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Background: During early stages, patients with neurodegenerative diseases (NDG) often present with depressive symptoms. However, because depression is a heterogeneous disorder, more precise delineation of the specific depressive symptom profiles that arise early in distinct NDG syndromes is necessary to enhance patient diagnosis and care. Methods and Findings: Five-hundred and sixty four participants self-reported their depressive symptoms using the Geriatric Depression Scale (GDS), including 111 healthy older control subjects (NC) and 453 patients diagnosed with one of six NDGs who were at the mild stage of disease (CDR® Dementia Staging Instrument ≤ 1) [186 Alzheimer's disease (AD), 76 behavioral variant frontotemporal dementia (bvFTD), 52 semantic variant primary progressive aphasia (svPPA), 46 non-fluent variant PPA (nfvPPA), 49 progressive supranuclear palsy syndrome (PSPS), 44 corticobasal syndrome (CBS)]. The GDS was divided into subscales based on a previously published factor analysis, representing five symptoms (dysphoria, hopelessness, withdrawal, worry, and cognitive concerns). Mixed models were created to examine differences in depression subscale by group, and logistic regression analyses were performed to determine if patterns of depressive symptoms could predict a patient's NDG syndrome. PSPS patients presented with a hopeless, dysphoric, and withdrawn pattern, while patients with CBS presented with a similar but less severe pattern. Worry was a key symptom in the profile of patients with svPPA, while ADs only had abnormally elevated cognitive concerns. Depressive profile accurately predicted NDG diagnosis at a rate of between 70 and 84% accuracy. Conclusions: These results suggest that attention to specific depressive symptom profile can improve diagnostic sensitivity and can be used to provide more individualized patient care.

We hypothesize that convolutional neural networks (CNN) can be used to predict neoadjuvant chemotherapy (NAC) response using a breast MRI tumor dataset prior to initiation of chemotherapy. An institutional review board-approved retrospective review of our database from January 2009 to June 2016 identified 141 locally advanced breast cancer patients who (1) underwent breast MRI prior to the initiation of NAC, (2) successfully completed adriamycin/taxane-based NAC, and (3) underwent surgical resection with available final surgical pathology data. Patients were classified into three groups based on their NAC response confirmed on final surgical pathology: complete (group 1), partial (group 2), and no response/progression (group 3). A total of 3107 volumetric slices of 141 tumors were evaluated. Breast tumor was identified on first T1 postcontrast dynamic images and underwent 3D segmentation. CNN consisted of ten convolutional layers, four max-pooling layers, and dropout of 50% after a fully connected layer. Dropout, augmentation, and L2 regularization were implemented to prevent overfitting of data. Non-linear functions were modeled by a rectified linear unit (ReLU). Batch normalization was used between the convolutional and ReLU layers to limit drift of layer activations during training. A three-class neoadjuvant prediction model was evaluated (group 1, group 2, or group 3). The CNN achieved an overall accuracy of 88% in three-class prediction of neoadjuvant treatment response. Three-class prediction discriminating one group from the other two was analyzed. Group 1 had a specificity of 95.1% ± 3.1%, sensitivity of 73.9% ± 4.5%, and accuracy of 87.7% ± 0.6%. Group 2 (partial response) had a specificity of 91.6% ± 1.3%, sensitivity of 82.4% ± 2.7%, and accuracy of 87.7% ± 0.6%. Group 3 (no response/progression) had a specificity of 93.4% ± 2.9%, sensitivity of 76.8% ± 5.7%, and accuracy of 87.8% ± 0.6%. It is feasible for current deep CNN architectures to be trained to predict NAC treatment response using a breast MRI dataset obtained prior to initiation of chemotherapy. Larger dataset will likely improve our prediction model.

Despite inquiry-based teaching was introduced and encouraged as significant tool to develop students' scientific knowledge and habits of mind, its implementation has not been well established in science classrooms in Korea. To understand the challenges and difficulties of the practice of inquiry practical work, this study particularly aims to understand how pre-service teachers' understandings of inquiry and practical work have been shaped in educational and social contexts in Korea and later how their views and willingness could be developed through redesigning and practicing textbook activities. 25 third-year students in an elementary science methods course in Korea participated in the study. Mixed methods including questionnaires and reflective discussion and writing were employed for data collection. The pre-service teachers expressed their ideas and difficulties of inquiry approach in their everyday classroom conditions and social situation and thus unwillingness to attempt its practice. Throughout the study, they gradually overcame their resistance and reluctance toward inquiry and practical work and develop willingness and motivation to practice in everyday science classrooms. This study further suggests need for thorough examination on teachers' situated contexts for developing ways of inquiry-based practical work. (Contains 1 table and 1 figure.)

BackgroundThe purpose of this study was to report the clinical outcomes and related prognostic factors of patients who underwent radiotherapy (RT) for the treatment of recurrent, never-irradiated oral cavity cancer (recurrent OCC).MethodsThe records of consecutive patients with nonmetastatic recurrent OCC who presented to and were treated with RT at our institution between 1989 and 2011 were reviewed. The Kaplan-Meier method was used to calculate overall survival (OS). The cumulative incidences of disease-specific death, local failure, regional failure, and distant metastasis were calculated with death as a competing risk.ResultsOne hundred twenty-three patients were identified. Median follow-up for living patients was 54 months and 16 months for all patients. Ninety-one patients had salvage surgery followed by adjuvant RT. Definitive RT was utilized in the remaining 32 patients. The 5-year OS was 40%. The 5-year cumulative incidence of disease-specific death, local failure, regional failure, and distant metastasis was 55%, 34%, 22%, and 20%, respectively. Recurrent T classification and lack of salvage surgery were independently associated with worse disease-specific death and decreased OS, respectively. Subset analysis of patients who underwent salvage surgery demonstrated that age, recurrent T classification, and perineural invasion (PNI) were independently associated with decreased OS; recurrent T classification and thicker tumors were independently associated with worse disease-specific death; and positive/close margins and primary T classification were independently associated with increased local failure.ConclusionIn this group of patients with recurrent OCC, clinical outcomes were similar or improved when compared with other recurrent OCC-specific reports. In the salvage surgery subset, tumor thickness and PNI are recurrent pathologic features associated with outcomes that were only previously demonstrated in studies of primary disease. Because of the relatively worse outcomes in patients receiving definitive or adjuvant RT for recurrent OCC, we advocate for the appropriate use of postoperative RT in the initial management of oral cavity cancers.

PurposeMinor salivary gland cancers are rare and account for roughly 2% to 3% of all head and neck tumors. This is a retrospective review in a modern cohort of patients treated for this rare cancer with surgery and adjuvant radiation therapy.Materials and methodsBetween February 1990 and December 2010, 98 patients with cancer of the minor salivary glands were identified and treated at a single institution. The median radiation dose was 63 Gy. Outcomes assessed included local control (LC), locoregional control (LRC), and overall survival (OS). Toxicity was graded using the Common Terminology Criteria for Adverse Events, version 3.0. Competing-risk analysis using the Gray test was performed, with death as the competing risk. OS was calculated by the Kaplan-Meier method.ResultsWith a median follow-up of 7.3 years, the 5- and 10-year LC and LRC rates were 87.9% and 83%, and 80.5% and 73.7%, respectively. Higher T stage and adenocarcinoma histology were the significant negative prognostic factors for both LC and LRC. Freedom from distant metastasis at 5 and 10 years were 83% and 63%, respectively. The median OS was 19.6 years. Overall, no grade 4 or 5 toxicities occurred, and 20% of the cohort experienced an acute grade 3 toxicity, and 6% with a grade 3 late toxicity.ConclusionsIn a modern cohort treated with surgery and radiotherapy, excellent outcomes can be achieved with lower toxicity rates compared with older published series.

Background: During early stages, patients with neurodegenerative diseases (NDG) often present with depressive symptoms. However, because depression is a heterogeneous disorder, more precise delineation of the specific depressive symptom profiles that arise early in distinct NDG syndromes is necessary to enhance patient diagnosis and care.Methods and Findings: Five-hundred and sixty four participants self-reported their depressive symptoms using the Geriatric Depression Scale (GDS), including 111 healthy older control subjects (NC) and 453 patients diagnosed with one of six NDGs who were at the mild stage of disease (CDR® Dementia Staging Instrument ≤ 1) [186 Alzheimer's disease (AD), 76 behavioral variant frontotemporal dementia (bvFTD), 52 semantic variant primary progressive aphasia (svPPA), 46 non-fluent variant PPA (nfvPPA), 49 progressive supranuclear palsy syndrome (PSPS), 44 corticobasal syndrome (CBS)]. The GDS was divided into subscales based on a previously published factor analysis, representing five symptoms (dysphoria, hopelessness, withdrawal, worry, and cognitive concerns). Mixed models were created to examine differences in depression subscale by group, and logistic regression analyses were performed to determine if patterns of depressive symptoms could predict a patient's NDG syndrome. PSPS patients presented with a hopeless, dysphoric, and withdrawn pattern, while patients with CBS presented with a similar but less severe pattern. Worry was a key symptom in the profile of patients with svPPA, while ADs only had abnormally elevated cognitive concerns. Depressive profile accurately predicted NDG diagnosis at a rate of between 70 and 84% accuracy.Conclusions: These results suggest that attention to specific depressive symptom profile can improve diagnostic sensitivity and can be used to provide more individualized patient care.

This study investigated the potential of students' written and oral questions both as an epistemic probe and heuristic for initiating collaborative argumentation in science. Four classes of students, aged 12-14 years from two countries, were asked to discuss which of two graphs best represented the change in temperature as ice was heated to steam. The discussion was initiated by asking questions about the phenomenon. Working in groups (with members who had differing viewpoints) and guided by a set of question prompts, an argument sheet, and an argument diagram, students discussed contrasting arguments. One group of students from each class was audiotaped. The number of questions written, the concepts addressed, and the quality of written arguments were then scored. A positive correlation between these factors was found. Discourse analysis showed that the initial focus on questions prompted students to articulate their puzzlement; make explicit their claims and (mis)conceptions; identify and relate relevant key concepts; construct explanations; and consider alternative propositions when their ideas were challenged. Productive argumentation was characterized by students' questions which focused on key ideas of inquiry, a variety of scientific concepts, and which made explicit reference to the structural components of an argument. These findings suggest that supporting students in productive discourse is aided by scaffolding student questioning, teaching the criteria for a good argument, and providing a structure that helps them to organize and verbalize their arguments. (Contains 5 tables and 2 figures.)

Students living in cities seldom experience the rural outdoors when learning science. This lack of first-hand experience with nature is of concern, especially when they are learning about animals, plants and ecosystems. This study investigated how a teacher in Singapore organised a field trip to the rainforest to help his students bridge the gap between what they learnt theoretically in school and experientially from the natural environment. The teacher first identified students' ideas and questions about tropical forests. Based on this formative feedback and using a "bottom-up" approach, he then designed investigative activities that resolved around students' questions and that addressed their preconceptions. (Contains 1 table.)

This study explores how student-generated questions can support argumentation in science. Students were asked to discuss which of two graphs showing the change in temperature with time when ice is heated to steam was correct. Four classes of students, aged 12-14 years, from two countries, first wrote questions about the phenomenon. Then, working in groups with members who differed in their views, they discussed possible answers. To help them structure their arguments, students were given a sheet with prompts to guide their thinking and another sheet on which to represent their argument diagrammatically. One group of students from each class was audiotaped. Data from both students' written work and the taped oral discourse were then analyzed for types of questions asked, the content and function of their talk, and the quality of arguments elicited. To illustrate the dynamic interaction between students' questions and the evolution of their arguments, the discourse of one group is presented as a case study and comparative analyses made with the discourse from the other three groups. Emerging from our analysis is a tentative explanatory model of how different forms of interaction and, in particular, questioning are needed for productive argumentation to occur. (Contains 6 tables and 6 figures.)

This study was carried out in the context of formative assessment where assessment and learning were integrated to enhance both teaching and learning. The purpose of the study was to: (a) identify pupils' ideas about biological inheritance through the use of a concept cartoon, pupils' drawings and talk, and (b) devise scaffolding structures that could be used together with the concept cartoon to support pupils in articulating their ideas about concepts associated with inheritance. The study was conducted in a primary 5 class (ages 10-11) in Singapore and pupils worked in small groups to discuss the opposing views posed by the characters in the concept cartoon. Scaffolding tools were used to guide pupils' discussions and to encourage pupils to evaluate, challenge, and document their own and their peers' ideas. A number of alternative conceptions were diagnosed through pupils' oral and written discourse, and students' questions and assertions had formative potential as they drew upon each others' ideas. By designing a formative learning environment, the teacher not only monitored pupils' thinking but also engaged the pupils in active learning. (Contains 4 figures.)

The purpose of this study was to investigate how concept cartoons, together with other diagnostic and scaffolding tools, could be used in formative assessment, to stimulate talk and argumentation among students in small groups, as part of peer-assessment and self-assessment; and to provide diagnostic feedback about students' misconceptions to the teacher for teaching towards conceptual change. Two classes of Primary 5 and 6 students worked in small groups to discuss the opposing viewpoints posed by the cartoon characters, using scaffolding tools to guide their discussions and to evaluate, challenge, and document each others' ideas. Students also used drawings to depict their ideas. The conversation from one group was audio-taped. These tools provided a record of students' thinking in a form that was accessible to the teacher for monitoring and feedback purposes. Findings showed dialogic talk and interactive argumentation among students where they made their reasoning visible. Students' assertions and questions had formative potential as they encouraged exploratory and reflective discourse by drawing upon each others' ideas. The teacher's discursive practices, as well as her role in designing scaffolding structures for supporting 'assessment conversations' when using concept cartoons and in devising strategies that take into account students' conceptual and epistemic thinking, are emphasised. (Contains 3 figures.)

One way of implementing project-based science (PBS) is to use problem-based learning (PBL), in which students formulate their own problems. These problems are often ill-structured, mirroring complex real-life problems where data are often messy and inclusive. In this article, the authors describe how they used PBL in a ninth-grade biology class in Singapore, where the socio-cultural context is different from the United States in some aspects. They discuss the tools, pedagogy, and strategies that they used during a unit on food and nutrition. (Contains 3 figures.)

Students' questions play an important role in meaningful learning and scientific inquiry. They are a potential resource for both teaching and learning science. Despite the capacity of students' questions for enhancing learning, much of this potential still remains untapped. The purpose of this paper, therefore, is to examine and review the existing research on students' questions and to explore ways of advancing future work into this area. The paper begins by highlighting the importance and role of students' questions from the perspectives of both the learner and the teacher. It then reviews the empirical research on students' questions, with a focus on four areas: (1) the nature and types of these questions; (2) the effects of teaching students questioning skills; (3) the relationship between students' questions and selected variables; and (4) teachers' responses to, and students' perceptions of, students' questions. Following this, some issues and implications of students' questions for classroom instruction are discussed. The paper concludes by suggesting several areas for future research that have significant value for student learning. (Contains 4 tables.)

The purpose of this study was to find out how teachers use questions in classroom discourse to scaffold student thinking and help students construct scientific knowledge. The study was conducted in large-class settings where the medium of instruction was English although the students were non-native speakers of the language. Six teachers teaching grade 7 science classes from four schools participated in the study. Thirty-six lessons covering a range of topics were observed across a variety of lesson structures such as expository teaching, whole-class discussions, and laboratory work. The lessons were audiotaped and videotaped. Verbal transcripts of classroom discourse were analyzed interpretively. Particular attention was paid to questioning exchanges that stimulated productive thinking in students, as manifested by their verbal responses. A framework was developed that included four questioning approaches adopted by the teachers. This included Socratic questioning, verbal jigsaw, semantic tapestry, and framing. This paper describes these various questioning approaches, their features, and the conditions under which they were used. It also discusses the implications of these approaches for instructional practice. The findings from this study have potential in translating research insights into practical advice for teachers regarding tactical moves in classroom discourse, and provide guidelines for teachers to increase their repertoire of questioning skills.

The purpose of this study was to (a) develop an analytical framework that represents classroom talk and questioning in science, (b) find out how teachers use questioning to engage their students in thinking about conceptual content that enables the construction of knowledge, and (c) identify the various forms of feedback provided by teachers in the follow-up move of the initiation-response-follow-up format of teaching exchange. Several lessons from Year 7 classes were observed across a variety of lesson structures such as expository teaching, whole-class discussions, laboratory demonstration, and hands-on practical work. The lessons were audiotaped and videotaped. Transcripts of the lessons were made and analysed, with particular attention paid to interactions that involved questions. Using the "Questioning-based Discourse" analytical framework developed in this study, four different types of feedback were identified. Interactional issues related to ways of speaking and questioning that encourage student responses and thinking are addressed. This information provides a description of what constitutes effective discourse in science teaching and learning, and will also be useful for both teachers and teacher-educators in identifying an appropriate repertoire of skills for subsequent teacher education and professional development. (Contains 7 tables and 1 figure.)

This case study involved year 9 students carrying out project work in biology via problem-based learning. The purpose of the study was to (a) find out how students approach and work through ill-structured problems, (b) identify some issues and challenges related to the use of such problems, and (c) offer some practical suggestions on the implementation of problem-based project work. Data sources included observation and field notes, students' written documents, audiotapes and videotapes of students at work, and student interviews. The findings showed that several students initially experienced difficulties in identifying a problem themselves but after discussing with family and friends, were able to overcome this initial barrier and subsequently formulated personally meaningful problems for investigation. The ill-structured problems stimulated students to pose questions which charted their courses of action, leading to independent inquiry. Students were led to investigate multidisciplinary elements beyond the boundaries of typical school science, and also learned about different modes of inquiry. The issues and challenges identified included identifying a problem for investigation; asking questions to negotiate the learning pathway; deciding what areas to pursue, given a multitude of possibilities; and figuring out how to extract relevant information from the available mass. Implications of the findings for instructional practice are discussed.

The purpose of this study was to find out: (a) pupils' attitudes towards open-ended science investigations, and (b) the problems that pupils encounter when carrying out such investigations in groups. The study was conducted in a class of 39 primary 6 pupils of mixed ability who carried out four investigations. Data were based on pupils' responses on an attitude survey questionnaire, interviews, video tapes of pupils performing the investigations and field notes. The majority of the pupils liked conducting such investigations. Reasons for positive responses were that the pupils had the freedom to explore and devise their own procedures to find out things that they wanted to know about, they could work together and discuss with friends, the investigations were interesting and it was a valuable learning experience. Reasons for negative responses included the difficulty of coming up with good ideas to design the investigations, and group conflicts. The findings also indicate that group dynamics played an important role in influencing pupils' attitudes towards the investigations.

This study employed problem-based learning for project work in a year 9 biology class. The purpose of the study was to investigate (a) students' inspirations for their self-generated problems and questions, (b) the kinds of questions that students asked individually and collaboratively, and (c) how students' questions guided them in knowledge construction. Data sources included observation and field notes, students' written documents, audiotapes and videotapes of students working in groups, and student interviews. Sources of inspiration for students' problems and questions included cultural beliefs and folklore; wonderment about information propagated by advertisements and the media; curiosity arising from personal encounters, family members' concerns, or observations of others; and issues arising from previous lessons in the school curriculum. Questions asked individually pertained to validation of common beliefs and misconceptions, basic information, explanations, and imagined scenarios. The findings regarding questions asked collaboratively are presented as two assertions. Assertion 1 maintained that students' course of learning were driven by their questions. Assertion 2 was that the ability to ask the "right" questions and the extent to which these could be answered, were important in sustaining students' interest in the project. Implications of the findings for instructional practice are discussed.

This study employed problem-based learning (PBL) for project work in a Year 9 biology class. The purpose of the study was to investigate (a) how self-generated problems and questions directed students in their learning, (b) how students reacted to this instructional approach, and (c) the problems that they encountered. Students formulated problems that they were interested in investigating and posed questions to which they wanted answers. These became the focus of subsequent inquiry and served to direct student learning in collaborative groups. Data sources included observation and field notes, students' written documents, audiotapes and videotapes of students working in groups, and student interviews. Issues relating to the design, management, and implementation of PBL in project work are discussed. (Contains 4 tables.)

Identifies the types of questions that students ask during science learning. Explicates the role of students' questions in the knowledge construction process, particularly in educational discourse. Investigates the relationship between students' questions and approaches to learning and discusses some emergent issues related to student questioning. Uses observations and interviews with six grade 8 students. (Author/LM)

Reports on a study that explored the types of questions that students ask for open-ended science investigations. Discusses how teachers can help students identify problems and pose questions that are feasible for investigation. (Contains 55 references.) (DDR)

Explores the differences between deep and surface approaches to learning science. Findings indicate that the deep-surface learning differences fall into five categories: (1) generative thinking; (2) nature of explanations; (3) asking questions; (4) metacognitive activity; and (5) approach to tasks. Suggests that teachers can encourage a deep learning approach by providing prompts and contextualized scaffolding. (Contains 89 references.) (Author/WRM)

Investigates science teachers' views about their use of science instructional techniques in general, and the problem-solving teaching approach in particular. Focuses on difficulties faced by science teachers in implementing the problem solving teaching approach in the science classroom. Indicates teachers' concerns about covering the science syllabus for examinations and students' abilities and motivation. (Contains 30 references.) (Author/YDS)

Correlates the kinds of strategies associated with a deep approach to learning science. Analyzes the interactions of two groups of grade 8 students while they were engaged in hands-on science activities during instruction in a chemistry unit. Focuses on two students who showed a deep approach to learning. (Contains 47 references.) (Author/YDS)