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PubMed2001

Writing multiple-choice test items that promote and measure critical thinking.

Faculties are concerned about measurement of critical thinking especially since the National League for Nursing Accrediting Commission cited such measurement as a requirement for accreditation (NLNAC, 1997). Some writers and researchers (Alfaro-LeFevre, 1995; Blat, 1989; McPeck, 1981, 1990) describe the need to measure critical thinking within the context of a specific discipline. Based on McPeck's position that critical thinking is discipline-specific, guidelines for developing multiple-choice test items as a means of measuring critical thinking within the discipline of nursing are discussed. Specifically, criteria described by Morrison, Smith, and Britt (1996) for writing critical-thinking multiple-choice test items are reviewed and explained for promoting and measuring critical thinking.

Cognition↗
PubMed1978

[Application of the multiple vocabulary test to determining premorbid intelligence levels].

The authors present three basic approaches to solving the problem of determining the premorbid level of intelligence for diagnostic and prognostic purposes. The indirect way of measuring the premorbid level of intelligence was chosen because of the empirical nature of this approach and the possibility of establishing a firm basis for this. Using a number of samples, it has been possible to show that the multiple vocabulary test satisfies all requirements that must be made of a method of measuring the premorbid level of intelligence. They are above all independence of aging and disease processes as well as a high level of internal validity. Results to date indicate that the multiple vocabulary test is a useful method of rapidly and reliably determining the general level of intelligence. Its special importance lies in the fact that it allows the premorbid level of intelligence to be ascertained, thus contributing to an empirical elucidation of problems associated with decreases in proficiency and general mental deterioration due to organic or psychological factors.

Adolescent↗
PubMed1994

Analysis of an older adult vision screening project.

BACKGROUND: The purpose of this study was to determine how a variety of reasonable vision screening criteria affected the results of vision screening previously performed on a community-dwelling older adult population. METHODS: The records of 201 previously performed vision screening evaluations of adults over the age of 65 were reanalyzed to determine failure rates using new theoretical criteria. Those criteria included screening by history alone, visual acuity alone, history in combination with visual acuity and a multiple test format with both 20/40 and 20/60 acuity criteria. RESULTS: Theoretical screening that would have taken place using visual acuity of less than 20/60 failed the fewest individuals; however, even using this minimal criteria 46 percent of those screened would have failed. Using a multiple test format the failure rate rises to almost 90 percent. The combination of historical criteria and visual acuity failed almost an identical population as would be failed by using an elaborate multiple test format. CONCLUSIONS: The prevalence of ocular abnormalities in this older adult populations was so high that vision screening done with even minimal criteria can be expected to fail very high numbers. Similar failure rates and composition can be achieved by using historical criteria in combination with visual acuity as are achieved using a more elaborate multiple-test format. Given the high prevalence of eye abnormalities in the older adult population the public health value of screening for the need for eye examination is questionable.

Aged↗
PubMed2005

Testing the multiple in the multiple read-out model of visual word recognition.

This study provided a test of the multiple criteria concept used for lexical decision, as implemented in J. Grainger and A. M. Jacobs's (1996) multiple read-out model. This account predicts more inhibition (or less facilitation) from a masked neighbor when accuracy is stressed more but more facilitation (or less inhibition) when the speed of responding is emphasized more. The authors tested these predictions by stressing accuracy (Experiment 1) and response speed (Experiment 2). The results of Experiment 1 showed a stronger neighbor-inhibition effect in the stress-on-accuracy condition than in the control condition. The results of Experiment 2 showed facilitation because of the neighbor prime in the stress-on-speed condition relative to the control condition. These results corroborate the multiple criteria account.

Humans↗
PubMed1981

Simplified E-UFA test for multiple sclerosis (MS): some sources of "false" results.

A simple modification of the Erythrocyte-Unsaturated Fatty Acid (E-UFA) Test for Multiple Sclerosis is described, whereby well washed erythrocytes (RBC) are allowed to stand in Hanks medium 199, for about 21 days at 4 degrees C. The control-experimental difference in electrophoretic mobility of RBC rises to nearly 20%. Precautions in interpretation and wider implications of the SE-UFA test, recently uncovered, are briefly indicated.

Adrenocorticotropic Hormone↗
PubMed1995

Station gender bias in a multiple-station test of clinical skills.

PURPOSE: To apply differential item functioning (DIF) procedures to investigate station gender bias in multiple-station tests of clinical skills, and to compare these results with those obtained by comparing the station-score distributions of men and women examinees. METHOD: The data were from 23 stations used in the selection of seven successive cohorts (1987-1993) of candidates to the Ontario Pre-Internship Program for graduates of foreign medical schools. The stations had been used on at least three occasions, with a minimum sample of about 210 candidates per station. Each station's score was expressed as both a binary score and a continuous score, and DIF was assessed using the Mantel-Haenszel procedure with the binary scores and analysis of covariance with the continuous scores. For each station, DIF effect sizes were calculated and compared with the gender-group mean differences. RESULTS: Using the binary scores, significant DIF was observed for three stations; using the continuous scores, significant DIF was observed for five stations. Significant gender differences were observed in the scores of nine stations. In eight, these differences favored women. Overall, in more stations the direction of DIF favored the men, while the women demonstrated higher levels of ability. CONCLUSION: The results suggest the importance of using a DIF approach for controlling the "ability factor" in studies of this kind: although significant gender differences were observed in the continuous score distributions of nine stations, generally these differences were not indicative of station gender bias.

Analysis of Variance↗
PubMed2005

Activity profiling of ectomycorrhiza communities in two forest soils using multiple enzymatic tests.

Data on the diversity and distribution of enzyme activities in native ectomycorrhizal (ECM) communities are inadequate. A microplate multiple enzymatic test was developed which makes it possible to measure eight enzyme activities on 14 individual, excised ECM root tips. Hydrolytic and oxidative enzymes are involved in the decomposition of lignocellulose, chitin and phosphorus-containing organic compounds. This test system was used to describe the functional diversity of ECM communities in two forest sites. This set of tests proved to be accurate and sensitive enough to reveal a high diversity of activity profiles, depending on the fungal symbiont and the soil horizon. Ectomycorrhizas can be classified into specialists and generalists, and appear to complement each other in the same horizon to collectively perform all eight activities studied. By including a higher number of different assays for more detailed analyses, ECM activity profiling will provide a valuable tool for studying the functional diversity of ECM communities.

Biodiversity↗
PubMed2001

Patient-controlled sedation with propofol for colonoscopy.

BACKGROUND: Patient-controlled sedation (PCS) allows the patient to titrate the dosage of sedative drugs according to need. METHODS: To compare the efficacy of PCS by using propofol with anesthetist-administered midazolam during colonoscopy, 88 patients were randomized to receive either intravenous midazolam 0.05 mg/kg bolus (1 mg increments as required) or propofol PCS (0.3 mg/kg bolus, zero lockout). Heart and respiratory rates, blood pressure, and oxygen saturation were monitored. Patient cooperation, endoscopist satisfaction, and level of sedation were scored. Patient satisfaction was assessed by questionnaire. To correct for multiple testing of data, statistical significance was asserted only for individually stated p values with p < 0.01. RESULTS: Oxygen saturation and hemodynamics were stable in both groups. Better patient cooperation (good vs. minimal; p = 0.008) and higher endoscopist satisfaction (very good vs. good; p = 0.001) were achieved with PCS. Although more sedated intraoperatively (sedation score 4 vs. 2; p = 0.03 for a single test of hypothesis; correction for multiple testing of data removes this significance), patients in the propofol PCS group were more alert by 30 minutes and discharged earlier (mean and SD times were 43.3 [12.1] min compared with 61.0 [29.7] min; p = 0.001.) More patients in the PCS group (86 vs. 6l%; p < 0.001) were satisfied with their overall level of comfort. CONCLUSION: PCS with propofol is effective and results in high patient satisfaction and faster discharge.

Adolescent↗
PubMed1998

The power to detect linkage in complex disease by means of simple LOD-score analyses.

Maximum-likelihood analysis (via LOD score) provides the most powerful method for finding linkage when the mode of inheritance (MOI) is known. However, because one must assume an MOI, the application of LOD-score analysis to complex disease has been questioned. Although it is known that one can legitimately maximize the maximum LOD score with respect to genetic parameters, this approach raises three concerns: (1) multiple testing, (2) effect on power to detect linkage, and (3) adequacy of the approximate MOI for the true MOI. We evaluated the power of LOD scores to detect linkage when the true MOI was complex but a LOD score analysis assumed simple models. We simulated data from 14 different genetic models, including dominant and recessive at high (80%) and low (20%) penetrances, intermediate models, and several additive two-locus models. We calculated LOD scores by assuming two simple models, dominant and recessive, each with 50% penetrance, then took the higher of the two LOD scores as the raw test statistic and corrected for multiple tests. We call this test statistic "MMLS-C." We found that the ELODs for MMLS-C are >=80% of the ELOD under the true model when the ELOD for the true model is >=3. Similarly, the power to reach a given LOD score was usually >=80% that of the true model, when the power under the true model was >=60%. These results underscore that a critical factor in LOD-score analysis is the MOI at the linked locus, not that of the disease or trait per se. Thus, a limited set of simple genetic models in LOD-score analysis can work well in testing for linkage.

Chromosome Mapping↗
PubMed1994

Repeat maternal serum testing in multiple marker Down's syndrome screening programmes.

The effect of repeat testing in maternal serum multiple marker screening for Down's syndrome was estimated using samples stored in an antenatal serum bank. Human chorionic gonadotropin (hCG) and unconjugated oestriol (uE3) levels were determined in 142 pairs of routinely collected samples which had already been tested for alpha-fetoprotein (AFP). For each marker, about two-thirds of the pairs of values were within 20 per cent of each other and most were within 40 per cent. A multivariate Gaussian model was used to estimate the detection and false-positive rates for different repeat testing policies. A policy of repeat testing those with a high risk of a Down's syndrome term pregnancy given age and marker levels would reduce the false-positive rate but there would also be a reduction in the detection rate. For example, using all three markers and a 1 in 250 cut-off risk, the estimated false-positive rate would fall from 5.3 to 3.8 per cent but the detection rate would decrease from 58 to 55 per cent. A policy of repeating those with either high or borderline risks would produce a modest improvement in screening efficiency. Repeating the 11 per cent with a risk exceeding 1 in 500 yields an estimated false-positive rate of 5.0 per cent and a detection rate of 60 per cent. A policy of selective repeat testing is not recommended as it would not substantially improve screening efficiency. Nonetheless, if a repeat test has been performed, the parameters given in this paper will enable an unbiased estimate of the Down's syndrome risk to be calculated for individual women.

Chorionic Gonadotropin↗
PubMed1999

Quality specifications for ordinal scale measurements with multiproperty (multiple) urine test strips.

Analytical quality specifications for ordinal scale measurements have not been presented so far. Criteria are suggested for multiproperty (multiple) urine test strips based on upper limits of healthy reference intervals, analytical performance and statistical tests applicable to ordinal scales. Trueness (accuracy) can be evaluated against an acceptable comparison method by applying sensitivity and specificity concepts, and defining a grey zone with a lower detection limit and an upper confirmation limit. Concordance (agreement) of two or more ordinal scale categories should be evaluated by subtracting random agreement, using Kappa statistics. Repeatability (precision) can be calculated for categorized results using binomial statistics.

Clinical Laboratory Techniques↗
PubMed1999

Patients don't present with five choices: an alternative to multiple-choice tests in assessing physicians' competence.

PURPOSE: To evaluate an open-ended, computer-scored testing format designed to overcome certain limitations of multiple-choice questions. METHOD: Test items covering content in family medicine were administered in two different formats to 7,036 resident physicians in 380 training programs, and to 35 experienced, board-certified physicians in conjunction with the In-training Examination of the American Board of Family Practice. Examinees completed a booklet of 40 open-ended, uncued (UnQ) test items by selecting the answer to each item from a list of over 500 responses. Similar items were administered using the standard multiple-choice question (MCQ) format. One year later, another test of 40 UnQ test items dealing with core content in family medicine was administered to 7,138 residents. RESULTS: Examinees completed over 560,000 UnQ responses with high compliance and few errors. Both reliability and validity for the UnQ format were higher than for the MCQ format, and the UnQ items discriminated more accurately among levels of physicians' experience. The UnQ format almost eliminated the possibility that the physicians could answer questions by sight recognition or random guessing, and it was particularly effective in measuring knowledge of core content. CONCLUSIONS: This study supports the feasibility of administering open-ended test items to enhance tests of physicians' competence.

Clinical Competence↗
PubMed2003

Interleukin 1 and receptor antagonist levels in gingival crevicular fluid in heavy smokers versus non-smokers.

BACKGROUND/AIMS: This study aimed to investigate the concentration of the cytokine interleukin (IL)-1beta and its receptor antagonist IL-1ra in gingival crevicular fluid (GCF) in patients with adult periodontitis who were heavy smokers compared with non-smokers. METHOD: GCF samples were collected from two groups of subjects: smokers and non-smokers. Thirty-nine GCF samples were harvested from 13 subjects with moderate to severe adult periodontitis who were heavy smokers. A further 30 GCF samples were harvested from 10 subjects with moderate to severe adult periodontitis who were non-smokers. Subjects were selected from both genders and none had any relevant systemic illness, were pregnant, had recent medication or had received any periodontal therapy in the preceding 3 months. One deep bleeding site, one deep non-bleeding site and one healthy site were investigated in each subject. Clinical measurements were recorded for each site, after obtaining a GCF sample using a Periopaper strip. IL-1beta and IL-1ra were quantified using new commercially available ELISA kits (Quantikine), and could be detected in all samples. RESULTS: For smokers, the mean concentrations for IL-1beta were 2714.5 (SD 4416.2) pg/ micro L for healthy sites, 37.0 (SD 57.2) pg/ micro L for non-bleeding periodontitis sites and 24.5 (SD 29.2) pg/ micro L for bleeding periodontitis sites. The concentrations of IL-1beta for non-smokers for the same category of sites were 393.8 (SD 867.1), 74.2 (SD 107.0) and 73.1 (SD 61.0) pg/ micro L, respectively. The mean concentrations of IL-1ra for smokers were 5.8 x 10(5) (SD 9.7) pg/ micro L for healthy sites, 2.2 x 10(5) (SD 0.15) pg/ micro L for deep non-bleeding sites and 0.19 x 10(5) (SD 0.07) pg/ micro L for deep bleeding sites. The concentrations for non-smokers were: 4.1 x 10(10) (SD 3.8), 18.1 x 10(5) (SD 20.4) and 3.2 x 10(5) (SD 2.3) pg/ micro L, respectively. Significance levels of P < 0.05 were found for comparisons of healthy vs. deep bleeding and deep non-bleeding sites for IL-1beta and IL-1ra in smokers, before adjustments for multiple testing. However, none of these comparisons reached statistical significance following adjustments for multiple testing. P < 0.05 for the correlation between IL-1beta and IL-1ra at healthy sites in smokers only. Differences in GCF concentrations for IL-1beta in smokers vs. non-smokers were significant for deep bleeding sites only (P < 0.05), the mean concentration of IL-1beta being lower in GCF from smokers vs. non-smokers. All differences in GCF concentrations of IL-1ra reached statistical significance for smokers vs. non-smokers. The mean concentrations of IL-1ra in GCF were lower in smokers compared with non-smokers for all categories of sites. CONCLUSIONS: A decreased concentration of IL-1beta and also IL-1ra was found in GCF from periodontitis sites compared to healthy sites in smokers and in non-smokers, although this did not reach statistical significance following adjustments for multiple testing. For comparisons between heavy smokers and non-smokers, statistically significant differences were found in the GCF concentrations of IL-1beta from deep bleeding sites only. Statistically significant differences were found in the IL-1ra concentrations for smokers vs. non-smokers for all categories of sites.

Adult↗
PubMed1994

Germline RET mutations in MEN 2A and FMTC and their detection by simple DNA diagnostic tests.

Multiple endocrine neoplasia type 2A (MEN 2A) and familial medullary thyroid carcinoma (FMTC) are two closely related cancer syndromes inherited in an autosomal dominant manner. Mutations in the RET proto-oncogene were found in MEN 2A and FMTC families. In this study we report seven different germline mutations in the RET proto-oncogene in five of five MEN 2A and five of six FMTC families. Each of the mutations involves a cysteine residue in the extracellular cysteine-rich domain of the RET receptor tyrosine kinase. We developed simple polymerase chain reaction based diagnostic tests for all seven mutations in these families.

Base Sequence↗
PubMed1989

Comparison of nominal recall (standard) and multiple-choice methods for administration of WISC-R information subtest: a preliminary study indicating a learning effect of multiple-choice testing.

The Wechsler Intelligence Scale for Children--Revised (WISC--R) Information subtest was administered to learning disabled children using two methods of administration, the standard (recall) method and a multiple-choice format. Those children who were tested first with the multiple-choice format and subsequently with the standard format did better on the standard format than expected. This preliminary study suggests a learning effect of such multiple-choice testing and the desirability of further research being undertaken.

Child↗
PubMed1984

A pocket calculator program for Duncan's New Multiple Range Test and analysis of variance.

A program for the TI-59 calculator to be used in analysis of variance and testing of significance of differences between each mean and every other mean by Duncan's New Multiple Range Test is presented. The test is both simple and powerful for data involving more than two treatment groups in a completely random design. Up to six groups with any number of replicates may be analyzed with this program.

Analysis of Variance↗