The laboratory test utilization management toolbox

Efficiently managing laboratory test utilization requires both ensuring adequate utilization of needed tests in some patients and discouraging superfluous tests in other patients. After the difficult clinical decision is made to define the patients that do and do not need a test, a wealth of interventions are available to the clinician and laboratorian to help guide appropriate utilization. These interventions are collectively referred to here as the utilization management toolbox. Experience has shown that some tools in the toolbox are weak and other are strong, and that tools are most effective when many are used simultaneously. While the outcomes of utilization management studies are not always as concrete as may be desired, what data is available in the literature indicate that strong utilization management interventions are safe and effective measures to improve patient health and reduce waste in an era of increasing financial pressure.     

A psychometric evaluation of the digital logic concept inventory

Concept inventories hold tremendous promise for promoting the rigorous evaluation of teaching methods that might remedy common student misconceptions and promote deep learning. The measurements from concept inventories can be trusted only if the concept inventories are evaluated both by expert feedback and statistical scrutiny (psychometric evaluation). Classical Test Theory and Item Response Theory provide two psychometric frameworks for evaluating the quality of assessment tools. We discuss how these theories can be applied to assessment tools generally and then apply them to the Digital Logic Concept Inventory (DLCI). We demonstrate that the DLCI is sufficiently reliable for research purposes when used in its entirety and as a post-course assessment of students’ conceptual understanding of digital logic. The DLCI can also discriminate between students across a wide range of ability levels, providing the most information about weaker students’ ability levels.     

Environmental inequality and disparities in school readiness: The role of neurotoxic lead

Developmental science has increasingly scrutinized how environmental hazards influence child outcomes, but few studies examine how contaminants affect disparities in early skill formation. Linking research on environmental inequality and early childhood development, this study assessed whether differences in exposure to neurotoxic lead explain sociodemographic gaps in school readiness. Using panel data tracking a representative sample of 1266 Chicago children (50% female, 16% White, 30% Black, 49% Hispanic, μ_age = 5.2 months at baseline, collected 1994–2002), analyses quantified the contribution of lead contamination to class and racial disparities in vocabulary skills and attention problems at ages 4 and 5. Results suggested that lead contamination explains 15%–25% and 33%–66% of the disparities in each outcome, respectively, although imprecise estimates preclude drawing firm inferences about attention problems.