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Virtual performance-based assessments (VPBAs) are environments for test takers to interact with systems, sometimes including other persons or agents, in order to provide evidence about their knowledge, skills, or other attributes. Examples include tasks based on interactive simulations, games, branching scenarios, and collaboration among students communicating through digital chats. They may be used for summative purposes, as in certification examinations, or for other purposes, as in intelligent tutoring systems and exploratory learning environments. They afford opportunities to obtain direct evidence about capabilities that inherently involve interaction, such as inquiry and collaboration. Our focus here is digital, usually with regard to the environment but always with regard to the form of data. Digital data capture makes it possible to acquire rich details about students’ actions and the evolving situations in which they occur. The challenges they pose to psychometrics lie in designing VPBAs to optimally evoke the targeted capabilities, providing students with affordances that evidence that cognition, capturing the relevant aspects of the performances, identifying meaningful patterns in performances that constitute evidence about the targeted capabilities, and providing an inferential framework for synthesizing the evidence and characterizing its properties. This chapter provides an introduction to VPBAs and psychometric considerations in VPBA design and analysis.

We report on the reversible, electrochemical (de)fluorination of the defect fluoride pyrochlore CsMnFeF6 at room temperature using a liquid electrolyte. CsMnFeF6 was synthesized via three different methods (hydrothermal, ceramic, and mechanochemical), each of which yield products of varying particle size and phase purity. Using galvanostatic cycling, we found that after three oxidative/ reductive cycles, approximately one fluoride ion can be reversibly inserted and removed from mechanochemically synthesized CsMnFeF6 for multiple cycles. Ex-situ X-ray absorption spectroscopy confirmed that both the Mn2+ and Fe3+ in this composition are redox active during cycling. Electrochemical impedance spectroscopy and ex-situ synchrotron powder diffraction were utilized to investigate the delayed onset of significant fluoride (de)insertion. We observed decreased impedance after one full cycle and subtle expansion and contraction of the CsMnFeF6 cubic lattice on oxidation (insertion) and reduction (removal), respectively, over the first two cycles. Our results suggest the formation of fluoride vacancies in early cycles generates mixed-valent Fe that enhances the conductivity and improves the reversibility in later cycles.

Background/Objective: Alteplase may elevate international normalized ratio (INR) results, although the exact rate of elevation occurrence is not firmly established in the literature. The purpose of this study is to determine the occurrence rate of INR elevation following alteplase administration. We also aimed to determine what factors are independently associated with the development of elevated INR following alteplase administration for ischemic stroke. Methods: We conducted a multicenter, retrospective, cohort study of patients who received alteplase for acute ischemic stroke. Patients were screened for baseline INR measurement and a repeat value within 24 hours of alteplase administration. The primary outcome was the percent of patients who experienced ≥0.4-point increase in INR. Secondary outcomes included the rate of adverse bleeding events and identification of factors independently associated with elevated INR following alteplase administration. Results and Conclusions: Two hundred and sixty-one patients were included, with 44 (16.9%) patients having an INR increase of 0.4 or more. Patients with an INR increase ≥0.4 experienced a nonstatistically significant increase in bleeding episodes (8.8% vs 18.2%; P = .10). We identified African American race (odds ratio, 3.48, 95% confidence interval, 1.5-7.6; P = .002) as an independent predictor of INR increase ≥0.04. An INR elevation is common following receipt of alteplase for ischemic stroke. Those of African American race were at increased risk of INR elevation; however, more studies are needed to determine whether these patients are at a higher bleeding risk as a result of INR elevation.

Collaborative problem solving (CPS) has been deemed a critical twenty-first century competency for a variety of contexts. However, less attention has been given to work aimed at the assessment and acquisition of such capabilities. Recently large scale efforts have been devoted toward assessing CPS skills, but there are no agreed upon guiding principles for assessment of this complex construct, particularly for assessment in digital performance situations. There are notable challenges in conceptualizing the complex construct and extracting evidence of CPS skills from large streams of data in digital contexts such as games and simulations. In the current paper, we discuss how the in-task assessment framework (I-TAF), a framework informed by evidence-centered design, can provide guiding principles for the assessment of CPS in these contexts. We give specific attention to one aspect of I-TAF, ontologies, and describe how they can be used to instantiate the student model in evidence-centered design whi...

Shear-phase early transition metal oxides, mostly of Nb, and comprising edge- and corner-shared metal–oxygen octahedra have seen a resurgence in recent years as fast-charging low-voltage electrodes for Li–ion batteries. Mo oxides, broadly, have been less well studied. Here we examine the reduced Mo oxide Mo4O11 that has a structure comprising only corner-connected MoO4 tetrahedra and MoO6 octahedra. Here we show that an electrode formed using micron sized particles of Mo4O11 as the active material can function as a high-rate Li–ion electrode against Li metal, with a stable capacity of over 200 mAh g-1 at the high rate of 5C. Operando X-ray diffraction (XRD), Raman spectroscopy, and entropic potential measurements are employed to understand the nature of charge storage. It is found that the structure dramatically changes upon the first lithiation, and subsequent cycling is completely reversible with low capacity fade. It is the newly formed, and potentially more layered structure that demonstrates high-rate cycling and small voltage polarization. This finding expands the scope of candidate high-rate electrode materials to those beyond the expected Nb-containing shear-phase oxide materials. Figure 1

Collaboration can support performance on a variety of tasks, but recent projects have indicated that group collaborations can also be associated with memory decrements. For example, when people discuss ideas, any shared inaccurate information can be used by group members to complete subsequent tasks. Across two experiments, we examined whether this social contagion is influenced by performance pressures that regularly emerge during group interactions. In Experiment 1, participants under individual-directed pressure, goal-directed pressure, or control conditions studied word lists before completing a collaborative recall with a confederate partner who occasionally recalled incorrect words. We examined whether partner-produced inaccuracies contaminated participants' memories for the list contents on a subsequent individual recall. Goal-directed pressure, focused on monitoring partner accuracy, facilitated subsequent individual recall, as demonstrated by reduced reproductions of partner-generated inaccuracies. In contrast, individual-directed pressure, focused on appearing competent, resulted in greater use of those inaccuracies. Experiment 2 ruled out that the benefits associated with goal-directed pressure were solely due to warning participants about the possibility of social contagion. These results demonstrate that different instantiations of pressure can help or hinder memory-related performance in collaborative settings. Under the right conditions, pressure can help overcome the effects of exposure to inaccurate information. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This project was presented at the 2018 ANNA conference. Funding to support the author’s conference attendance was received from Parkinson’s New South Wales and Mid North Coast Local Health District. Background: Individuals with Parkinson’s disease (PD) have more hospital admissions, longer hospital stay, more complications and worse outcomes compared with similar patients without PD. Limited understanding about PD among healthcare professionals and medication management are key issues for individuals with PD. Methods: This study presents a collaborative clinical practice improvement project that was implemented in a hospital in New South Wales, Australia (September 2015 to May 2018) to resolve issues for patients with PD on admission to hospital. Innovative interventions were implemented to address specific issues identified in the study setting, including an emergency department patient tracking icon, early referral to pharmacists and measures to ensure on-time medication administration and avoidance of contraindicated medications. Qualitative and quantitative data were collected through focus group discussions with PD support group members, surveys involving nurses and patients/carers and a chart audit. Data were analysed using descriptive statistics. Results: These initiatives resulted in practice improvements including identification of 100% of patients with PD presenting/admitted to hospital within 4 hours of presentation/admission, a 19% increase in patients receiving medications on time, an 89% reduction in prescription of contraindicated medications and reduced length of hospital stay. In addition, 80% of patients/carers reported they were very satisfied with their medication management. Conclusion: Patient safety was improved and clinical staff expressed satisfaction with care provision. The initiatives were also standardised across the hospital in a clinical guideline for the care of patients with PD.

Despite the existence of many different “Don’t drink and drive” programs and campaigns over the past 30 years, alcohol intoxication has continued to account for approximately one quarter to one third of all traffic crashes and crash-related deaths in the United States. The present study describes a new ‘hands on’ evidence-based approach involving real alcohol-intoxicated subjects using a virtual reality (VR) driving ‘game’ to educate the public more effectively about the dangers of drunk driving. A single demonstration subject ‘drove’ a VR-based portable driving simulator on multiple occasions before (Pre) and at 30 min intervals for up to six hours after either vehicle (no alcohol), two, four or six ‘drinks’ (3, 6, or 9 ounces of 80 proof vodka). The defensive driving task was a choice reaction crash avoidance steering maneuver in which the driver’s task was to determine which way to turn to avoid a crash and then aggressively steer away to avoid a crash. The primary dependent variable was the latency to initiate an avoidance steering response. Blood alcohol concentration (BAC) determinations (estimations) were conducted immediately prior to driving tests using BAC Track portable breathalyzers. Control drives (Pre-Treatment and Vehicle treatment) were characterized by an approximately 300–320 ms reaction time to initiate a crash avoidance. Alcohol increased crash-avoidance reaction time. Peak BAC values were 35, 78 and 120 mg/dL for two, four and six drinks, respectively, the decline in BAC was comparable and linear for all three treatments. There was a strong correlation (r = 0.85) between pre-drive BAC level and reaction time across all of the alcohol-related drives. There was a significant increase in crash avoidance reaction time when the BAC was 50–79 mg/dL, which is below the legally defined BAC limit (80 mg/dL) currently used in most states in the US. These results demonstrate that (1) this VR-based driving simulator task could be a useful ‘hands on’ tool for providing public service demonstrations regarding the hazards of drinking and driving and (2) a BAC concentration of 50 mg/dL represents a reasonable evidence-based cut-off for alcohol-impaired driving.

ObjectivesNurses and respiratory therapists are seldom allowed to use automated external defibrillators (AED) during in-hospital cardiac arrest. This can result in significant time delays before defibrillation occurs and lower survival for cardiac arrest victims. We sought to identify barriers and facilitators to AED use by nurses and respiratory therapists.MethodsWe conducted semi-structured qualitative interviews with a purposeful sample of nurses and respiratory therapists. We developed the interview guide based on the constructs of the theory of planned behaviour, which elicits salient attitudes, social influences, and control beliefs potentially influencing the intent to use an AED. Interviews were recorded, transcribed verbatim, and analysed until achieving data saturation. Two independent reviewers performed inductive analyses to identify emerging categories and themes, and ranked them by frequency of the number of participants stating the topic.ResultsDemographics for the 24 interviewees include mean age 40.5, 79.2% female, 87.5% performed cardiopulmonary resuscitation (CPR), 29.2% defibrillated a patient. Identified attitudes pertained to the timeliness of defibrillation, patient survival, simplicity of AED use, accuracy of rhythm recognition, and harm to self or others. Social influences consisted of physician and hospital administration support of AED use. Control beliefs included training on AED use, policy allowing AED use, familiarity with AED, and task burden during resuscitation.ConclusionsMost nurses and respiratory therapists intended to use an AED if permitted to do so by a medical directive. Successful implementation would require educational initiatives focusing on safety and efficacy of AEDs, support from physicians and hospital administrators, and additional training on AED use.

Collaborative problem solving (CPS) has been receiving increasing international attention because much of the complex work in the modern world is performed by teams. However, systematic education and training on CPS is lacking for those entering and participating in the workforce. In 2015, the Programme for International Student Assessment (PISA), a global test of educational progress, documented the low levels of proficiency in CPS. This result not only underscores a significant societal need but also presents an important opportunity for psychological scientists to develop, adopt, and implement theory and empirical research on CPS and to work with educators and policy experts to improve training in CPS. This article offers some directions for psychological science to participate in the growing attention to CPS throughout the world. First, it identifies the existing theoretical frameworks and empirical research that focus on CPS. Second, it provides examples of how recent technologies can automate analyses of CPS processes and assessments so that substantially larger data sets can be analyzed and so students can receive immediate feedback on their CPS performance. Third, it identifies some challenges, debates, and uncertainties in creating an infrastructure for research, education, and training in CPS. CPS education and assessment are expected to improve when supported by larger data sets and theoretical frameworks that are informed by psychological science. This will require interdisciplinary efforts that include expertise in psychological science, education, assessment, intelligent digital technologies, and policy.

This research identifies laboratory test methods designed to advance assessment of the effects of structural firefighter gloves on a firefighter’s ability to perform tasks with their hands. Two new hand dexterity test methods are discussed: a modified tool test for measuring glove effects on gross or whole hand motor control, and a novel cylinder lift method for evaluating glove effects on fine or fingertip hand dexterity. Data generated by testing a representative group of structural firefighter and other responder gloves are used to show that these new test methods provide less variable data and a more useful and informative assessment of the effects of glove construction on hand dexterity than that provided by standard small pin pegboard tests. Based on these comparisons, a combination of the newly developed tool and cylinder lift test methods are recommended for evaluating the effects of structural firefighter gloves on hand dexterity in standards used as the basis of certifying the performance of structural firefighter clothing.

Collaborative problem solving (CPS) is a complex construct comprised of skills associated with social and cognitive dimensions. The diverse set of skills within these dimensions make CPS difficult to measure. Typically, research on measuring CPS has used highly constrained environments that help narrow the problem space. In the current study, we applied the in-task assessment framework to support the exploration of CPS skills at a deep level in an open digital environment in which three students worked together to solve an electronics problem. The construct of CPS was defined in depth prior to the implementation of the environment through the development of a complex, hierarchical ontology. The features from the ontology were identified in the data and four theoretically-grounded profiles of types of collaborative problem-solvers were produced - high social/high cognitive, high social/low cognitive, low social/high cognitive, and low social/low cognitive. Results showed that students in the low social/low cognitive profile group demonstrated poorer performance than students in other profile groups. Further, having at least one high social/high cognitive member in a team facilitated performance. This study offers groundwork for future studies in measuring CPS with an approach suitable for less constrained collaborative environments.

PURPOSE: A training module for basic suturing training called Suture Tutor was developed by combining video instruction and voice commands with the Microsoft HoloLens software. We put forth two hypotheses: Trainees find the HoloLens helpful and 2.) HoloLens helps the trainees to achieve a better score in objective skill assessment tests. METHODS: Software module was developed to show instructional video in the HoloLens under voice command. Thirtytwo participants were split into the control group or the HoloLens group. The control group used videos displayed on a computer during training while the HoloLens group practiced with Suture Tutor. Each group was given seven minutes to train with their assigned training method before testing. Testing involved replication of a running locking suturing pattern with a time limit of five minutes and was video recorded. The videos were expert reviewed. Participants in the HoloLens group filled out a usability survey. RESULTS: The trainees found the Hololens to be usable and realistic, and the HoloLens group used the instructional videos more than the control group did (p = 0.0175). There was no difference in the skill assessment test scores between the HoloLens and the control group and their rates of completion in the allotted time was similar. CONCLUSION: Participants found the Suture Tutor to be a user friendly and helpful adjunct. The study was unable to determine if the Suture Tutor helps trainees in achieving a better score in skill assessment testing.

Statins are commonly used medications by HIV-1 patients. Elvitegravir/cobicistat/emtricitabine/tenofovir DF is a single tablet regimen for the treatment of HIV. The pharmacokinetic interaction between cobicistat-boosted elvitegravir (EVG/co) and rosuvastatin was evaluated. Breast cancer resistance protein (BCRP) and organic anion transporting polypeptide (OATP) 1B1 and 1B3 inhibition were assessed in vitro. Healthy subjects (N = 12) received a single dose of rosuvastatin 10 mg alone and in combination with EVG/co. Intensive pharmacokinetic sampling was conducted and safety was assessed throughout the study. Rosuvastatin pharmacokinetic exposure parameters were evaluated using 90% confidence intervals (CI) of the geometric mean ratio (GMR) of the test (combination) versus reference (rosuvastatin alone) using equivalence boundaries of 70-143% for AUCinf and 70-175% for Cmax . Elvitegravir and cobicistat inhibited BCRP and OATP in vitro, emtricitabine and TDF did not. Clinically, study treatments were well tolerated, with adverse events generally mild. Upon coadministration, rosuvastatin plasma concentrations increased (Cmax 89% higher), while AUCinf changes were modest (38% higher) and clinically nonrelevant, potentially driven by moderate inhibition of intestinal efflux by BCRP, and/or hepatic uptake by OATPs by EVG/co. Elvitegravir and cobicistat pharmacokinetics were comparable to historical data. Rosuvastatin may be coadministered with EVG/COBI/FTC/TDF without dose adjustment.

Obesity continues to be a global health problem, and thus it is imperative that new pathways regulating energy balance be identified. Recently, it was reported: (Hayashi K, Cao T, Passmore H, Jourdan-Le Saux C, Fogelgren B, Khan S, Hornstra I, Kim Y, Hayashi M, Csiszar K. J Invest Dermatol 123: 864–871, 2004) that mice carrying a missense mutation in myelin protein zero-like 3 ( Mpzl3rc) have reduced body weight. To determine how Mpzl3 controls energy balance in vivo, we generated mice deficient in myelin protein zero-like 3 ( Mpzl3-KO). Interestingly, KO mice were hyperphagic yet had reduced body weight and fat mass. Moreover, KO mice were highly resistant to body weight and fat mass gain after exposure to a high-fat, energy-dense diet. These effects on body weight and adiposity were driven, in part, by a pronounced increase in whole body energy expenditure levels in KO mice. KO mice also had reduced blood glucose levels during an intraperitoneal glucose challenge and significant reductions in circulating insulin levels suggesting an increase in insulin sensitivity. In addition, there was an overall increase in oxidative capacity and contractile force in skeletal muscle isolated from KO mice. Hepatic triglyceride levels were reduced by 92% in livers of KO mice, in part due to a reduction in de novo lipid synthesis. Interestingly, Mpzl3 mRNA expression in liver was increased in diet-induced obese mice. Moreover, KO mice exhibited an increase in insulin-stimulated Akt signaling in the liver, further demonstrating that Mpzl3 can regulate insulin sensitivity in this tissue. We have determined that Mpzl3 has a novel physiological role in controlling body weight regulation, energy expenditure, glycemic control, and hepatic triglyceride synthesis in mice.

This study evaluated the effect of cobicistat (COBI) on glomerular filtration rate in subjects with normal renal function (RF) or with mild/moderate renal impairment, by comparing creatinine clearance [estimated glomerular filtration rate (eGFR)] with actual GFR (aGFR) using iohexol, a probe drug excreted by glomerular filtration. COBI is a potent CYP3A inhibitor (pharmacoenhancer) currently in phase 3 testing with elvitegravir, atazanavir, and darunavir.Normal RF subjects received COBI 150 mg QD, ritonavir (RTV) 100 mg QD, or placebo for 7 days; subjects with mild/moderate renal impairment received COBI 150 mg QD. The eGFR and aGFR were measured on days 0, 7, and 14 and within-subject changes calculated relative to day 0. COBI and RTV pharmacokinetics were analyzed on day 7.All 36 subjects in cohort 1 and 17 of 18 subjects in cohort 2 completed all study treatments. Study treatments were well tolerated. Small increases in serum creatinine with corresponding mean decreases in eGFR (∼10 mL/min or mL/min per 1.73 m) were observed on day 7 relative to day 0 in subjects receiving COBI (P0.05). The decreases were reversible on COBI discontinuation; mean eGFR values returned to baseline on day 14 (P0.05). No statistically significant changes in aGFR on days 7 or 14 relative to day 0 were seen with COBI (P0.05). No statistically significant decreases in aGFR or eGFR were observed with RTV or placebo.COBI affects eGFR but not the actual GFR. The time to onset, magnitude, and time to resolution of changes in eGFR are consistent with altered proximal tubular secretion of creatinine through inhibition of drug transporters.

We have addressed the role of occipital and somatosensory cortex in a tactile discrimination task. Sight-ed and congenitally blind subjects rated the rough-ness and distance spacing for a series of raised dot patterns. When judging roughness, intermediate dot spacings were perceived as being the most rough, while distance judgments generated a linear relation. Low-frequency rTMS applied to somatosensory cortex disrupted roughness without affecting distance judgments, while rTMS to occipital cortex disrupted distance but not roughness judgments. We also tested an early blind patient with bilateral occipital cortex damage. Her performance on the roughness determination task was normal; however, she was greatly impaired with distance judgments. The findings suggest a double-dissociation effect in which roughness and distance are primarily processed in somatosensory and occipital cortex, respectively. The differential effect of rTMS on task performance and corroborative clinical evidence suggest that occipital cortex is engaged in tactile tasks requiring fine spatial discrimination.

Follistatin (FST) is a member of the tissue growth factor β family and is a secreted glycoprotein that antagonizes many members of the family, including activin A, growth differentiation factor 11, and myostatin. The objective of this study was to explore the use of an engineered follistatin therapeutic created by fusing FST315 lacking heparin binding activity to the N terminus of a murine IgG1 Fc (FST315-ΔHBS-Fc) as a systemic therapeutic agent in models of muscle injury. Systemic administration of this molecule was found to increase body weight and lean muscle mass after weekly administration in normal mice. Subsequently, we tested this agent in several models of muscle injury, which were chosen based on their severity of damage and their ability to reflect clinical settings. FST315-ΔHBS-Fc treatment proved to be a potent inducer of muscle remodeling and regeneration. FST315-ΔHBS-Fc induced improvements in muscle repair after injury/atrophy by modulating the early inflammatory phase allowing for increased macrophage density, and Pax7-positive cells leading to an accelerated restoration of myofibers and muscle function. Collectively, these data demonstrate the benefits of a therapeutically viable form of FST that can be leveraged as an alternate means of ameliorating muscle regeneration.

Statins are commonly used medications by HIV-1 patients. Elvitegravir/cobicistat/emtricitabine/tenofovir DF is a single tablet regimen for the treatment of HIV. The pharmacokinetic interaction between cobicistat-boosted elvitegravir (EVG/co) and rosuvastatin was evaluated. Breast cancer resistance protein (BCRP) and organic anion transporting polypeptide (OATP) 1B1 and 1B3 inhibition were assessed in vitro. Healthy subjects (N = 12) received a single dose of rosuvastatin 10 mg alone and in combination with EVG/co. Intensive pharmacokinetic sampling was conducted and safety was assessed throughout the study. Rosuvastatin pharmacokinetic exposure parameters were evaluated using 90% confidence intervals (CI) of the geometric mean ratio (GMR) of the test (combination) versus reference (rosuvastatin alone) using equivalence boundaries of 70-143% for AUCinf and 70-175% for Cmax . Elvitegravir and cobicistat inhibited BCRP and OATP in vitro, emtricitabine and TDF did not. Clinically, study treatments were well tolerated, with adverse events generally mild. Upon coadministration, rosuvastatin plasma concentrations increased (Cmax 89% higher), while AUCinf changes were modest (38% higher) and clinically nonrelevant, potentially driven by moderate inhibition of intestinal efflux by BCRP, and/or hepatic uptake by OATPs by EVG/co. Elvitegravir and cobicistat pharmacokinetics were comparable to historical data. Rosuvastatin may be coadministered with EVG/COBI/FTC/TDF without dose adjustment.

PURPOSE: To identify predictors of oral mucositis and gastrointestinal toxicity after high-dose therapy. PATIENTS AND METHODS: Mucositis and gastrointestinal toxicity were prospectively evaluated in 202 recipients of high-dose therapy and autologous or allogeneic stem-cell rescue. Of 10 outcome variables, three were selected as end points: the peak value for the University of Nebraska Oral Assessment Score (MUCPEAK), the duration of parenteral nutritional support, and the peak daily output of diarrhea. Potential covariates included patient age, sex, diagnosis, treatment protocol, transplantation type, stem-cell source, and rate of neutrophil recovery. The three selected end points were also examined for correlation with blood infections and transplant-related mortality. RESULTS: A diagnosis of leukemia, use of total body irradiation, allogeneic transplantation, and delayed neutrophil recovery were associated with increased oral mucositis and longer parenteral nutritional support. No factors were associated with diarrhea. Also, moderate to severe oral mucositis (MUCPEAK ≥ 18 on a scale of 8 to 24) was correlated with blood infections and transplant-related mortality: 60% of patients with MUCPEAK ≥ 18 had positive blood cultures versus 30% of patients with MUCPEAK less than 18 (P = .001); 24% of patients with MUCPEAK ≥ 18 died during the transplantation procedure versus 4% of patients with MUCPEAK less than 18 (P = .001). CONCLUSION: Gastrointestinal toxicity is a major cause of transplant-related morbidity and mortality, emphasizing the need for corrective strategies. The peak oral mucositis score and the duration of parenteral nutritional support are useful indices of gastrointestinal toxicity because these end points are correlated with clinically significant events, including blood infections and treatment-related mortality.