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The Pharmacy College Admission Test (PCAT�) is a specialized test that helps identify qualified applicants to pharmacy colleges. It measures general academic ability and scientific knowledge necessary for the commencement of pharmaceutical education. The PCAT is constructed specifically for colleges of pharmacy.

B1. General Biology B2. Microbiology
A. Cellular and Molecular Biology
1. Structure and functions of cells
2. Gene expression
3. Cell division and growth
4. Energy transformations
5. Metabolism
A. Microorganisms
B. Infectious Diseases & Prevention
C. Microbial Ecology
D. Medical Microbiology
E. Immunity
B3. Human Anatomy and Physiology
B. Diversity of Life Forms
1. Genetics
A. Structure
1. Cells
2. Tissues
3. Organs
C. Health
1. Nutrition
2. Diseases
3. Drugs
B. Systems
1. Skeletal/muscular/nervous
2. Circulatory/respiratory
3. Excretory/digestive
4. Endocrine/reproductive
5. Integumentary/immune

Biological Processes items may be presented either standing alone (Biological Processes Examples 1�4) or associated with a short passage (Biological Processes Examples 5�8). Stand-alone items can be answered independent of any passage or other item, while items associated with a passage will require understanding part or all of the passage in order to answer them correctly. � Each Biological Processes item stem will be either in the form of a question (followed by a question mark) or in the form of an incomplete sentence that requires completion (with no end punctuation).
� Answer options may contain more than one concept or piece of information but each one will plausibly relate to the stem.
A. leukocyte.
[A leukocyte is a white blood cell and not the target of an infection from a foreign molecule.] B. eosinophil.
[Eosinophil is a type of white blood cell that is involved in the immune response to parasitic infections or allergic reactions and not the target of infection from a foreign molecule.] C. immunoglobulin.
[Immunoglobulins are antibodies formed by B cells and not the targets of an infection from a foreign molecule.] D. antigen. * [CA: Antigen is the correct term for anything that is the target of the immune response, causing production of antibodies by the living organism. Antigens can include foreign pollen, bacteria, viruses, proteins, and some other materials.]
A. Respiratory alkalosis
[Respiratory alkalosis is due to alveolar hyperventilation leading to decreased plasma carbon dioxide concentration. It develops when the lungs remove more carbon dioxide than is produced in the tissues. It is a common finding in patients receiving medical ventilation, but it is not associated with emphysema, which results in a decreased expulsion of carbon dioxide.]
B. Metabolic alkalosis
[This condition results from an altered metabolism. A decreased hydrogen ion concentration results in increased bicarbonate and carbon dioxide concentrations. It occurs most commonly when a person has been vomiting profusely. It is not associated with emphysema, which results in a decreased expulsion of carbon dioxide.]
C. Respiratory acidosis *
[CA: Respiratory acidosis is a clinical disturbance that is due to alveolar hypoventilation. It results in low blood pH due to decreased clearance of carbon dioxide by the lungs. This condition occurs in emphysema as exhalation becomes insufficient.]
D. Metabolic acidosis
[Metabolic acidosis is a condition in which the blood pH is low due to increased production of hydrogen ions by the body or the inability of the body to form bicarbonate in the kidney. It is not associated with emphysema, which results in a decreased expulsion of carbon dioxide.]

A. Maternal meiotic division I *
[CA: Nondisjunction is an error that can occur during meiosis or mitosis, causing the daughter cells to have too many or too few chromosomes. Because the child has two maternal alleles that are not identical and one paternal allele, nondisjunction occurred at this stage of division.] B. Paternal meiotic division I
[If nondisjunction occurred here, the child would have two paternal alleles and one maternal allele.]
C. Maternal meiotic division II
[If nondisjunction had occurred here, the maternal contribution would have been either no allele or two of the same kind.]
D. Paternal meiotic division II
[If nondisjunction had occurred here, the paternal contribution would have been either no allele or two of the same kind. Because there is only one of paternal origin, disjunction did not occur at this stage of division.]

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prompt intervention for children with extreme speech motor delay: a randomized control trial | PCAT cheat sheet and braindumps

Design

This study used a multi-web page, two-arm, parallel community, RCT design with hid community allocations. in this examine, both the investigator and result assessors had been blinded to the neighborhood allocation. One arm bought 10 weeks of immediate intervention (intervention neighborhood), while the different arm changed into waitlisted for the same duration and received routine home training guidance (waitlist/home working towards community). The analyze integrity became monitored by an arm’s-size, external agency, The utilized fitness research center (AHRC) at St. Michael’s health center in Toronto, Ontario, Canada. The AHRC became chargeable for verifying the consent process; guaranteeing individuals met analyze inclusion/exclusion standards; conducting on-site facts monitoring visits; centrally administering randomized community allocation by means of sequentially numbered and opaque-sealed envelopes; verifying source information and statistics entry; conducting a priori and interim vigour evaluation and all other statistical analysis on outcome measures.

contributors and setting

babies were recruited from three group-primarily based healthcare facilities (in Mississauga, Toronto, and Windsor, Ontario, Canada). children were eligible to participate in the analyze in the event that they met the following inclusion standards: (a) aged between three and 10 years of age; (b) offered with a moderate-to-extreme SSD (≤64% severity decided by way of the percent of consonants suitable (PCC)19) and have been categorized descriptively as having SMD using features mentioned in the precision steadiness index;1,10 (c) have English because the simple language spoken at domestic; (d) hearing and vision within standard limits; (e) non-verbal intelligence at or above the twenty fifth percentile (general/inside ordinary limits on the cognitive examine with a typical ranking ≥90; basic check of Non-verbal Intelligence (P-TONI)20); (f) age-appropriate or mildly delayed receptive language potential (CELF-P2: clinical comparison of Language Fundamentals – Preschool 2nd edition for children between 3 and 6 years;21 CELF-four: medical assessment of Language Fundamentals – 4th edition for students between 5 and 21 years;22 common rating ≥seventy eight); (g) presence of a minimum of 4 out of nine warning signs for MSI (1. lateral jaw sliding, 2. lowered lip rounding and retraction, 3. inadequate integration of jaw and lips throughout two planes of move (entrance/returned and up/down, reminiscent of necessary within the sounds produced in, e.g., “down”, “chunk”, “mommy”), 4. constrained tongue tip elevation from jaw or limited posterior tongue actions, 5. inability to alternate place of articulation and/or planes of circulation (e.g., lip rounding/retraction in “yoyo” or in multisyllabic phrases comparable to “ladybug”, “doubleyou”), 6. confined variety of speech movements (e.g., the usage of jaw as primary articulator), 7. limited vowel and consonant repertoire and distortions of vowels and consonants, eight. confined syllable and note shapes, and 9. difficulty holding sound and syllable integrity with improved length and complexity of utterance5); and (h) proven readiness for direct speech remedy and age-appropriate play advantage. due to sluggish participant recruitment, amendments (March 2014) to the inclusion standards were made ~7.5 months following the beginning of the analyze/preliminary ethics approval (July 2013). These amendments pertain to a rise within the age latitude from three–6 to three–10 years ancient and the elimination of restrictions in expressive language (from (f)). infants have been excluded from the look at in the event that they introduced with any of the following: (a) signals and signs suggesting world motor involvement (e.g., cerebral palsy); (b) more than 7 out of 12 indications for CAS;23 (c) autism spectrum issues; (d) oral structural/resonance considerations; and (e) feeding/drooling concerns.

Intervention

Empirical reviews to guide using instant for infants and adults with speech disorders that affect speech motor planning and execution procedures were carried out, replicated, and validated by using researchers and impartial labs from world wide.5,13,17,24,25 In on the spot intervention, desires are chosen to mirror the advanced inter-relationships among actual-sensory, cognitive-linguistic, and social-emotional domains.4 A prompt clinician would use the motor-speech hierarchy (MSH4) to choose speech motor goals for intervention. The MSH represents seven hierarchal and interactive developmental stages in speech motor handle (stage I: tone; stage II: phonatory control; stage III: mandibular manage; stage IV: labial–facial handle; stage V: lingual control; stage VI: sequenced actions; stage VII: prosody). These hierarchical speech motor desires are embedded into cognitive-linguistic and social-emotional wants of the baby. Intervention typically proceeds from the bottom subsystem within the MSH where a toddler has speech motor manage issues. particular strategies are used to stimulate sensory enter (i.e., tactile, kinesthetic, proprioceptive, auditory, and visual) to facilitate the formation of sensory–motor pathways required for the acquisition and accurate production of speech circulation patterns. ideas of motor gaining knowledge of,26 such as pre-practice considerations, practice schedules (e.g., blocked and random follow), abilities of efficiency (KP; e.g., “use your small mouth”), and capabilities of outcomes (KR; e.g., “that became very good”), had been applied to intervention classes depending on the newborn’s wants. Early in intervention, instant, and general comments (KR and KP) became offered after each speech production to facilitate acquisition of accurate speech motor patterns. As periods progressed, comments frequency changed into diminished to motivate the infant to self-monitor and control their personal speech output.26 Intervention turned into delivered through an skilled and instant certified speech–language pathologist (SLP).

Caregivers of the infants within the waitlist/domestic practicing control neighborhood acquired a four-page handout detailing speech, language, and literacy strategies to be carried out at domestic. The substances had been developed essentially by using the Erinoak kids center for medication and building (https://www.erinoakkids.ca/domestic.aspx) and tailored from the literature.27 These handouts are provided as part of normal care in the province of Ontario, Canada to caregivers of little ones who are ready to receive speech and language capabilities. These strategies pertain to remedy readiness (e.g., follow your baby’s lead, use simple language, get face to face), responding to a toddler’s effort to speak (e.g., ask alternative questions, repeat any a part of the sentence that you simply take into account, be a model for children to teach the competencies of revision), and advertising early literacy capabilities (e.g., shared publication reading, deliver loads of encouragement, explain publication/print firm).

outcome measures

outcome measures have been assessed on the body constructions and features degree, and at the activities–participation stage as per the WHO-ICF-CY15,18 framework (see Fig. 1). These influence measures and reliability procedures had been assessed by means of SLPs blind to each group and session (baseline or 10-week comply with-up) allocation. All effect measures have been assessed at baseline and at a ten-week comply with-up (i.e., 10 weeks of intervention or 10 weeks of waitlist/home training).

Fig. 1: effect measures.

diverse outcome measures used to assess the physique constructions and capabilities, and actions and participation degrees for the WHO-ICF-CY framework.18 See area on “outcomes measures” for additional details. a Verbal Motor construction evaluation for little ones – Focal Oromotor control.28b Verbal Motor creation assessment for children – Sequencing.28c Probe words.13d Single-word articulation evaluation subtest of the Diagnostic assessment of Articulation & Phonology examine (DEAP).29e PCC, percentage of consonants relevant derived from the DEAP look at various.19f Single-observe phonology assessment subtest of the DEAP.29g children’s Speech Intelligibility Measure (CSIM).31h beginner’s Intelligibility check (BIT).32i center of attention on the effects of conversation beneath Six device (focus).33

Measures at physique constructions and services degree

(a)

Speech motor control function became assessed using the Verbal Motor creation assessment for infants (VMPAC28) and a criterion-referenced probe wordlist technique.13,24 The VMPAC was standardized on customarily setting up infants between the a while of three and 12 years. The VMPAC measures the accuracy and consistency of non-speech and speech productions on a 3-factor scale (0: wrong; 1: partly unsuitable; 2: proper), and aids the identification of the stage of breakdown in motor-speech control in babies. For the present examine, two subsections of VMPAC have been administered: (a) focal oromotor handle (VMPAC-FOC): assesses jaw, lip, and tongue oromotor handle in speech (e.g., “Say /a/”) and non-speech movements (e.g., “exhibit me the way you chew”); and (b) sequencing (VMPAC-SEQ): assesses the ability to accurately produce speech and non-speech movements in sequential order (e.g., “Say /m-o-i, m-o-i, m-o-i, m-o-i/”). The received raw scores are divided with the aid of the sum of the corresponding subsection scores and converted to a percent ranking (min 0 to max one hundred). A criterion-referenced measurement of the speech motor device the use of Probe Words13,24 was also conducted. The probe wordlist includes 4 degrees with ten words at every level. These ranges are in line with the hierarchical development of the speech motor equipment:four level 1 are phrases that focus on jaw-driven movements (e.g., “Bob”, “map”); stage 2 are phrases that center of attention on labial–facial movements (e.g., “moon,” “ft”); stage 3 are words that center of attention on lingual actions (e.g., “solar,” “dig”); and degree 4 are phrases that catch sequences of actions that integrates jaw–lip–tongue movements (e.g., “banana,” “ice cream”). The probe observe evaluation makes use of an image-naming project and the infant’s responses are scored as 1 or 0 counting on whether they meet the applicable movement standards (e.g., jaw latitude, jaw stability, lip symmetry, lip rounding/retraction, voicing transition, labial–lingual transition). The ratings are summed across all 40 phrases and may latitude from 0 to 298, with a much better score (at 10-week observe-up) implying enhanced results. For the latest look at, the scoring become carried out the usage of recorded video clips via blinded raters.

(b)

Speech articulation become assessed on the single-word level the usage of the Diagnostic comparison of Articulation & Phonology examine (DEAP29). The DEAP examine is a standardized, norm-referenced measure with posted validity and reliability records for toddlers between the a while of three and 8;11 years of age.29 infants are asked to identify 30 images within the DEAP look at various, which evaluates a toddler’s potential to as it should be articulate English vowels, diphthongs, and consonants in diverse notice (initial, medial, and ultimate) positions. Articulation blunders are phoneme substitutions, omissions, distortions, and additions. raw ratings are calculated via summing the variety of articulation errors across observe positions (complete possible articulation blunders = 103). The DEAP look at various manual29 gives tables to convert uncooked rankings to normal rankings (Z) using the system: Z = X − M/SD30 (where X is the raw rating, M the imply, and SD the usual deviation). typical rankings use an equal interval scale and hence will also be applied to song development over time.three,23 The common rating ranges from 55 to 145, with a much better ranking at 10-week follow-up indicating more suitable consequences. PCC19 is calculated from the same 30-item graphic-naming task as mentioned above for DEAP. PCC raw ratings are received via dividing the number of consonant blunders produced by means of the entire number of consonants (sixty seven) within the syllable-initial and syllable-remaining positions. The ensuing number is then extended with the aid of 100 to get a percent score (latitude 0–one hundred), with a more robust rating implying a higher influence at 10-week follow-up. Phonological process errors are speech sound error patterns such as the substitution of a plosive consonant (e.g., /p, b, t, d/) for a fricative consonant (e.g., /s, f/) as in “cleaning soap” → “toap”, cutting back the variety of consonants in a consonant cluster (e.g., “snake” → “nake”) and consonant deletions (e.g., “cat” → “ca”). The DEAP manual evaluates ten such speech sound error patterns and the raw scores are calculated with the aid of adding the error patterns across 50 words (complete possible speech sound error patterns = 21429). The raw ratings are then transformed to common ratings (starting from 55 to 145) as described up to now, the place a stronger normal ranking implies a much better result following 10 weeks.

(c)

Speech intelligibility turned into assessed the use of imitation projects selected from an inventory of closed set of single phrases from the babies’s Speech Intelligibility Measure (CSIM31) and a list of open-set connected speech sentences from the beginner’s Intelligibility examine (BIT32). a different listing of single phrases and sentences have been used for every baby in the baseline and 10-week observe-up assessments. The child’s imitations of the clinician’s mannequin have been audio-taped and played to a gaggle of three listeners who had been blinded to each group and session (pre or put up) allocation. No listener heard the identical newborn or the checklist of words/sentences twice. In complete, 135 listeners (age M = 22.sixty one years; SD = 3.94; 61% females) participated in the study. All listeners passed a listening to display at 25 dB HL (listening to stage) and stated little or no publicity to speech of babies with speech issues. Listeners were recruited from the college of Toronto.

The CSIM consists of 200 lists of fifty phrases. The infants have been required to imitate one randomly chosen wordlist. These words have been played in random order to a few naive listeners at a comfortable 70 dB SPL (sound pressure degree) loudness level via headphones. The listeners’ task turned into to select (through circling) the observe they suppose they heard from an inventory of 12 phonetically an identical phrases and the be aware-level intelligibility ranking changed into calculated from the percentage of phrases correctly circled (min 0 to max 100).

The BIT includes four lists of ten syntactically basic sentences that are 4 to six phrases in size. each sentence consists of 1 or two syllable words, that are everyday to toddlers. babies’s sentence productions are played to listeners who are asked to jot down down what they idea the child stated. Sentence-stage intelligibility rankings were calculated from the percent of goal phrases correctly transcribed (min 0 to max 100). further details on the methods for the validity, reliability, administration, and scoring of those checks are standardized and said elsewhere in aspect.three,5,12,23,31,32

actions and participation level

functional communication was assessed using the center of attention on the results of verbal exchange under Six tool (FOCUS33). FOCUS33 is a sound and professional influence device that assesses the adjustments in infants’s potential to communicate in established lifestyles and correlates well with exceptional-of-life measures.33 it is a standardized 50-merchandise questionnaire it really is rated on a seven-aspect ranking scale by means of either a caregiver or a SLP. For the existing study, they used the caregiver-scored questionnaire to investigate adjustments in useful communication. The minimum and optimum scores that may also be bought on this measure are 0 and 350 facets respectively, with a change of ≥sixteen facets indicating a minimal clinically crucial difference (MCID33). an improved score at 10-week observe-up implies better outcomes.

pattern size calculation

A priori vigor evaluation changed into calculated in keeping with impact sizes mentioned in an prior look at, which blanketed 12 babies (between the ages of 3;eleven and 6;7 years) with average to profound SSD and motor-speech difficulties, who acquired prompt intervention for a duration of 9 weeks.5 evaluation indicated that between 5 and 22 participants per group were required for distinctive variables (speech motor control, speech articulation, and speech intelligibility) to discover an intervention effect with a power of 0.95 and α degree of 0.05. demo measurement couldn't be calculated a priori for useful conversation as no center of attention facts was purchasable firstly of the examine for the given intervention and/or population to inform pattern measurement calculations. For the meantime (or study mid-aspect) pattern dimension calculation, CSIM and center of attention had been used. pattern sizes had been calculated handiest for focal point and CSIM as there have been no said meaningful modifications (cut-off rankings) to consider for power analysis for other variables (e.g., speech motor control, articulation). For focus, an SD of sixty seven (SD of waitlist/domestic working towards community) become chosen for the pattern dimension calculation. according to this SD, the required pattern measurement changed into calculated to notice a MCID33 of sixteen aspects with eighty% vigor and two-sided α of 5%. This resulted in a pattern estimate of 122 members per neighborhood that became adjusted for dimension at two time facets (correlation of 0.75 between pre/baseline and submit) the use of an analysis of covariance (ANCOVA). For CSIM, an SD of 17 (of waitlist/home practising community) become used for pattern measurement calculations to realize a change of 10% (absolute) with eighty% power and two-sided α of 5%. These calculations yielded a demo estimate of 21 participants per community in line with measurement at two time facets (correlation of 0.75 between pre/baseline and post) for an ANCOVA analysis. youngsters, a pattern measurement of 122 per community is clinically and practically challenging to obtain in an inexpensive timeframe for issues with such low incidence/prevalence rates. hence, they decided to terminate recruitment within the analyze with a clinically feasible closing demo measurement of 25 contributors per community in response to CSIM demo dimension calculations, acknowledging the indisputable fact that effects for the focus result measure would be underpowered.

Randomization

Randomization turned into conducted through an external facts monitoring and defense agency, the AHRC at St. Michael’s clinic in Toronto, Ontario, Canada. At AHRC, the randomization sequence was laptop generated and stratified by using medical site with random permuted blocks of sizes 2 and 4. The randomized group allocations were positioned in sequentially numbered, opaque, and sealed envelopes, that have been offered to medical websites in the beginning of the study by using AHRC. as soon as the eligibility standards were met and informed consent become got from every participant, the examine coordinator at every medical web page opened one envelope that contained a group allocation. a brand new envelope changed into opened for each participant.

Blinding

All look at personnels (including the most important investigator, all research and clinical group of workers, and influence assessors) have been blind to neighborhood allocation, except for the study coordinator (at the local medical website), the SLP providing the intervention, and the participants. result assessors (e.g., SLPs and listeners who evaluated speech intelligibility) bought edited audio and video recordings of the newborn’s productions, which didn't comprise group/session allocation information.

records administration

The ethics for this examine become permitted by means of the analysis Ethics Board on the school of Toronto (Protocol #29142) and the study became registered on the medical Trials Registry earlier than submission (#NCT02105402). The study’s integrity became maintained by means of AHRC who tested the consent manner, conducted on-site statistics monitoring visits, ensured members met the analyze inclusion/exclusion criteria, demonstrated supply facts, carried out facts entry verifications, randomized community allocation, and carried out intervening time energy evaluation and all statistical evaluation on influence measures. All consent forms and identifying tips are saved in a locked filing cabinet at each respective scientific website and might most effective be accessed by way of the look at coordinator and the AHRC. All experimental statistics had been de-recognized, blinded, and transferred to the research coordinating center at the Oral Dynamics Lab, institution of Toronto. Digital (audio and video) data were stored and transferred on a stage 2 HIPAA Hardware Encrypted external computer drive. All file storage and transfer met the requirements of the very own health information protection Act and ethics instructions.

Recording, fidelity, and reliability

All assessment and intervention classes had been video recorded (JVC Everio GZ-E220 HD: resolution 1920 × 1080) and audio recorded (the usage of Zoom H1 Ver 2.0: resolution 16 bit/pattern at 44.1 kHz) to calculate inter-rater reliability and intervention fidelity. κ-information was used for inter-rater reliability calculations, the place <0, 0.2, 0.4, 0.6, 0.eight, and 1, are often observed agreement it really is negative, mild, reasonable, average, titanic, and basically perfect, respectively.34 The κ coefficient became calculated from 20% of all information through SLPs who were blind to community and session allocations. The ordinary κ coefficient changed into 0.seventy three (vast) for evaluation transcriptions (overseas Phonetic Alphabet). The κ rankings calculated from video recordings of Probe words on the distinctive ranges ranged between fair and moderate: degree 1, mandibular = 0.fifty two; stage 2, labial–facial = 0.fifty seven; degree three, lingual = 0.sixty three; and level 4, sequenced = 0.48. To calculate inside consistency, the Cronbach’s α coefficient turned into used the place <0.5, 0.6, 0.7, 0.eight, and nil.9 are often known as unacceptable, terrible, questionable, ideal, decent, and brilliant, respectively for inner consistency levels.35 The Cronbach’s α rankings calculated at the diverse ranges of Probe words ranged between acceptable and good: stage 1, mandibular = 0.75; degree 2, labial–facial = 0.seventy nine; level 3, lingual = 0.78; and degree 4, sequenced = 0.83.

Intervention constancy became calculated for 20% of all intervention classes. Clinicians met the intervention constancy requirement of >eighty% in keeping with video recordings of intervention session the use of the fidelity checklist kind.16 Audio recordings of the toddlers’s productions of speech intelligibility gadgets were saved as .wav files and played in random order to three naïve listeners the use of a headphone amplifier (PreSonus HP60) and headphones (Sony MDR-XD10) at 70 dB SPL.

Statistical methods

All records entry verifications and first statistical analyses have been carried out by a analysis biostatistician from the AHRC. All outcomes measures were analyzed with an ANCOVA mannequin with baseline ratings set as a covariate the use of the intent-to-treat principle. lacking facts have been handled as missing in the analyses and offered in table 2. effect sizes have been calculated from the regression models within the common instruments for every variable and suggested along with their 95% confidence intervals. All statistical processes had been carried out using R utility version three.5.136 with a two-sided α stage of 0.05.

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