Applicant Reactions to a Situational Judgment Test used for Selection into Initial Teacher Training

We considered applicants’ perceptions of the use of a pilot situational judgment test (SJT) designed for selection into primary and secondary teacher training programs in the UK. Quantitative and qualitative data were collected from 304 applicants (73% female) to two postgraduate (PGCE) training programs in the 2013-2014 application cycle. Participants were asked to provide feedback on the content of the SJTs and on the appropriateness of the tests for selection into teacher training. Results from the rating scales showed that most of the applicants (76.7%) found the content and format of the pilot selection tool favourable. Results from open-ended questions suggested that applicants were aware of issues of procedural justice and fairness in selection for teacher training, with a recommendation that separate selection tests should be created for primary and secondary applicants

Developing a Proof-of-Concept Selection Test for Entry into Primary Teacher Education Programs

The purpose of this article is to report on the development of a proof-of-concept situational judgment test (SJT) to assist in the selection of candidates for primary teacher education (ITE) programs. Nine development steps involving practising teachers, teacher educators, and applicants to ITE programs were carried out to establish target attributes and to develop content for the test. The results from administering the test to 124 primary ITE candidates showed a near-normal distribution, high levels of reliability, and significant positive correlations with a range of concurrently administered interview scores. We conclude with a description of the necessary next steps needed to implement evidence-supported teacher education selection processes in a range of international settings

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Applicant Reactions to a Situational Judgment Test used for Selection into Initial Teacher Training

We considered applicants’ perceptions of the use of a pilot situational judgment test (SJT) designed for selection into primary and secondary teacher training programs in the UK. Quantitative and qualitative data were collected from 304 applicants (73% female) to two postgraduate (PGCE) training programs in the 2013-2014 application cycle. Participants were asked to provide feedback on the content of the SJTs and on the appropriateness of the tests for selection into teacher training. Results from the rating scales showed that most of the applicants (76.7%) found the content and format of the pilot selection tool favourable. Results from open-ended questions suggested that applicants were aware of issues of procedural justice and fairness in selection for teacher training, with a recommendation that separate selection tests should be created for primary and secondary applicants

Challenges and Future Directions of Palliative Care

The unprecedented global development of palliative care over the past 50 years, originating in a counterculture and evolving through to an integral element of the health-care system, has enabled many more of the world’s population to have access to quality palliative care. More of the world’s population, particularly those living in high-income countries, such as Europe, North America, Australia, and parts of Asia, now die at an older age of, or with, noncommunicable diseases. The need for palliative care is also significant and largely unmet in low- and middle-income countries such as sub-Saharan Africa where communicable diseases such as HIV/AIDS, tuberculosis, and malaria continue to lead to expected deaths for many people.These new patterns of dying have implications for the configuration of international, national, and local palliative care policies, health-care service delivery models, palliative care delivery, engagement with primary and specialist clinical streams, workforce education, and the focus of future research.This chapter will describe the current and future challenges to palliative care development in low-, middle-, and high-income countries and the opportunities offered by adopting a public health approach, novel technologies, and remote monitoring and better engaging communities to increase palliative care access globally

Clinical manifestations of intermediate allele carriers in Huntington disease

Objective: There is controversy about the clinical consequences of intermediate alleles (IAs) in Huntington disease (HD). The main objective of this study was to establish the clinical manifestations of IA carriers for a prospective, international, European HD registry. Methods: We assessed a cohort of participants at risk with <36 CAG repeats of the huntingtin (HTT) gene. Outcome measures were the Unified Huntington's Disease Rating Scale (UHDRS) motor, cognitive, and behavior domains, Total Functional Capacity (TFC), and quality of life (Short Form-36 [SF-36]). This cohort was subdivided into IA carriers (27-35 CAG) and controls (<27 CAG) and younger vs older participants. IA carriers and controls were compared for sociodemographic, environmental, and outcome measures. We used regression analysis to estimate the association of age and CAG repeats on the UHDRS scores. Results: Of 12,190 participants, 657 (5.38%) with <36 CAG repeats were identified: 76 IA carriers (11.56%) and 581 controls (88.44%). After correcting for multiple comparisons, at baseline, we found no significant differences between IA carriers and controls for total UHDRS motor, SF-36, behavioral, cognitive, or TFC scores. However, older participants with IAs had higher chorea scores compared to controls (p 0.001). Linear regression analysis showed that aging was the most contributing factor to increased UHDRS motor scores (p 0.002). On the other hand, 1-year follow-up data analysis showed IA carriers had greater cognitive decline compared to controls (p 0.002). Conclusions: Although aging worsened the UHDRS scores independently of the genetic status, IAs might confer a late-onset abnormal motor and cognitive phenotype. These results might have important implications for genetic counseling. ClinicalTrials.gov identifier: NCT01590589

Clinical and genetic characteristics of late-onset Huntington's disease

Background: The frequency of late-onset Huntington's disease (&gt;59 years) is assumed to be low and the clinical course milder. However, previous literature on late-onset disease is scarce and inconclusive. Objective: Our aim is to study clinical characteristics of late-onset compared to common-onset HD patients in a large cohort of HD patients from the Registry database. Methods: Participants with late- and common-onset (30–50 years)were compared for first clinical symptoms, disease progression, CAG repeat size and family history. Participants with a missing CAG repeat size, a repeat size of ≤35 or a UHDRS motor score of ≤5 were excluded. Results: Of 6007 eligible participants, 687 had late-onset (11.4%) and 3216 (53.5%) common-onset HD. Late-onset (n = 577) had significantly more gait and balance problems as first symptom compared to common-onset (n = 2408) (P &lt;.001). Overall motor and cognitive performance (P &lt;.001) were worse, however only disease motor progression was slower (coefficient, −0.58; SE 0.16; P &lt;.001) compared to the common-onset group. Repeat size was significantly lower in the late-onset (n = 40.8; SD 1.6) compared to common-onset (n = 44.4; SD 2.8) (P &lt;.001). Fewer late-onset patients (n = 451) had a positive family history compared to common-onset (n = 2940) (P &lt;.001). Conclusions: Late-onset patients present more frequently with gait and balance problems as first symptom, and disease progression is not milder compared to common-onset HD patients apart from motor progression. The family history is likely to be negative, which might make diagnosing HD more difficult in this population. However, the balance and gait problems might be helpful in diagnosing HD in elderly patients