HbA1c was 12.4%; fasting total cholesterol 5.92mmol/L (NR 2.5–5). The patient was prescribed oestrogen replacement and no adjustments were made to diet or insulin. Over several months, mood and energy improved and weight fell from 110kg to 81kg, HbA1c dropped to 7.6%, cholesterol was 2.56mmol/L and insulin dosage halved. The impact of menopausal symptoms on health and wellbeing

is often underestimated. In selected post-menopausal women with type 2 diabetes, short-term Quizartinib nmr treatment with hormone replacement therapy may be useful if benefits obtained outweigh potential risks. Copyright © 2010 John Wiley & Sons. “
“Diabetes in pregnancy, including Type 1 diabetes, Type 2 diabetes, and gestational diabetes, is increasingly common and now complicates over 20% of pregnancies in some populations. While interpretation of epidemiologic data is difficult due to variation in screening practices and diagnostic criteria, it has become clear that the prevalence of both obesity, as the key risk factor, and diabetes in pregnancy have increased. The impact of diabetes in pregnancy on the baby may be selleck chemical ameliorated by clinical intervention before and during pregnancy and has been shown to be

cost-effective. The long-term benefits of clinical intervention for diabetes in pregnancy on a population basis have yet to be proven, but if the intervention includes prepregnancy care and postnatal management of both mother and baby (including support for physical activity and healthy eating), these are likely to be of major public health importance. “
“There not is a lack of consensus among expert bodies regarding the virtue of screening for gestational diabetes mellitus (GDM). Central to the debate is the significance of GDM as a disease entity. A variety of screening tests are endorsed by different professional organizations. Not all organizations recommend screening to decide which patients are offered definitive testing for GDM. Furthermore,

international consensus regarding glycemic thresholds to define GDM has not as yet been achieved. In the US, Canada, and Australasia the 50-g, 1-hour glucose test is the recommended screening test. Prevalence rates of GDM vary with the choice of glucose thresholds for both screening and definitive tests. Glucose challenge test results are poorly reproducible and depend on timing of the last meal. Simple, and preferably single, screening and/or diagnostic tests are the ideal. Any screening test will have to be evaluated in relation to the new HAPO diagnostic criteria for GDM. “
“The aim of this survey was to establish the limitations of open loop continuous subcutaneous insulin infusion (CSII) as perceived by current users of the technology, and to ascertain their interest in and requirements for a non-electronic implantable closed loop insulin pump, INSmart, currently under development for the treatment of type 1 diabetes.

05). Imipenem selection did not modify the conjugation frequencies (Table 2). We showed that all the blaNDM-1-carrying plasmids were transferred to K. pneumoniae and S. typhimurium with frequencies ranging from 10−5 to 10−8 transconjugants per donor, showing a variable potential of transfer of blaNDM-1 plasmids in Enterobacteriaceae

(Table 2). As observed using E. coli JM109 as recipient, plasmids p419 and pKp7 were transferred to K. pneumoniae CIP53153 and S. typhimurium LT2 at the lowest frequencies (10−7 to 10−8 transconjugants per donor) and were not transferred to P. mirabilis CIP103181 (Table 2). Only two types of broad-host range plasmids (p601 and p271) were transferred into P. mirabilis CIP103181 but at low frequencies (Table 2), which is consistent with what has been observed Epigenetic inhibitor molecular weight previously (Naas et al., 2003). CTX 10 μg mL−1 NA 20 μg mL−1b CTX 10 μg mL−1 NA 20 μg mL−1 CTX 10 μg mL−1 NA 20 μg mL−1 IMP 0.25 μg mL−1 NA 20 μg mL−1 IMP 0.75 μg mL−1 NA 20 μg mL−1 CTX 10 μg mL−1 NA 20 μg mL−1 CTX 10 μg mL−1 RA 250 μg mL−1 CTX 10 μg mL−1 TE 30 μg mL−1 Transconjugants expressed variable levels of carbapenem resistance (Table 3), as previously observed (Kumarasamy et al., 2010). According to the updated breakpoints of the CLSI (Clinical and Laboratory Standards Institute, 2010) for imipenem, meropenem, doripenem (susceptible, ≤ 1 μg mL−1; resistant,

≥ 4 μg mL−1) and ertapenem (susceptible, ≤ 0.25 μg mL−1; resistant ≥ 1 μg mL−1), those transconjugants could be classified as susceptible, intermediate susceptibility or resistant to carbapenems. MICs of carbapenems were always the highest for K. pneumoniae used selleck chemicals as the recipient species that fits with its lower natural susceptibility to carbapenems compared to that of E. coli (Table 3). The lowest MIC values of carbapenems were obtained with P. mirabilis used as ZD1839 manufacturer a recipient, which is consistent with the previous findings showing low MIC values of β-lactams when other β-lactamase genes,

such as blaTEM, are expressed in P. mirabilis (Kontomichalou et al., 1974). Those low MIC values of carbapenems may explain further difficulties to identify NDM-1 producers in P. mirabilis. None of the five plasmids was transferred to A. baumannii and to P. aeruginosa by conjugation. One cannot exclude that conjugative transfer could have been obtained using clinical NDM-1 producers as donors that may contain helper plasmids for mobilization, providing conjugation proteins in trans. None of the five plasmids was transferred by electroporation in P. aeruginosa. A single plasmid type (p271) was transferred successfully by electroporation in A. baumannii CIP70.10 reference strain indicating that at least this untypeable plasmid can replicate in A. baumannii. This transformant was highly resistant to carbapenems (MICs of imipenem, meropenem and doripenem > 32 μg mL−1). They mirror published data with NDM-1 and NDM-2-positive A.

To achieve this, they continue induction therapy until CSF cultures are negative. Others will give a fixed course of therapy, most often two weeks, and switch the patient to a maintenance regimen, if well, without further lumbar puncture. This may be the preferred option for most individuals, bearing in mind that, assuming HAART

is started, the risk of relapse and mortality is likely to be lower than that reported in older studies. There should be consideration of a lumbar puncture and extension of therapy in individuals whose initial poor prognostic factors or slow response to therapy raise concerns that they are less likely to be cured by only two weeks’ induction (category IV recommendation). Options for maintenance therapy are daily fluconazole check details or itraconazole, or weekly liposomal amphotericin B. Fluconazole has been shown to be superior to amphotericin B with less drug-associated ATM/ATR inhibitor toxicity and lower rates of relapse [54], and also

to itraconazole which was associated with higher rates of CSF culture-positive relapse [40]. The optimal dose of fluconazole as maintenance therapy remains unclear. Although the standard dose is 200 mg daily, one retrospective study showed a benefit to a higher dose of 400 mg daily with a lower rate of relapse [55]. Serum cryptococcal antigen measurement is not useful in monitoring for relapse of disease [56]. 2.4.4.4 Cryptococcal infection without CNS involvement. Pulmonary cryptococcal infection, isolated cryptococcaemia or cryptococcal disease at another site outside the CNS and lungs should be assessed for associated occult CNS infection by performing an LP. If this is present, treatment is as for meningitis. If CSF examination is negative, isolated pulmonary disease can be treated with fluconazole. There are no controlled clinical studies of the treatment of isolated pulmonary cryptococcal disease in either the HIV

or the non-HIV setting. All HIV patients with isolated pulmonary disease should be treated due to the almost certain risk of dissemination. In those with moderate symptoms the treatment of choice is fluconazole 400 mg daily followed by secondary prophylaxis [57,58]. In those with more Morin Hydrate severe disease, liposomal amphotericin B should be used [57,59] until symptoms are controlled; again this should be followed by secondary prophylaxis. Similarly, in patients with isolated cryptococcaemia there are no studies to guide treatment options. Due to the rapid progression to meningitis from this condition [17] patients should be treated with either fluconazole 400 mg daily if mild or moderately symptomatic or liposomal amphotericin B if symptoms are more severe. Routine prophylaxis for cryptococcal disease is not recommended (category IV recommendation).

HCV antiviral recipients, diabetics and those on lipid-lowering drugs at baseline were excluded from the study. Factors associated with a decreased risk of grade 3 or 4 hyperlipidaemia or lipid-lowering drug use were assessed by multivariate logistic regression. A total of 1587 HIV-monoinfected, 190 HIV/HBV-coinfected and 255 HIV/HCV-coinfected patients were evaluated. Most were male (85–92% for the 3 groups evaluated: HIV, HIV/HBV, HIV/HCV). The median

[interquartile range (IQR)] age at HAART initiation was 48 (44–56) years and was similar between groups. The median (IQR) CD4 count at HAART initiation was 245 (120–370) cells/μL in HIV-monoinfected participants, 195 (110–330) cells/μL in HIV/HBV-coinfected participants and 268 (140–409) CTLA-4 antibody cells/μL in HIV/HCV-coinfected participants. Factors associated with a decreased risk of grade 3 or 4 hyperlipidaemia or lipid-lowering drug use included HIV/HCV coinfection [odds ratio (OR) 0.46; 95% confidence interval (CI) 0.34, 0.61; P<0.0001], HIV/HBV coinfection (OR

0.74; 95% CI 0.55, 0.99; P=0.04), year of starting HAART after 2004 vs. 1997 or earlier (OR 0.37; 95% CI 0.29, 0.48; P<0.0001) and year of starting HAART between 1998 and 2003 vs. 1997 or earlier (OR 0.75; 95% CI 0.61, 0.92; P<0.01). Factors selleck screening library associated with increased risk included age (OR 1.55; 95% CI 1.39, 1.72; per 10 years, P<0.0001) and male gender (OR 1.84; 95% CI 1.36, 2.48; P<0.0001). HIV/HCV and O-methylated flavonoid to a lesser extent HIV/HBV coinfections are protective against HAART-related hyperlipidaemia. HIV, hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infections frequently co-exist because of common risk factors for exposure

[1,2]. A negative interaction results in many instances. On average, HCV viral loads are increased and liver fibrosis rates are accelerated in the presence of HIV [3,4] and mortality rates are increased [5]. CD4 T-lymphocyte recovery following the initiation of combination antiretroviral therapy is blunted in HIV/HCV coinfection, although the causative role of HCV remains debatable [3]. Also, the occurrence of liver-specific adverse events related to antiretroviral therapy is increased and the efficacy of HBV and HCV antiviral therapy is diminished [4–6]. In contrast to the prevailing negative relationship between HIV and HCV infections in terms of the effect on the coinfected individual, there is evidence that the abnormal lipid profile observed in many patients following the initiation of highly active antiretroviral therapy (HAART) may be less pronounced in those with HIV/HCV coinfection [7]. Lower total cholesterol and low-density lipoprotein (LDL) cholesterol levels have been reported in those with HCV infection, with and without advanced liver disease [8–13].

To ensure that the differences in choice probability that we observed in these experiments was not the result of differential color selectivity in the two areas, we repeated the analysis after excluding neurons exhibiting significant color selectivity concurrently with spatial selectivity (P < 0.05 in two-way anova test, using spatial location and color as factors). This

possibility seemed unlikely from the outset, because similar check details percentages of neurons exhibited significant selectivity for the color of our stimuli in LIP and dlPFC (12 and 13%, respectively) and because the choice probability analysis pools trials with the salient stimuli of the two colors. Nonetheless, when we only analysed non-color selective neurons (PFC, n = 48; LIP, n = 50), the choice probability was still significantly different between areas during the fixation (t-test, t96 = −4.63, P < 10−4) and the second 0.5-s delay periods (t-test, t96 = −2.85, P < 0.01) for the target in receptive field trials (Fig. 5A). Similar trends were observed for trials involving the distractor appearing in the receptive field in the sample of non-color selective

neurons (compare Fig. 5B with Fig. 4C), though differences between areas failed to reach statistical significance in this smaller sample. The differential contribution of GSK1120212 molecular weight two areas to the behavioral choice could possibly be attributed to a difference in a neuron’s response variability

between areas. To investigate this possibility, we computed the Fano factor of a neuron’s spike counts during the task, defined as the variance divided by the mean (Churchland et al., 2010). The Fano factor was estimated in separate task periods in the delayed match-to-sample task, including the fixation period (0.5 s), the cue period (0.5 s) and the delay period (1.0 s) for correct and error trials with the target in the receptive field. The analysis was performed C59 price on neurons with at least five trials per condition in the difficulty level 3. The average Fano factor was generally lower for correct trials than for error trials during the cue period and the delay period in both dlPFC (Fig. 6, n = 60) and LIP (Fig. 6, n = 62) although there were no significant main effects of correct vs. error or task epoch in either area (two-way anova; PFC, F1,354 = 0.28, P > 0.5 for correct/error, F2,354 = 0.28, P > 0.7 for epoch; LIP, F1,366 = 0.64, P > 0.4 for correct/error, F2,366 = 1.67, P > 0.1 for epoch). We also performed two-way anova separately for correct and error conditions using area and task epoch as main factors. No significant main effects of area or task epoch were found in either correct or error conditions (two-way anova; Correct, F1,360 = 2.04, P > 0.1 for area, F2,360 = 0.52, P > 0.

We then compared the influence of activity in areas 8 and 46 of dlPFC and in area LIP of PPC on behavioral choice and behavioral

reaction time. Our results revealed that neuronal activity in each area influenced reaction time and behavioral choice to a different extent, in different task epochs. Two male rhesus monkeys (Macaca mulatta) weighing 5–8 kg were used in this study. All surgical and animal-use procedures in this study followed guidelines of the US Public Health Service Policy on Humane Care and Use of Laboratory Animals and the National Research Council’s Guide for the Care and Use of Laboratory Animals, and were reviewed and approved by the Wake Forest University Institutional

Ku-0059436 in vivo Animal Care and Use Committee. Two 20-mm diameter selleck kinase inhibitor recording cylinders were implanted over dlPFC and PPC of the same hemisphere in each monkey (Fig. 1A). Extracellular activity of single units was recorded using arrays of 2–8 microelectrodes in each cylinder, either with glass-coated tungsten electrodes (250 μm diameter, impedance 1 MΩ at 1 kHz; Alpha-Omega Engineering, Nazareth, Israel) or epoxylite-coated tungsten electrodes (125 μm diameter, impedance 4 MΩ at 1 KHz; FHC, Bowdoin, ME, USA). Electrodes were advanced individually into the cortex with a microdrive system (EPS drive; Alpha-Omega Engineering). The electrical signal from each electrode was amplified, band-pass filtered between 500 Hz and 8 kHz, and recorded with a modular data acquisition system at 25 μs resolution (APM system; FHC). The anatomical location of electrode penetration was confirmed with MR imaging

of the brain obtained after implantation of the recording cylinders. In the prefrontal cortex, neuronal data were collected from areas 46 and 8a of the dlPFC including both banks of the principal sulcus and the surface cortex dorsal to the principal sulcus and posterior to but excluding the arcuate sulcus. In the PPC, recordings were obtained from the lateral bank of Masitinib (AB1010) the intraparietal sulcus at depths > 3 mm from the surface of the cortex excluding area 7a, which is located superficially. The monkeys faced a computer monitor 60 cm away in a dark room with their head fixed. Eye position was sampled at 240 Hz, digitized, and recorded with an infrared eye position tracking system (model RK-716; ISCAN, Burlington, MA, USA). The visual stimulus presentation and behavior monitoring were controlled by in-house software (Meyer & Constantinidis, 2005) using the Psychophysics Toolbox (Brainard, 1997). The system was implemented in the MATLAB computational environment (Mathworks, Natick, MA, USA). Two different tasks were used in the present study: the delayed match-to-sample task (Fig. 1B) and the reaction-time task (Fig. 1C).

subtilis strains such as strain FT-3 (Morita et al., 1979).

Although specific roles for these polysaccharides have not been proposed, they are known to be comprised of glucose, galactose, fucose, glucuronic acid and O-acetyl groups in an approximate molar ratio of 2 : 2 : 1 : 1 : 1.5 (Morita et al., 1979). Information regarding the genes encoding the proteins that make these exopolysaccharides is also limited. yhxB is a gene related to the synthesis of an uncharacterized exopolysaccharide component of the B. subtilis biofilm matrix and putatively encodes an α-phosphoglucomutase and/or phosphomannomutase (Branda et al., 2004). In B. subtilis 3610, a deletion in yhxB is responsible for the production of a fragile surface pellicle when grown in a liquid culture and flat undifferentiated colonies when grown on ABT-888 manufacturer solid media. On the contrary, the B. subtilis wild-type strain shows a robust pellicle in liquid culture and colonies on

plates with web-like structures (i.e. bundled structures). Other genes important in matrix structure and biofilm architecture include the 16 genes of the eps operon (yveK-yvfF) involved in polysaccharide biosynthesis, modification and export (Branda TGF-beta inhibitor et al., 2001). From sequence comparisons, two genes belonging to the eps operon, named epsG (yveQ) and epsH (yveR), may be involved in the synthesis of exopolysaccharides. epsG encodes a protein that is presumably involved in EPS polymerization, while epsH encodes a glycosyl-transferase (Branda et al., 2001). eps mutants in B. subtilis 3610 show a reduction in the carbohydrate content and complexity of biofilm pellicle (Branda et al., 2006). Blair et al. (2008) have Anidulafungin (LY303366) recently demonstrated that another member of this eps operon,

the EpsE protein, is an inhibitor of cell motility. Despite the extensive study of the eps operon and its role, the structure and function of the polysaccharides resulting from the expression of these genes remain unknown. Characterization of this polysaccharide and its regulation awaits further investigations. The second category of EPS secreted by B. subtilis includes a polymer, which plays a role in the sorption of ions and/or charged molecules. Poly-γ-glutamate (γ-PGA) produced by B. subtilis strain IFO3336 is a well-characterized anionic, nontoxic and biodegradable viscous polymer of d- and l-monomers with a molecular mass of over 10 000 kDa. The γ-PGA of B. subtilis (natto) is composed 50–80% of d- and 20–50% of l-glutamate (Ashiuchi et al., 1999; Morikawa et al., 2006; Inbaraj et al., 2008). γ-PGA is synthesized by several Bacillus species, especially wild-type isolates, including B. subtilis strains IFO3336, IFO3335, TAM-4, F-2-01, B-1 (mucoid-type colonies), ZJU-7, B. subtilis (natto) and Bacillus anthracis (Kubota et al., 1993; Kunioka, 1995; Ito et al., 1996; Shi et al., 2006). The pgsBCA genes are responsible for the synthesis of γ-PGA.

In this review article, we describe some of the latest advances in our knowledge on the role of the endocannabinoid system, in its most recent and wider conception, in pain pathways, by focusing on: (1) neuron–glia interactions; and (2) emerging data on endocannabinoid cross-talk with neurotrophins, such as nerve growth factor and brain-derived neurotrophic factor. “
“Chronic N-methyl-d-aspartate

receptor (NMDAR) hypofunction has been proposed as a contributing factor to symptoms of schizophrenia. Pirfenidone nmr However, it is unclear how sustained NMDAR hypofunction throughout development affects other neurotransmitter systems that have been implicated in the disease. Dopamine neuron biochemistry and activity were examined to determine whether sustained NMDAR hypofunction causes

a state of hyperdopaminergia. We report that a global, genetic reduction in NMDARs led to a remodeling of dopamine neurons, substantially affecting two key regulators of dopamine homeostasis, i.e. click here tyrosine hydroxylase and the dopamine transporter. In NR1 knockdown mice, dopamine synthesis and release were attenuated, and dopamine clearance was increased. Although these changes would have the effect of reducing dopamine transmission, we demonstrated that a state of hyperdopaminergia existed in these mice because dopamine D2 autoreceptors were desensitized. In support of this conclusion, NR1 knockdown dopamine neurons have higher tonic firing rates. Although the tonic firing rates are higher, phasic signaling is impaired, and dopamine overflow cannot be achieved with exogenous high-frequency stimulation that models phasic firing. Through the examination of several parameters of dopamine neurotransmission, we provide evidence that chronic NMDAR hypofunction leads to a state of elevated synaptic dopamine. Compensatory mechanisms to attenuate hyperdopaminergia also impact the ability to generate dopamine surges through phasic firing. “
“Elimination of granule cells (GCs) in the olfactory bulb (OB) is not a continual event but is promoted during a short time window in the postprandial period, typically

with postprandial sleep. However, the neuronal mechanisms for the enhanced GC elimination during the postprandial period are not understood. Here, we addressed the question of whether top-down inputs of selleck chemicals centrifugal axons from the olfactory cortex (OC) during the postprandial period are involved in the enhanced GC elimination in the OB. Electrical stimulation of centrifugal axons from the OC of anesthetized mice increased GC apoptosis. Furthermore, pharmacological suppression of top-down inputs from the OC to the OB during the postprandial period of freely behaving mice by γ-aminobutyric acid (GABA)A receptor agonist injection in the OC significantly decreased GC apoptosis. Remarkable apoptotic GC elimination in the sensory-deprived OB was also suppressed by pharmacological blockade of top-down inputs.

, 2011). Briefly, recently fallen leaves were placed in leaf litter bags and immersed in the stream; selleckchem samples were collected intensively for bacterial biomass and enzymatic

activity until day 112 after immersion. Leaf samples were collected, rinsed with filtered stream water (0.2 μm), and cut to disks (1.1 cm diameter) with a metal borer. For phenol oxidase activity assays, disk samples were kept at 4 °C until analyzed in the laboratory (within 20 h). Samples for the determination of bacterial density were fixed with formaldehyde (2%). Finally, samples for molecular analyses were stored frozen (−20 °C). Bacterial densities were estimated according to the protocol of Porter & Feig (1980). Leaf disks were sonicated (2 + 2 min) in an ultrasonic bath (40 W power, 40 kHz frequency; Selecta, Spain), diluted (1 : 4), and stained for 5 min with 4, 6-diamidino-2-phenylindole (DAPI) at a final concentration of 2 μg mL−1. Bacterial suspensions were, then, filtered through 0.2 μm irgalan black–stained polycarbonate filters Venetoclax concentration (Nuclepore; Whatman International Ltd., Maidstone, UK) and counted using a fluorescence

microscope (Nikon Eclipse 600W, Tokyo, Japan) under ×1250 magnification. Bacterial densities were transformed into biomass units based on 2.2 × 10−13 g C μm3 conversion factors (Bratbak & Dundas, 1984) and using a mean bacterial biovolume of 0.163 μm3 (J. Artigas, unpublished data). Phenoloxidase enzyme activity (EC 1.10.3.2 and 1.14.18.1) was determined using L-3,4-dihidroxyphenylalanine ID-8 (L-DOPA) substrate and following the methodology described by Sinsabaugh et al. (1994). Triplicate leaf samples from each sampling date were pooled for the DNA extraction. The DNA was extracted from 100 to 200 mg of lyophilized leaf

material. Nucleic acids were extracted with the FastDNA® SPIN for Soil Kit (MP Biomedicals) following the instructions provided by the manufacturer, with the following modifications. The homogenizing step was repeated three times in a FastPrep Instrument (MP Biomedicals) using cycles of 30 s at a speed setting of 5.5. Samples were placed on ice for 5 min between every homogenizing step. The LmPH gene was amplified in a GeneAmp PCR system 2700 with the primer pair PheUf/PheUr (Futamata et al., 2001). PCR mixtures contained 1× PCR buffer, 1.5 mM MgCl2, 200 μM total dNTPs, 0.5 μM of each primer, 10 ng of the DNA extracts, and 0.5 units of Taq polymerase (Go Taq; Promega, Madison, WI) in a total volume of 30 μL. Amplification reactions were carried out exactly as previously described (Futamata et al., 2001). PCR products were analyzed by electrophoresis on 1.5% agarose gels and visualized after staining with ethidium bromide (0.2 mg L−1). The analysis of LmPH gene diversity was determined through cloning experiments.

With the implementation of a new curriculum the authors wanted to evaluate how to assess students more effectively. While the results show low-average discrimination which allows room for improvement, caution has been warranted by others regarding the sole use of discrimination to assess content.[10] Data suggest that questions with discrimination indices of less than 0.15 should be restructured or removed from future examinations since these click here items do not measure the same skills as the examination as a whole because these items may be puzzling or misleading to students.[10] Additionally, any distracters that are not chosen should be replaced with more

difficult alternatives and items in which the majority of students answer correctly should also be replaced or modified.[10] All these changes would make an examination more reliable, as the assessment items would be more homogenous in nature.

Future goals are to revisit individual items that demonstrate a high difficulty and discrimination Selleckchem GSK3 inhibitor level and use them as a standard or guide for writing new items. Additionally, any item displaying both a low discrimination and a low difficulty level will be removed. Faculty will make efforts to prospectively familiarize students with all item formats at the beginning of the therapeutics course sequence. The overall goal is to have a balanced homogenous examination which demonstrates moderate-to-high difficulty and moderately discriminating assessment items. This is the second study evaluating examination items using item response theory in TP courses in a pharmacy curriculum. However, it is the first to deconstruct items into the elements of format and content. Overall, our results demonstrate

that Case-based items were of greater Fossariinae difficulty compared to all other items and that they provided greater discrimination than Standard-type items. Dosing items appear to provide greater difficulty and discrimination compared to therapeutics items. However, efforts to find the most appropriate way to assess dosing knowledge in our students are ongoing. We also noted that difficulty and discrimination are closely correlated, and that in our student population item format is at least as equally important as content matter. Future studies and collaborative efforts among different pharmacy schools are needed to determine how to assess knowledge effectively. The Author(s) declare(s) that they have no conflicts of interest to disclose. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All Authors attest to the integrity of the work. All Authors contributed significantly to the design, and contributed actively to the study and dissemination of results. All Authors state that they had complete access to the study data that support the publication.