Discrimination Index Research Articles

Development of Mathematics Literacy Questions on Trigonometry

The 2022 Education Report reveals that high school-equivalent students scored 50.74% in numeracy literacy, below the minimum competency. Emphasizing mathematical literacy is crucial, yet such problems are scarce in classrooms. The research aims to develop mathematical literacy questions. The trigonometry material was chosen for the reason that this material should enable literacy activities related to material concepts. Following the ADDIE (Analysis, Design, Implementation, and Evaluation) model, the study employs expert validation and student responses as instruments, involving 20 students in small and large-scale test phases. It yields four trigonometry essay questions for high school. The research results show that the Mathematical Literacy test developed has quite valid categories in terms of content, construct and language. The questions are declared reliable. All types of questions are difficult. Discrimination index of questions, 1 question in the average category, and 3 questions in the low category. The developed questions are in the difficult category because at the mathematical literacy level, the abilities that are developed are not at the level of low-level thinking. This research supports efforts to increase student competency in mathematical literacy at the high school level.

Development and validation of conceptual test instrument in Physics: A synthesis

A well-developed physics conceptual test that can be a
 diagnostic, a misconception, or a summative test best suited to the
 science major will help educators to determine the level of physics
 understanding of the prospective science teachers at public and
 private high schools. Hence, the purpose of this synthesis paper is to
 look into the key aspects of the process of the development and
 validation of conceptual test instruments in physics subjects for the
 undergraduate level. A literature review was used to determine the
 process of the development of conceptual tests. The process starts
 with preparation or content analysis, development, validation, and
 pilot testing. Statistical analysis, such as difficulty and
 discrimination indices and biserial coefficients used by the authors
 of various researchers, was also included. A stable, usable, and
 promising form test instrument can help instructors evaluate the
 effectiveness of the pedagogies and new curriculum.

Leg strength and incidence of heart failure in patients with acute coronary syndrome.

The risk of developing heart failure (HF) after acute coronary syndrome (ACS) remains high. It is unclear whether skeletal muscle strength, in addition to existing risk factors, is a predictor for developing HF after ACS. We aimed to clarify the relationship between quadriceps isometric strength (QIS), a skeletal muscle strength indicator, and the risk of developing HF in patients with ACS. We included 1053 patients with ACS without a prior HF or complications of HF during hospitalization. The median (interquartile range) age was 67 (57-74) years. The patients were classified into two groups-high and low QIS-using the sex-specific median QIS. The endpoint was HF admissions. During a mean follow-up period of 4.4 ± 3.7 years, 75 (7.1%) HF admissions were observed. After multivariate adjustment, a high QIS was associated with a lower risk of HF [hazard ratio: 0.52, 95% confidence interval (CI): 0.32-0.87]. Hazard ratio (95% CI) per 5% body weight increment increase of QIS for HF incidents was 0.87 (0.80-0.95). Even when competing risks of death were taken into account, the results did not change. The inclusion of QIS was associated with increases in net reclassification improvement (0.26; 95% CI: 0.002-0.52) and an integrated discrimination index (0.01; 95% CI: 0.004-0.02) for HF. The present study showed that a higher level of QIS was strongly associated with a lower risk of developing HF after ACS. These findings suggest that skeletal muscle strength could be one of the factors contributing to the risk of developing HF after ACS.

Experiential Mobile Learning: QR Code Driven Strategy in Teaching Thermodynamics in Science 12

The purpose of this study was to examine whether QR code driven strategy would be effective in teaching thermodynamics in science 12. Experimental design was used to test the effectiveness of the strategy. Further, pretest-post- test design was employed wherein one section from grade 12 STEM strand was exposed to the intervention while the other section was exposed to traditional approach. Both groups took the same pretest-post-test which was composed of 50 multiple choice questions. The test questionnaire used was validated using Zipgrade application to determine the discrimination and difficulty index. Moreover, test scores were subjected to Cronbach’s Alpha for reliability test. Weighted mean was computed to describe the test scores of both controlled and experimental groups. T-test of difference between means of independent samples were used to determine the difference between the means of two groups and were tested at 0.05 level of significance. Results revealed that the two groups under study did not differ significantly in their pretest, which means that the students’ knowledge before the intervention were about at the same level. In contrast, based on the statistical analysis, the t-test significantly differentiated the two groups in favor of the experimental group, which registered higher means in the posttest. This means that after the learning units using the QR code driven strategy, the experimental group was greatly improved in the posttest. Together, these findings also suggest that the two groups exhibited significant difference in their pretest and posttest but the QR code driven strategy effects to be predominant.

A TEST TO MEASURE KNOWLEDGE OF DAIRY FRAMERS ABOUT IMPROVED DAIRY FARMING PRACTICES

Dairy farming is practised mainly by resource poor farmers who have limited access to knowledge, skill, training and credit. Extension interventions would help these farmers to access knowledge and technologies that can enhance their standard of living. This would facilitate them to obtain good economic returns. The major objective of study was to evaluate dairy farmers’ knowledge about improved dairy farming practices. The knowledge test of resource poor dairy farmers on four major areas of dairy farming (breeding, feeding, healthcare and management practices) was conducted. A tentative list of 35 items was drafted keeping in view the application of statement suited to the area of study. After getting jury opinion on the items of test, Item difficulty index, Discrimination index and items of validity were worked out. Finally, 28 statements were selected in the final format to measure knowledge about improved dairy farming practices. The reliability coefficient (rtt=0.77) obtained indicated that the internal consistency of the knowledge test developed for the study was very high.

A TEST TO MEASURE THE KNOWLEDGE LEVEL OF DAIRY FARMERS ABOUT ZOONOTIC DISEASES

One hundred and twenty-four items were initially constructed based on promoting thinking rather than memorization and differentiating the well-known target people from the poorly known ones to knowledge about the zoonotic disease. The scores from sample respondents were subjected to item analysis, item selection comprising of item difficulty index, item discrimination index and point biserial correlation. Sixty-two items with a difficulty index ranging from 20 to 80 per cent; discrimination index ranging from 0.2 to 0.8 and items with significant point biserial correlation either at 1 per cent or 5 per cent level were included in the final format of the knowledge test. The reliability of the knowledge test was found to be 0.96 using split–half method which was highly significant. The knowledge test was developed and standardized which is highly stable and dependable for measurement.

Potential mechanism of Qinggong Shoutao pill alleviating age-associated memory decline based on integration strategy

Context Qinggong Shoutao Wan (QGSTW) is a pill used as a traditional medicine to treat age-associated memory decline (AAMI). However, its potential mechanisms are unclear. Objective This study elucidates the possible mechanisms of QGSTW in treating AAMI. Materials and methods Network pharmacology and molecular docking approaches were utilized to identify the potential pathway by which QGSTW alleviates AAMI. C57BL/6J mice were divided randomly into control, model, and QGSTW groups. A mouse model of AAMI was established by d-galactose, and the pathways that QGSTW acts on to ameliorate AAMI were determined by ELISA, immunofluorescence staining and Western blotting after treatment with d-gal (100 mg/kg) and QGSTW (20 mL/kg) for 12 weeks. Results Network pharmacology demonstrated that the targets of the active components were significantly enriched in the cAMP signaling pathway. AKT1, FOS, GRIN2B, and GRIN1 were the core target proteins. QGSTW treatment increased the discrimination index from −16.92 ± 7.06 to 23.88 ± 15.94% in the novel location test and from −19.54 ± 5.71 to 17.55 ± 6.73% in the novel object recognition test. ELISA showed that QGSTW could increase the levels of cAMP. Western blot analysis revealed that QGSTW could upregulate the expression of PKA, CREB, c-Fos, GluN1, GluA1, CaMKII-α, and SYN. Immunostaining revealed that the expression of SYN was decreased in the CA1 and DG. Discussion and conclusions This study not only provides new insights into the mechanism of QGSTW in the treatment of AAMI but also provides important information and new research ideas for the discovery of traditional Chinese medicine compounds that can treat AAMI.

Study on item analysis of multiple – choice questions amongst the undergraduate dental students

Assessments are powerful tools for bringing on the achievement of educational goals and one of the tools for bringing it rightly is “item analysis.” Multiple - Choice Questions (MCQs) are one of the most common methods of assessing the knowledge capabilities of undergraduate and postgraduate medical students. The main objective of this study was to analyze the quality of MCQs and to assess the relationships of items having good difficulty and discrimination indices with their distracter efficiency. After getting an ethical approval from Institutional Review Committee of Nepal Medical College Teaching Hospital a cross – sectional study was conducted over a period of one year from January 2022 to December 2022 in the Department of Human Anatomy of Nepal Medical College. The difficulty index (DIF I), discrimination index (DI) and distracter efficiency (DE) were calculated and analyzed. The results obtained revealed that the mean and standard deviation of DIF I, DI and DE were 56.75±22.6, 0.3±0.2 and 43.24±25.66 respectively. The items analyzed were neither too easy and nor too difficult (DIF I = 62.8%). The majority of items fulfilled the criteria of acceptable difficulty and good discrimination index and the maximum number of items were found to have 2 NFDs (DE = 33.33 %). The present study was hence undertaken as it assists to evaluate the MCQ items to discern its effectiveness in assessing the knowledge of students as well as it plays a vital role in developing a question bank having valid MCQs.

ENGLISH-TEACHERS’ RELIGIOUS RESPONSIBILITY IN SMOOTH ASSESSMENT: AN ANALYSIS OF ITEM DISCRIMINATION OF EXAMS CONDUCTED AT UNIVERSITY LEVEL

Assessment is an essential part of all learning systems. Consideration of discrimination is a crucial step in test formation. No assessment may be claimed as standard without this important technique. The purpose of this study was to examine the discrimination index of exams conducted at university level. The assessment of item discrimination in semester exams administered at the university level is explored in this descriptive study. Convenient sampling techniques were used to collect data for analysis from a sample consisting of 12 mid-term papers of social sciences disciplines. To evaluate the test items' ability to distinguish between students who perform well and those who do not, the research focuses on analyzing the differences in performance of individual test items. Exam items' discriminatory power was assessed using the statistical technique of the item discrimination index. The results provided important information about how well exam items measure students' comprehension and knowledge in a range of academic settings. Moreover, they lacked validity as they were unable to discriminate between high and low achievers. Recommendations derived from the analysis suggested to improve the quality and discriminatory ability of examination items for more accurate evaluations in the academic setting.

Psychological Distress and the Risk of Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease

BackgroundPsychological distress is a recognized risk factor in patients with coronary heart disease (CHD), but its clinical significance is unclear. ObjectivesThe purpose of this study was to determine if an index of psychological distress is independently associated with adverse outcomes and significantly contributes to risk prediction. MethodsPooled analysis of 2 prospective cohort studies of patients with stable CHD (N = 891). A psychological distress score was constructed using measures of depression, anxiety, anger, perceived stress, and post-traumatic stress disorder, measured at baseline. The study endpoint included cardiovascular death or first or recurrent nonfatal myocardial infarction or hospitalization for heart failure at 5.9 years. ResultsIn both cohorts, first and recurrent events occurred more often among those in the highest tertile of distress score than those in the lowest tertile. After combining the 2 cohorts, compared with the lowest tertile, the hazards ratio for having a distress score in the highest tertile was 2.27 (95% CI: 1.69-3.06), and for the middle tertile, it was 1.52 (95% CI: 1.10-2.08). Adjustment for demographics and clinical risk factors only slightly weakened the associations. When the distress score was added to a traditional clinical risk model, C-statistic, net reclassification index, and integrative discrimination index all significantly improved. ConclusionsAmong patients with CHD, a composite measure of psychological distress was significantly associated with an increased risk of adverse events and significantly improved risk prediction.

Cajanus cajan (L) Millsp seeds extract prevents rotenone-induced motor- and non-motor features of Parkinson disease in mice: Insight into mechanisms of neuroprotection

Ethnopharmacological relevanceCajanus cajan (L) Millsp (Fabaceae) seed decoction is used by traditional healers in Nigeria as nerve tonic, hence, could be beneficial in the treatment of Parkinson's disease (PD), a progressive and debilitating neurodegenerative disease that imposes great burden on the healthcare system globally. Aim of the studyThis study aimed at investigating the neuroprotective effect of ethanol seed extract of Cajanus cajan (CC) in the treatment of rotenone-induced motor symptoms and non-motor symptoms associated with PD. Materials and methodsTo assess the protective action of CC on rotenone-induced motor- and non-motor symptoms of PD, mice were first pretreated with CC (50, 100 or 200 mg/kg, p.o.) an hour before oral administration of rotenone (1 mg/kg, p.o, 0.5% in carboxyl-methylcellulose) for 28 consecutive days and weekly behavioural tests including motor assessment (open field test (OFT), rotarod, pole and cylinder tests) and non-motor assessment (novel object recognition (NOR), Y-maze test (YM), forced swim and tail suspension, gastric emptying and intestinal fluid accumulation tests) were carried out. The animals were euthanized on day 28 followed by the collection of brain for assessment of oxidative stress, inflammatory markers and immunohistochemical analysis of the striatum (STR) and substantia nigra (SN). Phytochemicals earlier isolated from CC were docked with protein targets linked with PD pathology such as; catechol-O-methyltransferase (COMT), tyrosine hydroxylase (TH) and Leucine rich receptor kinase (LRRK).Results: this study showed that CC significantly reduced rotenone-induced spontaneous motor impairment in OFT, pole, cylinder and rotarod tests in mice as well as significant improvement in non-motor features (significant reversal of rotenone-induced deficits discrimination index and spontaneous alternation behaviour in NORT and YM test, respectively, reduction in immobility time in forced swim/tail suspension test, gastrointestinal disturbance in intestinal transit time in mice. Moreso, rotenone-induced neurodegeneration, oxidative stress and neuroinflammation were significantly attenuated by CC administration. In addition, docking analysis showed significant binding affinity of CC phytochemicals with COMT, TH and LRRK2 receptors. ConclusionCajanus cajan seeds extract prevented both motor and non-motor features of Parkinson disease in mice through its antioxidant and anti-inflammatory effects. Hence, could be a potential phytotherapeutic adjunct in the management of Parkinson disease.

Treadmill Exercise Reverses the Adverse Effects of Intermittent Fasting on Behavior and Cortical Spreading Depression in Young Rats.

Intermittent fasting (IF) and physical exercise (PE) have beneficial psychological and physiological effects, improving memory and anxiety-like behavior. However, the impact of this combination on brain electrophysiological patterns is unknown. We aimed to evaluate the behavior and parameters of a brain excitability-related phenomenon named cortical spreading depression (CSD) in young rats (31-87 days of life) submitted to IF and treadmill PE for eight weeks. Sixty-four male and female Wistar rats aged 24 days were randomized into control, IF, PE, and IF+PE groups. Behavioral tests (open field (OF), object recognition, and elevated plus maze (EPM)) were performed, and the CSD propagation features were recorded. IF caused behavioral responses indicative of anxiety (lower number of entries and time spent in the OF center and EPM open arms). IF also reduced the discrimination index for object recognition memory tests and increased the propagation velocity of CSD. PE rats displayed more entries into the OF center and lowered CSD propagation speed. Data suggest that IF worsens anxiety-like behavior and memory and accelerates CSD in young rats. In contrast, PE reverted the unfavorable effects of IF. The brain effects of IF and PE at younger ages are recommended for study.

Unveiling the potential of perampanel and pregabalin in addressing pentylenetetrazole-induced electrographic alterations and neurobehavioral anomalies

Chemical kindling is broadly used experimental model to investigate novel treatments on the process of epileptogenesis and coexisting behavioral comorbidities. The current study aimed to investigate the low dose perampanel (PER) (0.125 and 0.5 mg/kg) and pregabalin (PG) (15 mg/kg) as standalone treatments and in combination on kindling-induced seizure progression with concurrent electroencephalographic alterations. Mice were subjected to pentylenetetrazole (PTZ)-induced kindling followed by neurobehavioral assessment for anxiety-like activity and cognitive deficit through behavioral experiments. The monotherapy with PER at 0.5 mg/kg and PG at 15 mg/kg delayed the kindling process but PRP+PG yielded pronounced benefits and hindered the development of seizures of higher severity. PER+PG combination relieved the animals from anxiety-like behavior in various employed anxiogenic tests. Furthermore, the kindling-associated cognitive deficit was protected by PER+PG combination as increased alteration behavior, discrimination index and latencies to enter the dark zone were noted in y-maze, object recognition and passive avoidance tests, respectively while shorter escape latencies were noted in water maze. The brain samples of kindled mice had elevated malondialdehyde and reduced catalase, superoxide dismutase and glutathione peroxidase enzymes while treatment with PER and PG combination shielded the mice from heightened kindling-associated oxidative stress. Overall, the findings of the present study illustrate that concurrent administration of PER and PG effectively hindered the process of epileptogenesis by protecting neuronal excitability and brain oxidative stress. The results predict the dominance of PER and PG combination over monotherapy which might serve as an effective novel combination to combat drug resistance and behavioral disorders in epileptic patients.

Estimation of factors contributing to level differences in Japanese university decathlon athletes

This study aimed to estimate the factors that cause differences in competition level based on the competition performance structure among university student decathletes in Japan. The results of factor analysis using the maximum likelihood method (Oblimin rotation), assuming a five-factor structure estimated from parallel analysis and the information criterion, revealed the following competitive performance structures: "running speed and body projection,” "running endurance,” "rotational throwing power,” "translational throwing power,” and "vertical leaping power.” Some of these were similar to the competitive performance structures of the world’s top athletes, but they were found to have a unique structure: two throwing powers. The analysis results using latent rank theory allowed us to evaluate them on a seven-point scale. The calculated item reference profile, difficulty index, and discrimination index for each rank indicated that shot put and 100 and 400 m performance formed the basis of decathlon performance. In addition, high jump and pole vault, which fall under the category of "vertical leaping power," retained high difficulty and discrimination and were revealed to affect the stage of achievement of overall performance in the decathlon.

Machine Learning Models for Predicting Stroke Mortality in Malaysia: An Application and Comparative Analysis.

Background Stroke is a significant public health concern characterized by increasing mortality and morbidity. Accurate long-term outcome prediction for acute stroke patients, particularly stroke mortality, is vital for clinical decision-making and prognostic management. This study aimed to develop and compare various prognostic models for stroke mortality prediction. Methods In a retrospective cohort study from January 2016 to December 2021, we collected data from patients diagnosed with acute stroke from five selected hospitals. Data contained variables ondemographics, comorbidities, and interventionsretrieved from medical records. The cohort comprised 950 patients with 20 features. Outcomes (censored vs. death) were determined by linking data with the Malaysian National Mortality Registry.We employed three common survival modeling approaches, the Cox proportional hazard regression (Cox), support vector machine (SVM), and random survival forest (RSF), while enhancing the Cox model with Elastic Net (Cox-EN) for feature selection. Models were compared using the concordance index (C-index), time-dependent area under the curve (AUC), and discrimination index (D-index), with calibration assessed by the Brier score. Results The support vector machine (SVM) model excelled among the four, with three-month, one-year, and three-year time-dependent AUC values of 0.842, 0.846, and 0.791; a D-index of 5.31 (95% CI: 3.86, 7.30); and a C-index of 0.803 (95% CI: 0.758, 0.847). All models exhibited robust calibration, with three-month, one-year, and three-year Brier scores ranging from 0.103 to 0.220, all below 0.25. Conclusion The support vector machine (SVM) model demonstrated superior discriminative performance, suggesting its efficacy in developing prognostic models for stroke mortality. This study enhances stroke mortality prediction and supports clinical decision-making, emphasizing the utility of the support vector machine method.

Assessment of the Quality of Multiple-Choice Questions in the Surgery Course for an Integrated Curriculum, University of Bisha College of Medicine, Saudi Arabia.

Multiple-choice questions (MCQs) have been recognized as reliable assessment tools, and incorporating clinical scenarios in MCQ stems has enhanced their effectiveness in evaluating knowledge and understanding. Item analysis is used to assess the reliability and consistency of MCQs, indicating their suitability as an assessment tool. This study aims to ensure the competence of graduates in serving the community and establish an examination bank for the surgery course. This study aims to assess the quality and acceptability of MCQs in the surgery course at the University of Bisha College of Medicine (UBCOM). A psychometric study evaluated the quality of MCQs used in surgery examinations from 2019 to 2023 at UBCOM in Saudi Arabia. The MCQs/items were analyzed and categorized for their difficulty index (DIF), discrimination index (DI), and distracter efficiency (DE) Fifth-year MBBS students undergo a rotation in the department and are assessed at the end of 12 weeks. The assessment includes 60 MCQs/items and written items. Data was collected and analyzed using SPSS version 24. A total of 189 students were examined across five test sessions, with 300 MCQ items. Student scores ranged from 28.33% to 90.0%, with an average score of 64.6%±4.35. The 300 MCQ items had a total of 900 distractors. The DIF was 75.3% for the items, and 63.3% of the items showed good discrimination. No items had negative points in terms of biserial correlation. The mean number of functional distractors per test item was 2.19±1.007, with 34% of the items having three functional distractors. The psychometric indices used to evaluate the MCQs in this study were encouraging, with acceptable DIF, distractor efficiencies, and item reliability. Providing robust faculty training and capacity-building is recommended to enhance item development skills.

Prognostic value of CT-derived fractional flow reserve and fat attenuation index in patients with suspected coronary artery disease: a sex-disaggregated analyses

BackgroundThere are sex differences in many risk factors associated with coronary artery disease (CAD). CT-derived fractional flow reserve (CT-FFR) and fat attenuation index (FAI) have been shown to independently predict cardiovascular events. We aimed to examine the impact of sex on the prognostic value of CT-FFR and FAI in suspected CAD patients, and to examine the incremental prognostic value of FAI over CT-FFR in both sex.MethodsA total of 1334 consecutive suspected CAD subjects who underwent coronary computed tomographic angiography (CCTA) were retrospectively collected. We divided the patients into males and females and calculated CT-FFR and FAI data from CCTA images. Kaplan-Meier analysis was used to assess the risk of major adverse cardiovascular events (MACE) stratified by CT-FFR and FAI in both sex. Cox regression models were used to assess the incremental prognostic value of FAI by adding the variable to a model that included CT-FFR and clinical variables.ResultsDuring a median follow-up of 2.08 years, 212 patients had MACE. CT-FFR ≤ 0.80 was significantly associated with MACE in both sex. FAI value of left anterior descending artery (FAI[LAD]) and FAI value of left circumflex (FAI[LCX]) ≥ 70.1 were significantly associated with MACE in females. FAI[LCX] added incremental prognostic value over clinical and CT-FFR variables in females, with hazard ratio (HR) 3.230 (1.982–5.265, P = 0.000), Harrel’s C 0.669 (P < 0.001), net reclassification improvement (NRI) 0.161 (0.073–0.260, P < 0.001), and integrated discrimination index (IDI) 0.036 (0.008–0.090, P = 0.010). FAI[LAD] did not enhance risk prediction in females (Harrel’s C 0.643, P = 0.054; NRI 0.041, P = 0.189; IDI 0.005, P = 0.259). The decision curve analysis demonstrated that the model including FAI[LCX] resulted in the highest net benefit.ConclusionsIn suspected CAD patients, the prognostic value of CT-FFR is not significantly biased by sex. The prognostic value of FAI[LAD] and FAI[LCX] were significantly associated with MACE in females, but not males. FAI[LCX], not FAI[LAD], added incremental prognostic value over CT-FFR and might enhance CT-FFR risk stratification in females.

Developing and externally validating multinomial prediction models for methotrexate treatment outcomes in patients with rheumatoid arthritis: results from an international collaboration

ObjectivesIn rheumatology, there is a clinical need to identify patients at high risk (>50%) of not responding to the first-line therapy methotrexate (MTX) due to lack of disease control or discontinuation due to adverse events (AEs). Despite this need, previous prediction models in this context are at high risk of bias and ignore AEs. Our objectives were to (i) develop a multinomial model for outcomes of low disease activity and discontinuing due to AEs 6 months after starting MTX, (ii) update prognosis 3-month following treatment initiation, and (iii) externally validate these models. Study Design and SettingA multinomial model for low disease activity (submodel 1) and discontinuing due to AEs (submodel 2) was developed using data from the UK Rheumatoid Arthritis Medication Study, updated using landmarking analysis, internally validated using bootstrapping, and externally validated in the Norwegian Disease-Modifying Antirheumatic Drug register. Performance was assessed using calibration (calibration-slope and calibration-in-the-large), and discrimination (concordance-statistic and polytomous discriminatory index). ResultsThe internally validated model showed good calibration in the development setting with a calibration-slope of 1.01 (0.87, 1.14) (submodel 1) and 0.83 (0.30, 1.34) (submodel 2), and moderate discrimination with a c-statistic of 0.72 (0.69, 0.74) and 0.53 (0.48, 0.59), respectively. Predictive performance decreased after external validation (calibration-slope 0.78 (0.64, 0.93) (submodel 1) and 0.86 (0.34, 1.38) (submodel 2)), which may be due to differences in disease-specific characteristics and outcome prevalence. ConclusionWe addressed previously identified methodological limitations of prediction models for outcomes of MTX therapy. The multinomial approach predicted outcomes of disease activity more accurately than AEs, which should be addressed in future work to aid implementation into clinical practice.

Education Research: Quality and Validity Evidence for a National In-Training Examination for Epilepsy Fellows.

Epilepsy education has been transformed over the past 2 decades, leading to a need for structured formative assessment tools. The American Epilepsy Society developed the Epilepsy Fellowship In-Training Examination (EpiFITE) to provide high-quality formative assessment for fellows, to stimulate program improvement, and to guide future learning and teaching. The aim of this study was to explore validity evidence for the EpiFITE in meeting these goals. Validity evidence was sought from multiple sources. The content of the examination was linked to the American Board of Psychiatry and Neurology blueprint for initial certification in epilepsy, and items were developed by trained experts. Internal structure was studied using internal consistency and item analysis. Surveys of fellows and fellowship directors focused on the examination experience (response process) and how results influenced fellow assessment, future learning, and program improvement (relationship to other variables and consequences). The EpiFITE was first administered in 2020, with 172 examinees from 67 programs. By 2022 (year 3), the EpiFITE was completed by 195 epilepsy fellows from 77 programs. The overall mean score of the examination was stable from year to year, and the committee predicted the difficulty of individual items with a high degree of accuracy. The examination had high internal consistency (Cronbach α 0.76-0.81). The median item discrimination index ranged from 0.17 in 2020 to 0.21 in 2022. Discrimination indices were lower (mean ≤0.10) for items that were either very easy or very difficult and significantly higher (mean >0.20) for other items. Program directors and epilepsy fellows agreed the examination questions were appropriate and agreed that the EpiFITE helped them identify areas for self-directed learning. Program directors also found the examination helpful in identifying areas of strength and areas for improvement within their programs. There are several sources of evidence of the quality and validity of the EpiFITE. By exploring this validity evidence, we have identified several best practices in the development and evaluation of a subspecialty examination, and this experience could be helpful for developers of in-training examinations in other subspecialties.

Intraspecifična karakterizacija izolata Vibrio alginolyticus prikupljenih iz sustava akvakulture i morskih biotopa u Tunisu korištenjem PCR-RFLP, ECP i OMPS profiliranja

A total of 54 presumptive Vibrio alginolyticus strains isolated from a variety of Tunisian marine biotopes, such as seawater, sediment samples from some bathing areas, and aquaculture farms, were characterized and identified by several biochemical tests. DNA polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis, extracellular products (ECP) and outer membrane protein (OMP) profiling were used to evaluate their usefulness as a tool to investigate the Vibrio alginolyticus diversity within this complex group. Results showed that there is great heterogeneity in the diversity observed via the PCR-RFLP method related to the number of genotypes generated by the two enzymes SduI and FaqI tested. This heterogeneity was observed not only according to the origin (seawater, sediment, fish and bivalve aquaculture farms) but also within the same type of sample. The two other methods, ECP and OMP resulted in 32 and 26 profiles, respectively. The discriminatory index determined in this study highlighted the good ability of the PCR-RFLP method to discriminate similar V. alginolyticus strains.