Moral growth in medical students

Although students bring to medical school a fairly well established value system, the potential for moral growth through the medical school environment and experience is substantial. The educational environment poses a succession of developmental and adaptive tasks to be accomplished. Several of these tasks are discussed here, tasks that are value-laden and involve, directly or indirectly, the interplay of ethical theory and practice. During the past quarter century, the two influences that have had the greatest impact on the moral growth and moral reasoning capacity of medical students have been the incorporation into the medical school curriculum of courses in medical humanities and the admission to medical school of an increasing number of female students. The female students have brought to medical school a level or dimension of moral reasoning (morality as care or responsibility for others) to augment the male students' focus on rights and justice considerations.     

THE EFFECTS OF AN ENVIRONMENTAL “ENRICHMENT” PROGRAM ON THE BEHAVIOR OF INSTITUTIONALIZED PROFOUNDLY RETARDED CHILDREN

This study determined the effects of procedures designed to “enrich” the physical and social environment of an institutional ward on the “adaptive” and “maladaptive” child, adult, self, and object-directed behaviors of five profoundly retarded ambulatory females. Behavior observed in two treatment conditions, an environment “enriched” with toys and objects and an “enriched” environment coupled with differential reinforcement of adaptive behavior, was compared to behavior occurring in corresponding baseline or “austere” conditions and during a period of noncontingent reinforcement. The results generally revealed: (1) little change in adaptive and maladaptive child and adult-directed behavior across conditions, (2) an overall higher incidence of adaptive object-directed behavior and reduced self-directed maladaptive behavior in each treatment condition from that observed in corresponding control conditions, and (3) the use of an “enriched” environment and differential reinforcement of adaptive behavior resulted in maladaptive self-directed behavior being reduced and adaptive object-directed behavior being increased beyond that observed in the “enriched” environment alone. These behavioral gains were largely maintained during a follow-up condition by continuing the “enriched” environment and transferring the responsibility for differential reinforcement to direct-care staff.     

自适应分组认知诊断测验设计及其选题策略

应用OMST在线装配模式,提出自适应分组认知诊断测验（CD-AMGT）。由于知识状态的先决关系是偏序关系,而且构成格（lattice),利用知识状态当前估计值在格中的上下确界对被试真实知识状态的可能范围进行界定,由此装配下一分组,分组中结合PWKL策略或SHE策略进行选题以兼顾诊断精度、效率和安全性。模拟实验表明,CD-AMGT与PWKL、SHE对比,当题目类型丰富时,以分类准确率略微降低为代价,其题库使用均匀性和计算用时均表现出较大优势。     

Application of Sequential Interval Estimation to Adaptive Mastery Testing

In this paper, we apply sequential one-sided confidence interval estimation procedures with β-protection to adaptive mastery testing. The procedures of fixed-width and fixed proportional accuracy confidence interval estimation can be viewed as extensions of one-sided confidence interval procedures. It can be shown that the adaptive mastery testing procedure based on a one-sided confidence interval with β-protection is more efficient in terms of test length than a testing procedure based on a two-sided/fixed-width confidence interval. Some simulation studies applying the one-sided confidence interval procedure and its extensions mentioned above to adaptive mastery testing are conducted. For the purpose of comparison, we also have a numerical study of adaptive mastery testing based on Wald's sequential probability ratio test. The comparison of their performances is based on the correct classification probability, averages of test length, as well as the width of the “indifference regions.” From these empirical results, we found that applying the one-sided confidence interval procedure to adaptive mastery testing is very promising.     

High-dimensional maximum marginal likelihood item factor analysis by adaptive quadrature

Although the Bock–Aitkin likelihood-based estimation method for factor analysis of dichotomous item response data has important advantages over classical analysis of item tetrachoric correlations, a serious limitation of the method is its reliance on fixed-point Gauss-Hermite (G-H) quadrature in the solution of the likelihood equations and likelihood-ratio tests. When the number of latent dimensions is large, computational considerations require that the number of quadrature points per dimension be few. But with large numbers of items, the dispersion of the likelihood, given the response pattern, becomes so small that the likelihood cannot be accurately evaluated with the sparse fixed points in the latent space. In this paper, we demonstrate that substantial improvement in accuracy can be obtained by adapting the quadrature points to the location and dispersion of the likelihood surfaces corresponding to each distinct pattern in the data. In particular, we show that adaptive G-H quadrature, combined with mean and covariance adjustments at each iteration of an EM algorithm, produces an accurate fast-converging solution with as few as two points per dimension. Evaluations of this method with simulated data are shown to yield accurate recovery of the generating factor loadings for models of upto eight dimensions. Unlike an earlier application of adaptive Gibbs sampling to this problem by Meng and Schilling, the simulations also confirm the validity of the present method in calculating likelihood-ratio chi-square statistics for determining the number of factors required in the model. Finally, we apply the method to a sample of real data from a test of teacher qualifications.     

Data, model, conclusion, doing it again

This paper explores the robustness of conclusions from a statistical model against variations in model choice (rather than variations in random sampling and random assignment to treatments, which are the usual variations covered by inferential statistics). After the problem formulation in section 1, section 2 presents an example from Box and Tiao in which variation in parent distribution is modeled for a one sample location problem. An adaptive Bayesian procedure permits to use a weighted mixture of parent distributions rather than choosing just one, such as a normal or a uniform distribution.In section 3 similar considerations are applied to an event history model for the influence of education and gender on age at first marriage, but here the conclusions are hardly influenced by the choice of the duration distribution. In section 4 a brief discussion of model choice in factor analysis and structural equation models is followed by a more elaborate treatment of the choice of integer valued slopes for item response functions in the OPLM model which is an extension of the Rasch model. A modest simulation study suggests that Adaptive Bayesian Modeling with a mixture of sets of slopes works better than fixing one set of postulated slopes.The paper concludes with some remarks on the roles and sources of prior distributions followed by a short epilogue which argues that simultaneous consideration of a class of models for the same data is sometimes superior to exclusively analyzing the data under one specific model chosen from such a class.This article is based on the Presidential Address Ivo W. Molenaar gave on June 20, 1998 at the 1998 Annual Meeting of the Psychometric Society held at the University of Illinois in Champaign, Illinois. Thanks is given to John Wiley & Sons and George C. Tiao for granting permission to reprint three figures from the book George C. Tiao wrote with George E. P. Box titled Bayesian Inference in Statistical Analysis.—EditorThanks are due to Anne Boomsma, Jeffrey Hoogland, Mark Huisman, Tom Snijders, Marijtje Van Duijn, and Norman Verhelst for suggesting improvements and/or assisting with data analyses.     

Optimal sequential designs for on-line item estimation

Replenishing item pools for on-line ability testing requires innovative and efficient data collection designs. By generating localD-optimal designs for selecting individual examinees, and consistently estimating item parameters in the presence of error in the design points, sequential procedures are efficient for on-line item calibration. The estimating error in the on-line ability values is accounted for with an item parameter estimate studied by Stefanski and Carroll. LocallyD-optimaln-point designs are derived using the branch-and-bound algorithm of Welch. In simulations, the overall sequential designs appear to be considerably more efficient than random seeding of items.This report was prepared under the Navy Manpower, Personnel, and Training R&D Program of the Office of the Chief of Naval Research under Contract N00014-87-0696. The authors wish to acknowledge the valuable advice and consultation given by Ronald Armstrong, Charles Davis, Bradford Sympson, Zhaobo Wang, Ing-Long Wu and three anonymous reviewers.     

Characterizing adult cognitive development

A paradigm of adult cognitive development is elaborated that is derived from concepts inherent in the study of consistency and change during the adult years. It is argued that the antecedents and consequences of adult cognition are substantially different from those that pertain to earlier growth-oriented developmental periods and to later decline-oriented periods. Adult cognition and its development are characterized in terms of adaptive competencies in specific domains, elasticity of function within selected domains, and knowledge encapsulation. Another major characteristic of adult development is that knowledge and computation are integrated or encapsulated with experience and use. It is suggested that these characteristics serve to distinguish adult cognitive development from the discontinuous emerging properties of earlier cognitive development and from the general deficiencies of cognitive function that are characteristic of very late life.     

儿童适应行为评定量表的编制及城乡区域性常模的制定

儿童适应行为评定量表共有59个项目,分8个分量表和3个因子。为了适应目前我国城乡经济文化尚有较大差异这一特点,本量表分城乡两个版本,并分别制订了本省城市农村两套常模。常模样本在城市按父母文化程度和职业等分层比例取样520名,在农村按父母文化程度等取样400名。常模形式包括分量表百分位常模、因子T 分、适应能力商数及年龄儿童适应行为发展界碑。其信度、效度令人满意。本量表适用3—12岁智力正常或低下儿童。     

Within-person association of volitional factors and physical activity: Insights from an ecological momentary assessment study

ObjectiveCurrent health behavior models of physical activity (PA) suggest that not all PA intentions are translated into actual PA behavior, resulting in a significant intention-behavior gap (IBG) of almost 50%. These models further suggest that higher self-efficacy and specific planning can aid in decreasing this gap. However, as most evidence stems from between-person (trait level), questionnaire-based research, it is unclear how large short-term IBGs are, how self-efficacy and planning covary within-persons across time and whether they similarly predict smaller IBGs. It is likely that day-to-day changes in circumstances and barriers affect these variables thus the applicability of theoretical models is uncertain. Here, within-person prospective analyses of ecological momentary assessment (EMA) data can provide insights.Methods35 healthy participants (aged 23–67) completed four EMA-based questionnaires every day for three weeks. Each prompt assessed PA (retrospectively, “since the last EMA prompt”); PA intentions, planning specificity, self-efficacy, and intrinsic motivation (prospectively, “until the next EMA prompt”) and momentary affect. Generalized logistic mixed-effect modeling was used to test predictors of PA.ResultsAcross the 2341 answered EMA prompts, PA intentions were not enacted in 25% of the episodes (IBG). In episodes with given intentions, PA likelihood increased with higher levels of self-efficacy, planning specificity, and intrinsic motivation. The latter two also positively predicted PA duration and intensity.ConclusionsShort-term intention behavior gaps seem to be smaller than what is known from more long-term studies, most likely as individuals can anticipate the actual circumstances of PA. Further, current health behavior models show validity in explaining within-person dynamics in IBGs across time. Knowing the relevance of planning specificity, self-efficacy and intrinsic motivation for day-to-day variations in PA enactment can inform respective real-time mHealth interventions for facilitating PA.