A reappraisal was made with respect to a classical observation of the mode of instrumental phase reversals on inter-ictal EEG of seemingly bilateral synchronous spike-wave discharges in patients with either idiopathic generalized epilepsies (IGE) or symptomatic localization-related frontal lobe epilepsies (FLE). It was pointed out in the original observation by Tukel and Jasper that one phase reversal at midline or near the midline on the side of the parasagittal epileptogenic lesion designated as secondary bilateral synchrony (SBS) was found in patients with frontal lobe epilepsy (FLE), whereas a double phase reversal was found over the homologous frontal electrodes (F3 and F4) designated as primary bilateral synchrony (PBS) in patients with IGE. Twenty-three patients (IGE: 15, and FLE: 8) revealing bursts of seemingly bisynchronous spike-wave discharges in interictal EEGs were retrospectively studied. Discharge patterns were defined as stable phase reversal pattern if the site of phase-reversal was consistent, and as unstable pattern if the site of phase-reversal was not consistent but shifting in the same patient. Stable one phase-reversal pattern was found more frequently in FLE (50%) than in IGE patients (26.7%), and stable double phase-reversal pattern more frequently in the IGE (33.3%) than in the FLE group (12.5%). Notably, unstable pattern was found almost equally in both IGE and FLE patients (40% and 37.5%, respectively). Recognition of SBS or PBS in accordance with original observation was found not to clearly differentiate FLE from IGE in patients showing seemingly bisynchronous spike-wave complexes. The variability of instrumental phase-reversals can be accounted for by the fact that the localization of maxima of negative spike of the spike-and-wave complexes varies considerably.
IgE ; Pattern ; Right and left ; wave ; Patient observation

Signal fly, Scholastes sp. (Diptera: Platystomatidae) was observed associated with animal carcasses in Malaysia. The first observation was on a monkey carcass, which was killed by using a handgun and immediately placed in a forested area in Gombak, Selangor while the second observation was on a pig that died of natural causes and whose carcass was placed in an oil palm plantation in Tanjung Sepat, Selangor. Both animal carcasses were visited by Scholastes sp. flies during the fresh decomposition period. However, the role Scholastes flies in the decomposition process remains unknown. In this paper, we report the occurrence of Scholastes sp. on animal carcasses in Malaysia for the first time.
Diptera ; Animals ; Malaysia ; Patient observation ; First

INTRODUCTIONPlanning a high-stake clinical examination requires the evaluation of several psychometric and logistical variables. The authors conducted generalisability and decision studies to answer the following research questions in the context of the surgical long case: (1) Does the addition of a third examiner have any added benefit, vis-à-vis reliability, to the examination? (2) Is global marking more reliable than an itemised marking template? (3) What would be the impact on reliability if there was a reduction in the number of examinees that each panel of examiners is required to assess?

METHODSA third examiner and global marking were introduced. Separate generalisability and decision studies were carried out for both the two- and three-examiner models as well as for itemised and global scores.

RESULTSThe introduction of a third examiner resulted in a modest gain of reliability by 0.05-0.07. Gain in reliability was higher when each candidate was allowed to undertake a higher number of clinical cases. Both the global and itemised scores provided equivalent reliability (generalisability coefficient 0.74-0.89).

CONCLUSIONOur results showed that only a modest improvement in reliability of the surgical long case is achieved through the introduction of an additional examiner. Although the reliability of global scoring and the itemised marking template was comparable, the latter may provide opportunities for individualised feedback to examinees.

Clinical Competence ; Education, Medical, Undergraduate ; methods ; standards ; Educational Measurement ; methods ; Humans ; Medical History Taking ; methods ; Observation ; Professional-Patient Relations ; Psychometrics ; methods ; Reproducibility of Results ; Schools, Medical ; Singapore