Validation of mental agility test and personal qualities assessment tools for selecting medical students in Nepal: Mental agility and personal qualities tests

Introduction: Patan Academy of Health Sciences (PAHS) decided to test mental agility and personal qualities to select undergraduate medical students, different than the conventional approaches used to test for physics, chemistry, and biology contents in other universities in Nepal. Method: Personal Qualities Assessment (PQA) test batteries used to select medical students in twelve different countries were pilot tested with 10+2 non-sciences, 10+2 science, and 10+3 health science students. The PQA tools were forward translated into Nepali and back-translated in English by bilingual experts independently. The face and content validity of these tools in the Nepali language was established through discussions and consensus with the PAHS admission team and PQA team in Australia. Result: The PQA tools assessing non-cognitive qualities in the Nepali language were found to be internally consistent in the first pre-test with science and non-science students. PQA tool assessing mental agility in the English language showed acceptable internal consistency in the second pre-test with science and health science students. Conclusion: Mental agility test in the English language was found to be a suitable cognitive test for selecting medical students. Non-cognitive tests in the Nepali language were found to be reliable and valid to identify applicants with unusual personal traits, leading to deselection. These tests can be considered for selecting undergraduate medical students.   Keywords: Cognitive, mental agility test- MAT, Nepal, Non-cognitive, Patan Academy of Health Sciences- PAHS, personal qualities assessment- PQA

Seepage and slope stability modelling of rainfall-induced slope failures in topographic hollows

This study focuses on topographic hollows, their flow direction and flow accumulation characteristics, and highlights discharge of hillslope seepage so as to understand porewater pressure development phenomena in relation with slope failure in topographic hollows. For this purpose, a small catchment in Niihama city of Shikoku Island in western Japan, with a record of seven slope failures triggered by typhoon-caused heavy rainfall on 19–20 October 2004, was selected. After extensive fieldwork and computation of hydro-mechanical parameters in unsaturated and saturated conditions through a series of laboratory experiments, seepage and slope stability modellings of these slope failures were done in GeoStudio environment using the precipitation data of 19–20 October 2004. The results of seepage modelling showed that the porewater pressure was rapid transient in silty sand, and the maximum porewater pressure measured in an area close to the base of topographic hollows was found to be higher with bigger topographic hollows. Furthermore, a threshold relationship between the topographic hollow area and maximum porewater pressure in this study indicates that a topographic hollow of 1000 sq. m area can develop maximum porewater pressure of 1.253 kPa. However, the porewater pressures required to initiate slope instability in the upper part of the topographic hollows is relatively smaller than those in the lower part of the topographic hollows

Deterministic slope failure hazard assessment in a model catchment and its replication in neighbourhood terrain

In this work, we prepare and replicate a deterministic slope failure hazard model in small-scale catchments of tertiary sedimentary terrain of Niihama city in western Japan. It is generally difficult to replicate a deterministic model from one catchment to another due to lack of exactly similar geo-mechanical and hydrological parameters. To overcome this problem, discriminant function modelling was done with the deterministic slope failure hazard model and the DEM-based causal factors of slope failure, which yielded an empirical parametric relationship or a discriminant function equation. This parametric relationship was used to predict the slope failure hazard index in a total of 40 target catchments in the study area. From ROC plots, the prediction rate between 0.719–0.814 and 0.704–0.805 was obtained with inventories of September and October slope failures, respectively. This means September slope failures were better predicted than October slope failures by approximately 1%. The results show that the prediction of the slope failure hazard index is possible, even in a small catchment scale, in similar geophysical settings. Moreover, the replication of the deterministic model through discriminant function modelling was found to be successful in predicting typhoon rainfall-induced slope failures with moderate to good accuracy without any use of geo-mechanical and hydrological parameters

A study to correlate the incidence of cross arch balance and working side occlusal wear facets among different age groups: An in vivo study

Introduction: The prevalence of group function and canine guided occlusion is common in natural dentition, but cross arch balance is not often seen. Hence, a study was carried out with following objectives: Analysis of incidence of cross arch balance in different age groups and working side occlusal wear facets in following subjects. Materials and Methods: A total of 200 patients with natural dentition were included in the study. Subjects with cross arch balance were analyzed for working side occlusal wear facets. Data were analyzed statistically by Chi-square test. Results: The incidence of cross arch balance in the study group was 0.7%. On examination, subjects with group function on the working side and cross arch balance on the non-working side had more occlusal wear facets. Conclusion: From the study, it was observed that there was no significant variation in the number and extent of wear facets between the cross arch and without cross arch subjects due the smaller sample size hence it was difficult to conclude the relationship non-working side contact as interference and its influence in wearing of dentition in this study

Reduced blood pressure of CFTR-F508del carriers correlates with diminished arterial reactivity rather than circulating blood volume in mice.

The F508del mutation of the cystic fibrosis transmembrane conductance regulator (CFTR) is the most common cause of cystic fibrosis (CF). Both CF patients and F508del carriers have decreased blood pressure. While this has been attributed to salt depletion, recent studies have shown F508del expression interferes with smooth muscle cell calcium mobilization. We tested the hypothesis that carriers of the F508del mutation have lower adult blood pressures and reduced aortic contractility without a reduction in circulating blood volume. By radiotelemetry, F508del heterozygous mice had significantly lower arterial pressures than wild-type C57BL/6 controls, with the greatest effect seen at the time of dark-to-light cycle transition (mean difference of 10 mmHg). To replicate the vascular effects of sympathetic arousal, isoproterenol and epinephrine were co-infused, and F508del mice again had significantly reduced arterial pressures. Aortas isolated from F508del heterozygous mice had significantly decreased constriction to noradrenaline (0.9 ± 0.2 versus 2.9 ± 0.7 mN). Inhibition of wild-type CFTR or the inositol triphosphate receptor replicated the phenotype of F508del aortas. CFTR carrier status did not alter circulating blood volume. We conclude the CFTR-F508del mutation decreases aortic contractility and lowers arterial pressures. As a cAMP-activated chloride channel that facilitates calcium mobilization, we speculate wild-type CFTR co-activation during adrenergic receptor stimulation buffers the vasodilatory response to catecholamines, and loss of this compensatory vasoconstrictor tone may contribute to the lower arterial pressures seen in heterozygote carriers of a CFTR-F508del mutation

A Rare Case of Fungal Maxillary Sinusitis due to Paecilomyces lilacinus in an Immunocompetent Host, Presenting as a Subcutaneous Swelling

Paecilomyces is a colonizing fungal species which usually causes keratitis, endocarditis, sinusitis, nephritis, fungemia, cutaneous, and subcutaneous infections in immunocompromised host. Very rarely, it causes similar infection in immunocompetent host without any risk factors. We report a case of maxillary sinusitis due to Paecilomyces lilacinus in a 65–year-old immunocompetent male, who presented with a subcutaneous swelling below the left eye. The lesion was excised by surgery and treated with itraconazole for 6 months based on culture and sensitivity. After 1 year of follow up, he is free of symptoms with no evidence of recurrence

Conducting Integrated Objective Structured Clinical Examination: Experiences at KIST Medical College, Nepal

Background: Objective structured clinical examination (OSCE), an important tool for assessment of clinical skills, introduced more than 4 decades ago. KIST Medical College, a new medical school of Nepal, affiliated to Tribhuvan University Institute of Medicine, has made learning of physical examination skills structured and integrated with greater involvement of different clinical science departments. Students learn physical examination skills in second year MBBS as a part of early clinical exposure. Objective: To share the experiences regarding implementation of integrated OSCE. Materials and Methods: At the end of clinical posting of learning of physical examination skills, assessment was done with OSCE. Fifteen OSCE stations including each of 5 minutes were developed and arranged. Standardized patients and validated checklist were used. OSCE was conducted in novel way. Prior to the OSCE session: Suitable venue was selected, assessors were identified, standardized patients were selected, running order of the stations in circuit was developed, list of equipments/instruments required was prepared, and tasks, checklists, feedback questionnaires were printed. The day before the OSCE session: OSCE stations were inspected and clearly labeled, condition of required equipments/instruments was checked, a pack of the documents for each OSCE station were made available, and signs were displayed at proper places. On the day of the OSCE session: Reliable stop watch and loud manual bell were used, support staffs were placed to direct the candidates, examiners, and standardized patients (SPs), assessors explained SPs, students were briefed, supervisors observed the session, and feedback were taken from students, assessors, and SPs. At the end of the OSCE session: Checklists and feedback questionnaires were collected, token money was paid to SPs, and a contribution of everyone was appreciated. After the OSCE session: Score was compiled and result declared, and feedback questionnaires data compiled and shared with academic team. Results: Ninety eight percent of the students attended the OSCE session. All agreed that standardized patient were co-operative, 93% found the faculty′s presentation as non-threatening where as 99% found the overall OSCE environment conducive. Most (92%) of the faculties found the selection of simulated patients appropriate, and all were satisfied with student′s approach towards SP. All expressed satisfaction with the overall management. Only 250 US dollars expended for conducting session. Conclusion: Integrated OSCE session was organized in novel way and cost effectively. Both students and faculty members were satisfied with OSCE process and management