CORRELATION OF DIFFICULTY INDEX AND DISCRIMINATING INDEX IN MEDICAL STUDENT’S ASSESSMENT.

Multiple choice questions are nowadays used in competitive examination and formative assessment to assess the student's eligibility and certification.Item analysis is the process of collecting,summarizing and using information from students' responses to assess the quality of test items.Goal of the study was to identify the relationship between the item difficulty index and item discriminating index in medical student's assessment. 400 final year medical students from various medical colleges responded 200 items constructed for the study.The responses were assessed and analysed for item difficulty index and item discriminating power. Item difficulty index an item discriminating power were analysed by statical methods to identify correlation.The discriminating power of the items with difficulty index in 40%-50% was the highest. Summary and Conclusion:Items with good difficulty index in range of 30%-70% are good discriminator.

Prolongation of Electrocardiographic T Wave Parameters Recorded during the Head-Up Tilt Table Test as Independent Markers of Syncope Severity in Children

The head-up tilt table test (HUTT) with the upright phase is used to help determine an imbalance of the sympathetic nervous system that is related to abnormal electrocardiographic repolarization in children with vasovagal syncope (VVS) and also in patients with the long QT syndrome (LQTS). The study attempted to evaluate T wave morphology and QT and TpTe (Tpeak–Tend) intervals recorded in ECG during the HUTT for a more accurate diagnosis of children with VVS. The group investigated 70 children with a negative HUTT result: 40 patients with VVS and 30 healthy volunteers without syncope. The RR interval as well as TpTe, and QTc intervals were measured in lead V5 of electrocardiogram (ECG) on admission to the hospital and during three phases of the HUTT. In syncopal children, which included 23 children with bifid or flat T waves and 17 patients with normal T waves in the upright phase, the QTc and TpTe were longer (p < 0.001) compared to the other test phases and longer (p < 0.001) than in the control group, respectively, with the risk of arrhythmias. Only in the control group, the TpTe was shorter (p < 0.001) in the upright phase than in the other tilt phases. The TpTe in the upright phase (>70 ms) was a good discriminator, and was better than the QTc (>427 ms). Prolongation of electrocardiographic TpTe and QT intervals, in addition to the (abnormal T wave morphology recorded during the HUTT, are helpful for identifying VVS children more predisposed to ventricular arrhythmias with a latent risk of LQTS. Further studies are required to assess the value of these repolarization parameters in clinical practice.

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people

Purpose Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. Methods Hospitalised patients aged ≥ 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. Results In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93–1.12) and controls (HR 1.99, 95% CI 1.46–2.72), with an interaction term (HR 0.51, 95% CI 0.37–0.71) in multivariable models. Conclusions Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients.

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people

PurposeOur aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors.MethodsHospitalised patients aged ≥70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports.ResultsIn 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95%CI 0.93-1.12) and controls (HR 1.99, 95%CI 1.46-2.72), with an interaction term (HR 0.51, 95%CI 0.37-0.71) in multivariable models.ConclusionsOur findings suggest that (i) frailty is not a good discriminator of prognosis in COVID-19 and (ii) pathways to mortality may differ in fitter compared with frailer older patients.Key summary pointsAimTo describe associations between frailty, ethnicity, socioeconomic position and mortality in a cohort of older patients presenting to hospital with COVID-19.

Soccer Specific Fitness Differences Across the Common Playing Position Players

As a complex team sport, success in soccer relies on individuals’ performance, collective performance, and most importantly on team performance. In soccer, players are usually assigned to a specific position based on the demands of the position and the corresponding qualities of the players. The performance factors are varied and interrelated. As such, whether speed, change-of-direction-speed (CODS) and repeated sprinting ability (RSA) are used to discriminate different position players is not well-established. The purpose of this study was to examine how different position players are different against these parameters. The study participants included 88 soccer players at the Ethiopian National Soccer League classified into six playing positions such as centerbacks, fullbacks, holding-midfielders, attacking-midfielders, outside-midfielders and strikers. The participant players speed, CODS and RSA were measured weekly for about five weeks. The authors analyzed the collected data using one-way ANOVA and Games-Howell multiple comparisons. Results indicated that the position discriminating power of the three measures, including speed, CODS and RSA was found minimal. Among the different position players, only outside-midfielders were significantly higher performers with these qualities measured. Therefore, it was concluded that the performance difference in speed, CODS and RSA among the six position players is not a good discriminator, except for outside-midfielders, who outperformed all other position players (excluding the fullbacks) with the studied parameters.

Automated volumetric breast density measures: differential change between breasts in women with and without breast cancer

Background Given that breast cancer and normal dense fibroglandular tissue have similar radiographic attenuation, we examine whether automated volumetric density measures identify a differential change between breasts in women with cancer and compare to healthy controls. Methods Eligible cases (n = 1160) had unilateral invasive breast cancer and bilateral full-field digital mammograms (FFDMs) at two time points: within 2 months and 1–5 years before diagnosis. Controls (n = 2360) were matched to cases on age and date of FFDMs. Dense volume (DV) and volumetric percent density (VPD) for each breast were assessed using Volpara™. Differences in DV and VPD between mammograms (median 3 years apart) were calculated per breast separately for cases and controls and their difference evaluated by using the Wilcoxon signed-rank test. To simulate clinical practice where cancer laterality is unknown, we examined whether the absolute difference between breasts can discriminate cases from controls using area under the ROC curve (AUC) analysis, adjusting for age, BMI, and time. Results Among cases, the VPD and DV between mammograms of the cancerous breast decreased to a lesser degree (− 0.26% and − 2.10 cm3) than the normal breast (− 0.39% and − 2.74 cm3) for a difference of 0.13% (p value < 0.001) and 0.63 cm3 (p = 0.002), respectively. Among controls, the differences between breasts were nearly identical for VPD (− 0.02 [p = 0.92]) and DV (0.05 [p = 0.77]). The AUC for discriminating cases from controls using absolute difference between breasts was 0.54 (95% CI 0.52, 0.56) for VPD and 0.56 (95% CI, 0.54, 0.58) for DV. Conclusion There is a small relative increase in volumetric density measures over time in the breast with cancer which is not found in the normal breast. However, the magnitude of this difference is small, and this measure alone does not appear to be a good discriminator between women with and without breast cancer.

A checklist of Bombyliidae (Diptera) from Mordovia, Russia and variation of wing shape in Bombylius species

Chursina MA, Ruchin AB. 2018. A checklist of Bombyliidae (Diptera) from Mordovia, Russia and variation of wing shape in Bombylius species. Biodiversitas 19: 2147-2156. A checklist of Bombyliidae (Diptera) of Republic of Mordovia (Russia) is provided, based on material collected from 2008 to 2017. One hundred ninety specimens from 75 localities were collected. Fourteen of the twenty species are listed as belonging to the fauna for the first time. Intraspecific variation and sexual dimorphism in the wing shape of three species of the genus Bombylius Linnaeus, 1758 were investigated using geometric morphometric techniques. The analysis revealed that wing shape is a good discriminator of the species. In addition, significant sexual dimorphism were found: females of two of the three species had larger wings than males. The sex shape differences consisted mainly of сhanges in the placement of the CuA and A1, while interspecific wing shape variation distributed in more dimensions. There was no evidence for allometric relationships relating to sexual dimorphism and interspecific variation. Potential adaptive significance of interspecific and intersex variation in wing size and shape is discussed.

Performance of free prostate-specific antigen ratio in differentiating between prostatic cancer and benign prostatic lesions at a referral hospital in South Africa

Background: Prostate cancer is a leading cause of morbidity and mortality in our male population, thus screening initiatives will help to improve outcomes. The current screening marker, total prostate-specific antigen (PSA), is not prostate cancer specific. The development of percentage free PSA (%FPSA) has largely improved the detection of prostate cancer.Objectives: To assess the performance of %FPSA ratio at the 25% cut-off and its ability to distinguish between prostate cancer and benign prostatic lesions.Methods: This was a retrospective study conducted on male patients with total prostate-specific antigen values 10 ng/ml and with prostate histology results. Male patients with total prostate-specific antigen between 4 and 10 ng/ml had their free prostate-specific antigen determined together with the calculation of the free prostate-specific antigen ratio. The ratio was then correlated with prostate histology results to determine the presence of prostate cancer at the cut-off ratio of 25%.Results: Prostate cancer was detected in 28 (21.37%) patients out of the total population of 131. Ninety-two patients had a FPSA ratio of 25%, 22 (22.8%) of whom were found to have prostate cancer. Notably the sensitivity and specificity were found to be 86% and 27% respectively, with a positive predictive of value of 21% at this cut-off.Conclusions: The study demonstrates a %FPSA ratio of 25% not to be a good discriminator between prostatic cancerous and benign lesions. It is thus recommended that a prostate biopsy should be done based on clinical examination findings rather than the level of total prostate specific antigen from 0–10 ng/ml or %FPSA ratio.

Baremación de una tarea de repetición de pseudopalabras para la evaluación del desarrollo léxico

<p style="margin: 0cm 0cm 0pt; text-align: justify; line-height: 150%; -ms-text-justify: inter-ideograph;"><span style="line-height: 150%; font-family: 'Times New Roman',serif; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US">It has been demonstrated that the ability to repeat non-words is a good marker of lexical development in a number of languages, including Spanish. In addition, the ability to repeat nonwords has been used as a good discriminator between typically developing children and children with language delays or other language difficulties. However, despite its potential usefulness for clinical and research purposes, there is no validated scale in Spanish. To address this situation, we present a scale based on a sample of 342 monolingual Spanish-speaking children aged from four to seven years. After data analysis, a scale was elaborated to provide populational references for colleagues working in educational, clinical and research fields. The results show a ceiling effect for six years olds, as well as for monomorphemic and bisyllabic items. Implications of these scores are discussed in the corresponding section. </span></p>

Abstract 129: Clinical-imaging Mismatch versus Perfusion Imaging Mismatch Selection for Stroke Patients Undergoing Mechanical Thrombectomy

Background and Purpose: The best approach to select patients for reperfusion therapy in acute ischemic stroke remains to be established. Different methodologies have been proposed using different clinical, vascular, and parenchymal imaging parameters. Our aim is to compare Perfusion-imaging Mismatch (PIM) and Clinical-Core Mismatch (CCM) patient selection and assess their ability to predict outcomes. Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution for patients with acute anterior circulation strokes, adequate CT perfusion imaging maps and a National Institute of health Stroke Scale (NIHSS) ≥10 from September 2010 to March 2015. Patients were categorized according to the PIM and CCM definitions. PIM was defined as follows: Core Lesion ≤50cc; Tmax >10sec <100cc; Mismatch (Tmax> 6s lesion - core lesion) ≥15cc and ratio >1.8. CCM was defined as: NIHSS ≥ 10 and core infarct <31 cc (and age < 80) or NIHSS ≥ 20 and core infarct <51 cc (and age < 80) or NIHSS ≥ 10 and core infarct <21 cc (and age ≥ 80). The ability of PIM and CCM to predict good outcomes (modified Rankin scale 0-2) was evaluated using the area under the receiver operating characteristic curves (AUC), Akaike information criterion (AIC) and Bayesian information criterion (BIC). Results: A total of 368 patients qualified for the study. PIM had a lower number of qualifying patients compared to CCM (n=231, 62.8% vs n=303, 82.3%). The two groups were statistically different (p<0.001) with the following disagreement: 12 PIM+/CCM- and 84 PIM-/CCM+. There were no differences in good outcomes between PIM+ and PIM- patients (52% vs 48%, p=0.5). CCM+ patients had higher rates of good outcomes than CCM- (53% vs. 35%, p=0.015). There were no differences between PIM and CCM in predicting good outcomes as assessed by the AUC, AIC and BIC (0.82, 323.64 and 330.61 vs 0.82, 323.56 and 330.53 respectively) Conclusion: We were unable to demonstrate a difference between the PIM and CCM in predicting clinical outcomes. However, PIM seems to unjustifiably disqualify a significant proportion of patients that still benefit from reperfusion. In contrast with CCM, PIM does not seem to be a good discriminator of good outcomes. Future prospective studies are warranted.