Classic Exam Research Articles

Functional assessment and outcome following surgical treatment of displaced tibial plateau fractures: a retrospective analysis

PurposePatients with tibial plateau fractures (TPF) are at risk of long-term hampered bipedal locomotion. A retrospective single-center study using patient-related outcome measures and a sophisticated assessment of walking abilities was conducted.MethodsAdults receiving surgical treatment of an isolated TPF between January 2012 and December 2016 received the KOOS questionnaire together with the invitation for an extensive follow-up examination on the clinical outcome including standardized assessment of the walking abilities (loadsol® system). Outcome was assessed relative to the severity of the injury or time to follow-up. Fractures were classified according to AO/OTA and Luo, respectively.Results58 out of 132 eligible patients filled in the questionnaire and participated at a median follow-up of 3.05 years after injury. For the categories “pain”, “mobility”, and “daily life activities”, all patients were rather satisfied and this was virtually not related to the time between fracture and assessment. Relevant limitations were reported for “sports and recreational activities” and “quality of life”. Loading of the previously fractured leg was most evidently changed on stairs and outdoor walking. Outcome was not related to either fracture type severity or time from injury.ConclusionOutcome after an isolated TPF is neither related to fracture type, severity of the fracture nor time from injury. Simple gait analysis techniques relying on different tasks appear to yield a more sophisticated image on functional deficits after TPF than classical exam of ground-level walking and correlate quite well with validated patient-related outcome measures as the KOOS.

SAT347 Surprising Turn Of Events In A Patient With Weight Gain: Simultaneous Diagnosis Of Macroprolactinoma And Polycystic Ovary Syndrome

Abstract Disclosure: A.N. Keskinkilic: None. D. Sistla: None. Background: The differential diagnoses of excess weight gain are broad and endocrinopathies constitute a small proportion of these etiologies. A pattern of associated symptoms, classical exam findings and hormonal testing can signal some endocrine causes. However, diagnosis can still be challenging due to overlapping clinical and biochemical features and concurrent presentations of endocrine disorders. Here, we present a diagnostically challenging rare case of a young female with weight gain who had simultaneous diagnosis of macroprolactinoma and PCOS. Clinical Case: A 34-year-old healthy female presented with one year of weight gain despite lifestyle changes. She also reported headaches, acne, hirsutism, stretch marks, excessive sweating, and had 10 years of amenorrhea while on oral contraceptives (OCs). Labs revealed mildly low free T4 of 0.72 ng/dl (n: 0.70-1.48 ng/dl) and significantly elevated prolactin (PRL) of 259.8 ng/ml (n: 1.2-29.9 ng/ml); normal FSH, LH, GH, IGF, TSH, ACTH, 1 mg dexamethasone suppression test, and 24-hour urinary cortisol. HbA1c, lipid panel, plasma metanephrine and androgen levels were normal. MRI pituitary revealed a 2.1 x 1.9 x 1.5 cm macroadenoma with mild compression to the optic chiasm. A low dose levothyroxine and cabergoline 0.25 mg twice weekly was started with dose increment to 0.5 mg twice weekly. At 6-month follow-up, PRL decreased to 30 ng/ml. Repeat MRI showed a decrease in size of the pituitary adenoma (1.5 x 1.4 x 1.3 cm). However, she could not tolerate cabergoline due to persistent headaches and depression. Hence, she elected to undergo transsphenoidal pituitary resection. Tumor pathology showed sparsely granulated lactotroph adenoma. Post op PRL level normalized, and MRI showed radiological cure of the adenoma. Headaches improved but amenorrhea persisted despite discontinuation of OCs for 6 months. Progesterone challenge tests resulted in withdrawal bleed suggesting anovulation. Repeat work-up ruled out nonclassical CAH, Cushing’s, and androgen-secreting tumors. However, subsequent pelvic ultrasound confirmed polycystic ovarian morphology, suggesting PCOS. The patient preferred to avoid OCs and could not tolerate metformin. She elected progesterone IUD placement for endometrial protection in combination with lifestyle changes with notable improvement in her symptoms. Conclusion: PCOS is a diagnosis of exclusion. Thorough evaluation of symptoms like weight gain, amenorrhea, clinical hyperandrogenism is recommended to rule out serious pathology like prolactinoma. Dual diagnosis of PCOS and macroprolactinoma is rare and should be suspected if menstrual abnormalities persist even after treatment of hyperprolactinemia. Presentation: Saturday, June 17, 2023

Present status and future directions: Imaging techniques for the detection of periapical lesions.

Diagnosing and treating apical periodontitis (AP) in an attempt to preserve the natural dentition, and to prevent the direct and indirect systemic effects of this condition, is the major goal in endodontics. Considering that AP is frequently asymptomatic, and is most often associated with a lesion in the periapex of the affected tooth, within the maxillary bones, imaging becomes of paramount importance for the diagnosis of the disease. The aim of this narrative review was to investigate the most relevant classic and current literature to describe which are, to date, the diagnostic imaging systems most reliable and advanced to achieve the early and predictable detection of AP, the best measures of the lesions and the disclosure of the different features of the disease. Dental panoramic tomography (DPT) is a classic exam, considered still useful to provide the basic diagnosis of AP in certain districts of the maxillary bones. Periapical radiographs (PRs) represent a valid routine examination, with few, known limitations. Cone-beam computed tomography (CBCT) is the only system that ensures the early and predictable detection of all periapical lesions in the jaws, with the minor risk of false positives. These techniques can be successfully implemented, with ultrasounds (USI) or magnetic resonance (MRI) imaging, exams that do not use ionising radiations. MRI and USI provide information on specific features of the lesions, like the presence and amount of vascular supply, their content and their relationship with the surrounding soft tissues, leading to differential diagnoses. Further, all the three-dimensional systems (CBCT, USI and MRI) allow the volumetric assessment of AP. Pioneering research on artificial intelligence is slowly progressing in the detection of periapical radiolucencies on DPTs, PRs and CBCTs, however, with promising results. Finally, it is established that all imaging techniques have to be associated with a thorough clinical examination and a good degree of calibration of the operator.

A Multinomial Logistic Model for the Higher Education Value-Added with K-means Clustering

The implementation of state tests at the end of the different academic cycles, to pursue high standard education, is used by many countries in the world. For the Colombian case there are two classic exams: one of them is for all the students that are about to finish high school, called Saber 11, and the other one is for people that are finishing the university cycle, called Saber Pro. Both are measured by quantitative scores. This case study was considered because it was possible to know the Saber 11 and Saber Pro scores for the same individual. The machine learning k-means technique was used for defining different groups of Saber Pro scores. Then a multinomial logistic model was applied to estimate the probability of a student to fall in every one of those groups, given his own characteristics. In other words, the distribution probability of the Saber Pro results was produced through the different defined groups using k-means. This splitting technique is far better than the standard even subdivisions (like quartiles or quintiles), because it produces optimal distance-wise clusters that allows more natural statistical results. This work gives numerical insights regarding the performance for different student profiles, and shows that the educational achievement at the end of an academic program, is influenced by the initial academic level, the socioeconomic condition, and the university status, but also that more input variables must be analyzed and included. In particular, for the considered samples, the research concluded that the individuals with the least favorable socioeconomic condition have a tendency to underperform when compared with the rest of the population, and the students of the non-accredited institutions tend to obtain lower educational achievements than the accredited ones. Of course, in all the investigated groups, students with a high result in Saber 11 tend to achieve an outstanding performance in Saber Pro, regardless of their socioeconomic status or the accreditation status of the institution. On the other hand, the gender shows no general behavior or whatsoever.

Students Perceptions of Homework as a Formal Assessment Method

Whether it is formative or summative, an assessment which is explained in Oxford Advanced Learner’s Dictionary (2015) as “an opinion or judgement about sb/sth that has been thought about” (p.75) plays a significant role in completing the language education process because of its ability to provide feedback. Choosing the right assessment method is crucial for language teachers since most classical assignments create anxiety and make the process problematic for the students. Whether the classical assignments evaluate the students’ knowledge, or they understand that their grammar level for a definite time is another discrepancy to clarify. By taking into consideration those, this qualitative study focuses on the problems of classical exams and tries to reveal how beneficial and desirable can a difficult homework be as a formal assessment method. An unstructured interview form was used to collect data from 40 prep-class students who were selected using a convenience sampling method to understand their perceptions about homework as a formal assessment method. Results showed that although 32 of those students had difficulties while preparing the homework, most of them liked the process as well and think that this kind of homework is more beneficial than classical exams. Moreover, more than half of the participants’ desire to have such homework instead of classical exams despite homework’s difficulties, and they also express that this homework increased their language knowledge.

Merging Water Research, Analytical Chemistry, and Agile Management to Shape Prospective Professionals through the Project-Centred Collaborative Approach Focusing on Water Bodies rather than Water Samples

Professionals of different disciplines, including chemists and chemical engineers, engage in water research, even though they might not have been extensively trained in it during their studies. We describe a project-centred master level subject “Water as a Hydrogeological, Ecological, and Analytical System”, which, by focussing on waterbodies instead of a particular aspect of water quality, merges total analytical process with water research and, by a considerate choice of chemical parameters, enables students to apply water-research-specific data-treatment techniques, including the Piper and Stiff diagram, to discuss water genesis, processes in water, and influences on waterbodies. Agile management, initiated in computer engineering in 2001, is believed to contribute to better products in a shorter time. We demonstrate how its incorporation into the organisational scheme helped students self-organise, handle their projects, and collaborate within and between groups. Student’s expressions confirm their overall satisfaction, motivation, and that the omission of the final classical exam had no adverse effects on the learning outcomes. Their consent with different benefits of the project-centred collaborative approach and their self-efficacy beliefs, respectively, expressed as mean values in a five-grade Likert scale ranged from 4.26 to 5.00 and from 4.32 to 5.00. Regarding the students’ time investment, the project-centred approach as the mean grade 3 confirmed is not recognised as an easier way. We provide partially self-calculating, self-notifying Excel spreadsheet tables to ease the implementation of water research data-treatment techniques, which help students collaborate and discuss their subject extensively.

Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas.

IntroductionThe classical lymphoscintigraphic investigations of lower-limb lymphatic edema [LLLE] sometimes reveal either no or few lymph nodes [LNs] at the root of the limb[s] and/or in the abdomen. The aim of the present paper is to report the results of performing one additional injection at the root of the edematous limb[s] to force the visualization of the LNs and/or to demonstrate the collateral lymphatic pathways in such patients.Methods and findingsWe retrospectively reviewed our database and found 99 patients [44 primary LLLE with 47 limbs injected and 55 with LLLE secondary to treatments for cancer with 64 limbs injected] where such an additional injection had been performed.In the 43 LLLE patients where no LNs were seen at the end of the classical exam [15 primary LLLE and 28 secondary LLLE], the extra injection showed lymphatic drainage toward LN[s] in all except 3 and when at least one LN was seen, the injection showed lymphatic drainage in every case toward the same ipsilateral [inguinal and/or iliac] LNs [as shown by the classical injection] and/or toward additional LNs.In 40.7% of patients, we observed one or more additional lymphatic pathways: prepubic superficial lymphatic vessels [LV] crossing the midline anteriorly toward contralateral inguinal LNs in 21 [18.9%], “posterior” LV [toward contralateral inguinal LNs and/or ipsi- or contralateral lumbo-aortic and/or para-renal LNs] in 14 [12.6%], but deep LV toward the ipsilateral common iliac LNs passing between the gluteal muscles in 32 [28.8%].ConclusionOur work pinpoints one limitation of classical bipedal radionuclide lymphangiography. In patients with primary and secondary LLLE where inguinal and/or iliac LNs cannot be seen on bipedal radionuclide lymphangiography, this additional injection reveals the true lympho-nodal status and shows unexpected collateral lymphatic pathways in 40% of cases. Such information is of the utmost importance in LLLE management and its acquisition is consequently recommended in these patients.

Effects of new teaching approaches on motivation and achievement in higher education applied chemistry courses: A case study in Tunisia

New teaching approaches differ from classic ones in promoting active learning. Despite claims that new teaching approaches increase students’ motivation and achievement, empirical research concerning these positive effects is scarce, specifically regarding effects on achievement. In the present investigation, we conducted a series of quasi-experimental studies to compare new with classic teaching approaches. In four studies, we investigated the impact of flipped courses - an innovating teaching method (vs. classic teaching) - and of three innovative test formats - journal format report (vs. classic report), research article analysis and exam with all documents authorised (vs. classic exam) - on the motivation and achievement of students taking applied chemistry courses at the Higher Institute of Applied Biology of Medenine, Tunisia. Students’ motivation was increased by all new teaching approaches. Achievement scores were also significantly improved by these new methods, except for the exam with all documents authorized. Effect size calculations showed that all four new approaches had larger effects on motivation than on achievement, and that motivational vs. achievement benefits were unequally balanced across active learning tools.Our findings strengthen the relevance of active learning tools in high-level applied chemistry teaching, but they highlight the need to consider priority goals (increased motivation vs. achievement) when adopting a particular learning tool.

The evolution of headlight devices in the work of otorhinolaryngologists

Invention and improving the methods of ENT examination are closely connected with the technological inventions of the 19th and 20th centuries. The invention of the classical exam head mirror in 1861 and improvement of the manufacturing of compact and powerful sources of light (filament lamps) at the time caused the researchers to create new devices for ENT examination. In particular, a head-mounted electro-mirror was created, the principle of which later became the basis for the development of fiber-optic headlamps. The emergence of powerful halogen and xenon light sources in the mid-20th century and the use of fiber-optics technology led to the development of fundamentally new mirror less headlamps. The traditional head-mounted reflector has gradually disappeared from the practice of an otolaryngologist. For our part, we can see how fiber-optic headlamps have been progressively replaced by heavy-duty LED headlamps over the last nine years. In order to determine the effectiveness of each available headlamp type and to answer the question of whether there is a benefit in using and maintaining a reflector headlamp, and to determine which current head-lamps are effective, we conducted our own research. Summing up the results, we came to the conclusion that despite its historic role in the development of otorhinolaryngology, the headlamp reflector through its low, in comparison with modern illuminators, characteristics have lost its relevance and, apparently, nowadays can serve as a museum exhibit. The head-mounted LED illuminator, a 21st century device, is gaining in popularity and is gradually becoming the standard for use in primary ENT diagnosis and during otorhinolaryngological surgical interventions. Its features such as full autonomy, lightweight, ease of use – especially the alignment of the light beam with the surgeon's eye – long operating time without recharging the battery (7 to 30 days) – depending on the manufacturer and the workload of the device – is beyond competition with any other head-mounted device for ENT organ examination.

Digital game-based examination for sensor placement in context of an Industry 4.0 lecture using the Unity 3D engine – a case study

Due to the many advantages that digital teaching and testing methods have over traditional ones, they are increasingly finding their way into everyday educational practice. The current events of the COVID-19 pandemic have given these approaches an additional boost. In this paper, a first version of digital game-based examination for sensor placement is presented, which can supplement parts of a classical exam for an Industry 4.0 lecture designed for postgraduate engineering students. For the development of the environment the Unity 3D Engine as well as freely available models and plugins for Unity are leveraged. By doing so, an immersive virtual scenario is created in which complex problems can be depicted and solved by the student. To ensure the suitability of this exam type and the coverage of the desired learning objectives, an evaluation of the game-based examination environment will subsequently be conducted and the results are discussed.

Pediatric Emergency Medicine Simulation Curriculum: Cardiac Tamponade.

Cardiac tamponade is an uncommon presentation to the pediatric emergency department and requires early recognition and emergent intervention. We developed this patient simulation case to simulate a low-frequency, high-acuity scenario for pediatric emergency medicine fellows and resident physicians in emergency medicine, pediatrics, and family medicine. We ran the case in a pediatric emergency department using a high-fidelity pediatric mannequin and equipment found in the clinical environment, including a bedside ultrasound machine. The case involved a 10-year-old patient with Hodgkin lymphoma who presented with fever, neutropenia, and shock and was found to have a pericardial effusion with tamponade after evaluation. The providers were expected to identify signs and symptoms of shock, as well as cardiac tamponade, and demonstrate appropriate emergent evaluation and management. Required personnel included a simulation technician, instructors, and a nurse. Debriefing tools tailored specifically for this scenario were created to facilitate a formal debriefing and formative learner assessment at the end of the simulation. This case has been implemented with 10 pediatric emergency medicine fellows during two 3-year cycles of fellow education. Session feedback reflected a high level of satisfaction with the case and an increased awareness of bedside ultrasound in the identification of cardiac tamponade. This resource for teaching the critical components for diagnosing and managing unstable cardiac tamponade in the pediatric patient, including use of bedside ultrasound, was well received by pediatric emergency medicine fellows.

Clinical Predictors of Isolated Tubal Torsion: A Case Series

A rare cause of adolescent abdominal pain includes isolated tubal torsion (ITT), involving at minimum one complete turn of the fallopian tube around the infundibulopelvic and utero-ovarian ligaments without involving the ipsilateral ovary. The presentation of ITT is nonspecific and only a few previous studies have investigated adolescents. The aim of our study is to describe the presentation and management of ITT in a large case series. Retrospective observational case series of adolescent females aged 3–24, presenting to Children’s Hospital Colorado and diagnosed with ITT based on ICD-9 code between 1/2004 thru 8/2015. Details of the clinical presentation, physical exam, laboratory findings, and surgical diagnosis and treatment were extracted from the medical records of identified cases. Two authors reviewed each case to confirm accuracy of data gathering. A total of 19 cases were included (Table 1). Average age of subjects was 13.3 years old (11-18). In patients with unilateral abdominal pain (n=16), there was 100% correlation with side of adnexal pathology. Ultrasound imaging in 14 of 18 cases (78%) noted abnormal findings ipsilateral to the ITT. A majority of patients were managed with laparoscopy (84%) and detorsion +/-cystectomy (74%). Salpingectomy was more common with history of prolonged pain > 24 hours (RR 5.6, CI 0.7 – 39.0). The most common intraoperative pathology was a paratubal cyst (74%, n= 14). When ultrasound Doppler flow was performed, it was present in 88% (n = 15) of the effected adnexa. ITT was more common on the left side (68%, n= 13). The high occurrence of paratubal cysts may suggest pathologic predisposition for ITT. Providers should have high index of suspicion for ITT when evaluating adolescent abdominal pain, particularly if associated with a paratubal cyst. Classic exam findings of surgical abdomen, leukocytosis or fever and absence of Doppler flow on ultrasound are not always present. Laparoscopy and detorsion are appropriate treatment options for managing ITT.Table 1Clinical presentation, intraoperative findings, and managementClinical PresentationPercent (n = 19)Pain present100% (19)Duration of pain≤ 24 hours53% (10)> 24 hours47% (9)Pain onsetSudden63% (12)Gradual36% (7)Pain severityMild16% (3)Moderate37% (7)Severe47% (9)Nausea68% (13)Vomiting47% (9)Fever ( Temperature ≥ 38.0)11% (2)Tachycardia (Heart rate ≥ 100)32% (6)Abdominal tenderness95% (18)Guarding32% (6)Rebound37% (7)Leukocytosis (WBC ≥ 10)43% (61)Imaging modalityCT57% (11)Ultrasound95% (18)Adnexal mass present on imaging100% (182)Doppler flow present79% (152)TreatmentPercent (n = 19)Surgeon specialtyPediatric gynecology79% (15)Pediatric surgery21% (4)Surgical approachLaparoscopy84% (16)Laparotomy11% (2)Both5% (1)Surgery performedSalpingectomy32% (6)Detorsion5% (1)Detorsion + paratubal cystectomy58% (11)Detorsion + paratubal cyst drained6% (1)Detorsion + drainage of hydrosalpix6% (1)Oophoropexy0% (0)Oophorectomy0% (0)Associated paratubal cyst74% (14)1: 14 cases had preoperative CBC results2: 18 cases had preoperative ultrasound Open table in a new tab

English

The aim of this study is to analyze the mistakes that have been made in the group theory underlying the algebra mathematics. The 100 students taking algebra math 1 class and studying at the 2nd grade at a state university in Istanbul participated in this study. The related findings were prepared as a classical exam of 6 questions which have been presented by 3 academic members working at the same university and these questions were presented to the students accordingly. After findings were put into codes as Correct/Wrong answers, solutions coded as “Wrong” were analyzed according to the content analysis method. Classifying the mistakes made in the solutions by students, suggestions about how to rectify these mistakes were carefully offered. Key words: Math Training, Group Theory, Learning Disabilities.

Fever and Transaminitis: Sole Manifestations of Enteric Fever in a Traveler Returning From Bengladesh

Introduction: Approximately 400 cases of typhoid fever are diagnosed in the U.S. each year. The majority of cases are found in patients who acquired the illness while traveling to endemic countries; however, 25% of cases are acquired domestically. In most cases, patients complain of fever, headache, malaise, anorexia, abdominal pain, diarrhea, or constipation. Classic exam findings include a coated tongue (typhoid tongue), rose spots, fever, relative bradycardia, hepatosplenomegly, and altered mental status. Common laboratory abnormalities of infected patients include anemia, and leukopenia or leukocytosis. Typical time of exposure to presentation is usually 5-21 days. Here, we report a case of a 65-year-old Bangladeshi male with no significant past medical history who presented with 5 days of fever and rigors. He traveled to the U.S. from Bangladesh 29 days prior to onset of fever. He denied any history of headache, lethargy, abdominal pain, diarrhea, constipation, or change in stool color. He also denied taking any medication for the past 3 months, including over-the-counter medications. He reported a remote history of alcohol use with 3-4 hard liquor beverages daily, but has abstained for greater than 5 years. Vital signs were significant for fever of 102.1°F with normal blood pressure and heart rate. The only abnormality on physical exam was dry oral mucous membranes. Positive lab findings were elevated liver enzymes with AST 97 and ALT 100. All other laboratory values were within normal range, including CBC and hepatitis serology. Chest x-ray was significant for bilateral lower lobe infiltrates. Initially, he was started on broad spectrum antibiotics with vancomycin and cefepime due to concern for possible pneumonia. To determine the cause of transaminitis, a right upper quadrant ultrasound was performed, which did not show any abnormalities. Due to ongoing fevers on broad spectrum antibiotics, a CT scan of the abdomen was done to rule out abscess, which showed multiple enlarged mesenteric lymph nodes, but no other abnormalities. Blood cultures resulted positive for Salmonella paratyphi. Antibiotics were downgraded to ciprofloxacin, and subsequently his liver enzymes normalized, fever subsidized, and he was discharged home on a 7-day course of levofloxacin. As noted above, the majority of typhoid fever cases present with GI symptoms; however, this case presents rare findings of isolated fever and rigors and a history notable for an abnormally long period between exposure and onset of symptoms. Therefore, the diagnosis of typhoid fever should be considered in the differential for a patient with possible recent exposure and minimal signs and symptoms on presentation.

Assessing the Peripheral Sensitivity of Newly Diagnosed Type 2 Diabetes Mellitus Patients Using Caseivsystem and Classic Methods

Abstract Background and Aims: A complete evaluation of complications should be done each time a new case of Type 2 Diabetes Mellitus (T2DM) is diagnosed. A good screening of complications will be the background of an oriented treatment. Our aim was to assess the vibratory and thermal sensitivity using a Computer Aided Sensory Analyzer (CASEIVSystem) in newly diagnosed T2DM patients and to compare it with the threshold determined by classical methods. Material and Methods: We sequentially enrolled 260 patients with newly diagnosed T2DM. The threshold of peripheral vibratory and thermal sensitivity was comparatively assessed using CASEIVSystem and classic tools. Other neurological scores were obtained from patients. Results: The vibratory threshold was abnormal in 56.92% (hand) and respectively 75.00% (foot) of subjects. Altered perception for the thermal threshold was registered in 76.15% and, respectively, 76.92% of subjects for the same sites. The 10g-monofilament exam was positive for 28.46% and the 128Hz-tuning-fork exam was positive for 20.38% of the examined patients. Mean time for a complete CASEIVSystem exam was around 27.23±9.34min vs. 3.21±0.24min (p<0.05) for a classic exam. Conclusions: In our study, CASEIVSystem allowed the assessment of the vibratory and thermal thresholds. The time needed for investigation renders this tool difficult to use in a time effective manner

244: Significance of T-wave inversions in athletes

T-wave inversion beyond V1 is rarely observed on the ECG of healthy athletes (< 4%), whereas it is a common finding in patients with cardiomyopathy. Thus recent ESC recommendations for interpretation of resting ECG in the athlete underlined that this ECG pattern is not due to physical training and request cardiovascular exams. Classical exam performed is resting echocardiography. In this prospective study the respective value of different non invasive exams performed in case of negative T waves in athletes was evaluated. We prospectively included 49 athletes with T-wave inversion beyond V1. They underwent intensive cardiac investigations (exercise test, 24h ECG Holter monitor, rest and exercise echocardiography, cardiac MRI) to identify a potential cause. In all cases ECG was realized for pre-participation screening. Only few subjects reported cardiovascular symptoms (n=10) or cardiac murmur (n=5). Thus in most cases no evidence of cardiovascular disease (n=34) was noted. In 25 subjects no significant abnormality was detected. Cardiomyopathy was diagnosed in 24 (49%) subjects, 20 HCM, 1 ARVC and 3 resolutives myocarditis. In the cardiac disease group, only 4 presented cardiovascular symptoms vs 6 in the non pathologic one (n=25). In 2 patients with myocarditis but normal echocardiography, the diagnosis was performed by cardiac MRI because of evidence of late gadolinium enhancement (LGE). LGE was also useful for risk stratification in HCM patients (8). Exercise echocardiography was very useful in 2 patients for the diagnosis of HCM by unmasking dynamic LVOT obstruction, and in 1 patient with myocarditis by showing absence of contractile reserve. T-wave inversions in athletes cannot be regarded as a physiological adaptation even in absence of symptoms. An intensive cardiac evaluation is necessary including cardiac MRI and exercise echocardiography in subjects with considered normal resting echocardiography and exercise ECG.

Blended e-assessment: Migrating classical exams to the digital world

Existing e-assessment tools may not be a panacea to address all assessment situations, as students might find the traditional pen-and-paper approach to provide their answers more convenient than typing them online. For example, constructed response or essay-based assessments will require the active participation of students and lecturers to demonstrate and grade knowledge acquisition, reasoning, evaluation or argumentation. We propose an e-assessment solution that combines mainstream e-assessment features with the classical assessment approach where students write down their responses in paper.This approach supports both grading and access to exams anytime and anywhere. Students attend assessment sessions and are tested the traditional way, but grading, reporting of results, and statistical analysis are performed in the digital world. The proposed approach also provides support to the automated generation of assessment reports, and the administrative management of student grades and their automated transfer to student files. This tool may also be seen as a cost-effective alternative to computer-supported e-assessment, in those cases where the use of computers to perform assessment is not convenient or possible. The tool enables both formative and summative assessment, and also facilitates the transition from classical paper-and-pen-based assessment scenarios to digital ones. The tool has been validated during the last three academic years at University of Vigo, Spain. Highlights? We present a tool combining the paper-pen exams and digital assessment and grading. ? It supports both grading and access to exams anytime and anywhere trough the web. ? It may be seen as a cost-effective alternative to computer-supported e-assessment. ? The tool was validated during the last three years at University of Vigo, Spain.

EFFECT OF TEACHING VIA MODELING ON ACHIEVEMENT AND CONCEPTUAL UNDERSTANDING CONCERNING ELECTRICITY

In this study, it is aimed to determine the effects of teaching via modeling on academic achievement and conceptual understanding concerning some selected undergraduate electricity topics. Dependent variables of the research are academic achievement and conceptual understanding. Academic success was measured by using Electricity Success Test and Electricity Classical Exam and conceptual understanding on the other hand was measured by using an Electricity Concept Test. A total number of 41 students attended the research, 21 of the students were in the modeling group and 20 of the students were in the control group. The study was carried out experimentally by means of pre test-post test research design. In conclusion it is found that teaching via modeling method meaningfully enhances the academic achievement and conceptual understanding. Key words: achievement, conceptual understanding, electricity, modeling instruction, physics education.

Air Embolism and Central Venous Lines

It was the second postoperative day for Ms. A. She was 80 years old and had undergone an emergency laparotomy, immediately followed by a bowel resection to alleviate an obstruction caused by multiple adhesions. Ms. A's central venous pressure was being monitored by a catheter in the jugular vein. After getting her up in a chair, we observed that IV fluid was leaking out from under the dressing over the catheter site. On investigation, we discovered a slight disconnection between the catheter hub and the tubing. This was immediately remedied, but the patient suddenly became tachypneic, short of breath, pale, hypotensive, and unresponsive. Her condition is a classic exam-