The final examination in medicine : time for change?

Most medical programmes culminate in a final assessment, in order that participants may be tested and graded. In June 1995, at the University of Malta, a group of 53 medical students sat for their final examination; medicine was one of the three co-equal component subjects of this statutory qualifying examination. The scope of this paper is to analyze the results obtained in the final examination in medicine and to use this data to address such issues as aims of this examination, method and quality assurance of assessment. The result obtained by candidates in the final examination in medicine was correlated with their university entry qualifications. The composite mark for each candidate was split into its components and analysis took the form of description, correlation and clustering. Computation of Cronbach’s alpha facilitated anlaysis of reliability of each of the three parts of the examination. The findings of this paper suggest that there is room for improving the quality of assessment methods. A review of methods and procedures, with the dual purpose of decreasing bias and increasing specificity and sensitivity of this statutory examination will not only benefit candidates, but ultimately also the University of Malta. The final qualifying examination in medicine should have clearly defined objectives and methods of assessment should be aimed specifically at reaching them. It needs to be able to assess the ability to think critically about diagnosis and management and to ensure that the candidate has a satisfactory base of factual knowledge. It also needs to assess objectively the adequacy of basic clinical skills and candidates’ facility of communication.peer-reviewe

Concordance with the British Society of Rheumatology (BSR) 2010 recommendations on eligibility criteria for the first biologic agent

Aims: The aim of this study is to assess concordance with the British Society of Rheumatology (BSR) 2010 recommendations on the use of biologic therapy in Rheumatoid Arthritis (RA). The Disease Activity Score in 28 joints (DAS 28), a composite numerical score is included in these recommendations to assess disease activity and response to treatment. Methods: Clinical notes of fifty patients who were commenced on biologic treatment between March 2010 and June 2011 were reviewed for documentation of DAS 28 scores at baseline, after approximately 6 months of commencement of treatment and at approximately 6 monthly intervals during treatment. Results: Twenty two patients were eligible for this audit. Of these patients only half had a DAS 28 score performed prior to starting treatment, four patients had the score performed within 3-9 months of commencement of therapy and only 2 patients had continuous scores performed at six monthly intervals during treatment. Conclusions: This audit shows that we are not adhering to the BSR recommendations. In order to improve our adherence we plan to train all staff in contact with patients on biologic treatment to perform DAS 28 scores and have a DAS 28 calculator readily available at out patients. A proforma is being developed for patients on biologic therapy to ensure that DAS 28 scores are performed at baseline and during treatment.peer-reviewe

New Synthetic Endocannabinoid as Anti-Inflammaging Cosmetic Active: an In Vitro Study on a Reconstructed Skin Model

Endocannabinoids have been recently appointed as interesting cosmetic actives in regulating inflammaging, a state of chronic low-grade inflammation, known for being involved in many senescence\u2019s manifestations, included skin aging. The aim of this study was to assess the anti-inflammaging activity of a new synthetic endocannabinoid, Isopalmide\uae, on a reconstructed skin model, on which inflammaging has been reproduced through UVA radiation and light mechanical stress. We tested Isopalmide\uae both as a single active and conveyed in a cosmetic product, in comparison with Anandamide, a well-known natural endocannabinoid with anti-inflammatory action. The anti-inflammaging activity of topically applied products has been assessed, after 6 hours of treatment post-irradiation, through the transcriptional modification of genes involved in the NF-\u3baB pathway and the epigenetic pathway targeting miRs as potential biomarkers of inflammaging: miR-21, miR-126 and miR-146a. The results confirmed the anti-inflammatory action of Anandamide which inhibits NF-\u3baB, while Isopalmide\uae showed its anti-inflammaging activity through the establishment of an inflammatory/anti-inflammatory balance by maintaining NF-\u3baB inactive in the cytoplasm and active in the nucleus. The anti-inflammaging activity was shown also by the cosmetic product containing Isopalmide

Malignant lymphoma of the intestine : a report of three cases

Tumours arising in the small intestine are uncommon; those of them originating in the lymphoid tissues are said to be even less frequent than adennocarcinomas. Three cases hereby are reported, outlining the respective diagnosis and treatment. All the three cases were diagnosed histologically as Lymphosarcoma. It is interesting to note that in published series, Lymphosarcomas and Reticulum Cell Sarcomas have been about equally represented, and together accounted for the vast majority of cases. Various gross features have been reported, the commonest being polypoid, annular, ulcerative and aneurismal. An important feature of these tumours is that they have little connective tissue stroma. This, together with infiltration of the muscle coat, is said to account for the aneurismal varieties of the growth. Age incidence studies show that most cases occur in the age group 45 to 60 years, but no age group is exempt. As for signs and symptoms, it is true to say that no definite syndrome is produced by this disease. In general, it may be said that cases have presented either as surgical emergencies or insidiously. There is general consensus regarding the value of post-operative radiotherapy in unresectable growths, and in those with regional lymph node metastasis. What is uncertain is the value of radiotherapy where no evidence of lymph node spread is present.peer-reviewe

Multiparametric Analysis of Factors Associated With Eosinophilic Chronic Rhinosinusitis With Nasal Polyps

Introduction: Previous studies have reported a diverse range of threshold values for blood eosinophilia. In addition, a single predictive biomarker for eosinophilic chronic rhinosinusitis (CRS) with nasal polyps (ECRSwNP) has not yet been identified. Objectives: The aim of this study is to compare the clinical characteristics of ECRSwNP and non-ECRSwNP to evaluate the preoperative risk of tissue eosinophilia of chronic rhinosinusitis with nasal polyps (CRSwNP) through a multiparametric statistical analysis. Methods: One hundred ten patients with evidence of chronic polypoid rhinosinusitis were included in this study and clinical records were retrospectively reviewed. Eosinophilic CRSwNP was diagnosed based on the presence of at least 10 eosinophils per high-power field. The demographic and clinical features of ECRSwNP and non-ECRSwNP are described. The values of blood eosinophilia as predictors of tissue eosinophilia have been identified using receiver operating characteristic curves. As the predictive value of the identified cutoff through regression analysis was low, we evaluated whether other risk factors could be statistically associated with ECRSwNP, and from this, a new predictive model was proposed for the identification of eosinophilic nasal polyps before surgery. Results: We found that the best method for predicting ECRSwNP is based on a model having asthma, blood eosinophil percentage, posterior ethmoid value in Lund-Mackay score, and modified Lund-Kennedy score as explanatory variables. Conclusions: This study provides new data for a better understanding of the polypoid CRS endotypes, and the proposed model allows the endotype to be identified preoperatively

A trust based methodology for web service selection

In this paper, we propose a methodology for addressing trust in Semantic Web Services (SWS) - based applications. The aim is to enhance the capability-driven selection provided by current SWS frameworks with the introduction of trust-based selection criteria. We present an ontology - Web Services Trust Ontology (WSTO) - that models the context of a trust-based interaction and enables the participants to describe semantically their trust requirements and guarantees. WSTO makes use of WSMO as reference ontology for representing Web Services and embodies the problem of finding the most "trusted" Web service as a classification problem. To test our methodology, we implemented a specific module within IRS-III - a WSMO-based SWS broker - and deployed a prototype application based on a use case scenario

Influence of Y2O3 addition on the mechanical and oxidation behaviour of carbon fibre reinforced ZrB2/SiC composites

The influence of Y2O3 addition on the microstructure, thermo-mechanical properties and oxidation resistance of carbon fibre reinforced ZrB2/SiC composites was investigated. Y2O3 reacted with oxide impurities present on the surface of ZrB2 and SiC grains and formed a liquid phase, effectively lowering the sintering temperature and allowing to reach full density at 1900 °C. The presence of a carbon source (fibres) led to additional reactions which resulted in the formation of new secondary phases such as yttrium boro-carbides. Mechanical properties were significantly enhanced compared to the un-doped composite. Further tests at high temperatures resulted in strength increase up to 700 MPa at 1500 °C which was attributed to stress relaxation. Oxidation tests carried out at 1500 °C and 1650 °C in air showed that the presence of the Y-based secondary phases enhanced the growth of ZrO2 grains, but offered limited protection to oxygen due to the lower availability of surficial SiO2 formed from SiC

A two-step methodology for product platform design and assessment in high-variety manufacturing

The delayed product differentiation (DPD) recently rose as a hybrid production strategy able to overcome the main limits of make to stock (MTS) and make to order (MTO), guaranteeing the management of high variety and keeping low storage cost and quick response time by using the so-called product platforms. These platforms are a set of sub-systems forming a common structure from which a set of derivative variants can be efficiently produced. Platforms are manufactured and stocked following an MTS strategy. Then, they are customized into different variants, following an MTO strategy. Current literature proposes methods for platform design mainly using optimization techniques, which usually have a high computational complexity for efficiently managing real-size industrial instances in the modern mass customization era. Hence, efficient algorithms need to be developed to manage the product platforms design for such instances. To fill this gap, this paper proposes a two-step methodology for product platforms design and assessment in high-variety manufacturing. The design step involves the use of a novel modified algorithm for solving the longest common subsequence (LCS) problem and of the k-medoids clustering for the identification of the platform structure and the assignment of the variants to the platforms. The platforms are then assessed against a set of industrial and market metrics, i.e. the MTS cost, the variety, the customer responsiveness, and the variants production cost. The evaluation of the platform set against such a combined set of drivers enhancing both company and market perspectives is missing in the literature. A real case study dealing with the manufacturing of a family of valves exemplifies the efficiency of the methodology in supporting companies in managing high-variety to best balance the proposed metrics

Development of UHTCMCs via water based ZrB2 powder slurry infiltration and polymer infiltration and pyrolysis

Cf/ZrB2-SiC ultra-high temperature composites were manufactured via aqueous slurry impregnation coupled with polymer infiltration and pyrolysis, using a allylhydrido polycarbosilane precursor. For the first time we used ultra-high modulus pitch-based carbon fibres for the PIP process, investigating three different architectures, 0/0°, 0/90°, and 2D. Microstructure, mechanical properties and oxidation resistance in air at 1650 °C were investigated. As expected, the mechanical properties showed the tendency to decrease with increase of the preforms complexity, due to the higher amount of flaws and residual stresses. For instance, the flexural strength was approaching 500 MPa for 0/0°, 370 MPa for 0/90° and 190 MPa for 2D. The materials showed an optimal resistance to oxidation at 1650 °C thanks to formation of a viscous borosilicate glass that guaranteed a self-healing functionality

Toughening effect of non-periodic fiber distribution on crack propagation energy of UHTC composites

Different configurations of continuous carbon fiber-reinforced ultrahigh temperature ceramics (UHTCs), by combining coatings and matrix, were produced via electrophoretic deposition (EPD) and slurry infiltration. The toughening of non-periodic fiber distribution induced by the EPD process was investigated through work of fracture analysis. The results show that a non-periodic fiber distribution results in toughness increase from 8 MPa√m to 11 MPa√m with respect to a periodic fiber distribution. This toughness improvement does not strongly affect the flexural strength, which is mainly related to the fiber volumetric amount. It is shown that the assembling of carbon fibers into bundles (i.e. by dispersing the fibers with a non-periodic distribution) increases the crack propagation energy dissipated on the crack-wake from 0.5 kJ/m2 to 1 kJ/m2, which can be mainly ascribed to the fiber/bundle pull-out. On the other hand, the energy dissipated on the crack-tip (as fiber/matrix debonding) is fiber distribution-independent and increases from 0.3 kJ/m2 to 0.4 kJ/m2 with increasing the fiber amount from 33 vol% to 40 vol%. Finally, WoF analysis is proposed as test to evaluate pull-out toughening instead of push-in and push-out tests