First-time Test Research Articles

The Impact of Comorbidity and Age on the Risk of Hospitalization and Mortality in Patients with Previous COVID-19 Infection—Based on Nationwide Data

Objectives: The influence of comorbidity on long-term hospitalization and mortality after COVID-19 in adults (40–59 years) and older adults (≥60 years) is yet to be explored. Methods: This is a Danish population-based cohort study of patients with a first-time positive PCR test for COVID-19 from 1 March 2020, to 28 February 2022 (N = 1,034,103). Exposed cohorts were patients with 1) a Charlson Comorbidity Index (CCI) score of 1–2 and 2) a CCI score ≥3, who were compared to patients without comorbidity (CCI of zero) within the groups of adults (67.9%) and older adults (32.1%) for the risk of hospitalization and mortality. Next, within the age groups, each disease category of the CCI was considered as an exposed cohort and compared to patients who did not have the specific disease of interest. Adjusted hazard ratios (HR) for hospitalization and mortality were estimated by Cox regression models adjusted for confounders. Results: The highest HRs were in adult patients with a CCI score of ≥3. The adjusted HR was 4.54 (95%CI: 4.38–4.70) for hospitalization, and among older adults it was 3.05 (95%CI: 2.99–3.11). The adjusted HR for mortality among adults with a CCI score ≥3 was 21.04 (95%CI: 18.86–23.47), and the adjusted HR for mortality among older adults was 4.61 (95%CI: 4.44–4.78). The underlying disease influenced the risk estimates among adults and older adults, and “dementia” had the highest impact on mortality. Conclusion: A CCI score of 1 or above increases the risk of hospitalization and mortality up to 2 years after a positive PCR test of COVID-19 for adults and older adults. Further, the type of underlying disease in older adults highly influences the risk of hospitalization and mortality.

Severity outcomes of SARS-CoV-2 infection in the Omicron and pre-Omicron periods, in unvaccinated first-time test positive adults less than 65 years old without comorbidity, in Sweden

BackgroundThe COVID-19 pandemic has had several phases with varying characteristics. We aimed to compare severity outcomes in different phases in a population with limited bias from risk factors. MethodsIn a nationwide observational study of all unvaccinated first-time COVID-19 test positive individuals in Sweden aged 18–64 years without comorbidity, from week 45 of 2020 to week 5 of 2022, variant periods with certain variants constituting ≥ 92 % of all whole genome-sequenced cases nationwide, were compared regarding hospitalisation (with main discharge code of COVID-19), severe illness (use of high-flow nasal oxygen or admission to intensive care unit), and death due to COVID-19. Logistic regression was used to estimate odds ratios (ORs) for comparison of these outcomes between variant periods, using adjustments for variant period, age, sex, country of birth, place of residence, income, and education. FindingsThe study included 789,133 individuals, including 15,145 hospitalised individuals. Among all individuals, the adjusted ORs for hospitalisation were 1.7 for the Alpha period vs the Pre-variant period (week 45–52 2020), 1.8 for the Delta period vs the Alpha period, and 0.1 for the Omicron period vs the Delta period (all comparisons significant). Among hospitalised individuals, the adjusted ORs for severe illness were 1.4 for the Alpha period vs the Pre-variant period, 1.7 for the Delta period vs the Alpha period, and 0.5 for the Omicron period vs the Delta period (all comparisons significant), and the adjusted ORs for death were 1.1 for the Alpha period vs the Pre-variant period (non-significant), 1.8 for the Delta period vs the Alpha period (significant), and 0.1 for the Omicron period vs the Delta period (non-significant). InterpretationIn this population with limited bias from risk factors, vaccination, and previous infection, disease severity increased from the pre-variant to the Delta period and then decreased with the Omicron period, among all individuals and among hospitalised individuals. These severity outcome differences should be considered when the pandemic is evaluated.

Re-evaluating GPT-4’s bar exam performance

AbstractPerhaps the most widely touted of GPT-4’s at-launch, zero-shot capabilities has been its reported 90th-percentile performance on the Uniform Bar Exam. This paper begins by investigating the methodological challenges in documenting and verifying the 90th-percentile claim, presenting four sets of findings that indicate that OpenAI’s estimates of GPT-4’s UBE percentile are overinflated. First, although GPT-4’s UBE score nears the 90th percentile when examining approximate conversions from February administrations of the Illinois Bar Exam, these estimates are heavily skewed towards repeat test-takers who failed the July administration and score significantly lower than the general test-taking population. Second, data from a recent July administration of the same exam suggests GPT-4’s overall UBE percentile was below the 69th percentile, and $$\sim$$ ∼ 48th percentile on essays. Third, examining official NCBE data and using several conservative statistical assumptions, GPT-4’s performance against first-time test takers is estimated to be $$\sim$$ ∼ 62nd percentile, including $$\sim$$ ∼ 42nd percentile on essays. Fourth, when examining only those who passed the exam (i.e. licensed or license-pending attorneys), GPT-4’s performance is estimated to drop to $$\sim$$ ∼ 48th percentile overall, and $$\sim$$ ∼ 15th percentile on essays. In addition to investigating the validity of the percentile claim, the paper also investigates the validity of GPT-4’s reported scaled UBE score of 298. The paper successfully replicates the MBE score, but highlights several methodological issues in the grading of the MPT + MEE components of the exam, which call into question the validity of the reported essay score. Finally, the paper investigates the effect of different hyperparameter combinations on GPT-4’s MBE performance, finding no significant effect of adjusting temperature settings, and a significant effect of few-shot chain-of-thought prompting over basic zero-shot prompting. Taken together, these findings carry timely insights for the desirability and feasibility of outsourcing legally relevant tasks to AI models, as well as for the importance for AI developers to implement rigorous and transparent capabilities evaluations to help secure safe and trustworthy AI.

Magnetic resonance imaging respirators: a randomized crossover trial to assess respiratory protection, usability, and comfort.

Many available facepiece filtering respirators contain ferromagnetic components, which may cause significant problems in the magnetic resonance imaging (MRI) environment. We conducted a randomized crossover trial to assess the effectiveness, usability, and comfort of 3 types of respirators, judged to be "conditionally MRI safe" with an aluminum nosepiece (Halyard 46727 duckbill-type respirators and Care Essentials MSK-002 bifold cup-type respirators) or "MRI safe" completely metal free (Eagle AG2200 semirigid cup-type respirators). We recruited 120 participants to undergo a quantitative fit test (QNFT) on each of the 3 respirators in a randomized order. Participants then completed a usability and comfort assessment of each respirator. There were significant differences in the QNFT pass rates (51% for Halyard 46727, 73% for Care Essentials MSK-002, and 86% for Eagle AG2200, P < .001). The first-time fit test pass rate and overall fit factor were significantly higher for Eagle AG2200 compared with the other 2 respirators. Eagle AG2200 scored the lowest ratings in the ease of use and overall comfort. There were no significant differences in other modalities, including the seal rating, breathability, firmness, and overall assessment. Our study supports the utility of the Eagle AG2200 and Care Essentials MSK-002 respirators for healthcare professionals working in an MRI environment, based on their high QNFT pass rates and reasonably good overall usability and comfort scores. Eagle AG2200 is unique because of its metal-free construction. However, its comparatively lower usability and comfort ratings raise questions about practicality, which may be improved by greater user training.

ChatGPT Yields a Passing Score on a Pediatric Board Preparatory Exam but Raises Red Flags.

We aimed to evaluate the performance of a publicly-available online artificial intelligence program (OpenAI's ChatGPT-3.5 and -4.0, August 3 versions) on a pediatric board preparatory examination, 2021 and 2022 PREP® Self-Assessment, American Academy of Pediatrics (AAP). We entered 245 questions and answer choices from the Pediatrics 2021 PREP® Self-Assessment and 247 questions and answer choices from the Pediatrics 2022 PREP® Self-Assessment into OpenAI's ChatGPT-3.5 and ChatGPT-4.0, August 3 versions, in September 2023. The ChatGPT-3.5 and 4.0 scores were compared with the advertised passing scores (70%+) for the PREP® exams and the average scores (74.09%) and (75.71%) for all 10 715 and 6825 first-time human test takers. For the AAP 2021 and 2022 PREP® Self-Assessments, ChatGPT-3.5 answered 143 of 243 (58.85%) and 137 of 247 (55.46%) questions correctly on a single attempt. ChatGPT-4.0 answered 193 of 243 (79.84%) and 208 of 247 (84.21%) questions correctly. Using a publicly-available online chatbot to answer pediatric board preparatory examination questions yielded a passing score but demonstrated significant limitations in the chatbot's ability to assess some complex medical situations in children, posing a potential risk to this vulnerable population.

Optimizing HIV case identification: investigating client characteristics predictive of HIV positivity from provider-initiated testing (PITC) in central Kenya

BackgroundRoutine program data indicates positivity rates under 2% from HIV testing services (HTS) at sites supported by Centre for Health Solutions-Kenya in Central Kenya. Achieving the UNAIDS 95:95:95 goals requires continuous identification of people living with HIV in an environment of diminishing resources. We assessed non-clinical and clinical characteristics of persons who tested HIV-positive aimed at improving the process of HTS through Provider-Initiated HIV Testing & Counseling (PITC).MethodsWe conducted a retrospective analysis of routine PITC program data collected between October 2018 and September 2019 from six health facilities located in three counties in central Kenya. Stratification was based on county and facility volume. A multivariable logistic regression model, clustered adjusted for facility using robust standard errors, was used to determine predictors of a positive HIV result.ResultsThe total sample was 80,693 with an overall positivity rate of 1.2%. Most, (65.5%), were female and 6.1% were < 15 years. Most clients, 55,464 (68.7%), had previously tested for HIV. Client characteristics associated with a higher odds of positivity on multivariable analysis included: being female (adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI] (1.03–1.57); adults 15 years and above compared to children < 15 years, divorced and married polygamous compared to married monogamous [aOR 3.98, 95% CI (2.12–7.29) and aOR 2.41 95% CI (1.48–3.94) respectively]; clients testing for the first time compared to repeat testers in less than 12 months [aOR 1.39, 95% CI (1.27–1.51)]. Similarly, repeat testers in more than 12 months compared to repeat testers in less than 12 months [aOR 1.90, 95% CI (1.55–2.32)]; presumptive TB clients compared to those without signs of TB [aOR 16.25, 95% CI (10.63–24.84)]. Clients tested at inpatient departments (IPD) were more likely to get a positive HIV result compared to those tested at outpatient departments (OPD), and other departments.ConclusionsThe study findings highlight client characteristics such as age, marital status, HIV test entry point, first-time test, repeat test after 12 months, and TB status as factors that could influence PITC results and could be used to develop a screening tool to target eligible clients for HTS in low HIV prevalence settings.

The Pass/Fail Effect: A Longitudinal Study of United States Medical Licensing Examination (USMLE) Step 1 Performance Over a Decade.

Objectives This study aimed to analyze the impact of theUnited States Medical Licensing Examination (USMLE) Step 1 transition to a pass/fail scoring system in 2022 on the performance of first-time test takers in three distinct groups: Doctor of Osteopathy (DO) and Doctor of Medicine (MD) examinees from US/Canadian schoolsand examinees from non-US/Canadian schools. The analysis spans a decade-long period from 2012 to 2022, offering insights into the implications of this pivotal change in medical education. Methods We analyzed the performance of first-time USMLE Step 1 examinees from US/Canadian MD and DO programsand non-US/Canadian schools from 2012 to 2022, including the transition year to a pass/fail scoring system. Data were obtained from USMLE performance data reports and organized into annual contingency tables. Descriptive statistics and comparative analysis were used to identify trends and differences in performance across the groups. Data visualization techniques were employed to illustrate these findings, and the results were contextualized within the broader changes in medical education. Results In 2021, first-time takers from US/Canadian MD and DO Degree programs had passrates of 96% and 94%, respectively, while non-US/Canadian schools had a pass rate of 82%. However, in 2022, these rates dropped to 93%, 89%, and 74%, respectively. The most significant relative decline was observed among non-US/Canadian Schools' first-time takers, with an 8% decrease. Repeaters consistently had lower pass rates across all groups. Conclusion The study reveals a notable decline in pass rates following the transition to pass/fail scoring, although this is based on just one year of data. This underscores the importance of students not rushing into the exam and dedicating sufficient time for preparation. The potential impact of this research could be transformative for medical education, but more years of data post-transition will be needed to confirm these initial findings. These findings serve as a reminder that the change in scoring does not diminish the rigor of the exam, prompting students to approach their studies with diligence and patienceand potentially paving the way for systemic improvements in medical education and healthcare delivery worldwide.

Effectiveness of provider-initiated versus client-initiated HIV testing by different health facility departments in Northern Tanzania

BackgroundHIV prevalence in Tanzania is still high at 4.7% among adults. Regular HIV testing is consistently advocated in the country to increase the level of awareness of HIV status, thus contributing to national HIV prevention. We report findings from three years of implementation of an HIV Test and Treat project utilizing provider-initiated and client-initiated testing and counselling (PITC and CITC). This study compared the effectiveness of PITC versus CITC in HIV case detection by the different departments of health facilities.MethodThis retrospective cross-sectional study used health facility-based HIV testing data collected from adults aged 18 years and above between June 2017 – July 2019 in the Shinyanga region, Tanzania. Chi-square and logistic regression analysis were used to assess determinants of yield (HIV positivity).ResultsA total of 24,802 HIV tests were performed of which 15,814 (63.8%) were by PITC and 8,987 (36.2%) by CITC. Overall HIV positivity was 5.7%, higher among CITC at 6.6% than PITC at 5.2%. TB and IPD departments had the highest HIV positivity 11.8% and 7.8% respectively. Factors associated with a positive test were testing at a department in the facility compared to CITC, first-time test, and being or having been married compared to being single.ConclusionSuccess in identifying HIV + patients was highest among people visiting the clinic for HIV testing (CITC) and first-time testers. With PITC, HIV + patient detection differed between departments, suggesting divergent risk profiles of respective clients and/or divergent HIV alertness of staff. This underscores the importance of increased targeting for PITC to identify HIV + patients.

We Tabulated and Organized American Board of Neurological Surgeons Primary Exam Keywords (2015-2023) so You Don't Have to.

Background Passing the American Board of Neurological Surgeons (ABNS) Primary Exam is required for residents in training. Both the program directors and residents are given keywords of the exam afterward in the hope to help program directors determine their relative strengths and weakness.We have organized and tabulated these keywords for neurosurgery residents' benefit. Methodology We collected and analyzed ABNS Primary Exam keywords (2015-2023) in each of the exam's main categories for trends and recurrences. We examined the overall passing rates among first-time credit test takers. The frequency of each subcategory was calculated as a percentage within its corresponding category.Recurrent keywords were grouped together with their corresponding years and categorized as once, twice, or thrice and greater occurrences; the last category was considered to be high-yield keywords. Results The number of questions in Neurosciences and Neurology has decreased over the years while Neurosurgery and Critical Care questions have increased. Similarly, there are fewer keyword repeats in Neurosciences and Neurology. The most repeated keywords are in Neuroimaging. The most common keywords are presented and listed along with the years of occurrences.Overall, the passing rate among first-time credit test takers is over 90%. Conclusions Neurosurgery residents can consider the common keywords as a guide in preparation for the ABNS Primary Exam.

Fellowship Board Pass Rates Rising: Analysis of Pathology Subspecialty Board Examination Performance.

The American Board of Pathology (ABPath) publishes annual performance data for the anatomic pathology (AP) and clinical pathology (CP) board examinations, as well as for ABPath subspecialty examinations. Overall board pass rates for all AP and CP board examinees have increased during the past decade; however, no study has analyzed the board pass rates for pathology subspecialty examinations, and whether these follow the same trend. To evaluate ABPath subspecialty examination pass rates to assess the trend in certification. We analyzed the total number of first-time test takers and board pass rates for 11 pathology subspecialties recognized by the ABPath from 2007 to 2021, acquired from annual reports published by the ABPath. We compared the pass rates in 5-year intervals (2007-2011, 2012-2016, 2017-2021) for each individual specialty. We also analyzed the pass rate of CP subspecialties compared with AP subspecialties. The overall mean pass rate for ABPath subspecialty examinations during the previous 15 years was 89% (range, 78.9%-100%), with the overall pass rate being significantly higher in 2017-2021 (P = .02). The contemporary overall rate of passing was significantly higher for AP subspecialty examinations (P < .001) and was higher, though not significantly, for CP subspecialties (P = .13). There were significant differences between first-time test takers' mean pass rate (92.1%), repeat test takers' mean pass rate (54.5%), and the overall rate (P < .001). Contemporary pathology subspecialty board examination pass rates are significantly higher than historic rates, possibly reflecting continuously improving and readily available preparatory materials.

Preparing for the Fundamentals of Laparoscopic Surgery Exam: A Survey of Residents in Obstetrics & Gynecology

To describe the actual work-load and experience for first-time resident test takers preparing to meet the new high stakes cognitive and technical skills testing requirement for board certification in Obstetrics and Gynecology. A retrospective observational study. Participating residents completed a 2 page questionnaire about their preparation for the exam. Results are reported in aggregate. This study was conducted at the University of Texas Southwestern Medical Center, an academic medical school affiliated with both a private and public tertiary hospitals. Residents in obstetrics and gynecology who have completed their Fundamentals of Laparoscopic Surgery (FLS) certification exam between September 1, 2018 and September 31, 2019. Thirty-three PGY-2 and PGY-3 residents completed the survey. Participants spent an average of 6.7 ± 3.1 hours viewing online modules over an average of 3.6 ± 2.1 nonconsecutive days. Utilizing the campus simulation center, residents spent an average of 2.1 ± 2.1 hours on each of the 5 tasks to practice to the established proficiency score. Twenty-two out of 31 residents rated the ligating loop the easiest skill to master and 13/31 residents rated the precision cut the most difficult. The pass rate for the technical skills portion was 100% (33/33 residents) and for the cognitive portion was 93% (31/33 residents). Our data suggest that residents spent upward of 10 hours practicing to proficiency on the simulation tasks, in addition to time spent watching FLS-provided training videos. The 100% pass rate for the technical skills portion at our program may be impacted by a required technical skills curriculum that residents must complete prior to registering for the FLS exam. Obstetrics and gynecology residents and training programs will benefit from understanding the time and resources required for first-time resident test takers preparing to take the Fundamentals of Laparoscopic Surgery exam.

POSC234 Impact of Community Pharmacies on Access to Point-of-Care Tests for HIV and Hepatitis C and B Infections: An Observational, Cross-Sectional Study

Portugal has set early identification and diagnosis of HIV, HCV and HBV infections as a priority in 2018. Considering that community pharmacies started performing point-of-care tests for such infections to the public (≥18 years) upon request, this study aims to characterize the population using this service, their behaviors, and motivations for getting tested at that setting. An observational, cross-sectional study was carried out in the community pharmacies in the Municipality of Cascais, who voluntarily participate in the Fast-Track Cities international initiative, with pharmacists specifically trained to this service, and data collection from October 2018 to December 2019, with two instruments: matrix filled by pharmacists (tests performed and results per user); questionnaire to users (self-administered, optional, anonymous, confidential). The 21 participating pharmacies (51.2%) performed 1,422 tests (54.9% HIV, 37.9% HCV, 7.2% HBV), on 808 individuals (mean age 37 [SD=14] years, 60% male); 16 tests with reactive result (1.1% total, 1.0% HIV, 1.5% HCV) in 2.0% of users. 70.4% (n=569) of individuals completed the questionnaire. The results showed access to migrant populations (24.8% foreigners), to first-time test users (37.9% HIV, 40.8% HCV, 50.9% HBV) and to younger populations (half of the first-time users are under 30). Main reasons for taking the test: “Unprotected sexual intercourse” (52.6%) and “I never did the test” (23.9%). More than 50% considered the “Reduced waiting time”, “Privacy” and “Trust in pharmaceutical counseling and competence” to be extremely important when choosing the pharmacy over other testing sites. Instead, “Fear of discrimination in other place”, “Lack of willingness to go to other places” and “Ignorance of other place to perform the test” are not differentiating factors. Performing point-of-care tests in community pharmacies seems to improve the population’s access with potential for reducing inequities, and allowing earlier diagnose, contributing to societal costs reduction.

Automated static perimetry short-term learning effects in test-naive patients

Purpose The aim of this study was to evaluate the intrasession learning effects in patients undergoing first-time automated perimetry.Patients and methods The study included 59 eyes of test-naive patients who were tested twice within a short time interval. Reliability indices, mean deviation values, visual-field index percentage, test time, scotoma size, and depth were recorded and compared between the two tests.Results The second test showed a statistically significant decrease in fixation losses, false-positive, and false-negative responses in about 56% of the eyes upon retesting. The mean false-positive errors were 5.4±8.7% in the first test (T1) and dropped to 1.9±2.4% in the second test (T2), a mean difference of 3.54% (P=0.002). Similarly, the mean false-negative errors dropped by 4.76% (P=0.002), and the mean fixation losses by 13.5% in T2 (P=0.000). The time taken to finish the test decreased. The scotoma size and depth improved, as well as the visual-field index and the mean deviation values.Conclusion Repeating a first-time test may give more reliable results even if repeated in the same session. This may be useful in the timely diagnosis and management of ophthalmic disorders in which the early therapy is an important factor as in glaucoma and neurological disorders.

Low-temperature designing of BiVO4 nanocubes with coexposed {0 1 0}/{1 1 0} facets for solar light photocatalytic degradation of methyl orange and diazinon

We present the low-temperature, template-free synthesis and photocatalytic activity of cubic-shaped monoclinic scheelite BiVO4 nanocrystals with coexposed {010}/{110} facets in this paper. The first-time diazinon photodegradation test over the studied samples under solar light irradiation was also carried out. The results showed that, by selecting suitable preparative parameters, the as-prepared 55-nm BiVO4 nanocubes with coexposed {010}/{110} facets were obtained at hydrothermal temperature as low as 60 °C. The optimized BiVO4 samples exhibited excellent photocatalytic efficiency for photodegradation of both methyl orange and diazinon under solar light irradiation. This photocatalytic activity enhancement of the {010}/{110}-facets coexposed monoclinic scheelite BiVO4 with respect to that of the bulk counterpart was supposed to be caused by the formation of surface heterojunctions between two adjunct facets of {010} and {110} that boost the charge transfer and separation.

Risk Factors for Failure in First-Time Hearing Screening Tests among High-Risk Neonates in Neonatal Intensive Care Unit

Objective: The aim of the study was to investigate into the risk factors for failure in the first-time screening test among high-risk neonates in neonatal intensive care unit (NICU) in order to further clarify the etiology of neonatal hearing impairment, thus providing insights into early prevention and intervention. Methods: We performed automated auditory brainstem response (AABR), distortion product otoacoustic emission (DPOAE), and acoustic immittance (AI) on 2,194 high-risk neonates admitted into the NICU of Shanghai Children’s Medical Center from January 2015 to December 2019, and the risk factors, including premature birth, hyperbilirubinemia, and infant respiratory distress syndrome, were analyzed retrospectively by the univariate χ² test and multivariate stepwise logistic regression analysis. Results: The pass rates of AABR, DPOAE, and AI were 70.21, 78.44, and 93.12%, respectively, in 2,194 cases of high-risk neonates screened, which are significantly lower than those of healthy controls. The most common diagnoses included artificial feeding, preterm birth, C-section, low birth weight (LBW), neonatal hyperbilirubinemia (NHB), neonatal respiratory distress syndrome (NRDS), congenital heart disease (CHD), gestational diabetes mellitus, pregnancy-induced hypertension syndrome, advanced maternal age (AMA), twins, and in vitro fertilization. Stepwise logistic regression analysis indicated that the AABR pass rate was negatively correlated with LBW (p = 0.002), NHB (p < 0.001), NRDS (p = 0.007), artificial or mixed feeding (p = 0.018), and CHD (p = 0.005). The pass rate of DPOAE was negatively correlated with artificial or mixed feeding (p = 0.041), NHB (p < 0.001), LBW (p = 0.007), very LBW (VLBW) (p = 0.008), and C-section (p < 0.001). The pass rate of AI was negatively correlated with revised AMA (≥40 year) (p < 0.001), NHB (p = 0.043), C-section (p = 0.005), and artificial/mixed feeding (p = 0.036). Conclusion: The hearing screening pass rates of high-risk neonates in the NICU were lower than those of normal neonates, among which the rate of AABR was significantly lower than that of DPOAE. NRDS, NHB, LBW, revised AMA, CHD, C-section, and artificial feeding are potential risk factors of hearing impairment. The combination of different hearing screening tests is necessary for accurate diagnosis of congenital hearing disorders.

Hepatitis C virus: Testing rate and attrition at linkage to specialized care, Catalonia, Spain 2011-2016.

Hepatitis C virus (HCV) screening through primary care providers (PCP) might increase linkage to specialized care. This study aimed to calculate HCV testing rate and prevalence of anti-HCV according to socio-demographic factors in primary care in Catalonia, Spain, from 2011 to 2016, and to identify the rate and determinants of attrition at linkage to specialized care. Patient data from 274 primary care centres (3414 PCP) were analysed, including socio-demographic information, morbidity, laboratory tests and treatments (1-Jan-2011 to 31-Dec-2016). Both descriptive and inferential statistics were used to examine HCV testing rate, HCV seroprevalence and rate of attrition at linkage to specialized care. In the study period, there were 839072 people tested for HCV infection and 21156 with first-time positive anti-HCV test results. Rate of HCV testing was 143.54/103 pop (95% CI: 143.26-143.83). Women had higher HCV testing rate (158.65/103 women [95% CI: 158.24-159.07]), compared to men (128.10/103 men [95% CI: 127.72-128.49]). The highest HCV testing rate was among people aged 25-34 (284.11/103 pop [CIs: 283.10-285.12]). The anti-HCV seroprevalence was 3.62/103 pop (CIs: 3.57-3.67). The highest prevalence was found among men (4.20/103 men [CIs: 4.12-4.27]), people aged 45-54 (7.19/103 pop [CIs: 7.01-7.37]), people aged 75-84 (7.26/103 pop [CIs: 6.99-7.53]), Spanish (3.68/103 [CIs: 3.61-3.75]), European and Northern Americans (5.64/103 [CIs: 5.33-5.96]) and Asians (9.78/103 [CIs: 9.21-10.35]). From those who had a positive anti-HCV result, 49.8% (N=10528) were not linked to specialized care. Appropriate clinical care pathways and referral systems need to be established to ensure optimal linkage to specialized care for people newly diagnosed with HCV in primary care.

Determination of diagnostic value (validity) leukocyte esterase (urine dipstick strip) in differentiating inflammatory arthritis from bacterial arthritis

BackgroundThe current diagnostic cornerstone for septic arthritis contains gram stains, bacterial culture, and cell count with a differential of aspirated synovial fluid. Recently, a synovial leukocyte esterase (LE) test has been used for diagnosing septic arthritis. Since this test measures the esterase activity of leukocytes, there is always a dilemma for using this test in patients with inflammatory arthritis.MethodsWe collected the synovial fluid specimens as part of the general diagnostic protocol for patients suspected of Juvenile Idiopathic Arthritis (JIA) or Septic Arthritis (SA). Each group included 34 patients. We compared the result of the synovial LE test with the result of the culture of each patient.ResultsThe mean ages of patients were 64.14 ± 31.27 and 50.88 ± 23.19 months in the JIA group and septic arthritis group, respectively. The LE test results were positive in 30 specimens, trace in 3 and negative in one in the first-time test and were positive in 31 specimens and trace in 3 in the second-time test, while it was negative in all patients with JIA. Hence, the sensitivity of the synovial LE test was 80.8%, the specificity, PPV, and NPV were 78.6, 70.0, 86.8% respectively based on a positive culture.ConclusionThe leukocyte esterase strip test can be used as a rapid, bedside method for diagnosing or excluding bacterial infections in different body fluids. The synovial LE test can be used as an accurate test to rapidly rule in or out an acute articular bacterial infection, even in patients with concurrent inflammatory arthritis.

Factors Associated with Music Therapy Board Certification Examination Outcomes

Abstract The Music Therapy Board Certification (BC) Examination is a high-stakes test that affects test takers’ entry into the profession and reflects the quality of music therapy programs. Accumulating studies in the health sciences have identified the factors that contribute to first-time test takers’ success in passing credentialing examinations. However, these variables have not been investigated in music therapy. The purposes of this study are to investigate recent certificants’ perceptions and experiences of the BC examination and identify the predictors of success on the first attempt. It aims to delineate the factors associated with performance in the BC examination; identify effective strategies and resources for future test takers; and inform educators, internship directors, clinical supervisors, and test administrators regarding areas of concern and necessary support. A sample of 662 recent music therapy board certificants completed a 32-item online survey consisting of checklists, Likert scales, open-ended questions, and the Westside Test Anxiety Scale. Self-reported cumulative grade point average and general test anxiety scores were significant predictors of BC examination success on the first attempt. The results suggest the need for (a) a consistent standard for education programs that includes various theoretical orientations and clinical practice models to better prepare students with content knowledge and (b) program progression policies to identify students at risk of failing the examination and to provide remediation.

Correlation Between Radiology ACGME Case Logs Values and ABR Core Exam Pass Rate

There is discordance between the American Board of Radiology (ABR) and many radiology trainees with respect to the most appropriate means to prepare for the ABR Core Examination. Whereas the ABR suggests that participation in routine clinical examination interpretation best prepares a trainee for the practical material of the test, residents, and many program directors feel that time away from clinical service for study and review courses are necessary. This study examines the relationship between studies interpreted in the first three years of residency as reported in the Accreditation Council for Graduate Medical Education case logs and performance of first-time test takers on the ABR Core Examination. Accreditation Council for Graduate Medical Education case log data was anonymized for a single year cohort of residents in all accredited radiology residencies. This was then provided to the ABR and matched with performance on the Core Examination. A random effects logistic regression model was used to evaluate for a relationship between the number of examinations read and the pass/fail status of the Core Exam. Modeling using a linear and a quadratic term yields a significant relationship between case log values and Core Exam performance. There is a positive correlation until an inflection point of approximately 11,000 examinations, at which point a negative correlation develops. The data supports that active engagement in clinical duties is associated with better performance on the ABR Core Examination, with the caveat that there appears to be a point at which service outweighs educational value. Beyond this, performance on the examination declines.

Educational level and first-time PSA testing in general practice

Introduction: Different patterns in the use of prostate-specific antigen (PSA) testing might explain socioeconomic differences in prostate cancer incidence and mortality. We examined the association between socioeconomic position, measured as education and first-time PSA testing in general practice.Material and Methods: A population-based cohort study of men aged 45–79 years without prior prostate cancer diagnosis living in the Capital Region of Denmark between 2000 and 2014. Information on socioeconomic indicators (education, income, cohabitation status and work market affiliation), prostate cancer diagnoses, and vital status were obtained from national registries. Date of first PSA test was obtained from the Copenhagen Primary Care Laboratory database. Temporal trends of PSA testing were calculated as annual age-standardised incidence rates and the association was examined by a multivariable Cox proportional hazards model.Results: The cohort consists of 431,997 men of which 105,476 (24%) had a first-time PSA test in the study period. Men with longer education, higher income, living with a partner, and employed had higher rates of PSA testing. For men with short education, the rate of PSA test was 28.3 tests per 1000 person-years compared to 31.2 tests among men with long education. The fully adjusted hazard ratio for a first PSA test among men with short education was 0.87 (95% CI, 0.85–0.89) compared to men with long education.Conclusion: The association between education and first-time PSA testing indicates socioeconomic disparities in health care utilisation, which could explain part of the observed socioeconomic difference in prostate cancer incidence and mortality.