An Examination of Performance of First Year Students at an Ontario University: An Admission Perspective

Major changes in the Ontario secondary school system over the last 15 years have increased the concerns within some universities about the use of Grade 13 marks as the principal criterion for evaluating applicants. These concerns focus on grade inflation, variability of marks among schools, and how appropriate some subjects are for university admission. This paper reports on a study of these issues conducted at McMaster University. The relationship between Grade 13 admission and Year I university averages was examined. Two issues that have received little attention elsewhere were also examined: how Year I performance varied by applicant status, and the relationship between individual Grade 13 subjects and Year I performance. The results indicate that Grade 13 marks, which are the only measure of a student's achievement available, continue to be a reasonable predictor of subsequent performance in Year I. Grade 13 subjects were identified that were more consistently associated with Year I performance than others. There was also evidence that some Grade 13 subjects may be contributing to an "inflated" admission average. The results of this study should be useful in evaluating existing admission policies and in the development of the new Ontario Academic Courses.Au cours des 15 dernières années, de sérieux changements dans le système des écoles secondaires de l'Ontario ont ajouté à l'inquiétude qui règne au sein de certaines universités face à l'emploi des notes de la 13e année comme critère principal d'évaluation des candidats universitaires. Ces craintes se centrent sur des notes "gonflées", sur une notation variable d'école en école et sur la pertinence de certains cours à l'entrée universitaire. Ce papier traite d'une étude à ce sujet, menée à l'université McMaster, qui visait à percevoir les rapports entre la moyenne d'admission de la 13e année et celle de la lere année universitaire. L'étude porta également sur l'écart entre la performance universitaire et le statut du candidat et sur la performance universitaire reliée à certaines matières de la 13e année, deux questions qui avaient suscité jusqu 'ici peu d'intérêt. Les résultats de cette étude indiquent que les notes de la 13e année, qui sont le seul système de mesure actuel du rendement scolaire, n'en demeurent pas moins un indice valide de la performance post-secondaire. Dans ce rapport, certaines matières de 13e année furent identifiées et étroite-ment associées au succès universitaire. Les découvertes signalèrent également un rapport probable entre certains sujets de 13e année et la hausse dans la moyenne d'admission. Toutes ces données devraient servira évaluer les procédures actuelles d'admission et servir à la mise sur pied de nouveaux 'cours pré-universitaires'

Recent trends in the characteristics and prognosis of patients hospitalized with acute heart failure

BACKGROUND: Despite the magnitude and impact of heart failure (HF) in the United States, relatively little data are available that describe the prognosis associated with acute HF, especially from the perspective of a population-based investigation. The purpose of this nonconcurrent prospective study was to describe the overall, and changing trends therein, prognosis of 4228 patients discharged from all eleven greater Worcester (MA) medical centers after a documented episode of acute HF and factors associated with an increased risk of dying after hospital discharge. METHODS: The study population consisted of residents of the Worcester metropolitan area discharged after being hospitalized for acute HF at all greater Worcester medical centers during 1995 (n = 1783) and 2000 (n = 2445). RESULTS: The 3-month (20% versus 18%), 1-year (41% versus 38%), and 5-year (84% versus 82%) death rates were lower in patients discharged from all metropolitan Worcester hospitals in 2000 versus 1995, respectively. Improving long-term survival rates for patients discharged in 2000 as compared with 1995 were magnified after controlling for several confounding demographic and clinical factors of prognostic importance. A number of potentially modifiable demographic, medical history, and clinical factors were associated with an increased risk of dying during the first year after hospital discharge for acute HF. CONCLUSION: The results of this community-wide observational study suggest improving trends in the long-term prognosis after acute HF. Despite these encouraging trends, the long-term prognosis for patients with acute HF remains poor, and several at-risk groups can be identified for early intervention and increased monitoring efforts

Vitamin A and zinc supplementation among pregnant women to prevent placental malaria: a randomized, double-blind, placebo-controlled trial in Tanzania

BACKGROUND: Malaria causes nearly 200 million clinical cases and approximately half a million deaths each year, primarily in sub-Saharan Africa.1 The risk of malaria increases during pregnancy,2 a period during which its prevention is especially important. Not only do pregnant women experience greater severity of illness compared with nonpregnant women,2 but studies have shown strong associations between prenatal malaria and maternal anemia,2 fetal loss, low birthweight, and infant mortality.2 Improving preventive measures that specifically target malaria in pregnancy is a global health priority.3 METHODS: Study design and participants. This randomized, doubleblind, placebo-controlled trial was implemented at 8 antenatal care clinics in the urban Temeke and Ilala districts of Dar es Salaam, Tanzania. The trial was registered RESULTS: A total of 2,500 screened participants were enrolled in the trial. The trial profile is shown in Figure 1. It was not possible to collect placentas from 875 participants for the following reasons: miscarriages (fetal loss before 28 weeks of gestation) (N = 234), delivery outside of Dar es Salaam or at a non-study hospital (N = 577), or withdrawal from the study (N = 34). Of the remaining 1,589 women, 1,404 placental samples were obtained (88%); histology results were available for 1,361 participants. PCR results were available for 1,158 participants, and 1,404 participants had either histology or PCR results available. CONCLUSION: This study is the first to examine the impact of vitamin A and zinc supplementation starting in early pregnancy on placental malaria. We observed that supplementation with 25 mg zinc per day from the first trimester until delivery was associated with a 36% (95% CI = 9–56%) reduced risk of histopathology-positive placental infection, but not PCRpositive infection. Vitamin A supplementation had no impact on placental malaria, but was associated with an increased risk for severe anemia

Magnitude of and Prognostic Factors Associated With 1-Year Mortality After Hospital Discharge for Acute Decompensated Heart Failure Based on Ejection Fraction Findings

BACKGROUND: Limited data exist about the magnitude of and the factors associated with prognosis within 1 year for patients discharged from the hospital after acute decompensated heart failure. Data are particularly limited from the more generalizable perspective of a population-based investigation and should be further stratified according to currently recommended ejection fraction (EF) findings. METHODS AND RESULTS: The hospital medical records of residents of the Worcester, Massachusetts, metropolitan area who were discharged after acute decompensated heart failure from all 11 medical centers in central Massachusetts during 1995, 2000, 2002, 2004, and 2006 were reviewed. The average age of the 4025 study patients was 75 years, 93% were white, and 44% were men. Of these, 35% (n=1414) had reduced EF ( \u3c /=40%), 13% (n=521) had borderline preserved EF (41-49%), and 52% (n=2090) had preserved EF ( \u3e /=50%); at 1 year after discharge, death rates were 34%, 30%, and 29%, respectively (P=0.03). Older age, a history of chronic obstructive pulmonary disease, systolic blood pressure findings \u3c 150 mm Hg on admission, and hyponatremia were important predictors of 1-year mortality for all study patients, whereas several comorbidities and physiological factors were differentially associated with 1-year death rates in patients with reduced, borderline preserved, and preserved EF. CONCLUSIONS: This population-based study highlights the need for further contemporary research into the characteristics, treatment practices, natural history, and long-term outcomes of patients with acute decompensated heart failure and varying EF findings and reinforces ongoing discussions about whether different treatment guidelines may be needed for these patients to design more personalized treatment plans

Hyperglycemia and risk of ventricular tachycardia among patients hospitalized with acute myocardial infarction

BACKGROUND: Little is known about the association of hyperglycemia Tranwith the development of ventricular tachycardia (VT) in patients hospitalized with acute myocardial infarction (AMI) which we examined in the present study. The objectives of this community-wide observational study were to examine the relation between elevated serum glucose levels at the time of hospital admission for AMI and occurrence of VT, and time of occurrence of VT, during the patient\u27s acute hospitalization. METHODS: We used data from a population-based study of patients hospitalized with AMI at all central Massachusetts medical centers between 2001 and 2011. Hyperglycemia was defined as a serum glucose level \u3e /= 140 mg/dl at the time of hospital admission. The development of VT was identified from physicians notes and electrocardiographic findings by our trained team of data abstractors. RESULTS: The average age of the study population was 70 years, 58.0% were men, and 92.7% were non-Hispanic whites. The mean and median serum glucose levels at the time of hospital admission were 171.4 mg/dl and 143.0, respectively. Hyperglycemia was present in 51.9% of patients at the time of hospital admission; VT occurred in 652 patients (15.8%), and two-thirds of these episodes occurred during the first 48 h after hospital admission (early VT). After multivariable adjustment, patients with hyperglycemia were at increased risk for developing VT (adjusted OR = 1.48, 95% CI = 1.23-1.78). The presence of hyperglycemia was significantly associated with early (multivariable adjusted OR = 1.39, 95% CI = 1.11-1.73) but not with late VT. Similar associations were observed in patients with and without diabetes and in patients with and without ST-segment elevation AMI. CONCLUSIONS: Efforts should be made to closely monitor and treat patients who develop hyperglycemia, especially early after hospital admission, to reduce their risk of VT

Admission Hyperglycemia in Setting of Acute Heart Failure is Associated with Increased In-hospital Mortality Among Patients without Diabetes

Background: Heart Failure (HF) in the setting of comorbid diabetes mellitus (DM) has been extensively examined and is associated with increased mortality. More recently, hyperglycemia independent of DM status during critical illness admissions has become recognized as an indicator of poor outcomes. Despite evolving understanding of DM in the setting of acute HF, hyperglycemia at time of admission for acute HF has not been examined with regard to in-hospital treatment and patient outcomes. Objective: The goal of this study is to examine differences in in-hospital treatment and outcomes of patients hospitalized for acute HF according to glycemic status. Methods: The sample consisted of 9,748 residents of the Worcester (MA) metropolitan area hospitalized at all 11 greater Worcester medical centers for acute decompensated HF during the years 1995 - 2004 with data available on diabetic status and admission glucose measurements. Patients were stratified into three groups based on history of DM and admission hyperglycemia defined by glucose ≥200 mg/dL: 1) nondiabetic, normoglycemic (NDNG); 2) non-diabetic, hyperglycemic (NDHG); and 3) diabetic (DM). Results: Non-diabetic, normoglycemic patients were similar to NDHG patients with respect to age and medical history and were significantly older and less likely to have a history of various comorbid conditions such as hypertension, stroke and renal disease when compared to diabetics (p-values Conclusions: The results of our population-based investigation suggest that non-diabetic patients hospitalized for acute HF who are hyperglycemic at the time of admission represent a vulnerable group of patients at risk for increased mortality during hospitalization. Hyperglycemia ≥200 mg/dL during acute HF hospitalization should be taken into account when providing in-hospital management for HF with additional consideration given to ascertainment of diabetic status and glycemic control

Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study

BACKGROUND: Limited recent data are available describing differences in long-term survival, and factors affecting prognosis, after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), especially from the more generalizable perspective of a population-based investigation. The objectives of this study were to examine differences in post-discharge prognosis after hospitalization for STEMI and NSTEMI, with a particular focus on factors associated with reduced long-term survival. METHODS: We reviewed the medical records of residents of the Worcester, MA, USA metropolitan area hospitalized at eleven central Massachusetts medical centers for acute myocardial infarction (AMI) during 2001, 2003, 2005, and 2007. RESULTS: A total of 3762 persons were hospitalized with confirmed AMI; of these, 2539 patients (67.5%) were diagnosed with NSTEMI. The average age of study patients was 70.3 years and 42.9% were women. Patients with NSTEMI experienced higher post-discharge death rates with 3-month, 1-year, and 2-year death rates of 12.6%, 23.5%, and 33.2%, respectively, compared to 6.1%, 11.5%, and 16.4% for patients with STEMI. After multivariable adjustment, patients with NSTEMI were significantly more likely to have died after hospital discharge (adjusted hazards ratio 1.28; 95% confidence interval 1.14-1.44). Several demographic (eg, older age) and clinical (eg, history of stroke) factors were associated with reduced long-term survival in patients with NSTEMI and STEMI. CONCLUSIONS: The results of this study in residents of central Massachusetts suggest that patients with NSTEMI are at higher risk for dying after hospital discharge, and several subgroups are at particularly increased risk

Karhunen-Lo\`eve expansion for a generalization of Wiener bridge

We derive a Karhunen-Lo\`eve expansion of the Gauss process $B_t - g(t)\int_0^1 g'(u)\,d B_u$, $t\in[0,1]$, where $(B_t)_{t\in[0,1]}$ is a standard Wiener process and $g:[0,1]\to R$ is a twice continuously differentiable function with $g(0) = 0$ and $\int_0^1 (g'(u))^2\,d u =1$. This process is an important limit process in the theory of goodness-of-fit tests. We formulate two special cases with the function $g(t)=\frac{\sqrt{2}}{\pi}\sin(\pi t)$, $t\in[0,1]$, and $g(t)=t$, $t\in[0,1]$, respectively. The latter one corresponds to the Wiener bridge over $[0,1]$ from $0$ to $0$.Comment: 25 pages, 1 figure. The appendix is extende