Pre-analytical mysteries: A case of severe hypervitaminosis D and mild hypercalcaemia

We describe a case of severe hypervitaminosis D and mild hypercalcaemia in a 68-year-old woman who presented with fatigue and weight loss. Her 25-hydroxy vitamin D (25OHD) was > 400 nmol/L (50-150) and corrected serum calcium was 2.83 mmol/L (2.1-2.6). Her intact parathyroid hormone (PTH) was 4.9 pmol/L (2.0-9.5). Further investigation revealed an IgM kappa paraprotein, and a bone marrow aspirate confirmed a diagnosis of lymphoplasmacytic lymphoma/Waldenstrom’s macroglobulinemia (LPL/WM). As the vitamin D level was discordant with the patient’s other results and presentation, the presence of an assay interferent was suspected. A 1-in-2 dilution of the sample returned a 25OHD result of 84 nmol/L in keeping with the presence of an interferent. Testing for rheumatoid factor was negative. The sample was treated with an antibody blocking reagent (Scantibodies) and results were not consistent with heterophile antibody interference. The sample was then analysed using liquid chromatography tandem mass spectrometry (LC-MS/MS), which returned a 25OHD result of 82 nmol/L. Testing on an alternative immunoassay platform produced a 25OHD result of 75 nmol/L. Reapeted testing on the original platform following reduction of the monoclonal paraprotein with chemotherapy, returned a result of 64 nmol/L. The patient’s mild hypercalcaemia persisted following resolution of the monoclonal paraprotein, in keeping with a diagnosis of primary hyperparathyroidism. This case highlights the potential for paraproteins to cause assay interference, and the importance of considering interference when results are incongruous with the clinical presentation.     

To Study or to Sleep? The Academic Costs of Extra Studying at the Expense of Sleep

This longitudinal study examined how nightly variations in adolescents’ study and sleep time are associated with academic problems on the following day. Participants (N = 535, 9th grade M_age = 14.88) completed daily diaries every day for 14 days in 9th, 10th, and 12th grades. Results suggest that regardless of how much a student generally studies each day, if that student sacrifices sleep time to study more than usual, he or she will have more trouble understanding material taught in class and be more likely to struggle on an assignment or test the following day. Because students are increasingly likely to sacrifice sleep time for studying in the latter years of high school, this negative dynamic becomes increasingly prevalent over time.     

OpenAthens odyssey: challenges of implementing federated authentication for a multi-institutional user population

Background:The Texas Medical Center (TMC) is home to one of the world''s largest cohorts of faculty, students, researchers, and clinicians who rely on seamless and immediate access to digital biomedical and health resources. This group is served by the TMC Library, with a collection that includes over 380,000 ebooks and 59,000 ejournals. In 2018, the TMC Library implemented OpenAthens, a federated authentication system to replace a locally hosted instance of EZproxy.Case Presentation:The TMC Library is unique in its multi-institutional user population, which presents distinct challenges in adopting a single sign-on authentication system. Our project involved OpenAthens technical support, information technology teams from six academic institutions, and over thirty publishers. Implementation included the creation of an OpenAthens parent account, an active user directory, a resource catalog, and installation of our OpenAthens credentials at each publisher site. Because the TMC Library serves multiple institutions, OpenAthens built a custom login page and a portal to support both single sign-on and a generic username and password option. This case report discusses the reasons why OpenAthens was chosen, the preparation methods for implementation, the various challenges encountered and resolved, and recommendations for other health sciences libraries considering this system.Conclusions:The OpenAthens system provides important benefits: granular usage reports, single sign-on access, and data to negotiate reduced pricing for online resources. With prior knowledge and preparation, health sciences libraries can successfully implement OpenAthens with customizations tailored to their specific resources and user population.     

The emergence of unique elective identities in the professional identity development research in the counseling profession

In this study, a qualitative content analysis of the professional identity development research in counseling was conducted to describe elements of the development of “elective identities” of leader, research, counselor educator, and social justice practitioner. Predisposing, process, and outcome codes reveal experiences and contexts that influence this development in students, educators, and counselors.     

University students’ motivation,engagement and performance in a large lecture-format general education course

We investigated how high-performers and low-performers differ with regard to motivation and engagement in a university-level, large-format general education geography course. One hundred and ten students participated in the study. A self-report measure was administered three times (at the beginning, middle and end of the semester). Performance data were obtained from final course grades. Results showed there were significant differences between the high- and low-performer groups in motivation but not in engagement. With regard to students’ perceptions of motivational aspects of the course, the low-performer group showed a significant decrease in attention but the high-performer group showed a significant increase. The relevance perceived by both groups decreased over time. The confidence and satisfaction of the low-performer group decreased whereas there was no change in those of the high-performer group throughout the semester. Findings as well as implications for teaching in a college large-format general education course are discussed.     

Exact Small-Sample Differential Item Functioning Methods for Polytomous Items With Illustration Based on an Attitude Survey

Exact nonparametric procedures have been used to identify the level of differential item functioning (DIF) in binary items. This study explored the use of exact DIF procedures with items scored on a Likert scale. The results from an attitude survey suggest that the large-sample Cochran-Mantel-Haenszel (CMH) procedure identifies more items as statistically significant than two comparable exact nonparametric methods. This finding is consistent with previous findings; however, when items are classified in National Assessment of Educational Progress DIF categories, the results show that the CMH and its exact nonparametric counterparts produce almost identical classifications. Since DIF is often evaluated in terms of statistical and practical significance, this study provides evidence that the large-sample CMH procedure may be safely used even when the focal group has as few as 76 cases.     

Contextual Explanations of Local Dependence in Item Clusters in a Large Scale Hands-On Science Performance Assessment

This study provides hypothesized explanations for local item dependence (LID) in a large scale hands-on science performance assessment. Items within multi-step item clusters were classified as low or high in LID using contextual analysis procedures described in this and other studies. LID was identified statistically using the average within cluster (AWC) correlation procedure described in previous studies. Levels of LID identified in contextual analyses were compared to levels of LlD identified in correlation analyses. Consistent with other studies, items that appear to elicit locally dependent responses require examinees to answer and explain their answer or to use given or generated information to respond     

Equivalence of Paper-and-Pencil and Online Administration Modes of the Statewide English Test for Students With and Without Disabilities

This study investigated whether scores obtained from the online and paper-and-pencil administrations of the statewide end-of-course English test were equivalent for students with and without disabilities. Score comparability was evaluated by examining equivalence of factor structure (measurement invariance) and differential item and bundle functioning analyses for the online and paper groups. Results supported measurement invariance between the online and paper groups, suggesting that it is meaningful to compare scores across administration modes. When the data were analyzed at both the item and item bundle (content area) levels, similar performance appeared between the online and paper groups.     

A pathway for wisdom-focused education

ABSTRACT

Interest in the topic of wisdom-focused education has so far not resulted in empirically validated programs for teaching wisdom. To start filling this void, we explore the emerging empirical evidence concerning the fundamental elements required for understanding how one can foster wisdom, with a particular focus on wise reasoning. We define wise reasoning through a combination of intellectual humility, recognition of world in flux/change, open-mindedness to diverse viewpoints, and search for compromise/integration of diverse perspectives. In this article, we review evidence concerning how wise reasoning can be facilitated through experiences, teaching materials, environments and cognitive strategies. We also focus on educators, reviewing emerging evidence on how the process of explaining and guiding others impacts one’s wisdom. We conclude by discussing the development of wisdom-focused education, proposing that greater attention to the situational demands and the variability in wisdom-related characteristics across social contexts should play a critical role in its development.