Morphology of the earliest reconstructable tetrapod Parmastega aelidae.

The known diversity of tetrapods of the Devonian period has increased markedly in recent decades, but their fossil record consists mostly of tantalizing fragments1-15. The framework for interpreting the morphology and palaeobiology of Devonian tetrapods is dominated by the near complete fossils of Ichthyostega and Acanthostega; the less complete, but partly reconstructable, Ventastega and Tulerpeton have supporting roles2,4,16-34. All four of these genera date to the late Famennian age (about 365-359 million years ago)-they are 10 million years younger than the earliest known tetrapod fragments5,10, and nearly 30 million years younger than the oldest known tetrapod footprints35. Here we describe Parmastega aelidae gen. et sp. nov., a tetrapod from Russia dated to the earliest Famennian age (about 372 million years ago), represented by three-dimensional material that enables the reconstruction of the skull and shoulder girdle. The raised orbits, lateral line canals and weakly ossified postcranial skeleton of P. aelidae suggest a largely aquatic, surface-cruising animal. In Bayesian and parsimony-based phylogenetic analyses, the majority of trees place Parmastega as a sister group to all other tetrapods

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist

Queering Counselor Education: Situational Analysis of LGBTQ+ Competent Faculty

Research demonstrates counselor educators often lack skills and knowledge to train counselors to become lesbian, gay, bisexual, transgender, queer and other sexualities and gender identities (LGBTQ+) competent. This study explores the process of educators integrating LGBTQ+ competencies into their professional work. Using grounded theory and situational analysis methodologies, in-depth interviews with seven LGBTQ+ competent counselor educators were conducted and analyzed. Findings suggest educators infuse personal passion for LGBTQ+ topics into their professional work, experienced discrimination and resistance across multiple domains, infuse advocacy into their work, and have a similar definition of LGBTQ+ competent counseling. Various techniques are presented to help educators infuse LGBTQ+ competency in the classroom

Inter-Rater and Intra-Rater Reliability of the INSPECT (Interactive Nutrition Specific Physical Exam Competency Tool) Measured in Multi-Site Acute Care Settings

Even as new medical modalities, diagnostics, and technologies are rapidly changing healthcare, providing patients with safe, high-quality care remains the central focus. To provide safe patient care, healthcare providers are obligated to demonstrate and maintain the necessary competence. As more healthcare disciplines move toward a competency-based education model, it is essential to extend the competence verification from the academic educational level to the patient’s bedside. The nutrition-focused physical exam (NFPE) is a competency recently adopted by registered dietitian nutritionists (RDNs) for assessing patients’ nutritional status. Being a newly acquired skill, validated tools are required to measure NFPE competence during routine clinical practice. The Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) is a new tool developed specifically to observe and measure RDNs’ NFPE competence in clinical settings. The INSPECT was designed and validated for content using expert RDNs’ input in the first and second phases of the study. This current study aimed to assess the reliability of the INSPECT through multi-site observations by clinical supervisors evaluating RDNs’ NFPE competency during patient assessment. The INSPECT exhibited good inter-rater reliability (ICC = 0.78 for the first assessment and ICC = 0.68 for the second assessment), moderate to strong intra-rater reliability for 37 of 41 items (Spearman rho = 0.54 to 1.0), and excellent internal consistency (Cronbach’s α = 0.86 for the first assessment and α = 0.92 for the second assessment). In total, 10 out of the 11 INSPECT subsets showed good to excellent internal consistency (α ranging from 0.70 to 0.98). The results demonstrate that the INSPECT is a reliable tool, is stable over time, and has good agreement and excellent consistency between raters. The INSPECT can be a valuable tool to measure, promote and maintain RDNs’ NFPE competence in authentic acute care settings

Item-Level Analysis of a Newly Developed Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) Using the Rasch Measurement Model

The Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) is a tool designed specifically to observe and measure registered dietitian nutritionists&rsquo; (RDNs) nutrition-focused physical exam (NFPE) competence in authentic acute care settings. The initial INSPECT items were generated and tested for content and face validity using expert RDNs&rsquo; input. The INSPECT was further examined for inter-rater, intra-rater, and internal consistency using clinical supervisor observations of RDNs performing NFPE on patients in real-life acute care settings. These previous studies showed the INSPECT to have excellent content validity, acceptable face validity, good inter-rater reliability, moderate to strong intra-rater reliability, and excellent internal consistency. In the current study, the Rasch measurement model was applied to examine the item-level properties of the INSPECT. Results confirm that the INSPECT measured a single construct. All items fit the established criteria for clinical observations of &gt;0.5 and &lt;1.7, had positive point measure correlations, met the Wright Unidimensionality Index criteria of &ge;0.9, exhibited one latent construct with &gt;40% variance explained by the Rasch dimension as well as a sub-dimension based on item difficulty from the principal component analysis of the first contrast Rasch residuals. Rasch rating scale analysis revealed that the rating scale and majority of the items (39/41) fit the Rasch model. Rasch item hierarchy analysis matched the a priori hypothesized hierarchy for the top-most and bottom-most items. Ceiling effects were seen for three items (hand hygiene, personal protective equipment, and patient position) and one item (handgrip using hand dynamometer) reached the floor effect. Rasch reliability assessment demonstrated high person reliability (0.86), high item reliability (0.96), and person separation of 3.56 ability levels. The principal component analysis of residuals revealed two factors based on item difficulty, one for micronutrient exam and another for macronutrient exam, initial steps, and bedside manner. The resulting two factors may likely be due to a sub-dimension of the latent NFPE trait. Overall, the INSPECT items were found to have good item-level psychometrics. Continued testing of the INSPECT with RDNs at different ability levels will help to determine cut-off scores ranging from novice to expert. Establishing cut-off scores for the INSPECT will further enhance the utility of the tool

Content and Face Validation of a Novel, Interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) to Evaluate Registered Dietitians’ Competence: A Delphi Consensus from the United States

The nutrition-focused physical examination (NFPE) is an integral component of nutrition assessment performed by registered dietitian nutritionists (RDNs) to determine signs of malnutrition and other nutrition-related complications. Increased use of this essential skill among RDNs and the transformation of dietetics education to a competency-based model in the near future calls for appropriately validated tools to measure RDNs’ NFPE competence. To fill the need for a validated competency tool, this study developed an Interactive Nutrition-Specific Physical Exam Competency Tool (INSPECT) utilizing the initial 70 items identified in the first phase of the study. The second phase of this study aimed to test the preliminary version of the INSPECT for content and face validity. An expert panel of 17 members provided consensus recommendations through the Delphi process. Internal consistency of the consensus was measured with Cronbach’s alpha (α) and α of ≥0.70 was defined as acceptable a priori. Inter-rater agreement among the expert panel was determined using the intraclass correlation coefficient (ICC) and an a priori ICC of 0.75 to 0.9 was established as good and &gt;0.9 as excellent agreement. The results showed acceptable face validity (α = 0.71) and excellent content validity for the INSPECT, with an internal consistency of α = 0.97 in the first round and α = 0.96 in the second round. The inter-rater agreement was also excellent with ICC = 0.95 for each of the Delphi rounds. A total of 52 items were retained from the preliminary version of the INSPECT. Open feedback from the experts allowed for the consolidation of 11 similar items for better scoring and evaluation and thus, a total of 41 items were included in the final version of the INSPECT. The final version of the INSPECT is currently being studied in real-life, multi-site clinical settings among practicing RDNs to examine construct validity, reliability, and item-level psychometric properties. Ultimately, the validated INSPECT will be available for the competency evaluation of RDNs practicing in clinical settings