Analysis of MCQ and distractor use in a large first year Health Faculty Foundation Program: assessing the effects of changing from five to four options.

BACKGROUND: Multiple choice questions are commonly used in summative assessment. It is still common practice for tertiary institutions and accrediting bodies to use five-option single best answer multiple choice questions, despite a substantial body of evidence showing that multiple choice questions with only three or four options provide effective and discriminatory assessment. METHODS: In this study we investigated the distribution of distractor efficacy in exams from four large first-year undergraduate courses in chemistry and in anatomy and physiology in a Health Faculty; assessed the impact on overall student score after changing from five-option to four-option single best answer multiple choice questions; and assessed the impact of changing from five options to four options on item difficulty and discrimination. RESULTS: For the five-option questions analysed, 19% had four effective distractors, which is higher than previous studies, but still a minority of questions. After changing from five to four options, the overall student performance on all multiple choice questions was slightly lower in the second offering of one course, slightly higher in the second offering of another course, and similar in the second offering for two courses. For a subset of questions that were used in both offerings, there were negligible differences in item difficulty and item discrimination between offerings. CONCLUSIONS: These results provide further evidence that five-option questions are not superior to four-option questions, with reduction to four options making little if any difference to overall performance, particularly when MCQ is used in conjunction with other assessment types (including short answer questions, and practical or laboratory assessment). Further areas of study that arise from these findings are: to investigate the reasons for resistance to changing established assessment practice within institutions and by accrediting bodies; and to analyse student perceptions of the impact of a reduced number of options in MCQ-based assessment.

The impact of MTHFR 677 C/T genotypes on folate status markers: a meta-analysis of folic acid intervention studies.

PURPOSE: Methylenetetrahydrofolate reductase (MTHFR) is a key folate pathway enzyme with the T variant of the MTHFR gene increasing the risk of low folate status, particularly coupled with low folate intake. As genetic variability of MTHFR influences folate status, it is important to ensure an adequate intake that overrides genetic effects but minimises any adverse effects. Our aim was to assess the influence of MTHFR genotype on folate status followed by response to supplementation. METHODS: We performed a meta-analysis of ten folate intervention studies to assess the degree to which MTHFR C677T genotype influenced plasma homocysteine and serum folate levels as measures of folate status. We then examined response after supplementation at intake values up to the upper tolerable limit. RESULTS: The MTHFR 677TT genotype was associated with higher plasma homocysteine (2.7 µmol/L, TT vs. CT/CC; 2.8 µmol/L, TT vs. CC) and lower serum folate (2.5 nmol/L, TT vs. CT/CC; 3.6 nmol/L, TT vs. CC). In two studies, the TT groups had mean plasma Hcy >15 µmol/L. Serum folate levels were >7 nmol/L for all genotype groups. After supplementation of 400 up to 1670 µg DFEs of folic acid or folic acid + fortified foods and/or natural food folates for a minimum of 4 weeks, there were no significant differences in plasma homocysteine levels; however, individuals with the TT genotype had a lower serum folate response to supplementation (7.2 nmol/L, TT vs. CT/CC; 8.7 nmol/L, TT vs. CC). CONCLUSIONS: This meta-analysis confirms observations from observational and intervention studies that MTHFR TT genotype is associated with increased plasma homocysteine and lowered serum folate and less response to short-term supplementation. The results can be used for modelling and guiding personalised intake recommendations for the nutrient folate.

Probiotics and Subclinical Psychological Symptoms in Healthy Participants: A Systematic Review and Meta-Analysis.

INTRODUCTION/AIM: Interest in the gut-brain axis and emerging evidence that the intestinal microbiota can influence central nervous system function has led to the hypothesis that probiotic supplementation can have a positive effect on mood and psychological symptoms such as depression and anxiety. Although several human clinical trials have investigated this, results have been inconsistent. Therefore, a systematic review and meta-analytic approach was chosen to examine if probiotic consumption has an effect on psychological symptoms. METHODS: The online databases PubMed, Scopus, and the Cochrane Library were searched for relevant studies up to July 2016. Those that were randomized and placebo controlled and measured preclinical psychological symptoms of depression, anxiety, and perceived stress in healthy volunteers pre and post supplementation with a probiotic were included. To control for differences in scales of measurement, data were converted to percentage change, and the standardized mean difference between the probiotic and control groups was investigated using Revman software. A random effects model was used for analysis. Heterogeneity was assessed using the I2 statistic. Quality assessment was undertaken using the Rosendal scale. RESULTS: Seven studies met the inclusion criteria and provided data for nine comparisons. All studies passed the quality analysis. The meta-analysis showed that supplementation with probiotics resulted in a statistically significant improvement in psychological symptoms (standardized mean difference 0.34; 95% confidence interval 0.07-0.61, Z = 2.49) compared with placebo. CONCLUSION: These results show that probiotic consumption may have a positive effect on psychological symptoms of depression, anxiety, and perceived stress in healthy human volunteers.

Occupational health and metabolic risk factors: A pilot intervention for transport workers.

OBJECTIVES: Heavy vehicle transport workers have a high risk of obesity and obesity-related disorders including cardiovascular disease and diabetes. Sedentary nature of their work makes a healthy work and lifestyle balance difficult to achieve. Educational interventions that promote behavioral changes have been shown to be effective in various group settings. The aims of this study were to determine the prevalence of metabolic risk factors among a population of urban bus drivers; to deliver a 3-month educational intervention specifically tailored for the workplace environment of transport workers; and to evaluate the efficacy of the intervention through quantitative measurements and qualitative feedback. MATERIAL AND METHODS: Thirty-three bus drivers from depots in south Queensland were recruited for the study. Baseline metabolic data were collected through anthropometric measurements, blood collection and diet/lifestyle questionnaires. Metabolic risk factors that were analyzed included: waist circumference, blood pressure, fasting glucose, blood triglycerides and high density lipoprotein cholesterol (HDL-C). Three interactive seminars were delivered over a 3-month period. At the end of the period, data collection was repeated. RESULTS: At the commencement of the study, 35% of the participants exhibited ≥ 3 of the metabolic risk factors that characterize metabolic syndrome. This is higher than the reported prevalence in the general Australian population (22.1%). A total 21 of the 33 participants remained committed to the intervention and provided pre and post intervention data. Of these, 28% (N = 6) showed a decrease in one or more of the risk factors associated with metabolic syndrome. There was a significant increase in the average HDL-C after the intervention. Qualitative feedback indicated that the workers benefited from the program, especially regarding their awareness of the risks associated with their profession. CONCLUSIONS: This pilot study demonstrates that lifestyle education seminars specifically tailored for the workplace can have an impact on the health behaviors of transport workers.

A refined high carbohydrate diet is associated with changes in the serotonin pathway and visceral obesity.

Consumption of palatable foods high in refined carbohydrate has been implicated as a contributing factor to the epidemic levels of obesity. Such foods may disrupt appetite regulation in the hypothalamus through alterations in hunger and satiety signalling. This investigation examined whether a palatable high refined carbohydrate (HRC) diet with the potential to induce obesity was linked to modulation of serotonin and dopamine signalling within the hypothalamus of rats. Male Wistar rats were allowed ad libitum access to either a palatable refined carbohydrate enriched (HRC) diet or standard chow (SC). Visceral fat percentage was used as a measure of the animals' weight gain during the trial. Real-time PCR was applied to determine any variation in levels of expression of the serotonin (Slc6A4 or Sert) and dopamine transporter (Slc6A3 or Dat) genes. After 29 weeks, the HRC group showed a significant increase in visceral fat percentage accompanied by increased expression of Sert. Higher levels of circulating triglycerides were also seen. This investigation determined that a refined high carbohydrate diet is associated with visceral obesity, increased circulating lipids in the blood and distorted serotonergic signalling, which possibly alters satiety and hunger signals.

Promoting metacognition in first year anatomy laboratories using plasticine modeling and drawing activities: a pilot study of the "blank page" technique.

Many first year students of anatomy and physiology courses demonstrate an inability to self-regulate their learning. To help students increase their awareness of their own learning in a first year undergraduate anatomy course, we piloted an exercise that incorporated the processes of (1) active learning: drawing and plasticine modeling and (2) metacognition: planning, monitoring, reaction, and reflection. The activity was termed "blank page" because all learning cues were removed and students had to create models and diagrams from reflection and recall. Two hundred and eighty-two students responded to a questionnaire reporting qualitative feedback on the exercise. Based on student responses, the "blank page" activity was a positive learning experience and confirmed a need to teach metacognitive skills. From this pilot study, we established that drawing or plasticine modeling is an excellent vehicle for demonstration of the metacognitive processes that enable self-regulation: a known predictor of academic success.