perceived learning across time, and chose between either blocked or interleaved practice. Half of the participants (N = 74) were provided with a metacognitive prompt that showed them how their subjective experiences per strategy changed across time and required them to relate these experiences to the efficacy of learning strategies. Results indicated that subjective experiences with interleaved practice improved across time: students' perceived learning increased as their perceived effort decreased. Mediation analysis revealed that the increased feeling of learning increased the likelihood to select interleaved practice. The percentage of students who chose interleaved practice increased from 13 to 40%. Students' learning strategy decisions, however, did not benefit from the metacognitive prompt. Qualitative results revealed that students initially had inaccurate beliefs about the efficacy of learning strategies, but on-task experiences overrode the influence of prior beliefs in learning strategy decisions. This study suggests that repeated monitoring of effort and learning have the potential to improve the use of interleaved practice. [ABSTRACT FROM AUTHOR]

Memory generalisations may be underpinned by either encoding- or retrieval-based generalisation mechanisms and different training schedules may bias some learners to favour one of these mechanisms over the other. We used a transitive inference task to investigate whether generalisation is influenced by progressive vs randomly interleaved training, and overnight consolidation. On consecutive days, participants learnt pairwise discriminations from two transitive hierarchies before being tested during fMRI. Inference performance was consistently better following progressive training, and for pairs further apart in the transitive hierarchy. BOLD pattern similarity correlated with hierarchical distances in the left hippocampus (HIP) and medial prefrontal cortex (MPFC) following both training schedules. These results are consistent with the use of structural representations that directly encode hierarchical relationships between task features. However, such effects were only observed in the MPFC for recently learnt relationships. Furthermore, the MPFC appeared to maintain structural representations in participants who performed at chance on the inference task. We conclude that humans preferentially employ encoding-based mechanisms to store map-like relational codes that can be used for memory generalisation. These codes are expressed in the HIP and MPFC following both progressive and interleaved training but are not sufficient for accurate inference. Author summary: Integrating information across distinct situations allows both humans and non-human animals to solve novel problems. For instance, by observing that topaz is hard enough to scratch quartz, and that quartz is hard enough to scratch gypsum, one can infer that topaz must be harder than gypsum—even if these materials have never been seen together. This type of generalisation (transitive inference) can be achieved by combing different pieces of information either, 1) when an inference is actually needed (retrieval-based generalisation), or 2) when new information is first encountered (encoding-based generalisation). We predicted that the use of these generalisation mechanisms depends on the order in which information is presented and whether that information was learnt before an overnight rest. Contrary to our predictions, behavioural and neuroimaging analyses of a transitive inference task in humans showed convergent evidence for encoding-based generalisations in all conditions. While these conditions had a large impact on inferential ability, we found that brain regions involved in memory invariably learnt inferred relationships between items that had not been seen together. Strikingly, this appeared to be the case even when participants where unbale to make accurate inferences. [ABSTRACT FROM AUTHOR]

In their recent paper, Chen et al. (Educational Psychology Review, 2021) propose that rest periods between deliberate learning characterize the spacing effect and the alternation between skills without rest characterizes the interleaving effect. In this commentary, we show that this theory is inadequate in two aspects. First, the operationalization of their constructs are problematic—their mechanism of rest-from-deliberate-learning mismatches their operationalization (e.g., they code deliberate learning activities that should not allow for working memory recovery as rest-from-deliberate-learning), and their definition of whether stimuli require discriminative contrast appears to depend on the study outcome. Second, their systematic review neglects a large body of literature that is incompatible with their theory. For example, they neglect classic spacing studies on vocabulary learning, and their theory of spacing effects as being a result of working memory recovery cannot account for lag effects or interactions found in the literature. We conclude that there are almost certainly mechanistic differences between spacing and interleaving effects, but the mechanisms are likely not mutually exclusive, as defined by Chen and colleagues. [ABSTRACT FROM AUTHOR]

Observing category exemplars in an interleaved manner is more beneficial for inductive learning than blocked (massed) presentation, a phenomenon termed the interleaving effect on inductive learning. However, people tend to erroneously believe that massed is more beneficial than interleaved learning, and learners prefer the former during self-regulated learning. We report four experiments designed to investigate whether explicit instructions, which include individual performance feedback and the interleaving effect results from previous research, can (1) correct metacognitive illusions regarding the interleaving effect, (2) promote self-employment of interleaving, and (3) facilitate category learning. In addition, the current study explored (4) whether the intervention effect is long-lasting and (5) transferable to learning of categories in other domains. Experiments 1–4 established the effectiveness of the instruction intervention to enhance metacognitive appreciation of the interleaving effect, to promote self-employment of interleaving, and to facilitate learning of new categories. The intervention effect was long-lasting (at least 24 h; Experiment 2), and transferable to learning of categories in different domains (Experiments 3 and 4). These findings support the practical use of the instruction intervention. [ABSTRACT FROM AUTHOR]

Introduction: During the COVID‐19 pandemic, dental schools were required to reformat their curricula to accommodate regulations mandated to protect the health of students and faculty. For students enrolled in the Operative Dentistry preclinical courses at the Harvard School of Dental Medicine (HSDM), this modified curriculum included frontloading the course with lectures delivered remotely, followed by in‐person laboratory exercises of learned concepts. The aim of this article was to determine the impact that the modifications had on student performance and student self‐evaluation capabilities. Materials and methods: Thirty‐eight students were introduced to this restructured course. Their performance in a final multiple‐choice (MC) examination, four preclinical laboratory competency assessments (class II amalgam preparation and restoration, class III composite preparation and restoration) and their self‐assessment of these preclinical competency assessments were then compared with the pre‐COVID pandemic (P‐CP) classes from years 2014 to 2019 (n = 216 students). Linear regressions were performed to determine differences in mean faculty scores, self‐assessment scores, student‐faculty score gaps (S‐F gaps) and absolute S‐F gaps seen between the class impacted by the pandemic and the P‐CP classes. Results: The results demonstrated that students during the COVID‐19 pandemic (D‐CP) had a higher average faculty score in all four preclinical laboratory competency assessments and in the final MC examination. In addition, the S‐F gap was smaller in this cohort as compared with the P‐CP classes. Conclusion: Despite the challenges of restructuring the preclinical curricula, D‐CP students performed better than their P‐CP predecessors in multiple facets of this Operative Dentistry course including self‐assessment accuracy. [ABSTRACT FROM AUTHOR]

Background: In the United States, state-level policies requiring vaccination of school-going children constitute a critical strategy for improving vaccination coverage. However, policies allowing vaccination exemptions have also been implemented and contribute to reductions in vaccination coverage and potential increases in the burden of vaccine-preventable diseases. Understanding the geographic disparities in the distribution of vaccination exemptions and identifying high risk areas is necessary for guiding resource allocation and public health control strategies. This study investigated geographic disparities in vaccination exemptions as well as socioeconomic and demographic predictors of vaccination exemptions in Florida. Methods: Vaccination exemption data were obtained from the Florida Department of Health's Florida HealthCHARTS web interface. Spatial patterns in geographic distribution of total and non-medical vaccination exemptions were assessed using county-level choropleth maps. Negative binomial models were used to identify significant predictors of county-level risks of both total and non-medical vaccination exemptions. Results: Total exemptions varied from 0 to 30.2 per 10,000 people. Nine counties had exemption risks in the top two classes (10.4-15.9 and 15.9-30.2 exemptions per 10,000 people). These counties were distributed in five distinct areas: Western Panhandle, central northern area, central, South-eastern coastal area, and the southern coastal border of the state. Non-medical exemptions varied from 0 to 10.4 per 10,000 people. Fifteen counties had exemption risks in the top two classes (3.7-5.6 and 5.6-10.4 exemptions per 10,000 people), and were located in six distinct areas: Western and Central Panhandle, Northeastern, Central-eastern coastal area, Central-western coastal area, and the South-western coastal border of the state. Predictors of high risk of total vaccination exemptions were high density of primary care providers (p < 0.001), high median income (p = 0.001), high percentage of Hispanic population (p = 0.046), and low percentage of population with a college education (p = 0.013). A predictor of high risk of non-medical vaccination exemptions was high percentage of White population (p = 0.045). However, predictors of low risks of non-medical exemptions were high percentages of population: living in rural areas (p = 0.023), with college education (p = 0.013), with high school education (p = 0.009), and with less than high school education (p < 0.001). Conclusions: There is evidence of county-level geographic disparities in both total and non-medical vaccination exemption risks in Florida. These disparities are explained by differences in county-level socioeconomic and demographic factors. Study findings are important in guiding resource allocation for health planning aimed at improving vaccination rates and reducing incidence of vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

The article presents an examination of a manuscript titled "Dīvān," that was written by the Ottoman panegyrist Nef'i. The author discusses the design and layout of the manuscript noting that it is made up of three columns of poetry. The center column is the main text and appears to be the oldest, dating to the 16th century. This center column is flanked on either side by newer text that the author believes was added in the 17th century. The author notes that their is no dedication to Sultan Murad IV, whose reign began shortly after the manuscript was published. The author explores the differences between the center column and the two marginal columns.

Prior knowledge of relational structure allows people to quickly make sense of and respond to new experiences. When awareness of such structure is not necessary to support learning, however, it is unclear when and why individuals "spontaneously discover" an underlying relational schema. The present study examines the determinants of such discovery in discrimination-based transitive inference (TI), whereby people learn about a hierarchy of interrelated premises and are tested on their ability to draw inferences that bridge studied relations. Experiencing "chained" sequences of overlapping premises during training was predicted to facilitate the discovery of relational structure. Among individuals without prior knowledge of the hierarchy, chaining improved relational learning and was most likely to result in explicit awareness of the underlying relations between items. Observation of chained training sequences was also more effective than the self-generation of training sequences. These findings add to growing evidence that the temporal dynamics of training, including successive presentation of overlapping associations, are key to understanding spontaneous relational discovery during learning. [ABSTRACT FROM AUTHOR]

The corticotropin-releasing hormone (CRH) family is widely distributed among the central nervous system and peripheral tissues, such as the digestive, cardiovascular, immune, reproductive, endocrine systems. The CRH family members are widely involved in the regulation of human cell biological processes, immune response, and regulation of inflammatory processes that can affect the occurrence and development of tumors. At present, CRH family members and their receptors can be detected in many tumor tissues, and some people think that members of the CRH family may be potential tumor treatment targets as they can affect cellular processes, such as proliferation, migration, invasion, and apoptosis. However currently, there is no systematic introduction to the relationship between the CRH family and various tumors. This review introduces the molecular regulation of the CRH family in tumor formation and seeks further targeted therapy. [ABSTRACT FROM AUTHOR]

We develop an agent-based computational model of epidemics with varying amounts of heterogeneity in regional vaccination coverage. We examine the severity of the resulting epidemics and the externalities created between high and low vaccination regions. The resulting size of the epidemics depends upon the heterogeneity of coverage, the interaction structure in the population, and how close the population is to herd immunity. Holding overall vaccination levels constant, the mean epidemic size increases and a larger level of vaccinations is needed to reach herd immunity when there is greater variability in the regional vaccination rates as long as the vaccination level is sufficiently high. This relationship amplifies when the contacts of individuals in the model have a greater share of inter-regional linkages. However, when inter-regional linkages and vaccination levels are sufficiently low, the mean epidemic size can decrease when there is greater variability in the regional vaccination rates. Further, we find that the magnitude of externalities between regions with different levels of vaccine coverage depends crucially on how close the population is to herd immunity. If population level vaccination coverage is sufficiently high (low) shifting connections from low coverage regions to high coverage regions will decrease (increase) mean epidemic size. [ABSTRACT FROM AUTHOR]

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Retrieval practice has been widely studied as an effective strategy for enhancing memory. In this review article, we discuss how its effects on learning complex problem-solving procedures are less straightforward, however, with repeated studying of worked examples sometimes more effective than problem-solving practice. This worked example benefit has been interpreted within the framework of cognitive load theory. In both memory-based tasks and problem-solving tasks, students rate retrieval as more effortful, and less effective for learning, than repeated study. Self-regulated learning decisions do not align with the evidence about the effectiveness of retrieval, as students often avoid using retrieval in memory-based tasks but frequently use it in more complex problem-solving tasks. Patterns associated with self-report survey data and self-regulated learning decisions suggest that retrieval may be used primarily as a means of checking knowledge, and the effort experienced during retrieval may drive subsequent study decisions (i.e., the choice to engage in retrieval vs. further study) to the extent that the experienced effort is interpreted as a sign that learning has been ineffective. We discuss implications of students' views about the purpose of retrieval for effective monitoring and regulation of effort during learning, and propose interventions that may improve students' optimal use of retrieval in their study decisions. [ABSTRACT FROM AUTHOR]

Background: One of the most effective public health interventions in the world is immunization. However, some parents doubt its usefulness and safety. Many factors influence their decision to vaccinate, including their sociodemographic characteristics, their trust in the public health system, the parent-physician relationship, their level of knowledge and their attitudes towards vaccination. Our objective was to determine the factors, especially the parent-physician communication, associated with parental knowledge, attitudes and practices of their children's vaccination. Methods: Three thousand five hundred parents (father, mother or both) of children aged between 1 month and 15 years were approached by a trained personnel who performed the data collection through personal interviews (February–April 2019). Results: The response rate was 79.5%. The results of the multivariable analysis showed that a better patient-physician communication was significantly associated with higher knowledge, better attitude and practice. Better knowledge was significantly associated with better attitude, whereas better knowledge and attitude were significantly associated with better practice. Conclusion: Our study shows the importance of good physician-patient communication in improving knowledge, attitude and practice of parents towards their children's vaccination. [ABSTRACT FROM AUTHOR]

Well-structured knowledge allows us to quickly understand the world around us and make informed decisions to adequately control behavior. Knowledge structures, or schemas, are presumed to aid memory encoding and consolidation of new experiences so we cannot only remember the past, but also guide behavior in the present and predict the future. However, very strong schemas can also lead to unwanted side effects such as false memories and misconceptions. To overcome this overreliance on a schema, we should aim to create robust schemas that are on the one hand strong enough to help to remember and predict, but also malleable enough to avoid such undesirable side effects. This raises the question as to whether there are ways to deliberately influence knowledge construction processes, with the goal to reach such optimally balanced schemas. Here, we will discuss how the mnemonic processes in our brains build long-term knowledge and, more specifically, how different phases of memory formation (encoding, consolidation, retrieval, and reconsolidation) contribute to this schema build-up. We finally provide ways how to best keep a balance between generalized semantic and detailed episodic memories, which can prove very useful in, e.g., educational settings. [ABSTRACT FROM AUTHOR]

Background: As conscientious vaccination exemption (CVE) percentages rise across the United States, so does the risk and occurrence of outbreaks of vaccine-preventable diseases such as measles. In the state of Texas, the median CVE percentage across school systems more than doubled between 2012 and 2018. During this period, the proportion of schools surpassing a CVE percentage of 3% rose from 2% to 6% for public schools, 20% to 26% for private schools, and 17% to 22% for charter schools. The aim of this study was to investigate this phenomenon at a fine scale.Methods and Findings: Here, we use beta regression models to study the socioeconomic and geographic drivers of CVE trends in Texas. Using annual counts of CVEs at the school system level from the 2012-2013 to the 2017-2018 school year, we identified county-level predictors of median CVE percentage among public, private, and charter schools, the proportion of schools below a high-risk threshold for vaccination coverage, and five-year trends in CVEs. Since the 2012-2013 school year, CVE percentages have increased in 41 out of 46 counties in the top 10 metropolitan areas of Texas. We find that 77.6% of the variation in CVE percentages across metropolitan counties is explained by median income, the proportion of the population that holds a bachelor's degree, the proportion of the population that self-reports as ethnically white, the proportion of the population that is English speaking, and the proportion of the population that is under the age of five years old. Across the 10 top metropolitan areas in Texas, counties vary considerably in the proportion of school systems reporting CVE percentages above 3%. Sixty-six percent of that variation is explained by the proportion of the population that holds a bachelor's degree and the proportion of the population affiliated with a religious congregation. Three of the largest metropolitan areas-Austin, Dallas-Fort Worth, and Houston-are potential vaccination exemption "hotspots," with over 13% of local school systems above this risk threshold. The major limitations of this study are inconsistent school-system-level CVE reporting during the study period and a lack of geographic and socioeconomic data for individual private schools.Conclusions: In this study, we have identified high-risk communities that are typically obscured in county-level risk assessments and found that public schools, like private schools, are exhibiting predictable increases in vaccination exemption percentages. As public health agencies confront the reemerging threat of measles and other vaccine-preventable diseases, findings such as ours can guide targeted interventions and surveillance within schools, cities, counties, and sociodemographic subgroups. [ABSTRACT FROM AUTHOR]

Learning science is an emerging interdisciplinary field that offers educators key insights about what happens in the brain when learning occurs. In addition to explanations about the learning process, which includes memory and involves different parts of the brain, learning science offers effective strategies to inform the planning and implementation of activities and programs in continuing education and continuing professional development. This article provides a brief description of learning, including the three key steps of encoding, consolidation and retrieval. The article also introduces four major learning-science strategies, known as distributed learning, retrieval practice, interleaving, and elaboration, which share the importance of considerable practice. Finally, the article describes how learning science aligns with the general findings from the most recent synthesis of systematic reviews about the effectiveness of continuing medical education. [ABSTRACT FROM AUTHOR]

Previous work demonstrates that individuals who obtain exemptions from school immunization requirements are geographically clustered, making regional differences in vaccination coverage a significant concern. Even where exemption levels are high, there are still parents that vaccinate. School-level assessments have determined that exemptors are more likely to attend wealthier schools with fewer minorities. Few studies have assessed divergent opinions within the context of a higher-exemption community to examine subtle differences in opinion surrounding vaccinations. Therefore, the objective of this work was to assess attitudes and perceptions towards vaccinations and compare them for exemptors and non-exemptors. We administered surveys to parents in high-exemption (>10%) elementary schools in Arizona during the 2012–13 school year. A total of 404 surveys were completed by parents among schools in Maricopa (n = 7) and Yavapai (n = 2) counties. Of these, 35% (n = 141) were exemptors and 65% (n = 261) were non-exemptors. Exemptors were more likely than non-exemptors to be concerned about serious side-effects (p<0.001). They were more likely to report knowing someone who had been diagnosed with a vaccine-preventable disease (p<0.001) but less likely to report that this had been a serious illness in that person (p<0.001) and they believed it is better for a child to develop immunity through illness than vaccination (p<0.001). They were less likely to trust physicians (p<0.001) and information about vaccines (p<0.001) and were more likely to obtain their health care from a naturopath (p<0.001). In summary, exemptors in these Arizona schools do not appear to be exempting their children from vaccinations due to convenience, as has been hypothesized in other settings. Based on the divergent views within high-exemption schools and reported distrust of the medical establishment, target interventions for high-exemption schools are discussed. Additionally, given the lack of effective non-policy based interventions to-date, the negligible declines in personal belief exemption rates, and vaccine preventable disease rate increases in Arizona, especially in high-exemption areas, legislative action in Arizona may also warrant further investigation. [ABSTRACT FROM AUTHOR]

Knowledge representations that result from practicing problem solving can be expected to differ from knowledge representations that emerge from explicit verbalizing of principles and rules. We examined the degree to which the two types of learning improve problem-solving knowledge and verbal explanation knowledge in classroom instruction. We presented algebraic addition and multiplication problems to 153 sixth graders randomly assigned to two conditions. Students in the explicit learning condition had to verbally compare contrasted algebra problems. Students in the implicit learning condition had to generate and solve new problems. On three follow-up tests over 10 weeks, students in the explicit learning condition exhibited better problem-solving knowledge than students in the implicit learning condition, as well as some advantages in verbal concept knowledge. Implicit learning showed some advantages on not directly taught but incidentally learned aspects. Overall, this outcome favors the explicit learning of concepts. Explicit comparison fostered student performance on non-verbal and verbal measures, indicating that verbalization facilitates effective comparison. [ABSTRACT FROM AUTHOR]

Mumps is a systemic viral illness, preventable by vaccination, that typically affects children and is characterized by unilateral or bilateral swelling of the parotid glands. Uncommon complications such as orchitis, oophoritis, deafness, pancreatitis, aseptic meningitis, and encephalitis occur more often in adults. Recent outbreaks of the disease appear to be caused by a failure to maintain herd immunity in certain populations, particularly in affl uent white communities. This article reviews the clinical manifestations, diagnosis, and potential complications in patients with mumps. [ABSTRACT FROM AUTHOR]

We examined the extent to which college students’ self-reported study strategy use relates to perceived peer strategy use, allowing us to determine whether college students misperceive peers’ use of different study strategies. College students (n = 195) reported their use and perceived peer use of 10 different study strategies. Study strategy use positively related to GPA. Moreover, students perceived higher rates of peers’ use of relatively ineffective strategies (e.g., highlighting/underlining) and perceived lower rates of peers’ use of the highly effective strategy of distributing practice, compared to actual reports. Perceiving that peers are more likely to utilize ineffective strategies and less likely to utilize effective strategies may contribute to continued use of counterproductive or ineffective study behavior. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of the interleaving approaches and spacing in the classroom for improving the learning capabilities of students. Topics include the application of effective teaching on the students, use of hypothesis based on the discriminative-contrast, and the result of the researches on the spacing in the classroom.

The science of learning has made a considerable contribution to our understanding of effective teaching and learning strategies. However, few instructors outside of the field are privy to this research. In this tutorial review, we focus on six specific cognitive strategies that have received robust support from decades of research: spaced practice, interleaving, retrieval practice, elaboration, concrete examples, and dual coding. We describe the basic research behind each strategy and relevant applied research, present examples of existing and suggested implementation, and make recommendations for further research that would broaden the reach of these strategies. [ABSTRACT FROM AUTHOR]

Background: Dr. Athina Markou sought treatments for a common neural substrate shared by depression and drug dependence. Antagonists of corticotropin-releasing factor (CRF) receptors, a target of interest to her, have not reached the clinic despite strong preclinical rationale and sustained translational efforts. Methods: We explore potential causes for the failure of CRF antagonists and review recent findings concerning CRF-CRF systems in psychopathology. Results: Potential causes for negative outcomes include (1) poor safety and efficacy of initial drug candidates due to bad pharmacokinetic and physicochemical properties, (2) specificity problems with preclinical screens, (3) the acute nature of screens vs. late-presenting patients, (4) positive preclinical results limited to certain models and conditions with dynamic CRF-CRF activation not homologous to tested patients, (5) repeated CRF activation-induced plasticity that reduces the importance of ongoing CRF agonist stimulation, and (6) therapeutic silencing which may need to address CRF receptor or CRF-binding protein molecules, constitutive CRF activity, or molecules that influence agonist-independent activity or to target structural regions other than the allosteric site bound by all drug candidates. We describe potential markers of activation towards individualized treatment, human genetic, and functional data that still implicate CRF systems in emotional disturbance, sex differences, and suggestive clinical findings for CRF antagonists in food craving and CRF-driven HPA-axis overactivation. Conclusion: The therapeutic scope of selective CRF antagonists now appears narrower than had been hoped. Yet, much remains to be learned about CRF's role in the neurobiology of dysphoria and addiction and the potential for novel anti-CRF therapies therein. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate trends in rates of personal belief exemptions (PBEs) to immunization requirements for private kindergartens in California that practice alternative educational methods. Methods. We used California Department of Public Health data on kindergarten PBE rates from 2000 to 2014 to compare annual average increases in PBE rates between schools. Results. Alternative schools had an average PBE rate of 8.7%, compared with 2.1% among public schools. Waldorf schools had the highest average PBE rate of 45.1%, which was 19 times higher than in public schools (incidence rate ratio = 19.1;95%confidence interval = 16.4, 22.2).Montessori and holistic schools had the highest average annual increases in PBE rates, slightly higher than Waldorf schools (Montessori: 8.8%; holistic: 7.1%; Waldorf: 3.6%). Conclusions. Waldorf schools had exceptionally high average PBE rates, and Montessori and holistic schools had higher annual increases in PBE rates. Children in these schools may be at higher risk for spreading vaccine-preventable diseases if trends are not reversed. [ABSTRACT FROM AUTHOR]

The Parent Attitudes about Childhood Vaccines (PACV) survey for identifying vaccine-hesitant parents was recently validated in Washington State but did not include all recommended childhood vaccines. The current study compares vaccination rates for all recommended childhood vaccines and PACV scores at one pediatric practice in Tennessee. Children were enrolled at the 2-week well visit, and vaccination rates were assessed at 19 months of age. Outcomes at 19 months of age included mean percentage of days underimmunized and up-to-date status (yes/no) compared with PACV scores. The impact of provider on immunization status was assessed. Complete vaccination data were available for 158 children of 183 enrolled (86%). Higher PACV scores were associated with more days underimmunized (P < .001) and being overdue for vaccine doses at 19 months of age (P < .001). No difference was seen between providers and up-to-date status. Our study supports the predictive validity of the PACV for underimmunization. [ABSTRACT FROM AUTHOR]

Context Chest radiograph interpretation is a complex skill and learners may benefit from deliberate instructional design modalities, such as mixed practice. Proposed benefits of mixed over blocked practice include the elimination of cueing and the highlighting of contrasting features. However, current evidence for the superiority of mixed practice is conflicting. Objectives This study compares mixed versus blocked practice, after the initial teaching of concepts, among medical students using online self-study chest X-ray ( CXR) modules. Methods Two online CXR modules were developed that cover identical content but differ in the organisation of practice images. Blocked modules provided practice CXRs after each category, whereas mixed modules randomly ordered practice radiographs after all categories had been taught. Medical students in Years 1-3 were randomised to either module and were tested on 20 new CXRs immediately after completion and at 2 weeks. The primary outcome was immediate diagnostic accuracy. Secondary outcomes included diagnostic accuracy at 2 weeks, time per module and reported module difficulty. Results A total of 58 medical students participated (32 in the blocked and 26 in the mixed module). Level of training and previous CXR experience were similar across the groups. Totals of 1160 and 1120 answers were evaluated for immediate and 2 week post-test scores, respectively. There were no significant differences in mean diagnostic accuracy between the blocked (mean score: 11.7/20) and mixed (mean score: 11.0/20) practice groups on immediate testing ( t = 0.83, d.f. = 56, p = 0.41) or at 2 weeks (mean score: 11.2/20 versus 10.9/20; t = 0.518, d.f. = 54, p = 0.61). Post-test scores showed no correlation with training level ( R = 0.23, p = 0.09) or completion time ( R = −0.09, p = 0.5). Reported module difficulty was similar between the mixed (3.22/5) and blocked (3.19/5) groups. On multivariable linear regression controlling for completion time, training level and CXR experience, between-group differences remained non-significant. Conclusions Performance after mixed practice was similar to that after blocked practice. Results may reflect similarities between modules in teaching, which emphasised contrast learning, greater effect of initial teaching rather than practice, or absence of tutor-led instruction. Alternatively, results may reflect the higher cognitive load in mixed practice imposed by contrasting multiple diagnoses. [ABSTRACT FROM AUTHOR]

Longitudinal assessment (LA) involves the regular, spaced delivery of a limited number of questions on practice relevant content on a computer or mobile internet platform. Depending on the platform, participants may indicate relevance of the content to their practice and confidence in their answer prior to receiving immediate feedback (including critiques) on each question. Individual dashboards may be included to assist participants in tracking progress and identifying areas of strength and weaknesss across a content blueprint. This paper provides an overview of the theoretical underpinnings underlying LA programs, briefly describes current uses of LA in medicine and suggests areas for evaluating the role of LA in continuing medical specialty certification and continuing professional development. [ABSTRACT FROM AUTHOR]

We summarized studies describing the prevalence of, trends in, and correlates of nonmedical exemptions from school vaccination mandates and the association of these policies with the incidence of vaccine-preventable disease. We searched 4 electronic databases for empirical studies published from 1997 to 2013 to capture exemption dynamics and qualitatively abstracted and synthesized the results. Findings from 42 studies suggest that exemption rates are increasing and occur in clusters; most exemptors questioned vaccine safety, although some exempted out of convenience. Easier state-level exemption procedures increase exemption rates and both individual and community disease risk. State laws influence exemption rates, but policy implementation, exemptors’ vaccination status, and underlying mechanisms of geographical clustering need to be examined further to tailor specific interventions. [ABSTRACT FROM AUTHOR]

Visual categories group together different objects as the same kinds of thing. We review a selection of research on how visual categories are learned. We begin with a guide to visual category learning experiments, describing a space of common manipulations of objects, categories, and methods used in the category learning literature. We open with a guide to these details in part because throughout our review we highlight how methodological details can sometimes loom large in theoretical discussions of visual category learning, how variations in methodological details can significantly affect our understanding of visual category learning, and how manipulations of methodological details can affect how visual categories are learned. We review a number of core theories of visual category learning, specifically those theories instantiated as computational models, highlighting just some of the experimental results that help distinguish between competing models. We examine behavioral and neural evidence for single versus multiple representational systems for visual category learning. We briefly discuss how visual category learning influences visual perception, describing empirical and brain imaging results that show how learning to categorize objects can influence how those objects are represented and perceived. We close with work that can potentially impact translation, describing recent experiments that explicitly manipulate key methodological details of category learning procedures with the goal of optimizing visual category learning. WIREs Cogn Sci 2014, 5:75-94. doi: 10.1002/wcs.1268 Conflict of interest: The authors have declared no conflicts of interest for this article. For further resources related to this article, please visit the WIREs website. [ABSTRACT FROM AUTHOR]

Early life stress increases the risk of developing psychopathology accompanied by reduced cognitive function in later life. Maternal separation induces anxiety-like behaviours and is associated with impaired memory. On the other hand, exercise has been shown to diminish anxiety-like behaviours and improve cognitive function. The effects of maternal separation and exercise on anxiety, memory and hippocampal proteins were investigated in male Sprague-Dawley rats. Maternal separation produced anxiety-like behaviours which were reversed by exercise. Maternal separation also enhanced object location memory which was not affected by exercise. Exercise did, however, increase synaptophysin and phospho-extracellular signal-regulated kinase (p-ERK) in the hippocampus of non-separated rats and this effect was not observed in maternally separated rats. These findings show that maternal separation selectively enhanced n memory and prevented activation of the MAPK/ERK signalling pathway in the adult rat hippocampus. [ABSTRACT FROM AUTHOR]

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that often results in joint pain, inflammation and bone erosions. Perhaps the most notable change in RA treatment during the last decade is the advent of biologics, and, in particular, anti-tumour necrosis factor agents. Given these advances, it is useful to assess how healthcare and work-loss costs of patients with RA have changed. Objective: Our objective was to assess changes in healthcare utilization and costs from 1997 to 2006 for patients diagnosed with RA. Methods: Two cohorts (1997 and 2006) of patients withRAandmatched controls were identified fromtwo administrative claims databases along with subsamples of employed patients and matched controls. The analysis focused on the more homogeneous employee subsample. We compared annual excess co-morbidity rates, resource utilization and healthcare and work-loss costs per patient between the 1997 (n= 279) and 2006 cohorts (n= 837) with difference-in-differences methodology. Results with p< 0.05 were considered statistically significant. Results: In the employee subsample, there were no statistically significant differences in the excess prevalence of non-RA co-morbidities or Charlson Co-morbidity Index results, except for cardiovascular disease, which decreased by 11.1%. Excess number of ED visits and days hospitalized decreased by 1.1 visits/patient and 0.9 days/patient, respectively, while rheumatologist visits increased by 0.9 visits/patient. Excess per-patient direct costs were unchanged. However, drug costs increased by $US633/patient, but medical costs decreased by $US618/patient (not significant) [year 2006 values]. Conclusion: For employed patients with RA, there were significant reductions in per-patient excess hospital days, as well as ED visits, and no changes in excess total direct costs over time. New treatments introduced during the study period may be associated with cost savings that offset changes in employee utilization of drug and medical services. In addition, the reductions in excess ED visits and hospital days suggest improvements in patient quality of life. [ABSTRACT FROM AUTHOR]

The authors comment on the importance of integration, continuity and longitudinality to promote patient-centered learning in clinical clerkship.They stress that the understanding of these elements should revolve around the patient. They cite the definition of these three elements and their implications for clinical education. To better prepare trainees for residency and future practice, they suggest creating a harmony among these elements and integrate them into the curriculum.