A Diagnostic Framework for the Empirical Evaluation of Learning Maps

Learning progressions and learning map structures are increasingly being used as the basis for the design of large-scale assessments. Of critical importance to these designs is the validity of the map structure used to build the assessments. Most commonly, evidence for the validity of a map structure comes from procedural evidence gathered during the learning map creation process (e.g., research literature, external reviews). However, it is also important to provide support for the validity of the map structure with empirical evidence by using data gathered from the assessment. In this paper, we propose a framework for the empirical validation of learning maps and progressions using diagnostic classification models. Three methods are proposed within this framework that provide different levels of model assumptions and types of inferences. The framework is then applied to the Dynamic Learning Maps® alternate assessment system to illustrate the utility and limitations of each method. Results show that each of the proposed methods have some limitations, but they are able to provide complementary information for the evaluation of the proposed structure of content standards (Essential Elements) in the Dynamic Learning Maps assessment.

Understanding Barriers to Diagnosis in a Rare, Genetic Disease: Delays and Errors Diagnosing Schwannomatosis

Diagnosis of rare, genetic diseases is challenging, but conceptual frameworks of the diagnostic process can be used to guide benchmarking and process improvement initiatives. Using the National Academy of Medicine diagnostic framework, we assessed the extent of, and reasons for, diagnostic delays and errors in schwannomatosis, a neurogenetic syndrome characterized by nerve sheath tumors and chronic pain. We reviewed the medical records of 97 patients with confirmed or probable schwannomatosis seen in two U.S. tertiary care clinics from 2005-2016. Survival analysis revealed a median time from first symptom to diagnosis of 16.7 years (95% CI, 7.5-26.0 years) and median time from first medical consultation to diagnosis of 9.8 years (95% CI, 3.5-16.2 years). Factors associated with longer times to diagnosis included initial signs/symptoms that were intermittent, non-specific, or occurred at younger ages (p<0.05). Thirty-six percent of patients experienced a misdiagnosis of underlying genetic condition (18.6%), pain etiology (16.5%) and/or tumor imaging/pathology (11.3%). One-fifth (19.6%) of patients had a clear missed opportunity for appropriate workup that could have led to an earlier schwannomatosis diagnosis. These results suggest that interventions in clinician education, genetic testing availability, expert review of pathology findings, and automatic triggers for genetics referrals may improve diagnosis in schwannomatosis.

Mild behavioral impairment: measurement and clinical correlates of a novel marker of preclinical Alzheimer’s disease

Background Late-life onset neuropsychiatric symptoms are established risk factors for dementia. The mild behavioral impairment (MBI) diagnostic framework was designed to standardize assessment to determine dementia risk better. In this Mini Review, we summarize the emerging clinical and biomarker evidence, which suggests that for some, MBI is a marker of preclinical Alzheimer’s disease. Main MBI is generally more common in those with greater cognitive impairment. In community and clinical samples, frequency is around 10–15%. Mounting evidence in cognitively normal samples links MBI symptoms with known AD biomarkers for amyloid, tau, and neurodegeneration, as well as AD risk genes. Clinical studies have found detectable differences in cognition associated with MBI in cognitively unimpaired people. Conclusion The emerging evidence from biomarker and clinical studies suggests MBI can be an early manifestation of underlying neurodegenerative disease. Future research must now further validate MBI to improve identification of those at the very earliest stages of disease.

Estimation and Mitigation of Unknown Airplane Installation Effects on GPA Diagnostics

In gas turbines used for airplane propulsion, the number of sensors are kept at a minimum for accurate control and safe operation. Additionally, when data are communicated between the airplane main computer and the various subsystems, different systems may have different constraints and requirements regarding what data transmit. Early in the design process, these parameters are relatively easy to change, compared to a mature product. If the gas turbine diagnostic system is not considered early in the design process, it may lead to diagnostic functions having to operate with reduced amount of data. In this paper, a scenario where the diagnostic function cannot obtain airplane installation effects is considered. The installation effects in question is air intake pressure loss (pressure recovery), bleed flow and shaft power extraction. A framework is presented where the unknown installation effects are estimated based on available data through surrogate models, which is incorporated into the diagnostic framework. The method has been evaluated for a low-bypass turbofan with two different sensor suites. It has also been evaluated for two different diagnostic schemes, both determined and underdetermined. Results show that, compared to assuming a best-guess constant-bleed and shaft power, the proposed method reduce the RMS in health parameter estimation from 26% up to 80% for the selected health parameters. At the same time, the proposed method show the same degradation pattern as if the installation effects were known.

Empirical evidence for robust personality-gaming disorder associations from a large-scale international investigation applying the APA and WHO frameworks

Disordered gaming has gained increased medical attention and was recently included in the eleventh International Classification of Diseases (ICD-11) by the World Health Organization (WHO) after its earlier inclusion in the Diagnostic and Statistical Manual of Mental Disorders (fifth revision) (DSM-5) as an emerging disorder by the American Psychiatric Association (APA). Although many studies have investigated associations between personality and disordered gaming, no previous research compared the differential associations between personality and disordered gaming with time spent gaming. Due to the novelty of the WHO diagnostic framework for disordered gaming, previous research focused mainly on the associations between personality and disordered gaming in relation to the APA framework. Beyond that, these studies are generally limited by small sample sizes and/or the lack of cross-cultural emphasis due to single-country sampling. To address these limitations, the present study aimed to investigate the associations between personality and gaming behavior in a large and culturally heterogeneous sample (N = 50,925) of individuals from 150 countries. The results obtained suggested that low conscientiousness and high neuroticism were robustly associated with disordered gaming across both the APA and WHO frameworks. Interestingly, personality associations with weekly time spent gaming were smaller. The findings of the present study suggest that personality is of higher importance to predict disordered gaming compared to weekly time spent gaming.

Diagnose the viability of separation of power in Egypt: a cybernetics perspective

PurposeThe aim of this study is to diagnose the Egyptian political system from the perspective of the viable system model (VSM). That in turn gives us significant insights on how to improve the distribution and control of power in Egypt to warrant greater autonomy and representativeness in the branches of government.Design/methodology/approachThe proposed diagnostic framework in this study was accomplished by applying the principles and aspects of Stafford Beer's VSM to the three state powers of Egypt: the executive, legislative and judiciary. In addition, it adopts the guidelines for applying the VSM described by both Stafford Beer and José Pérez Ríos.FindingsThe presented framework in this study shows a comprehensive explanation of the essential functions and their distribution among the entities of the Egyptian political system. In addition to that, the findings give us insights about the need for greater autonomy and self-organization among the political system's entities. Greater communication, consensus, cooperation and coordination is needed to achieve balance, regulate the interactions between them and to monitor each other without intervention. This, in turn, would ensure greater representation of citizen demands and expectations, and protect and guarantee their rights and freedoms.Originality/valueThe modeling of the Egyptian political system from a VSM perspective suggests the necessity of reform of the political system by a clear division of functions and tasks within the operational entities and subentities, decentralization of power structures and utilization of the decision marketing mechanism to reach public acceptance. The application of the VSM, for the sake of diagnosing and designing the viability of separation of power, can be considered as highly original.

Unexplained arterial thrombosis: approach to diagnosis and treatment

Arterial thrombotic events in younger patients without a readily apparent etiology present significant diagnostic and management challenges. We present a structured approach to diagnosis with consideration of common causes, including atherosclerosis and embolism, as well as uncommon causes, including medications and substances, vascular and anatomic abnormalities, systemic disorders, and thrombophilias. We highlight areas of management that have evolved within the past 5 years, including the use of dual-pathway inhibition in atherosclerotic disease, antithrombotic therapy selection in embolic stroke of undetermined source and left ventricular thrombus, the role of closure of patent foramen ovale for secondary stroke prevention, and the thrombotic potential of coronavirus disease 2019 infection and vaccination. We conclude with a representative case to illustrate the application of the diagnostic framework and discuss the importance of consideration of bleeding risk and patient preference in determining the appropriate management plan.