Modeling and Testing Differential Item Functioning in Unidimensional Binary Item Response Models with a Single Continuous Covariate: A Functional Data Analysis Approach

Differential item functioning (DIF), referring to between-group variation in item characteristics above and beyond the group-level disparity in the latent variable of interest, has long been regarded as an important item-level diagnostic. The presence of DIF impairs the fit of the single-group item response model being used, and calls for either model modification or item deletion in practice, depending on the mode of analysis. Methods for testing DIF with continuous covariates, rather than categorical grouping variables, have been developed; however, they are restrictive in parametric forms, and thus are not sufficiently flexible to describe complex interaction among latent variables and covariates. In the current study, we formulate the probability of endorsing each test item as a general bivariate function of a unidimensional latent trait and a single covariate, which is then approximated by a two-dimensional smoothing spline. The accuracy and precision of the proposed procedure is evaluated via Monte Carlo simulations. If anchor items are available, we proposed an extended model that simultaneously estimates item characteristic functions (ICFs) for anchor items, ICFs conditional on the covariate for non-anchor items, and the latent variable density conditional on the covariate—all using regression splines. A permutation DIF test is developed, and its performance is compared to the conventional parametric approach in a simulation study. We also illustrate the proposed semiparametric DIF testing procedure with an empirical example.     

MTHFR: Addressing Genetic Counseling Dilemmas Using Evidence-Based Literature

The 5, 10 methylenetetrahydrofolate reductase (MTHFR) enzyme is a catalyst in the folate metabolism pathway, the byproducts of which are involved in the remethylation of homocysteine to methionine. Methionine is a precursor for a major DNA methyl donor and is important for DNA methylation and gene regulation. Rare mutations in the MTHFR gene have been associated with autosomal recessive MTHFR deficiency leading to homocystinuria. In addition, two polymorphic variants in this gene (C677T and A1298C) have been implicated in a mild form of MTHFR deficiency associated with hyperhomocysteinemia. Mild to moderate hyperhomocysteinemia has been previously implicated as a risk factor for cardiovascular disease. Further, the presence of these variants, with and without mildly elevated levels of homocysteine, has been studied in relation to several multifactorial disorders including recurrent pregnancy loss, neural tube defects and congenital anomalies, cancer, and neurodevelopmental disorders. Given this wide spectrum of purported clinical implications and the prevalence of these polymorphisms, genetic counselors may encounter questions regarding the significance of MTHFR polymorphisms in a variety of settings. Here we present a brief background of the MTHFR polymorphisms, review of the literature regarding clinical considerations, and discussion of relevant genetic counseling aspects through case vignettes. Educational resources for patients and providers are also included.     

Forum on seminary teaching and formation online

This Forum explores what the Association of Theological Schools (ATS) has been learning about formation in online contexts through the Educational Models and Practices project. Deborah Gin's opening essay briefly enumerates operating assumptions, several widespread misconceptions, and emerging recommended practices. G. Brooke Lester proposes a definition of formation as transformation towards community, which is grounded in constructivist learning theory. He then reflects on the possibilities for this kind of community through online learning environments. Barbara Blodgett's contribution draws on “transactional distance theory” to analyze how a variety of pedagogical techniques (both online and face to face) can work to either exacerbate or minimize the distance between learners, which is an important contributor to formation and community. The Forum originated as panel presentations at the November 2017 Society of Biblical Literature and American Academy of Religion conferences.     

Fighting Back Against Achievement Culture: Cheating as an Act of Rebellion in a High-Pressure Secondary School

This article argues that document analysis can add a more nuanced understanding of student ethical reasoning and enhance current approaches to cheating research. To demonstrate the benefits of this approach, I examine the cheating epidemic at Stuyvesant High School through editorials in their school newspaper. Stuyvesant is known for academically talented students focused on elite college admission. My findings suggest that the influence of achievement culture on cheating is more complex than what was captured by the school’s internal cheating survey or in traditional cheating research. Further, contrary to existing expectations, students do not collaborate purely to boost their own academic performance. In a system they define as unfair and rigged, they collaborate even when it puts them at an academic disadvantage. The finding that there is a sense of communal rebellion against their achievement-oriented context demonstrates the efficacy of document analysis as a complementary approach for understanding student cheating.     

Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system’s six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.     

Decision-making capacity in elderly, terminally ill patients with cancer

Despite the importance and complexity of evaluating decision-making capacity at the end of life, little research has focused on terminally ill patients' decision-making ability. The purpose of this study was to explore the decision-making capacity of elderly, terminally ill patients and the psychological and physical factors that affect decision making. Decision-making capacity and cognitive abilities were assessed using four measures: the Hopkins Competency Assessment Kit, the Bechara Gambling Task, the Concept Assessment Kit, and the Mini Mental Status Exam. In addition, symptoms of depression, level of physical functioning, and extent of physical symptoms were evaluated in order to identify correlates of decision-making ability. Two samples were compared: elderly, terminally ill patients with cancer (n = 43) and elderly, physically healthy adults living in supportive community residence (n = 35). Results revealed significantly poorer decision-making abilities among the terminal ill sample compared with healthy comparisons, but no association between demographic variables (e.g., age, race, or education) or clinical variables (depression or physical symptoms) and decision making. Implications for evaluating decision-making capacity are addressed.     

How Best to Prevent Future Persons From Suffering: A Reply to Benatar

Abstract

David Benatar claims that everyone was seriously harmed by coming into existence. To spare future persons from this suffering, we should cease having children, Benatar argues, with the result that humanity would gradually go extinct. Benatar’s claim of universal serious harm is baseless. Each year, an estimated 94% of children born throughout the world do not have a serious birth defect. Furthermore, studies show that most people do not experience chronic pain. Although nearly everyone experiences acute pain and discomforts, such as thirst, these experiences have instrumental value. For example, when a person picks up a hot object, in response to the pain, the person releases the object, thereby preventing serious harm. The standard that Benatar uses to evaluate the quality of our lives is arbitrary, as I will demonstrate. His proposal that we phase humanity out of existence by ceasing to have children is misguided and an overreaction to the problem of human suffering. The ‘threshold conception of harm’, which is a targeted approach for preventing future persons from suffering, is a more sensible approach.