Multiple Diagnostic Tests Research Articles

Combined strategy of upfront CTCA and optimal treatment for stable chest pain: rationale and design of the CLEAR-CAD trial.

Patients with stable chest pain suspected of coronary artery disease (CAD) usually undergo multiple diagnostic tests to confirm or rule out obstructive CAD. Some tests may not effectively assess the presence of CAD, precluding optimal treatment. Adiagnostic strategy of upfront computed tomography coronary angiography (CTCA) combined with optimal medical therapy (OMT) tailored to the extent of CAD may be superior to standard care in preventing major adverse cardiac events. The CLEAR-CAD trial is aprospective, open-label, multicentre, randomised, superiority trial of an upfront CTCA-guided strategy in 6444 patients presenting in an outpatient setting with suspected CAD compared with standard care, in approximately 30participating centres in the Netherlands. The upfront CTCA-guided strategy consists of an initial CTCA which is assessed using the Coronary Artery Disease-Reporting and Data System (CAD-RADS2.0). In patients without CAD (CAD-RADS0) no specific cardiac medication is mandated. Patients with non-obstructive CAD (CAD-RADS 1-2) are treated with preventive OMT. Patients with obstructive CAD (CAD-RADS ≥ 3) are treated with preventive and anti-anginal OMT; in the presence of pharmacologically refractory symptoms patients undergo selective revascularisation after non-invasive functional imaging for myocardial ischaemia (≥ 10%). Patients with significant left main or proximal left anterior descending coronary artery stenosis on CTCA undergo direct invasive coronary angiography and subsequent revascularisation. The primary endpoint is the composite of all-cause death and myocardial infarction. The CLEAR-CAD trial is the first randomised study to investigate the efficacy of acombined upfront CTCA-guided medical and selective revascularisation strategy in an outpatient setting with suspected CAD compared with standard care.

Seropositivity of chikungunya in hospital setting, India: A systematic review and meta-analysis

Backround: Information about the chikungunya disease burden by age groups and geographic distribution is necessary to guide appropriate control measures. With this, we conducted a systematic review and meta-analysis to estimate the disease burden of chikungunya fever in India. Material and Methods: We conducted this systematic review according to the Cochrane Collaboration guidelines. We retrieved relevant articles from PubMed and a free online search. Two investigators screened titles and abstracts and extracted data from the relevant articles. Our primary outcome is the proportion of laboratory-confirmed Chikungunya fever among clinically suspected patients. We used a random effect model to estimate the pooled proportion of Chikungunya fever. Result: A total of 20 articles were included in the quantitative syntheses. The pooled proportion of laboratory-confirmed chikungunya fever from 20 studies estimated using the random effects model is 24% (95%CI: 15-34%). We found the pooled proportion in the southern region was 35% (95%CI: 4-66%), 28% (95%CI: 3-58%) in the western region, 24% (95%CI: 1-48%) in the eastern region, 20% (95%CI: 12-29%) in the northern region, and 4% (95%CI: 1-6%) in North-eastern region. Conclusion: This review emphasizes the need to strengthen the surveillance of disease burden using multiple diagnostic tests and the need for an appropriate molecular diagnostic for early detection of the chikungunya virus.

A Prospective Comparative Study on the Clinical Diagnostic Performance of Blood Inflammatory Markers in Acute Appendicitis.

Despite the substantial advancements in imaging techniques for the diagnosis and differential diagnosis of acute appendicitis (AA) over recent decades, the specificity and sensitivity of widely utilized laboratory biomarkers in clinical practice remain inadequate.This study aimed to investigate the diagnostic utility of commonly employed blood inflammatory markers for AA. A total of 399 participants who either sought medical care or underwent health examinations were enrolled in this prospective study. The cohort comprised 200 patients diagnosed with AA (AA group), 100 patients presenting with abdominal pain but without AA (AP group), and 99healthy individuals undergoing routine health check-ups (HC group). For all subjects, the following biomarkers were measured: plasma neutrophil gelatinase-associated lipocalin (NGAL), white blood cell count (WBC), neutrophil count (NEU), percentage of neutrophils (NEU%), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP). The diagnostic performance of the observed indicators, both individually and in combination, was assessed for the diagnosis of AA using Receiver Operating Characteristic (ROC) curves analysis and Delong's test. The laboratory indicators demonstrated a progressive increase from the HC group to the AP group, and further to the AA group (all p<0.05). Multifactorial logistic regression analysis identified NEU% and plasma NGAL as significant risk factors for the occurrence of AA. ROC curve analysis and Delong's test indicated that, in distinguishing the AA group from the HC group, the diagnostic performance of plasma NGAL, CRP, and NLR was equally substantial and superior to that of NEU and WBC. Within the AP group, plasma NGAL and CRP exhibited comparable diagnostic efficacy, outperforming NEU, WBC, and NLR. When differentiating AA in the non-appendicitis group (ie HC group + AP group), NGAL and CRP demonstrated comparable diagnostic efficacy, surpassing that of NEU, white WBC, and NLR. While the integration of multiple diagnostic tests can potentially improve overall diagnostic accuracy, the observed enhancement in the AUC is not statistically significant. NGAL, CRP, WBC, NEU% and NLR were significantly increased in patients with acute abdomen. NGAL and NEU% may function as independent risk factors for predicting the incidence of AA, with NGAL and CRP demonstrating similar and favorable diagnostic performance. While the combined evaluation of these biomarkers may enhance the diagnostic value for AA, the improvement in the area under the curve (AUC) is not substantial.

Modelling the joint accuracy of two diagnostic tests using evidence synthesis methods incorporating linked electronic health records

Background and ObjectivesTo compare the accuracy of different diagnostic pathways comprising of multiple diagnostic tests, statistical methods that evaluate combined or sequential test accuracy are required. This can only be achieved through joint synthesis of diagnostic accuracy data on all tests of interest, using models that account for dependencies between multiple tests. The aim of this research is to develop joint models to assess the diagnostic accuracy of two tests, using real-world evidence to inform within-study dependencies between tests. ApproachUsing a case study in Alzheimer’s disease dementia (ADD), we will develop Bayesian meta-analysis models to evaluate the combined diagnostic accuracy of two tests. A novel application of trivariate copulas will be used to capture within-study dependencies between two tests assessed in the same patients. Individual participant data from Dementias Platform UK (DPUK) Data Portal – a repository of linked electronic health record data optimised for dementia research – will be used to estimate dependencies between diagnostic tests for ADD. ResultsThe DPUK Data Portal includes records of over 3 million people from 51 long-term cohort studies, including individual-level test results for ADD verified against confirmed diagnoses. Analysis will focus on modelling the diagnostic accuracy of different testing strategies for ADD, combining cognitive function, imaging, and biomarker tests. Conclusions and ImplicationsResults of this study have the potential to inform healthcare decision-making regarding optimal diagnostic pathways by enabling the comparison of different testing strategies. The incorporation of real-world data from the DPUK Data Portal makes better use of the available evidence.

PORTRAIT OF STUDENTS’ MISCONCEPTIONS USING FOUR-TIER MULTIPLE CHOICE DIAGNOSTIC TEST ON ROTATIONAL DYNAMICS MATERIAL IN CLASS XI SENIOR HIGH SCHOOL

Misconception is a mismatch between the understanding of the concept known by students and the actual concept. Physics is a science that has several concepts. The profile of misconceptions on physics concepts must be identified so that students have an appropriate understanding of the concepts. The purpose of this research is to analyze students’ concept understanding and misconceptions of Rotational Dynamics material using a four-tier multiple choice diagnostic test. The type of research used is descriptive with qualitative and quantitative approaches. This research was conducted in one of the high schools in Medan in Grade XI IPA. The population in this research was grade XI students majoring in IPA. The research sample was obtained by using purposive sampling technique as many as 64 students of grade XI IPA 2 and XI IPA 3. Sampling based on certain criteria from population participants. The criteria are classes whose students have finished learning Rotational Dynamics material and have not been tested on Rotational Dynamics material. Data collection techniques in the form of diagnostic tests response questionnaires and interviews. The test used is a four-tier multiple choice diagnostic test that has been validated by experts. The diagnostic test consists of 18 valid items with a reliability of 0.912 including a very high category, good differentiating power, and moderate difficulty level. The results showed that students' concept understanding of Rotational Dynamics material was categorized as moderate with 44.88% of students understood the concept, 50.17% of students had misconceptions, and 4.95% of students did not understand the concept, and students' responses to the use of four-tier multiple choice diagnostic tests obtained 80% with good criteria.

Analysis of Understanding the Concept of Alkenes through the Three-tier Multiple Choice Diagnostic Test Instrument

The ability of prospective teacher students to master chemistry material will influence the achievement of learning objectives. Alkenes are an important sub material in organic chemistry courses because alkenes are often used as basic ingredients in chemical reactions. This research aims to analyze Untan chemistry education students' understanding of alkene sub materials. The research method used is quantitative descriptive. The research sample consisted of 50 students. The instrument used was Three-Tier Multiple Choice with a total of 10 questions and a semi-structured interview. Before using the instrument, a validity and reliability test was carried out first. The analysis results of students who understand the concept well are only 28.06%, and 6.06% of students understand but are not sure, while the percentage of students who do not understand the concept is 40.21%, and 29.95% of students experience misconceptions.

The significance of multimodality approach in the management of non-lesional drug-resistant focal parietal lobe epilepsies.

Due to extensive connectivity of the parietal lobe, non-lesional drug-resistant (DRE) parietal lobe epilepsies (PLEs) are difficult to localize and often imitate other epilepsies. Therefore, patients with PLEs have low rates of seizure freedom following epilepsy surgery. Previous studies have highlighted the need to combine EEG and semiology for more accurate localization of PLEs. As sophisticated tools for localization become more available, the use of multiple different neuroimaging and neurophysiologic diagnostic tests may more readily identify PLE. We hereby report a unique case of a complex localization in a non-lesional PLE, which was initially falsely localized to frontal lobe. This case underscores the utility of voxel-based morphometry (VBM) in identifying an epileptogenic lesion on a non-lesional MRI and the significance of multimodality approach including PET, magnetoencephalopathy (MEG), interictal and ictal EEG, semiology and cortical stimulation for accurate localization of PLEs. Understanding epilepsy through multimodality approach in this fashion can help with accurate localization especially in difficulty to localize and deceptive non-lesional PLEs. PLAIN LANGUAGE SUMMARY: Parietal lobe epilepsies are hard to pinpoint in the brain and can mimic other types of epilepsy, especially when brain MRIs appear normal. As sophisticated tools for locating epilepsies in the brain become more available, using multiple diagnostic tests may help identify parietal lobe epilepsies more easily. We describe a unique case of a parietal lobe epilepsy patient with normal brain MRI whose epilepsy was initially misidentified as being in the frontal lobe. Using various advanced diagnostic tests, we accurately found the epilepsy's true location in the parietal lobe and successfully treated the patient with surgery.

Feasibility of Four-Tier Multiple Choice Diagnostic Test for Identification Conception on Chemical Equilibrium Concept

The purpose of this study was to obtain the feasibility of a four-tier multiple choice (4TMC) diagnostic test instrument for the identification of conceptions on chemical equilibrium material in terms of validity, practicality, and effectiveness criteria. This type of research is ADDIE development research with the Analyze, Design, Development, and Evaluation stages. Validity is obtained from a validation sheet consisting of construct, content, and language validity which gets mode = 4, so that the four-tier multiple choice instrument is said to be valid. Practicality is obtained from a learner response questionnaire supported by a learner activity observation sheet. Practicality in terms of the student's response questionnaire is 84% with a very practical category, while the student activity observation sheet gets mode = 1, so the diagnostic test instrument is said to be practical. Effectiveness is obtained from the diagnostic test instrument reliability test. The Cronbach alpha value obtained in the reliability test was 0.798, so the diagnostic test instrument developed was declared reliable. Based on the results of validity, practicality, and effectiveness, the four-tier multiple choice diagnostic test instrument is declared suitable for use.

Financial Technology Services, Government Regulations and Financial Inclusion of Small-Scale Fish Farmers in Homa Bay County, Kenya

This study explored the impact of FinTech and Government Policies on Financial Inclusion for small-scale fish farmers in Homa Bay County, Kenya. The study focused on how access to finance has been widened through agency banking, mobile money and online banking services among these people who had low incomes or were marginalized. The research also examined whether government regulations affect the relationship between fintech channels and financial inclusion. The study was underpinned by Innovation Diffusion Theory, Financial Intermediation Theory, Technology Acceptance Theory and Public Interest Regulation Theory. This study employed causal research design with a sample size of 495 small scale fish farmers using stratified random sampling technique that yielded 144 respondents. Data analysis involved multiple regression, correlation analysis and diagnostic tests that utilized SPSS 26.0 for data analysis. The results showed that agency banking; mobile money services and online banking together explained 58.1% of variation in financial inclusion among the farmers indicated by R squared of 0.581.The findings revealed that Agency Banking had significant effect on financial inclusion (β = .231, p = .001 &lt; .05), as well as Mobile Money Services (β = .196, p = .019 &lt; .05) and Online Banking Services (β = .410, p = .000 &lt; .05). Therefore, the study concludes that Agency Banking; Mobile Money and Online Banking play important role in enhancing financial autonomy among small scale fish farming communities through increased access to bank accounts, secured transactions processes and agent incomes respectively. In view of the findings, the study recommends that financial institutions together with fintech companies should invest in platforms which are user-friendly safe secure meant for use by small holder dairy farmers themselves. Keywords: Agency banking, Mobile money services, Online banking services, Government regulations, Financial technology services, Financial inclusion

Applications of Urinary Extracellular Vesicles in the Diagnosis and Active Surveillance of Prostate Cancer.

Prostate cancer is the most common non-cutaneous cancer among men in the UK, causing significant health and economic burdens. Diagnosis and risk prognostication can be challenging due to the genetic and clinical heterogeneity of prostate cancer as well as uncertainties in our knowledge of the underlying biology and natural history of disease development. Urinary extracellular vesicles (EVs) are microscopic, lipid bilayer defined particles released by cells that carry a variety of molecular cargoes including nucleic acids, proteins and other molecules. Urine is a plentiful source of prostate-derived EVs. In this narrative review, we summarise the evidence on the function of urinary EVs and their applications in the evolving field of prostate cancer diagnostics and active surveillance. EVs are implicated in the development of all hallmarks of prostate cancer, and this knowledge has been applied to the development of multiple diagnostic tests, which are largely based on RNA and miRNA. Common gene probes included in multi-probe tests include PCA3 and ERG, and the miRNAs miR-21 and miR-141. The next decade will likely bring further improvements in the diagnostic accuracy of biomarkers as well as insights into molecular biological mechanisms of action that can be translated into opportunities in precision uro-oncology.

Thrombophilia testing for whom, why and when – a review of current practices

Thromboembolic conditions have accounted for 1 in 4 deaths worldwide in 2010. Thrombosis, which is the common pathogenesis of myocardial infarction, ischaemic stroke, and venous thromboembolism (VTE), is the leading cause of death (1/5 deaths in 1990). Hospital-acquired VTE accounts for approximately 60 percent of all VTEs annually. Others include cancer-associated thrombosis and gender associated risks. In addition to the disease burden, it also causes a significant economic burden world-wide. Multiple diagnostic tests and treatment, prolonged hospital stay and follow-up care, including management of recurrent VTE can be extremely costly. Therefore, it is important to focus on VTE prevention so that health care systems can save money, improve outcomes and save lives. In this background, it is important to have a clear direction as to when, how and whom to test for thrombophilia. Testing for thrombophilias is often performed without a clear understanding of the clinical implications of such results. Guidelines vary in the appropriate use of thrombophilia testing. In this review, these variations in thrombophilia testing and the implications mentioned in the recent guidelines and other articles are discussed. The review of such guidelines, guidance statements, review articles conclude that screening for hereditary thrombophilia has very limited advantage in the management of patients with thrombosis. Screening for antiphospholipid syndrome (APLS) is more important given its high rate of recurrence in both venous and arterial thrombosis. Screening for underlying haematological conditions such as myeloproliferative neoplasms (MPN) and paroxysmal nocturnal haemoglobinuria (PNH) is also considered important.

Diagnosis and classification of portosystemic shunts: a machine learning retrospective case-control study.

Diagnosis of portosystemic shunts (PSS) in dogs often requires multiple diagnostic tests, and available clinicopathologic tests have limitations in sensitivity and specificity. The objective of this study was to train and validate a machine learning model (MLM) that can accurately predict the presence of a PSS utilizing routinely collected demographic data and clinicopathologic features. Dogs diagnosed with PSS or control dogs tested for PSS but had the condition ruled out (non-PSS) were identified. Dogs were included if a complete blood count and serum chemistry panel were available from PSS diagnostic testing. Dogs with a PSS were subcategorized as having a single intrahepatic PSS, a single extrahepatic PSS, or multiple extrahepatic PSS. An extreme gradient boosting (XGboost) MLM was trained with data from 70% of the cases, and MLM performance was determined on the test set, comprising the remaining 30% of the case data. Two MLMs were created. The first was designed to predict the presence of any PSS (PSS MLM), and the second to predict the PSS subcategory (PSS SubCat MLM). The trained PSS MLM had a sensitivity of 94.3% (95% CI 90.1-96.8%) and specificity of 90.5% (95% CI 85.32-94.0%) for dogs in the test set. The area under the receiver operator characteristic curve (AUC) was 0.976 (95% CI; 0.964-0.989). The mean corpuscular hemoglobin, lymphocyte count, and serum globulin concentration were most important in prediction classification. The PSS SubCat MLM had an accuracy of 85.7% in determining the subtype of PSS of dogs in the test set, with variable sensitivity and specificity depending on PSS subtype. These MLMs have a high accuracy for diagnosing PSS; however, the prediction of PSS subclassification is less accurate. The MLMs can be used as a screening tool to increase or decrease the index of suspicion for PSS before confirmatory diagnostics such as advanced imaging are pursued.

Utilizing Visual Teaching Materials to Assist Students in Science Subjects Improves Science Process Skills

The purpose of this study is to analyze the improvement of student's science process skills with the application of visual gaining knowledge media in science subjects. The research method used is an experiment with a quantitative approach. The research design employed in this study is true experiment. The study's target population were all students at SMP Negeri 11 Banda Aceh, while the instance selected in this research were 56 pupils making use of the non-simple random sampling method by means of proportional sampling. The instrument used was 20 items to measure science process skills with multiple choice diagnostic tests. The outcomes of research on science process skills in the experimental class for each indicator were obtained: observing by 31.76%, classifying by 39.99%, interpreting by 62.31%, predicting by 53.42%, asking questions by 27.27%, formulating hypotheses by 21.74%, designing experiments by 34.95%, using tools and materials by 25.83%, applying concepts by 15.46%, and communicating by 21.72%. The study's findings allow for the conclusion that the highest indicator of students' science process skills is in the interpretation indicator, but the least significant indication is in the communication indicator. Therefore, the implementation of visual learning media in science subjects can have a positive impact on improving students science process skills.

Identifikasi Pemahaman Konsep Siswa pada Materi Titrasi Asam Basa

This research was conducted to identify the level of students' conceptual understanding in acid-base titration material for class XI IPA MAN I Gorontalo City. This research is descriptive research, the instrument used in this research is a two-tier multiple choice diagnostic test consisting of 10 item questions. This instrument has been tested for validity with validation results obtained at 100%. The research respondents were 118 students of class XI IPA at MAN I Gorontalo City. Data collection was obtained by means of observation, giving tests and documentation. The results showed that students' understanding of the concept of acid-base titration material in the understanding category was 80%, in the category of misconceptions was 13%, in the category of guessing was 2%, and in the category of not understanding the concept was 5%. So it can be concluded that students' understanding of acid-base titration material tends to understand the concept.

An empirical comparison of statistical methods for multiple cut-off diagnostic test accuracy meta-analysis of the Edinburgh postnatal depression scale (EPDS) depression screening tool using published results vs individual participant data

BackgroundSelective reporting of results from only well-performing cut-offs leads to biased estimates of accuracy in primary studies of questionnaire-based screening tools and in meta-analyses that synthesize results. Individual participant data meta-analysis (IPDMA) of sensitivity and specificity at each cut-off via bivariate random-effects models (BREMs) can overcome this problem. However, IPDMA is laborious and depends on the ability to successfully obtain primary datasets, and BREMs ignore the correlation between cut-offs within primary studies.MethodsWe compared the performance of three recent multiple cut-off models developed by Steinhauser et al., Jones et al., and Hoyer and Kuss, that account for missing cut-offs when meta-analyzing diagnostic accuracy studies with multiple cut-offs, to BREMs fitted at each cut-off. We used data from 22 studies of the accuracy of the Edinburgh Postnatal Depression Scale (EPDS; 4475 participants, 758 major depression cases). We fitted each of the three multiple cut-off models and BREMs to a dataset with results from only published cut-offs from each study (published data) and an IPD dataset with results for all cut-offs (full IPD data). We estimated pooled sensitivity and specificity with 95% confidence intervals (CIs) for each cut-off and the area under the curve.ResultsCompared to the BREMs fitted to the full IPD data, the Steinhauser et al., Jones et al., and Hoyer and Kuss models fitted to the published data produced similar receiver operating characteristic curves; though, the Hoyer and Kuss model had lower area under the curve, mainly due to estimating slightly lower sensitivity at lower cut-offs. When fitting the three multiple cut-off models to the full IPD data, a similar pattern of results was observed. Importantly, all models had similar 95% CIs for sensitivity and specificity, and the CI width increased with cut-off levels for sensitivity and decreased with an increasing cut-off for specificity, even the BREMs which treat each cut-off separately.ConclusionsMultiple cut-off models appear to be the favorable methods when only published data are available. While collecting IPD is expensive and time consuming, IPD can facilitate subgroup analyses that cannot be conducted with published data only.

Epidemiology and treatment of invasive Bartonella spp. infections in the United States.

Bartonella spp., renowned for cat-scratch disease, has limited reports of dissemination. Tissue and blood cultures have limitations in detecting this fastidious pathogen. Molecular testing (polymerase chain reaction, PCR) and cell-free DNA have provided an avenue for diagnoses.This retrospective observational multicenter study describes the incidence of disseminated Bartonella spp. and treatment-related outcomes. Inclusion criteria were diagnosis of bartonellosis via diagnosis code, serology testing of blood, polymerase chain reaction (PCR) of blood, 16/18S tests of blood or tissue, cultures of blood or tissue, or cell-free DNA of blood or tissue from January 1, 2014, through September 1, 2021. Exclusions were patients who did not receive treatment, insufficient data on treatment course, absence of dissemination, or retinitis as dissemination. Patients were primarily male (n = 25, 61.0%), white (n = 28, 68.3%), with mean age of 50 years (SD 14.4), and mean Charlson comorbidity index of 3.5 (SD 2.1). Diagnosis was primarily by serology (n = 34, 82.9%), with Bartonella henselae (n = 40, 97.6%) as the causative pathogen. Treatment was principally doxycycline with rifampin (n = 17, 41.5%). Treatment failure occurred in 16 (39.0%) patients, due to escalation of therapy during treatment (n = 5, 31.3%) or discontinuation of therapy due to an adverse event or tolerability (n = 5, 31.3%). In conclusion, this is the largest United States-based cohort of disseminated Bartonella spp. infections to date with a reported 39% treatment failure. This adds to literature supporting obtaining multiple diagnostic tests when Bartonella is suspected and describes treatment options.

Management of idiopathic chylous peritonitis during laparoscopy: a case report and review of literature

Chylous ascites is rare. Etiology can be traumatic, atraumatic or idiopathic. We present a case of idiopathic peritonitis managed by laparoscopic drainage and a medium-chain triglyceride diet. We present a case of a 60-year-old white female who presented to the emergency department with diffused abdominal pain, migrated from the back, and clinical signs of peritonitis. Blood works showed high leukocytosis, and computed tomography showed a large amount of intraperitoneal and retroperitoneal fluid. During an emergency laparoscopy, a chylous ascites was seen and drained, but a causing factor was not identified intraoperatively. Postoperatively, medium-chain triglyceride diet was initiated for a period of 6 weeks, cytological, microbiological and chemical analysis showed elevated levels of triglycerides in absence of other disease. Multiple diagnostic tests revealed no malignancy nor another underlying pathological processes. patient recovered well with no complications. When confronted with chylous ascites, surgeons should drain the abdomen and do thorough evaluation. When no cause is found intraoperatively, surgeons should not take aggressive measures but instead initiate a medium-chain triglyceride diet and search for underlying causes by means of further laboratory testing and positron emission tomography combined with computed tomography (PET-CT). When no etiology is found, medium-chain triglyceride diet can be stopped with no reports of recurrence.

Effect of Interactive Learning Media Using Visual Basic for Application Excel Spreadsheet to Reduce Misconception in Physics Learning

Misconceptions in physics learning are often caused by students’ preconceptions that are not in accordance with the actual physics theory. The use of interactive digital technology-based learning media makes it easier for students to understands physics concepts. This research aims to apply interactive learning media based on Visual Basic for Application (VBA) excel spreadsheets to remediate misconceptions in traveling wave material. The research method is a pre-experimental design, with one group for pretest and posttest. A total of 21 samples were selected using purposive sampling technique. Data collection was carried out twice, namely during the pretest and posttest using a five-tier multiple choice diagnostic test with 10 questions. The results of the misconception remediation analysis showed a decrease in misconceptions from 28.5% to 11.3% with an average N-Gain score (-0.31). This means that there was a decrease in the percentage of misconceptions before and after treatment. This data is also supported by the results of the paired sample t-test analysis, namely 0.000 &lt; 0.5, which means that the use of interactive learning media based on Visual Basic for Application (VBA) Excel spreadsheets has a significant effect on remediating students' misconceptions about traveling wave material. This interactive learning media is expected to be an alternative for teachers in remediating misconceptions in learning physics.

The Development of Four-tier Diagnostic Test for Identifying Misconception in Chemical Equilibrium of Students Pharmacy Vocational School

Chemical equilibrium material includes abstract concepts, mathematical calculations, and involves macroscopic, microscopic and symbolic representations. The characteristic of the chemical equilibrium have the potential to cause students to have difficulty understanding the material which can lead to misconceptions. One of the test instruments that is expected to be effective in identifying misconceptions in student is a Four-Tier Diagnostic Test.&#x0D; This study aimed to develope a Four-tier Diagnostic Test Instrumen that can identifity misconceptions of chemical equilibrium in student’s pharmacy vocational school, know the quality of the developed diagnostic test items and find out informations about the analysis results of the diagnostic test.&#x0D; This study was a development research by Borg &amp; Gall, 4D (defining, designing, developing, disseminating) with content validation by three validators. The participants of main field testing were 60 grade XI students of pharmacy vocational school. Data collections is to provide four-tier diagnostic test in the form multiple choice with CRI (Certainty of Response Index), obeservation, interview and questionnaire. It used descriptive quantitative and qualitative.&#x0D; The result of is that the four-tier multiple choice diagnostic test instrument developed was declared to be feasible and met the criteria as a good problem with averege validity of 3,77 and reability of the best 0,80 included in the high category, discriminating power of the items composed 8 good questions and 12 enough questions and the difficulty test items composed 18 good questions and 2 difficult questions. There are many misconceptiond from chemical equilibrium developed.&#x0D; This research only developed Four-tier diagnostic test in the conigtive. The next researcher can be combine in the cognitive and afektif. Four-tier diagnostic test is able to identifity misconseptions of chemical equilibrium.

Understanding the Disease Burden of Severe Von Willebrand Disease in a Resource Poor Country: An Indian Cohort Study

Background : The national economic status impacts identification of rare diseases which also reflects access to standard healthcare infrastructure.Though VWD is the commonest bleeding disorder, the disease remains under-recognized and underdiagnosed in India due to its phenotypic and clinical heterogeneity and the need for multiple and complex diagnostic tests. The hospital based data shows a contrasting prevalence to that of the west, in that type 3 is the commonest subtype followed by type 1 and type 2 subtype. The treatment patterns of VWD too differs between countries and geographical regions. Unlike hemophilia, the bleed patterns and treatment details are not very well defined. There is a need to identify the unmet needs in the area of diagnosis and management. Aim : The study is aimed to increase understanding of clinical manifestations, treatment practices along with Quality of life (qoL) in severe VWD patients from India Methods : This is a cross-sectional, patient reported retrospective analysis of severe VWD patients from India. The eligibility criteria is confirmed diagnosis of VWD with documented laboratory reports. An informed consent was taken from each patient before participation in the study and the study was initiated after obtaining approval from Institute Ethics Committee. The EQ-5D instrumentswere used to measure patient reported health related QoL. Results : A total of sixty two severe VWD patients were included in the present study. Mean age of the patients was 23.8 years (SD + 13.2 years); median 22 years (range 5-56 years) and the mean age of diagnosis was 4.9 years (SD + 6.9 years). The mean ABR was 12.6 (SD + 8.9). Twenty five patients (40%) had a positive family history and 37 (60%) of the patients reported parental consanguinity. Common bleeding symptoms were of mucocutaneous nature like epistaxis, ecchymoses and gingival bleed .Prolonged bleed from cuts was reported by 46 (74%) of patients and 14 out of 27 women (52%) in the reproductive age group complained of severe menorrhagia ( Table 1). In approximately 76% of the patients, the major treatment product was intermediate purity FVIII whereas 3 patients were still being treated with either cryprecipitate or fresh frozen plasma. The EQ-5D data reported a worse health state in the EQ-5D-5L dimensions of pain/discomfort (34% moderate and 8% moderate to severe problems),usual activities (21% moderate problems and 3% moderate to severe problems), self-care (21% moderate problems) and anxiety (moderate 21% and 2% moderate to severe).There were two deaths due to bleeding in the previous 10 years . Conclusion : In a resource limited country like India, type 3 is the predominant subtype presenting in the treatment centers. All patients had mucocutaneous bleeding with epistaxis being the predominant manifestation, but joint bleeding is also not uncommon. The study also reveals much lower than optimal QoL in all patients, mobility being the least affected parameter. Despite India being the pharmacy of the world, these conditions are neglected by stakeholders.