Short case-based questions lead to thinking processes which represent problem-solving ability better than those elicited by factual knowledge questions.
This study shows that in standard-setting the individual judgement of the individual item is not only a reflection of the difficulty of the item but also of the inherent stringency of the judge and his/her subject-related knowledge. Considerable variation between judges in their stringency was found, and Angoff estimates were significantly affected by a judge knowing or not knowing the answer to the item. These findings stress the importance of a careful selection process of the Angoff judges when making pass/fail decisions in health professions education. They imply that judges should be selected who are not only capable of conceptualising the 'minimally competent student', but who would also be capable of answering all the items.
M Mo od du ul la at ti io on n o of f g gl lu uc co oc co or rt ti ic co oi id d r re ec ce ep pt to or r e ex xp pr re es ss si io on n i in n h hu um ma an n b br ro on nc ch hi ia al l e ep pi it th he el li ia al l c ce el ll l l li in ne es s b by y I IL L--1 1β, , T TN NF F--α a an nd d L LP PS S
nM, respectively. Using electrophoretic mobility shift assays we demonstrated the binding of nuclear translocated GR to specific sites on deoxyribonucleic acid (DNA), named glucocorticoid responsive elements (GRE).Lipopolysaccharide (LPS) and interleukin-1β (IL-1β) significantly increased the number of GR per cell (median=312% and 171% of control, respectively; p<0.05), but significantly reduced the ligand affinity of these receptors, i.e. increased the Kd (median=410% and 145% of control, respectively; p<0.05) in BEAS 2B cells.These results indicate that the bronchial epithelium may be an actual target for glucocorticoid therapy. Inflammatory mediators, such as IL-1β and LPS, modulate the number and ligand affinity of these GR. Therefore, the response of bronchial epithelium to glucocorticoid therapy may be modulated by airway diseases associated with inflammation. Eur Respir J., 1996Respir J., , 9, 2036Respir J., -2043
Previously, we found that inflammatory mediators modulated the number and binding affinity of glucocorticoid receptors (GR) in human bronchial epithelial cell lines. In this study we investigated whether smoking and chronic obstructive pulmonary disease (COPD), both characterized by airway inflammation with increased levels of inflammatory mediators, affect GR characteristics in cultured human bronchial epithelial cells (HBEC). A statistically significant difference was found between the dissociation constant (Kd) values in HBEC from smoking (Kd = 0.98+/-0.08 nM; n = 6) and nonsmoking controls (Kd = 0.76+/-0.10 nM, P = 0.03; n = 5), but no significant difference was found between the mean number of binding sites. Our results are the first indication that cultured HBEC from smokers possess GR with a lower binding affinity. This may result from the inflammation found in the airways from smokers. Furthermore, these results provide further evidence that the bronchial epithelium may be an actual target for inhaled glucocorticoid therapy.
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