COMPARISON OF FOUR-AND FIVE-OPTION MULTIPLE-CHOICE QUESTIONS IN NURSING ENTRANCE TESTS

Abstract Introduction: Most multiple-choice tests comprise questions with four options per item. However, a number of academic teachers believe that a larger number of options per question shall increase the scope of variability of test results. An increase in discrimination capability is particularly important with reference to selective examinations. In 2011 and 2013, Nursing Entrance Test at Medical University of Warsaw (MUW) comprised 5-option items tests, which was an exception from 4-option items tests used in 2009-2010 and 2012. Aim of study: Assessment of the impact of change of the number of options in multiple-choice questions (MCQs) on the quality of Nursing Entrance Exams for an MA programme at MUW between 2009-2013. Materials and Methods: A total of 250 multiple-choice exam questions, including 150 four-option items (2009-2010 and 2012) and 100 five-option items (2011 and 2013). In order to compare the quality of particular exams, the level of easiness, substitute differentiation power, and Pearson's linear correlation coefficient were established for each pool of questions. The comparison comprised the scope of variability of the results (coefficient of variation, scope of results, and quartile range) as well as the average easiness and capacity of differentiating particular questions in consecutive versions of the exam. A one-way analysis of ANOVA variance and post-hoc RIR Tukey honestly significant difference test were used. Results: In 2011 and 2013, when the 5-option items tests were introduced, the difficulty of the exam expressed as the mean score amounted to 24.3 and 25.7 points, respectively. These values are comparable to the results achieved in 2010 (25.6), but they are clearly different from those obtained in 2009 (30.2) and 2012 (31.5). Similar differences were observed in comparison of coefficients of variation that were similar in 2010, 2011, and 2013 (17.1, 17.9 and 18.4%, respectively) and significantly different from those obtained in 2009 and 2012 (14.3 and 14.1%, respectively). Moreover, a greater symmetry (skewness ≈ 0) in frequency distribution of test scores was observed in the case of 5-option items tests compared to 4-option items tests. The reliability of the exam was variable, Cronbach's α coefficient ranged between 0.429 and 0.559. No statistically significant differences were found in discrimination capability of the exams performed in the form of 4-or 5-option items tests (ANOVA test, P> 0.05). It was also demonstrated that the 2011 exam (5 options) was significantly more difficult than that of 2012 (4 options) (ANOVA test (P = 0.0025) and post-hoc RIR Tukey honestly significant difference test (P< 0.01)). Conclusions: The introduction of an additional option item to the test questions did not significantly improve the qualitative parameters of the Nursing Entrance Exams at MUW. Significant increase in selective capacity of the exam and reliability of assessment was not observed. It is recommended to use 4-option items tests and to develop a good test content outline for future editions of the exam

COMPARISON OF FOUR-AND FIVE-OPTION MULTIPLE-CHOICE QUESTIONS IN NURSING ENTRANCE TESTS

Abstract Introduction: Most multiple-choice tests comprise questions with four options per item. However, a number of academic teachers believe that a larger number of options per question shall increase the scope of variability of test results. An increase in discrimination capability is particularly important with reference to selective examinations. In 2011 and 2013, Nursing Entrance Test at Medical University of Warsaw (MUW) comprised 5-option items tests, which was an exception from 4-option items tests used in 2009-2010 and 2012. Aim of study: Assessment of the impact of change of the number of options in multiple-choice questions (MCQs) on the quality of Nursing Entrance Exams for an MA programme at MUW between 2009-2013. Materials and Methods: A total of 250 multiple-choice exam questions, including 150 four-option items (2009-2010 and 2012) and 100 five-option items (2011 and 2013). In order to compare the quality of particular exams, the level of easiness, substitute differentiation power, and Pearson's linear correlation coefficient were established for each pool of questions. The comparison comprised the scope of variability of the results (coefficient of variation, scope of results, and quartile range) as well as the average easiness and capacity of differentiating particular questions in consecutive versions of the exam. A one-way analysis of ANOVA variance and post-hoc RIR Tukey honestly significant difference test were used. Results: In 2011 and 2013, when the 5-option items tests were introduced, the difficulty of the exam expressed as the mean score amounted to 24.3 and 25.7 points, respectively. These values are comparable to the results achieved in 2010 (25.6), but they are clearly different from those obtained in 2009 (30.2) and 2012 (31.5). Similar differences were observed in comparison of coefficients of variation that were similar in 2010, 2011, and 2013 (17.1, 17.9 and 18.4%, respectively) and significantly different from those obtained in 2009 and 2012 (14.3 and 14.1%, respectively). Moreover, a greater symmetry (skewness ≈ 0) in frequency distribution of test scores was observed in the case of 5-option items tests compared to 4-option items tests. The reliability of the exam was variable, Cronbach's α coefficient ranged between 0.429 and 0.559. No statistically significant differences were found in discrimination capability of the exams performed in the form of 4-or 5-option items tests (ANOVA test, P> 0.05). It was also demonstrated that the 2011 exam (5 options) was significantly more difficult than that of 2012 (4 options) (ANOVA test (P = 0.0025) and post-hoc RIR Tukey honestly significant difference test (P< 0.01)). Conclusions: The introduction of an additional option item to the test questions did not significantly improve the qualitative parameters of the Nursing Entrance Exams at MUW. Significant increase in selective capacity of the exam and reliability of assessment was not observed. It is recommended to use 4-option items tests and to develop a good test content outline for future editions of the exam

Interim Guidance for Emergency Medical Services Management of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic

The novel coronavirus disease 2019 (COVID-19) has caused immense adverse health consequences around the world. The pandemic’s potential impact upon out-of-hospital cardiac arrest (OHCA) resuscitation and related training are substantial. Given the public health implications of OHCA, resuscitation in the COVID-19 era must strive to correctly balance the best practices achieved by the links in the chain of survival with the added risks of COVID-19. Importantly, changes that are implemented to address COVID-specific risks are likely to affect resuscitation care for all patients with OHCA given the challenges of accurate and timely assessment of COVID infection in the prehospital setting. Preliminary reports indicate that OHCA care and outcome have been adversely impacted in communities with low and high COVID-19 prevalence. Some of the mortality toll may be attributable directly to COVID-19 infection among patients with OHCA. However, an important contributor appears to be adverse impacts of the pandemic on circumstances and care for OHCA patients without COVID-19, highlighting the far-reaching challenges to resuscitation as systems and society navigate the pandemic

Rituximab-associated hypogammaglobulinemia in children with idiopathic nephrotic syndrome: results of an ESPN survey

Background: There is paucity of information on rituximab-associated hypogammaglobulinemia (HGG) and its potential infectious consequences in children treated for idiopathic nephrotic syndrome (INS). Methods: A survey was distributed by the European Society Pediatric Nephrology to its members. It addressed the screening and management practices of pediatric nephrology units for recognizing and treating RTX-associated HGG and its morbidity and mortality. Eighty-four centers which had treated an overall 1328 INS children with RTX responded. Results: The majority of centers administered several courses of RTX and continued concomitant immunosuppressive therapy. Sixty-five percent of centers routinely screened children for HGG prior to RTX infusion, 59% during, and 52% following RTX treatment. Forty-seven percent had observed HGG prior to RTX administration, 61% during and 47% >9 months following treatment in 121, 210, and 128 subjects respectively. Thirty-three severe infections were reported among the cohort of 1328 RTX-treated subjects, of whom 3 children died. HGG had been recognized in 30/33 (80%) of them. Conclusions: HGG in steroid-dependent/frequently relapsing nephrotic syndrome (SDNS/FRNS) children is probably multifactorial and can be observed prior to RTX administration in children with SDNS/FRNS. Persistent HGG lasting >9 months from RTX infusion is not uncommon and may increase the risk of severe infections in this cohort. We advocate for the obligatory screening for HGG in children with SDNS/FRNS prior to, during, and following RTX treatment. Further research is necessary to identify risk factors for developing both HGG and severe infections before recommendations are made for its optimal management

A Comprehensive Investigation on Common Polymorphisms in the MDR1/ABCB1 Transporter Gene and Susceptibility to Colorectal Cancer

ATP Binding Cassette B1 (ABCB1) is a transporter with a broad substrate specificity involved in the elimination of several carcinogens from the gut. Several polymorphic variants within the ABCB1 gene have been reported as modulators of ABCB1-mediated transport. We investigated the impact of ABCB1 genetic variants on colorectal cancer (CRC) risk. A hybrid tagging/functional approach was performed to select 28 single nucleotide polymorphisms (SNPs) that were genotyped in 1,321 Czech subjects, 699 CRC cases and 622 controls. In addition, six potentially functional SNPs were genotyped in 3,662 German subjects, 1,809 cases and 1,853 controls from the DACHS study. We found that three functional SNPs (rs1202168, rs1045642 and rs868755) were associated with CRC risk in the German population. Carriers of the rs1202168_T and rs868755_T alleles had an increased risk for CRC (Ptrend = 0.016 and 0.029, respectively), while individuals bearing the rs1045642_C allele showed a decreased risk of CRC (Ptrend = 0.022). We sought to replicate the most significant results in an independent case-control study of 3,803 subjects, 2,169 cases and 1,634 controls carried out in the North of Germany. None of the SNPs tested were significantly associated with CRC risk in the replication study. In conclusion, in this study of about 8,800 individuals we show that ABCB1 gene polymorphisms play at best a minor role in the susceptibility to CRC

Directed assembly and dynamics of anisotropic particles

Structures of nanometer and micrometer sized particles exhibit a variety of useful properties both as naturally occurring phenomena and in technological applications. In nature, colloidal crystals account for the colors in an opal and colloidal crystals can be used to create materials with photonic or phononic properties or used as coatings or templates. Creating these structures with nonspherical particles allows for a greater variety of properties. However, although the structures are dictated by thermodynamics, whether they are ultimately achievable as well as on what time scale they form, are limited by kinetics. In particular, concentrating particles slows their dynamics and reduces the rate at which they can arrange into the desired crystal. When nonspherical particles are assembled, both translational and orientational order is required to create crystals. Dicolloids, the shape of two overlapping spheres, are a particularly interesting particle shape to study due to the fact that their crystal structure can be changed with aspect ratio. The goal of this thesis is to investigate the kinetic limitations to assembly with increasing volume fraction. Specifically, we focus on concentrated monolayers of particles assembled into two-dimensional structures using oscillating electric fields. Multiple light scattering is used to probe the dynamics of dicolloid particles with different shapes. With greater anisotropy, an increase in the diffusivity is observed. The diffusivity as a function of volume fraction could also be normalized by the random-close-packed volume fraction onto a master curve. The localization of particles was also characterized as a function of volume fraction and after accounting for repulsive interactions could be used to determine the glass transition of the dicolloids. The response of the localization length also compared well with theoretical predictions. AC electric field induced assembly provides one potential pathway for directed self-assembly of colloidal particles. The advantage of using electric fields is that they orient and concentrate particles into a close-packed state. The structure of an assembled monolayer of dicolloids is studied both using microscopy and light scattering techniques. The scaling of the order to disorder transition was determined to be similar to that observed for spherical particles and optimal conditions for assembly were discovered. This optimum highlights the balance between creating a structure at thermal equilibrium and concentrating the particles quickly. The assembly of dicolloids is also unique in that the structure at low concentrations and in the initial phases of the assembly demonstrates end-to-end chaining which disappears for concentrated assemblies. Furthermore, orientational defects are apparent even in this low volume fraction case. Although electric fields are chosen due to their ability to orient and concentrate nonspherical particles into structure, even at low concentration, care must be taken to ensure particles are oriented before concentrated. Otherwise they arrest into nonequilibrium structures. The concentrated particle dynamics, including the localizalization length and glass transitions are mapped out for dicolloid particles of different sizes and shapes. Values for the glass transition and diffusivity provide a metric for where the assembly is inhibited to better understand the optimal conditions for assembly processes