Background: Single best answer (SBA) as multiple-choice items are often advantageous to use for its reliability and validity. However, SBA requires good number of plausible distractors to achieve reliability. Apart from psychometric evaluation of assessment it is important to perform item analysis to improve quality of items by analysing difficulty index (DIF I), discrimination index (DI) and distractor efficiency (DE) based on number of non-functional distractors (NFD). Objective: To evaluate quality of SBA items administered in professional examination to apply corrective measures determined by DIF I, DI and DE using students' assessment score. Method: An evaluation of post summative assessment (professional examination) of SBA items as part of psychometric assessment is performed after 86 weeks of teaching in preclinical phase of MD program. Forty SBA items and 160 distractors inclusive of key were assessed using item analysis. Hundred and thirty six students' score of SBA was analysed for mean and standard deviation, DIF I, DI and DE using MS Excel 2007. Unpaired t-test was applied to determine DE in relation to DIF I and DI with level of significance. Item-total correlation (r) and internal consistency by Cronbach's alpha and parallel-form method was also computed. Result: Fifteen items had DIF I = 0.31-0.61 and 25 items had DIF I (≤ 0.30 or ≥ 0.61). Twenty six items had DI = 0.15-≥ 0.25 compared to 14 items with DI (≤ 0.15). There were 26 (65%) items with 1-3 NFD and 14 (35%) items without any NFD. Thirty nine (32.50%) distractors were with choice frequency = 0. Overall mean DE was 65.8% and NFD was 49 (40.5%). DE in relation to DIF I and DI were statistically significant with p = 0.010 and 0.020 respectively. Item-total correlation for most items was < 0.3. Internal consistency by Cronbach's alpha in SBA Test 1 and 2 was 0.51 and 0.41 respectively and constancy by parallel-form method was 0.57 between SBA Test 1 and 2. Conclusion: The high frequency of difficult or easy items and moderate to poor discrimination suggest the need of items corrective measure. Increased number of NFD and low DE in this study indicates difficulty of teaching faculty in developing plausible distractors for SBA questions. This has been reflected in poor reliability established by alpha. Item analysis result emphasises the need of evaluation to provide feedback and to improve quality of SBA items in assessment.
Smoking and obesity are leading causes of morbidity and mortality worldwide. E-cigarette which was first introduced in 2000s is perceived as an effective alternative to conventional tobacco smoking. Limited knowledge is available regarding the risks and benefits of e-cigarettes. This study systematically reviews the current literature on the effects of e-cigarettes on body weight changes and adipocytes. The search was performed using OVID Medline and Scopus databases and studies meeting the inclusion criteria were independently assessed. This review included all English language, empirical quantitative and qualitative papers that investigated the effects of e-cigarettes on bodyweight or lipid accumulation or adipocytes. Literature searches identified 4965 references. After removing duplicates and screening for eligibility, thirteen references which involve human, in vivo and in vitro studies were reviewed and appraised. High prevalence of e-cigarette was reported in majority of the cross sectional studies conducted among respondent who are obese or overweight. More conclusive findings were identified in in vivo studies with e-cigarette causing weight decrease. However, these observations were not supported by in vitro data. Hence, the effect of e-cigarette on body weight changes warrants further investigations. Well-designed population and molecular studies are needed to further elucidate the role of e-cigarettes in obesity.
Background: The Anatomy Education Environment Measurement Inventory (AEEMI) evaluates the perception of medical students of educational climates with regard to teaching and learning anatomy. The study aimed to cross-validate the AEEMI, which was previously studied in a public medical school, and proposed a valid universal model of AEEMI across public and private medical schools in Malaysia.Methods: The initial 11-factor and 132-item AEEMI was distributed to 1,930 pre-clinical and clinical year medical students from 11 medical schools in Malaysia. The study examined the construct validity of the AEEMI using exploratory and confirmatory factor analyses. The best-fit model of AEEMI was achieved using five factors and 26 items (ꭓ2 = 3300.71 (df = 1680), P < 0.001, ꭓ2/df = 1.965, RMSEA = 0.018, GFI = 0.929, CFI = 0.962, NFI = 0.927, TLI = 0.956) with Cronbach’s alpha values ranging from 0.621 to 0.927.Results: Findings of the cross-validation across institutions and phases of medical training indicated that the AEEMI measures nearly the same constructs as the previously validated version with several modifications to the item placement within each factor.Conclusions: These results confirmed that variability exists within factors of the anatomy education environment among institutions. Hence, with modifications to the internal structure, the proposed model of the AEEMI can be considered universally applicable in the Malaysian context and thus can be used as one of the tools for auditing and benchmarking the anatomy curriculum.
The detection of phospholipase A2 receptor (PLA2R) and thrombospondin domain containing 7A THSD7A among primary membranous glomerulonephritis (MGN) patients transformed the diagnosis, treatment monitoring, and prognosis. Anti-PLA2R can be detected in 70–90% of primary MGN patients while anti-THSD7A in 2–3% of anti-PLA2R negative primary MGN patients depending on the technique used. Serum and urine samples are less invasive and non-invasive, respectively, and thus can detect the presence of anti-PLA2R and anti-THSD7A with higher sensitivity and specificity, which is significant in patient monitoring and prognosis. It is better than exposing patients to a frequent biopsy, which is an invasive procedure. Different techniques of detection of PLA2R and THSD7A in patients’ urine and sera were reviewed to provide newer and alternative techniques. We proposed the use of biomarkers (PLA2R and THSD7A) in the diagnosis, treatment decision, and follow-up of patients with primary MGN. In addition, other prognostic renal biomarkers like retinol binding protein (RBP) and beta-2 microglobulin were reviewed to detect the progression of renal damage for early intervention.
Equol is a soy isoflavone metabolite that can be produced by intestinal bacteria. It is lipophilic and resembles natural oestrogens with an affinity to oestrogen receptors. This review is focused on how equol affects breast cancer, as evidenced by in vivo and in vitro studies. Equol is considered chemoprotective in specific endocrine-related pathologies, such as breast cancer, prostate cancer, cardiovascular diseases, and menopausal symptoms. In humans, not everyone can produce equol from gut metabolism. It is postulated that equol producers benefit more than non-equol producers for all the endocrine-related effects. Equol exists in two enantiomers of R-equol and S-equol. Earlier studies, however, did not specify which enantiomer was being used. This review considers equol’s type and concentration variations, pathways affected, and its outcome in in vivo and in vitro studies.
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