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Raman",authors:[{id:"179146",title:"Dr.",name:"Poondy Gopalratnam",middleName:null,surname:"Raman",fullName:"Poondy Gopalratnam Raman",slug:"poondy-gopalratnam-raman"}]},{id:"49818",title:"Amoxicillin in the Aquatic Environment, Its Fate and Environmental Risk",slug:"amoxicillin-in-the-aquatic-environment-its-fate-and-environmental-risk",signatures:"Armando Elizalde-Velázquez, Leobardo Manuel Gómez-Oliván,\nMarcela Galar-Martínez, Hariz Islas-Flores, Octavio Dublán-García and Nely SanJuan-Reyes",authors:[{id:"179818",title:"Dr.",name:"Leobardo Manuel",middleName:null,surname:"Gómez-Oliván",fullName:"Leobardo Manuel Gómez-Oliván",slug:"leobardo-manuel-gomez-olivan"}]}]}],publishedBooks:[{type:"book",id:"425",title:"Pesticides in the Modern World",subtitle:"Effects of Pesticides Exposure",isOpenForSubmission:!1,hash:"231a93684b2f371567b7afb37c32180d",slug:"pesticides-in-the-modern-world-effects-of-pesticides-exposure",bookSignature:"Margarita Stoytcheva",coverURL:"https://cdn.intechopen.com/books/images_new/425.jpg",editedByType:"Edited by",editors:[{id:"6375",title:"Prof.",name:"Margarita",surname:"Stoytcheva",slug:"margarita-stoytcheva",fullName:"Margarita Stoytcheva"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3477",title:"Herbicides",subtitle:"Current Research and Case Studies in Use",isOpenForSubmission:!1,hash:"793817029a616fa096c3ffb2d68d04ff",slug:"herbicides-current-research-and-case-studies-in-use",bookSignature:"Andrew J. Price and Jessica A. Kelton",coverURL:"https://cdn.intechopen.com/books/images_new/3477.jpg",editedByType:"Edited by",editors:[{id:"13747",title:"Dr.",name:"Andrew",surname:"Price",slug:"andrew-price",fullName:"Andrew Price"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"430",title:"Pesticides in the Modern World",subtitle:"Pests Control and Pesticides Exposure and Toxicity Assessment",isOpenForSubmission:!1,hash:"9ac0f193fefb3556d429c90f3f467beb",slug:"pesticides-in-the-modern-world-pests-control-and-pesticides-exposure-and-toxicity-assessment",bookSignature:"Margarita Stoytcheva",coverURL:"https://cdn.intechopen.com/books/images_new/430.jpg",editedByType:"Edited by",editors:[{id:"6375",title:"Prof.",name:"Margarita",surname:"Stoytcheva",slug:"margarita-stoytcheva",fullName:"Margarita Stoytcheva"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"3521",title:"Weed and Pest Control",subtitle:"Conventional and New Challenges",isOpenForSubmission:!1,hash:"66ed4d91a67af8b180cb863d339021c1",slug:"weed-and-pest-control-conventional-and-new-challenges",bookSignature:"Sonia Soloneski and Marcelo Larramendy",coverURL:"https://cdn.intechopen.com/books/images_new/3521.jpg",editedByType:"Edited by",editors:[{id:"14863",title:"Dr.",name:"Sonia",surname:"Soloneski",slug:"sonia-soloneski",fullName:"Sonia Soloneski"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}},{type:"book",id:"431",title:"Pesticides in the Modern World",subtitle:"Risks and Benefits",isOpenForSubmission:!1,hash:"0244c500e5044b9fb7e20ba348845230",slug:"pesticides-in-the-modern-world-risks-and-benefits",bookSignature:"Margarita Stoytcheva",coverURL:"https://cdn.intechopen.com/books/images_new/431.jpg",editedByType:"Edited by",editors:[{id:"6375",title:"Prof.",name:"Margarita",surname:"Stoytcheva",slug:"margarita-stoytcheva",fullName:"Margarita Stoytcheva"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}],publishedBooksByAuthor:[{type:"book",id:"923",title:"Herbicides",subtitle:"Theory and Applications",isOpenForSubmission:!1,hash:"54a8eb808c05a5fe01c676e7047d4576",slug:"herbicides-theory-and-applications",bookSignature:"Sonia Soloneski and Marcelo L. Larramendy",coverURL:"https://cdn.intechopen.com/books/images_new/923.jpg",editedByType:"Edited by",editors:[{id:"14764",title:"Dr.",name:"Marcelo L.",surname:"Larramendy",slug:"marcelo-l.-larramendy",fullName:"Marcelo L. Larramendy"}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},onlineFirst:{chapter:{type:"chapter",id:"81018",title:"Item Analysis: Concept and Application",doi:"10.5772/intechopen.100138",slug:"item-analysis-concept-and-application",body:'“Assessment is a central component of the teaching and learning” process. It is defined as “the systematic collection and analysis of information to improve student learning” [1]. Test (exam) is a part of student assessment and should be “An objective and standardized measure of a sample of behavior” [2]. Item analysis is a post-examination evaluation and can provide information about the quality of tests.
Item analysis is a statistical analysis of the student’s responses on a test. Collection and summarization of students’ responses can provide quantitative objective information that is useful in deciding the quality of the test items and increasing the assessment’s efficiency [3, 4]. Also, Item analysis “investigates the performance of items considered individually either in relation to some external criterion or the remaining items on the test” [5].
Any educational test should measure students’ achievement in content material. Also, it leads to an overall assessment of students’ development to decide their academic status [6, 7].
The importance of item analysis is determined by the objective of the assessment [8]. In summative assessment, the assessment results should be reliable and valid because incorrect decisions about the academic status will lead to negative consequences [9]. While for the formative evaluation where the target is students learning, the item analysis has no much importance in giving feedback about items construction to test composers.
In literature, many reasons were reported for the conduction of item analysis, including examining if the item is functioning as intended, did it assess the required concepts (content)?, did it discriminate between those who master the content material and those who were not? was it within the acceptable level of difficulty?, whether the distracters are functioning or not? [10, 11].
Many factors can affect item analysis and hence its interpretation [8]. Difficulty and discrimination indices were constantly changing per administration and influenced by the ability and number of the examinee, the number of items, and the quality of instructions [8, 12].
Whatever the exam or test blueprinting (item selection) method, exam items remain a sample of the needed content material. The number of items (item sampling) carries excellent importance because one cannot ask about all contents. With a too-small number of items, the results may not be enough to reflect true student ability [8]. Technical item flaws are divided into two major types, test wiseness, and irrelevant difficulty. Test wiseness flaws can result in more easy items. Faults related to irrelevant difficulty can result in more challenging items unrelated to the content under assessment. It was reported that item analysis of exam with 200 examinees is stable, and with fewer than 100 examinees should be interpreted with caution (item difficulty or item discrimination index). While Downing and Yudkowsky described that even for a small number of the examinee (e.g., 30) still, the item analysis can provide a piece of a helpful information to improve item [13, 14].
The item or psychometric analysis parameters include difficulty index, reliability, discrimination index, distractor efficiency [2]. The descriptive statistics of the exam are important and can provide helpful generalized information [2]. The descriptive statistics include scores frequency, the mean, the mode, the median, and the standard deviation.
Cronbach’s alpha (KR20) is widely accepted and used estimate of test reliability (the internal consistency) and reported to be superior to the split-half estimate [15, 16]. Although validity and reliability are closely associated, the reliability of an assessment does not depend on its validity [16, 17]. Coefficient alpha is known to be equal to Kr-20 if the item has a single answer, such as in the case of type A MCQs or binary [18, 19, 20, 21].
Coefficient alpha reflects the degree to which item response scores correlate with total test scores [15]. It also describes the degree to which items in the exam measure the same concept or construct [22]. Therefore, it is connected to the inter-relatedness and dimensionality of the items within the exam [16, 20]. Cronbach’s alpha is affected by exam time, the number and inter-relation of the items (dimensionality) and easy or hard, poorly written or confusing items, Variations in examinee responses, curriculum content not reflected in the test, Testing conditions, and Errors in recording or scoring [22, 23, 24]. The value of alpha is decreased in the exam with fewer items and increased if items assessing the same concept (unidimensionality of the exam) [16]. Other factors were reported to impact alpha value, such as item difficulty, number of the examinee, and student performance in the exam time. It was argued that very high alpha values could indicate lengthy exams, parallel items, or a narrow coverage of the content material [22].
The alpha value of the exam can be increased by increasing the number of items with a high p-value (difficulty index). It was reported that items with moderate difficulty could maximize alpha value and while those with zero difficulties or 100 can minimize it [15]. In the same way, deletion of faulty items can increase alpha value. It should be considered that repetition of items in the same exam or using items assessing the same concept can increase alpha value.
The interpretation of reliability is the correlation of the test with itself. When the estimate of reliability increases, the portion of a test score related to the error will decrease. Wise interpretation of alpha needs an understanding of the interrelatedness of items and whether the items measure a single latent trait or construct. Exam or test with different content materials such as integrated courses, for example, in the musculoskeletal system course, although is dominated by anatomy it contains other subjects of basic medical and clinical sciences that have different contains. Therefore, interpretation of such a course exam needs deep looks beyond the alpha figure. It was reported that KR20 of 0.7 is acceptable to short test (less than 50 items) and KR20 of 0.8 for an extended test (more than 50 item-test) [25]. Moreover, it was documented that a multidimensional exam does not have a lower (Table 1) alpha value than a unidimensional one [30].
Author | Interpretation of Cronbach’s alpha (KR20) |
---|---|
Robinson, Shaver et al. [26] | ≥0.80 Exemplary |
0.70–0.79 Extensive | |
0.60–0.69 Moderate | |
<0.60 Minimal | |
Cicchetti [27] | <0.70 Unacceptable |
0.70–0.80 Fair | |
0.80–0.90 Good | |
< 0.90 Excellent | |
Axelson and Kreiter [28] | >0.90 is needed for very high stakes tests (e.g., licensure, certification exams) |
0.80–0.89 is acceptable for moderate stakes tests (e.g., end-of-year summative exams in medical school, end-of-course exams) | |
0.70–0.79 would be acceptable for lower stakes assessments (e.g., formative or summative classroom-type assessments created and administered by local faculty | |
<0.70 might be useful as one component of an overall composite score. | |
Obon and Rey [12] | >0.90 Excellent reliability |
0.80–0.90 Very good for a classroom test | |
0.70–0.80 good for a classroom test | |
0.60–0.70 Somewhat low (The test needs to be supplemented by other measure) | |
0.50–0.60 Suggests need for revision of test (unless it is quite short, ten or fewer Items). | |
0.50 < Questionable reliability. | |
Hassan and Hod [29] | > 0.7 is excellent |
0.6–0.7 is acceptable | |
−0.5-0.6 is poor | |
< 0.5 is unacceptable | |
< 0.30 is unreliable |
Reference values and interpretation of Cronbach’s alpha (KR20).
A low alpha value can be due to a smaller number of items, reduced interrelatedness between items, or heterogeneous constructs [22]. A high value of alpha can suggest exam reliability, and some items are non-functional as they are testing the same content but in a different guise or repeated ones [16, 22]. Also, a high value indicates items with high interrelatedness, indicating a limited coverage of the content materials [22].
Adding new items with an acceptable difficulty index, high discrimination power and distractor efficiency can increase the test reliability [22, 31, 32]. In addition, deletion of faulty items or those with low or very high p-value can improve Cronbach’s alpha. Items with poor correlation or are not related should be revised or discarded from the exam.
Commonly are formed of a stem with or without leading question and five or four alternatives (type A MCQs). Among item’s alternatives, only one is the key answer and others are called distractors [4]. Distractors should carry or convey a miss concept about the key answer and appear plausible. The distractors should appear similar to the key answer in terms of the used words, grammatical form, style, and length [19]. Distractor efficiency (DE) is the ability of incorrect answers to distract the students [12].
A functional distractor (FD) the distractor that is selected by 5% or more of the examinee [4, 33]. At the same time, those chosen by less than 5% of the examinee are considered non-functional (NFD) [4]. In comparison, other authors reported 1% of the examinee as the demarcation of functional distractors [34, 35]. Commonly items are categorized based on the numbers of NFDs in the item (Table 2) [12, 26, 36, 37].
Number of NFD | Percentage | Interpritation |
---|---|---|
3 | 0 | Poor |
2 | 33.3 | Moderate |
1 | 66.6 | Good |
0 | 100 | Excellent |
Classification of items according to thee number of the nonfunctional distractors (NFD).
The occurrence of NFD makes the item easier and reduces its discrimination power, while FD distractors are making it more difficult [36, 38]. It was reported that non-functional distractors are negatively correlating with reliability [38]. The presence of non-functional distractors can be related to two main causes. First is the training and construction ability of the item writer or composer. Second, the miss-match between the target content and the possible number of a distractor created. Thus, training and more effort in item writing and construction can decrease NFDs [36]. Other causes were related to NFDs, including the low cognitive level of the item, irrelevant or limited number of plausible distractors, or presence of logic cues [39]. Another possibility of NFDs is mastering the content material of the item, and students can identify the distractor as the wrong one. If no other cause (s) for NFDs, they should be removed or changed with a more plausible option because it has no contribution to the measurement of the test [12]. If a distractor is selected more frequently than the key answer by a higher-scoring examinee, this may indicate poor constructions or a misleading question or miss or double-keyed [12, 40]. In this, concerning the use of three options is more practical than four, does not affect reliability, and does not affect the discrimination index significantly [26, 35, 36, 37].
Furthermore, it was reported that there is no psychometric reason that all items in the exam should have the same number of distractors [26, 41]. The required number of options in an item should be considered according to the content material from which plausible distractors can be developed [33, 40, 42].
Reducing the number of options/distractors will result in other important benefits such as reducing the answering time of the test and safe time can be used to cover more content material, reduce the burden on item composers, and have items with more acceptable parameters [43, 44].
Puthiaparampil et al. reported a non-high significant negative and positive correlation between the number of functional distractors and difficulty and discrimination indices, respectively [34]. While a significant positive correlation was reported between the DIF and the number of NFDs [45].
Many authors concluded that no predictable relationship between DE and difficulty index and discrimination index [26, 31, 40, 46, 47]. In addition Licona-Chávez et al. did not find a parallel performance between DE and other parameters of item analysis including Cronbach alpha [46]. In contrast, some authors claimed that low DE decreases the difficulty index [47, 48].
Restoring the optimal DE of the item can be achieved by identifying flaws related to the NFDs and correcting them or removing the NFDs from the item [39].
The item difficulty (easiness, facility index, P-value) is the percentage of students who answered an item correctly [6, 40]. The difficulty index ranges from 0 to 100, whereas the higher the values indicate, the easier the question and the low value represents the difficulty of hard items. The ideal (optimal) difficulty levels for type A MCQs is varying according to the number of the options (Table 3) [49, 50]. The range of items difficulty can be categorized into difficult, moderate, and easy. Easy and difficult items were reported to have very little discrimination power [48]. Item difficulty is related to the item and the examinee that took the test in the given time [24]. Thus, reusing of the item depending on its difficulty index should be controlled. Some authors found that difficulty indices of items assessing high cognitive levels in Bloom’s taxonomy such as evaluation, explanation, analysis, and synthesis are lower than those assessing remembering, understanding, and applying [51, 52].
The ideal (optimal) difficulty level (for tests with 100 items).
During item or exam construction, the constructor should aim for acceptably level of difficulty [6]. Sugianto reported that items within the exam could be distributed according to difficulty to moderate level (40%), easy and challenging levels (20%), and easier and more challenging levels (10%) [6]. Other authors reported that most items should be of moderate difficulty or 5% should be in the difficult range [50, 53]. Some authors found that difficulty indices of items assessing high cognitive levels in Bloom’s taxonomy such as evaluation, explanation, analysis, and synthesis are lower than those assessing remembering, understanding, and applying [51, 52]. Regarding the general arrangement of test or examination, easy items start first then are followed by difficult ones. At the same time, in the case of diagnostic assessment, the sequence of the learning material is more important [6, 7].
Easy and difficult items affect the item’s ability to discriminate between students and show low discrimination power. Some reports described a negative correlation between exam reliability and difficult and easy items [38]. Oermann et al. reported that educationalists must be careful in deleting items with poor DIF because the number of items has more effect on test validity [54]. It is recommended that difficult items should be reviewed for the possible technical and content causes [50]. Possible causes of low difficulty index include uncovered (taught) content material, challenging items, missed key or no correct answer among the item options [55]. Easy items (high
In literature including medical education, many ranges of difficulty indices were reported (Table 4).
Author | Difficulty index | Interpretation |
---|---|---|
Uddin et al. [50] | >80% | Easy |
30–80% | Moderate | |
<30% | Difficult | |
Kaur, Singla et al. [56] | >80 | Easy |
40–80 | Moderate | |
<39 | Difficult | |
Sugianto [6] | 90 | Easy |
50 | Moderate | |
10 | Difficult | |
Date, Borkar et al. [37] and Kumar, Jaipurkar et al. [36] | <30 | Too difficult |
>70% | Too easy | |
50–60% | Excellent/ideal | |
30–70% | Good/acceptable/average | |
Obon and Rey [12] | > 0.76 | Easy (Revise or Discard) |
0.26–0.75 | Right difficult (Retain) | |
0–0.25 | Difficult (Revise or Discard) | |
Bhat and Prasad [57] | >70% | Easy |
30–70% | Good | |
<30% | Difficult |
Reference values and interpretation of difficulty index (p-value).
Item discrimination (DI) is the ability of an item to discriminate between higher achiever (good) students and low ones. It was defined as “stated that item discrimination is a statistic that indicates the degree to which an item separates the students who performed well from those who did poorly on the test as a whole” [6]. The discrimination power of an item is calculated by categorizing the examinee into upper 27% and lower 27% according to their total test score. The difference between the upper and lower group is divided by the number of the examinee in the upper group or the larger group or by half of the total number of the examinee or even by the total number [4, 6, 58, 59]. Obon and Rey [12] calculated the discrimination index as the difference of difficulty index between the upper and lower groups [12]. In literature, both 25 and 27% were reported as possible percentages of examinee categorization [60, 61]. The 27% is commonly used to maximize differences in normal distributions and increase the number of examinees in each category. The discrimination index range from 1.0 to −1.0. The positive discrimination index indicates that high achievers answer the item correctly more than those in the lower ones, which is desirable. The negative discrimination index reflects that lower achiever examinees answer the item more correctly, while zero discrimination indicates equal numbers of students in the upper and lower groups [36, 37]. Negative discrimination is thought to be due to item flaws or inefficient distractors, miss keys, ambiguous wording, gray areas of opinion, and areas of controversy [12, 62]. Nevid and McClelland [52] reported that items assessing evaluation and explanation domains could discriminate between high and low performers, while Kim et al. [51] comments that items assessing remembering and understanding levels have low discrimination power [52, 54].
It was reported that discrimination indices are positively associated with difficulty index and distractor efficiency [39, 63]. The discrimination power of the item is reduced by the increased number of non-functional distractors [36].
A test with poor discriminating power will not provide a reliable interpretation of the examinee’s actual ability [6, 64]. In addition, discrimination power will not indicate item validity, and deletion of items with poor discrimination power negatively impacts validity due to a decrease in the item number [65].
Discrimination coefficients can evaluate item discrimination. The discrimination coefficients include point biserial correlation, biserial correlation, and phi coefficient. Although point biserial correlation is used interchangeably with the discrimination index, discrimination coefficients are considered superior to the discrimination index [24]. The superiority came from the fact that discrimination coefficients are calculated using all examinees’ responses in the item rather than only 54% of the examinees such as in the discrimination index.
The difference between Point-biserial correlation (rBP) and discrimination indexes is that rBP is the correlation between an item in the exam and the overall student score [2, 66]. In cases of highly discriminating items, the examinees who responded to the item correctly also did well on the test. In general, the examinees who responded to the item incorrectly also tended to perform poorly on the overall test. It was suggested that point biserial can express the predictive validity better than Biserial correlation coefficients [61, 67].
Discrimination power of items more than 0.15 was reported as evidence of item validity [50, 53]. While any item with less than 0.15 or negative should be reviewed [50] (Table 5).
Author | Discrimination power | Interpretation |
---|---|---|
Elfaki, Bahamdan et al. [53] | ≥0.35 | Excellent |
0.25–0.34 | Good | |
0.21–0.24 | Acceptable | |
≤ 0.20 | Poor | |
Obon and Rey [12] | ≥ 0.50 | Very Good Item (Definitely Retain) |
0.40–0.49 | Good Item (Very Usable) | |
0.30–0.39 | Fair Quality (Usable Item) | |
0.20–0.29 | Potentially Poor Item (Consider Revising) | |
≤ 0.20 | Potentially Very Poor (Possibly Revise Substantially or Discard) | |
Bhat and Prasad [57] | > 0.35 | Excellent |
0.2–0.35 | Good | |
< 0.2 | Poor | |
Sugianto [6] | >0.40 | Very good |
0.30–0.39 | Reasonably good possibly need to improvement | |
0.20–0.29 | Marginal item usually needing and being to improvement | |
<0.19 | Poor item rejected or improved by revision | |
Aljehani, Pullishery et al. [66] and Sharma [4] | ≥ 0.40 | Very discriminating, very good item(Keep) |
0.30–0.39 | Discriminating item, good item (Keep) | |
0.20–0.29 | Moderately discriminating, fair item (Keep) | |
< 0.20 | Not discriminating item, marginal item (Revise/Discard) | |
Negative | Worst/ defective item (Definitely Discard) | |
Ramzan, Imran et al. [63] | > 0.30 | Excellent discrimination |
0.20–0.29 | Good discrimination | |
0–0.19 | Poor discrimination | |
00 | Defective | |
Uddin et al. [50] | ≥ 0.35 | Excellent |
0.25–0.34 | Good | |
0.21–0.24 | Acceptable | |
< 0.20 | Poor |
Reference values and interpretation of discrimination index (power).
When interpreting the discrimination power of an item to decide about, especial consideration should be related to its difficulty. Items with a high difficulty index (most of the examinee answer it right) and those with low difficulty index (most of the examinee answer it wrong) commonly have low discrimination power [35, 63]. In both cases, such items will not discriminate examines as the majority are on one side. Thus items with a moderate difficulty index are more likely to have good discrimination power.
The common causes of poor discrimination power of item include technical or writing flaws, untaught or not well covered content material, ambiguous wording, gray areas of opinion and controversy, and wrong keys [12, 50, 62, 66].
In general, the statistical data obtained from item analysis can help item constructors and exam composers to detect defective items. The decision to revise an item or distractors must be based on the difficulty index, discrimination index, and distractor efficiency. Revision of items can lead to modification in the teaching method or the content material [68].
Standard item analysis of mid-course examination. The total number of items is 40, and the total number of the examinee is 21. The KR20 is 0.82. Pt.Biserial: Point biserial correlation, Disc Index: discrimination index, Correct: number and percentage of the correct answer (difficulty index), Pct. Incorrect: percentage of an incorrect answer.
In this Example 1.
The number of examinees was 21.
The number of test items (Total possible) is 40.
The highest and lowest scores were 38 and 14 respectively.
The class average (mean) (30.3) is more than the class median (30) which represents a positively skewed distribution of examinee scores. Despite this, examinee scores may show normal ball-shape distribution. If the median is larger than the average (mean), the examinee scores will be negatively skewed distribution. Average equals median, the examinees’ scores are symmetrically (zero skewed) and normally distributed with ball-shaped.
The KR20 (Cronbach’s alpha) is 0.82 which is an acceptable value for most of the authors. Such value of internal consistency of exam allows deciding pass/fail. Lower values put the exam in questionable status.
Item 1: the difficulty index is 85.7% (easy). Although it has high discrimination power (DE = 0.6, Pbiserial = 0.58), two distractors are non-functional (B, C).
Comment: the item needs reediting. Distractors B and C need to be revised or changed by more plausible ones before being re-used.
Item 2: the difficulty index is 100% (easy). It has low discrimination power (DE = 00, Pbiserial = 00), all distractors are non-functional.
Comment: the item needs major revision or rewriting. This item is absolutely easy with no difficulty or discrimination index. Such items should be removed from the question bank and removal from the exam is considered valid.
Item 6: the difficulty index is 66.7% (moderate). It has high discrimination power (DE = 0.6, Pbiserial = 0.43) and all the distractors are functional.
Comment: The item has acceptable indices. Such items can be saved in the question bank for further use. The distractors need to be updated to have more efficiency.
Item 7: the difficulty index is 28.6% (difficult). Although it has high discrimination power (DE = 0.67, Pbiserial = 0.39), all the distractors are functional.
Comment: The item has acceptable indices. Such items can be saved in the question bank for further use. The distractors need to be updated to have more efficiency.
Item 8: the difficulty index is 76.2% (moderate). This item has a negative discrimination index (−0.33) and poor Pbiserial (0.04). Only one distractor is functional (C). The negative discrimination index is caused by the increased number of students in the lower account (27%) than those in the upper account (27%).
Comment: although the item has a moderate difficulty index, but is poorly discriminating. Such an item needs major revision.
Standard item analysis of Mid-course examination. The total number of items is 40, and the total number of examinee is 25. The KR20 is 0.74. Pt.Biserial: Point biserial correlation, Disc Index: discrimination index, Correct: number and percentage of the correct answer (difficulty index), Pct. Incorrect: percentage of an incorrect answer.
In this Example 2.
The number of examinees was 25.
The number of test items is 40.
The highest and lowest scores were 33 and 13 respectively.
The class average (mean) (24.6) is more than the class median (25), distribution of examinee scores is skewed to the left. Despite this, examinee scores may show normal ball shape distribution.
The KR20 (Cronbach’s alpha) is 0.74 which is an acceptable value for most of the authors. Such a value of internal consistency is suitable for class tests.
Item 8: the difficulty index is 4.0% (difficult). It has negative discrimination power (DE = -0.17, Pbiserial = −0.06), one distractors is non-functional (C).
Comment: the correct answer is (A) while most of the examinees chose (B). According to distractor analysis, this item is miss-keyed rather than an implausible distractor.
Item 9: the difficulty index is 20% (difficult). It has low discrimination power (DE = 0.17, Pbiserial = 0.09), all distractors are functional.
Comment: distractor analysis show option number (A) and (B) are more selected by examinees. This can be due to implausible. The presence of implausible can affect the item difficulty index. Distractors in this item should be revised or changed with plausible ones.
Item 11: the difficulty index is 44.0% (moderate). It has low discrimination power (DE = 0.0, Pbiserial = 0.01) and only one the distractors is non-functional.
Comment: The item has an acceptable difficulty index. Distractor (D) is more selected by upper examinee such as the key answer. Such a situation can favor missed key or implausible distractors. The distractors need to be updated to have more efficiency.
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Luna-Muñoz and M.A.\nMeraz-Ríos",authors:[{id:"42225",title:"Dr.",name:"Jose",middleName:null,surname:"Luna-Muñoz",slug:"jose-luna-munoz",fullName:"Jose Luna-Muñoz"},{id:"114746",title:"Dr.",name:"Marco",middleName:null,surname:"Meraz-Ríos",slug:"marco-meraz-rios",fullName:"Marco Meraz-Ríos"},{id:"169616",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Cardenas-Aguayo",slug:"maria-del-carmen-cardenas-aguayo",fullName:"Maria del Carmen Cardenas-Aguayo"},{id:"169857",title:"Dr.",name:"Maria del Carmen",middleName:null,surname:"Silva-Lucero",slug:"maria-del-carmen-silva-lucero",fullName:"Maria del Carmen Silva-Lucero"},{id:"169858",title:"Dr.",name:"Maribel",middleName:null,surname:"Cortes-Ortiz",slug:"maribel-cortes-ortiz",fullName:"Maribel Cortes-Ortiz"},{id:"169859",title:"Dr.",name:"Berenice",middleName:null,surname:"Jimenez-Ramos",slug:"berenice-jimenez-ramos",fullName:"Berenice Jimenez-Ramos"},{id:"169860",title:"Dr.",name:"Laura",middleName:null,surname:"Gomez-Virgilio",slug:"laura-gomez-virgilio",fullName:"Laura Gomez-Virgilio"},{id:"169861",title:"Dr.",name:"Gerardo",middleName:null,surname:"Ramirez-Rodriguez",slug:"gerardo-ramirez-rodriguez",fullName:"Gerardo Ramirez-Rodriguez"},{id:"169862",title:"Dr.",name:"Eduardo",middleName:null,surname:"Vera-Arroyo",slug:"eduardo-vera-arroyo",fullName:"Eduardo Vera-Arroyo"},{id:"169863",title:"Dr.",name:"Rosana Sofia",middleName:null,surname:"Fiorentino-Perez",slug:"rosana-sofia-fiorentino-perez",fullName:"Rosana Sofia Fiorentino-Perez"},{id:"169864",title:"Dr.",name:"Ubaldo",middleName:null,surname:"Garcia",slug:"ubaldo-garcia",fullName:"Ubaldo Garcia"}]},{id:"58070",doi:"10.5772/intechopen.72427",title:"MRI Medical Image Denoising by Fundamental Filters",slug:"mri-medical-image-denoising-by-fundamental-filters",totalDownloads:2564,totalCrossrefCites:17,totalDimensionsCites:30,abstract:"Nowadays Medical imaging technique Magnetic Resonance Imaging (MRI) plays an important role in medical setting to form high standard images contained in the human brain. MRI is commonly used once treating brain, prostate cancers, ankle and foot. The Magnetic Resonance Imaging (MRI) images are usually liable to suffer from noises such as Gaussian noise, salt and pepper noise and speckle noise. So getting of brain image with accuracy is very extremely task. An accurate brain image is very necessary for further diagnosis process. During this chapter, a median filter algorithm will be modified. Gaussian noise and Salt and pepper noise will be added to MRI image. A proposed Median filter (MF), Adaptive Median filter (AMF) and Adaptive Wiener filter (AWF) will be implemented. The filters will be used to remove the additive noises present in the MRI images. The noise density will be added gradually to MRI image to compare performance of the filters evaluation. The performance of these filters will be compared exploitation the applied mathematics parameter Peak Signal-to-Noise Ratio (PSNR).",book:{id:"6144",slug:"high-resolution-neuroimaging-basic-physical-principles-and-clinical-applications",title:"High-Resolution Neuroimaging",fullTitle:"High-Resolution Neuroimaging - Basic Physical Principles and Clinical Applications"},signatures:"Hanafy M. Ali",authors:[{id:"213318",title:"Dr.",name:"Hanafy",middleName:"M.",surname:"Ali",slug:"hanafy-ali",fullName:"Hanafy Ali"}]},{id:"41589",doi:"10.5772/50323",title:"The Role of the Amygdala in Anxiety Disorders",slug:"the-role-of-the-amygdala-in-anxiety-disorders",totalDownloads:9671,totalCrossrefCites:4,totalDimensionsCites:28,abstract:null,book:{id:"2599",slug:"the-amygdala-a-discrete-multitasking-manager",title:"The Amygdala",fullTitle:"The Amygdala - A Discrete Multitasking Manager"},signatures:"Gina L. Forster, Andrew M. Novick, Jamie L. Scholl and Michael J. Watt",authors:[{id:"145620",title:"Dr.",name:"Gina",middleName:null,surname:"Forster",slug:"gina-forster",fullName:"Gina Forster"},{id:"146553",title:"BSc.",name:"Andrew",middleName:null,surname:"Novick",slug:"andrew-novick",fullName:"Andrew Novick"},{id:"146554",title:"MSc.",name:"Jamie",middleName:null,surname:"Scholl",slug:"jamie-scholl",fullName:"Jamie Scholl"},{id:"146555",title:"Dr.",name:"Michael",middleName:null,surname:"Watt",slug:"michael-watt",fullName:"Michael Watt"}]},{id:"26258",doi:"10.5772/28300",title:"Excitotoxicity and Oxidative Stress in Acute Ischemic Stroke",slug:"excitotoxicity-and-oxidative-stress-in-acute-ischemic-stroke",totalDownloads:7157,totalCrossrefCites:6,totalDimensionsCites:25,abstract:null,book:{id:"931",slug:"acute-ischemic-stroke",title:"Acute Ischemic Stroke",fullTitle:"Acute Ischemic Stroke"},signatures:"Ramón Rama Bretón and Julio César García Rodríguez",authors:[{id:"73430",title:"Prof.",name:"Ramon",middleName:null,surname:"Rama",slug:"ramon-rama",fullName:"Ramon Rama"},{id:"124643",title:"Prof.",name:"Julio Cesar",middleName:null,surname:"García",slug:"julio-cesar-garcia",fullName:"Julio Cesar García"}]},{id:"62072",doi:"10.5772/intechopen.78695",title:"Brain-Computer Interface and Motor Imagery Training: The Role of Visual Feedback and Embodiment",slug:"brain-computer-interface-and-motor-imagery-training-the-role-of-visual-feedback-and-embodiment",totalDownloads:1439,totalCrossrefCites:13,totalDimensionsCites:23,abstract:"Controlling a brain-computer interface (BCI) is a difficult task that requires extensive training. Particularly in the case of motor imagery BCIs, users may need several training sessions before they learn how to generate desired brain activity and reach an acceptable performance. A typical training protocol for such BCIs includes execution of a motor imagery task by the user, followed by presentation of an extending bar or a moving object on a computer screen. In this chapter, we discuss the importance of a visual feedback that resembles human actions, the effect of human factors such as confidence and motivation, and the role of embodiment in the learning process of a motor imagery task. Our results from a series of experiments in which users BCI-operated a humanlike android robot confirm that realistic visual feedback can induce a sense of embodiment, which promotes a significant learning of the motor imagery task in a short amount of time. We review the impact of humanlike visual feedback in optimized modulation of brain activity by the BCI users.",book:{id:"6610",slug:"evolving-bci-therapy-engaging-brain-state-dynamics",title:"Evolving BCI Therapy",fullTitle:"Evolving BCI Therapy - Engaging Brain State Dynamics"},signatures:"Maryam Alimardani, Shuichi Nishio and Hiroshi Ishiguro",authors:[{id:"11981",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Ishiguro",slug:"hiroshi-ishiguro",fullName:"Hiroshi Ishiguro"},{id:"231131",title:"Dr.",name:"Maryam",middleName:null,surname:"Alimardani",slug:"maryam-alimardani",fullName:"Maryam Alimardani"},{id:"231134",title:"Dr.",name:"Shuichi",middleName:null,surname:"Nishio",slug:"shuichi-nishio",fullName:"Shuichi Nishio"}]}],mostDownloadedChaptersLast30Days:[{id:"29764",title:"Underlying Causes of Paresthesia",slug:"underlying-causes-of-paresthesia",totalDownloads:192666,totalCrossrefCites:3,totalDimensionsCites:7,abstract:null,book:{id:"1069",slug:"paresthesia",title:"Paresthesia",fullTitle:"Paresthesia"},signatures:"Mahdi Sharif-Alhoseini, Vafa Rahimi-Movaghar and Alexander R. Vaccaro",authors:[{id:"91165",title:"Prof.",name:"Vafa",middleName:null,surname:"Rahimi-Movaghar",slug:"vafa-rahimi-movaghar",fullName:"Vafa Rahimi-Movaghar"}]},{id:"63258",title:"Anatomy and Function of the Hypothalamus",slug:"anatomy-and-function-of-the-hypothalamus",totalDownloads:4558,totalCrossrefCites:6,totalDimensionsCites:12,abstract:"The hypothalamus is a small but important area of the brain formed by various nucleus and nervous fibers. Through its neuronal connections, it is involved in many complex functions of the organism such as vegetative system control, homeostasis of the organism, thermoregulation, and also in adjusting the emotional behavior. The hypothalamus is involved in different daily activities like eating or drinking, in the control of the body’s temperature and energy maintenance, and in the process of memorizing. It also modulates the endocrine system through its connections with the pituitary gland. Precise anatomical description along with a correct characterization of the component structures is essential for understanding its functions.",book:{id:"6331",slug:"hypothalamus-in-health-and-diseases",title:"Hypothalamus in Health and Diseases",fullTitle:"Hypothalamus in Health and Diseases"},signatures:"Miana Gabriela Pop, Carmen Crivii and Iulian Opincariu",authors:null},{id:"57103",title:"GABA and Glutamate: Their Transmitter Role in the CNS and Pancreatic Islets",slug:"gaba-and-glutamate-their-transmitter-role-in-the-cns-and-pancreatic-islets",totalDownloads:3478,totalCrossrefCites:3,totalDimensionsCites:9,abstract:"Glutamate and gamma-aminobutyric acid (GABA) are the major neurotransmitters in the mammalian brain. Inhibitory GABA and excitatory glutamate work together to control many processes, including the brain’s overall level of excitation. The contributions of GABA and glutamate in extra-neuronal signaling are by far less widely recognized. In this chapter, we first discuss the role of both neurotransmitters during development, emphasizing the importance of the shift from excitatory to inhibitory GABAergic neurotransmission. The second part summarizes the biosynthesis and role of GABA and glutamate in neurotransmission in the mature brain, and major neurological disorders associated with glutamate and GABA receptors and GABA release mechanisms. The final part focuses on extra-neuronal glutamatergic and GABAergic signaling in pancreatic islets of Langerhans, and possible associations with type 1 diabetes mellitus.",book:{id:"6237",slug:"gaba-and-glutamate-new-developments-in-neurotransmission-research",title:"GABA And Glutamate",fullTitle:"GABA And Glutamate - New Developments In Neurotransmission Research"},signatures:"Christiane S. Hampe, Hiroshi Mitoma and Mario Manto",authors:[{id:"210220",title:"Prof.",name:"Christiane",middleName:null,surname:"Hampe",slug:"christiane-hampe",fullName:"Christiane Hampe"},{id:"210485",title:"Prof.",name:"Mario",middleName:null,surname:"Manto",slug:"mario-manto",fullName:"Mario Manto"},{id:"210486",title:"Prof.",name:"Hiroshi",middleName:null,surname:"Mitoma",slug:"hiroshi-mitoma",fullName:"Hiroshi Mitoma"}]},{id:"35802",title:"Cross-Cultural/Linguistic Differences in the Prevalence of Developmental Dyslexia and the Hypothesis of Granularity and Transparency",slug:"cross-cultural-linguistic-differences-in-the-prevalence-of-developmental-dyslexia-and-the-hypothesis",totalDownloads:3601,totalCrossrefCites:2,totalDimensionsCites:7,abstract:null,book:{id:"673",slug:"dyslexia-a-comprehensive-and-international-approach",title:"Dyslexia",fullTitle:"Dyslexia - A Comprehensive and International Approach"},signatures:"Taeko N. Wydell",authors:[{id:"87489",title:"Prof.",name:"Taeko",middleName:"N.",surname:"Wydell",slug:"taeko-wydell",fullName:"Taeko Wydell"}]},{id:"58597",title:"Testosterone and Erectile Function: A Review of Evidence from Basic Research",slug:"testosterone-and-erectile-function-a-review-of-evidence-from-basic-research",totalDownloads:1331,totalCrossrefCites:2,totalDimensionsCites:2,abstract:"Androgens are essential for male physical activity and normal erectile function. Hence, age-related testosterone deficiency, known as late-onset hypogonadism (LOH), is considered a risk factor for erectile dysfunction (ED). This chapter summarizes relevant basic research reports examining the effects of testosterone on erectile function. Testosterone affects several organs and is especially active on the erectile tissue. The mechanism of testosterone deficiency effects on erectile function and the results of testosterone replacement therapy (TRT) have been well studied. Testosterone affects nitric oxide (NO) production and phosphodiesterase type 5 (PDE-5) expression in the corpus cavernosum through molecular pathways, preserves smooth muscle contractility by regulating both contraction and relaxation, and maintains the structure of the corpus cavernosum. Interestingly, testosterone deficiency has relationship to neurological diseases, which leads to ED. Testosterone replacement therapy is widely used to treat patients with testosterone deficiency; however, this treatment might also induce some problems. Basic research suggests that PDE-5 inhibitors, L-citrulline, and/or resveratrol therapy might be effective therapeutic options for testosterone deficiency-induced ED. Future research should confirm these findings through more specific experiments using molecular tools and may shed more light on endocrine-related ED and its possible treatments.",book:{id:"5994",slug:"sex-hormones-in-neurodegenerative-processes-and-diseases",title:"Sex Hormones in Neurodegenerative Processes and Diseases",fullTitle:"Sex Hormones in Neurodegenerative Processes and Diseases"},signatures:"Tomoya Kataoka and Kazunori Kimura",authors:[{id:"219042",title:"Ph.D.",name:"Tomoya",middleName:null,surname:"Kataoka",slug:"tomoya-kataoka",fullName:"Tomoya Kataoka"},{id:"229066",title:"Prof.",name:"Kazunori",middleName:null,surname:"Kimura",slug:"kazunori-kimura",fullName:"Kazunori Kimura"}]}],onlineFirstChaptersFilter:{topicId:"18",limit:6,offset:0},onlineFirstChaptersCollection:[{id:"81646",title:"Cortical Plasticity under Ketamine: From Synapse to Map",slug:"cortical-plasticity-under-ketamine-from-synapse-to-map",totalDownloads:14,totalDimensionsCites:0,doi:"10.5772/intechopen.104787",abstract:"Sensory systems need to process signals in a highly dynamic way to efficiently respond to variations in the animal’s environment. For instance, several studies showed that the visual system is subject to neuroplasticity since the neurons’ firing changes according to stimulus properties. This dynamic information processing might be supported by a network reorganization. Since antidepressants influence neurotransmission, they can be used to explore synaptic plasticity sustaining cortical map reorganization. To this goal, we investigated in the primary visual cortex (V1 of mouse and cat), the impact of ketamine on neuroplasticity through changes in neuronal orientation selectivity and the functional connectivity between V1 cells, using cross correlation analyses. We found that ketamine affects cortical orientation selectivity and alters the functional connectivity within an assembly. These data clearly highlight the role of the antidepressant drugs in inducing or modeling short-term plasticity in V1 which suggests that cortical processing is optimized and adapted to the properties of the stimulus.",book:{id:"11374",title:"Sensory Nervous System - Computational Neuroimaging Investigations of Topographical Organization in Human Sensory Cortex",coverURL:"https://cdn.intechopen.com/books/images_new/11374.jpg"},signatures:"Ouelhazi Afef, Rudy Lussiez and Molotchnikoff Stephane"},{id:"81582",title:"The Role of Cognitive Reserve in Executive Functioning and Its Relationship to Cognitive Decline and Dementia",slug:"the-role-of-cognitive-reserve-in-executive-functioning-and-its-relationship-to-cognitive-decline-and",totalDownloads:22,totalDimensionsCites:0,doi:"10.5772/intechopen.104646",abstract:"In this chapter, we explore how cognitive reserve is implicated in coping with the negative consequences of brain pathology and age-related cognitive decline. Individual differences in cognitive performance are based on different brain mechanisms (neural reserve and neural compensation), and reflect, among others, the effect of education, occupational attainment, leisure activities, and social involvement. These cognitive reserve proxies have been extensively associated with efficient executive functioning. We discuss and focus particularly on the compensation mechanisms related to the frontal lobe and its protective role, in maintaining cognitive performance in old age or even mitigating the clinical expression of dementia.",book:{id:"11742",title:"Neurophysiology",coverURL:"https://cdn.intechopen.com/books/images_new/11742.jpg"},signatures:"Gabriela Álvares-Pereira, Carolina Maruta and Maria Vânia Silva-Nunes"},{id:"81488",title:"Aggression and Sexual Behavior: Overlapping or Distinct Roles of 5-HT1A and 5-HT1B Receptors",slug:"aggression-and-sexual-behavior-overlapping-or-distinct-roles-of-5-ht1a-and-5-ht1b-receptors",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.104872",abstract:"Distinct brain mechanisms for male aggressive and sexual behavior are present in mammalian species, including man. However, recent evidence suggests a strong connection and even overlap in the central nervous system (CNS) circuitry involved in aggressive and sexual behavior. The serotonergic system in the CNS is strongly involved in male aggressive and sexual behavior. In particular, 5-HT1A and 5-HT1B receptors seem to play a critical role in the modulation of these behaviors. The present chapter focuses on the effects of 5-HT1A- and 5-HT1B-receptor ligands in male rodent aggression and sexual behavior. Results indicate that 5-HT1B-heteroreceptors play a critical role in the modulation of male offensive behavior, although a definite role of 5-HT1A-auto- or heteroreceptors cannot be ruled out. 5-HT1A receptors are clearly involved in male sexual behavior, although it has to be yet unraveled whether 5-HT1A-auto- or heteroreceptors are important. Although several key nodes in the complex circuitry of aggression and sexual behavior are known, in particular in the medial hypothalamus, a clear link or connection to these critical structures and the serotonergic key receptors is yet to be determined. This information is urgently needed to detect and develop new selective anti-aggressive (serenic) and pro-sexual drugs for human applications.",book:{id:"10195",title:"Serotonin and the CNS - New Developments in Pharmacology and Therapeutics",coverURL:"https://cdn.intechopen.com/books/images_new/10195.jpg"},signatures:"Berend Olivier and Jocelien D.A. Olivier"},{id:"81093",title:"Prehospital and Emergency Room Airway Management in Traumatic Brain Injury",slug:"prehospital-and-emergency-room-airway-management-in-traumatic-brain-injury",totalDownloads:49,totalDimensionsCites:0,doi:"10.5772/intechopen.104173",abstract:"Airway management in trauma is critical and may impact patient outcomes. Particularly in traumatic brain injury (TBI), depressed level of consciousness may be associated with compromised protective airway reflexes or apnea, which can increase the risk of aspiration or result in hypoxemia and worsen the secondary brain damage. Therefore, patients with TBI and Glasgow Coma Scale (GCS) ≤ 8 have been traditionally managed by prehospital or emergency room (ER) endotracheal intubation. However, recent evidence challenged this practice and even suggested that routine intubation may be harmful. This chapter will address the indications and optimal method of securing the airway, prehospital and in the ER, in patients with traumatic brain injury.",book:{id:"11367",title:"Traumatic Brain Injury",coverURL:"https://cdn.intechopen.com/books/images_new/11367.jpg"},signatures:"Dominik A. Jakob, Jean-Cyrille Pitteloud and Demetrios Demetriades"},{id:"81011",title:"Amino Acids as Neurotransmitters. The Balance between Excitation and Inhibition as a Background for Future Clinical Applications",slug:"amino-acids-as-neurotransmitters-the-balance-between-excitation-and-inhibition-as-a-background-for-f",totalDownloads:19,totalDimensionsCites:0,doi:"10.5772/intechopen.103760",abstract:"For more than 30 years, amino acids have been well-known (and essential) participants in neurotransmission. They act as both neuromediators and metabolites in nervous tissue. Glycine and glutamic acid (glutamate) are prominent examples. These amino acids are agonists of inhibitory and excitatory membrane receptors, respectively. Moreover, they play essential roles in metabolic pathways and energy transformation in neurons and astrocytes. Despite their obvious effects on the brain, their potential role in therapeutic methods remains uncertain in clinical practice. In the current chapter, a comparison of the crosstalk between these two systems, which are responsible for excitation and inhibition in neurons, is presented. The interactions are discussed at the metabolic, receptor, and transport levels. Reaction-diffusion and a convectional flow into the interstitial fluid create a balanced distribution of glycine and glutamate. Indeed, the neurons’ final physiological state is a result of a balance between the excitatory and inhibitory influences. However, changes to the glycine and/or glutamate pools under pathological conditions can alter the state of nervous tissue. Thus, new therapies for various diseases may be developed on the basis of amino acid medication.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Yaroslav R. Nartsissov"},{id:"80821",title:"Neuroimmunology and Neurological Manifestations of COVID-19",slug:"neuroimmunology-and-neurological-manifestations-of-covid-19",totalDownloads:41,totalDimensionsCites:0,doi:"10.5772/intechopen.103026",abstract:"Infection with SARS-CoV-2 is causing coronavirus disease in 2019 (COVID-19). Besides respiratory symptoms due to an attack on the broncho-alveolar system, COVID-19, among others, can be accompanied by neurological symptoms because of the affection of the nervous system. These can be caused by intrusion by SARS-CoV-2 of the central nervous system (CNS) and peripheral nervous system (PNS) and direct infection of local cells. In addition, neurological deterioration mediated by molecular mimicry to virus antigens or bystander activation in the context of immunological anti-virus defense can lead to tissue damage in the CNS and PNS. In addition, cytokine storm caused by SARS-CoV-2 infection in COVID-19 can lead to nervous system related symptoms. Endotheliitis of CNS vessels can lead to vessel occlusion and stroke. COVID-19 can also result in cerebral hemorrhage and sinus thrombosis possibly related to changes in clotting behavior. Vaccination is most important to prevent COVID-19 in the nervous system. There are symptomatic or/and curative therapeutic approaches to combat COVID-19 related nervous system damage that are partly still under study.",book:{id:"10890",title:"Recent Advances in Neurochemistry",coverURL:"https://cdn.intechopen.com/books/images_new/10890.jpg"},signatures:"Robert Weissert"}],onlineFirstChaptersTotal:17},preDownload:{success:null,errors:{}},subscriptionForm:{success:null,errors:{}},aboutIntechopen:{},privacyPolicy:{},peerReviewing:{},howOpenAccessPublishingWithIntechopenWorks:{},sponsorshipBooks:{sponsorshipBooks:[],offset:0,limit:8,total:null},allSeries:{pteSeriesList:[{id:"14",title:"Artificial Intelligence",numberOfPublishedBooks:9,numberOfPublishedChapters:87,numberOfOpenTopics:6,numberOfUpcomingTopics:0,issn:"2633-1403",doi:"10.5772/intechopen.79920",isOpenForSubmission:!0},{id:"7",title:"Biomedical Engineering",numberOfPublishedBooks:12,numberOfPublishedChapters:99,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2631-5343",doi:"10.5772/intechopen.71985",isOpenForSubmission:!0}],lsSeriesList:[{id:"11",title:"Biochemistry",numberOfPublishedBooks:27,numberOfPublishedChapters:288,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2632-0983",doi:"10.5772/intechopen.72877",isOpenForSubmission:!0},{id:"25",title:"Environmental Sciences",numberOfPublishedBooks:1,numberOfPublishedChapters:9,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2754-6713",doi:"10.5772/intechopen.100362",isOpenForSubmission:!0},{id:"10",title:"Physiology",numberOfPublishedBooks:11,numberOfPublishedChapters:139,numberOfOpenTopics:4,numberOfUpcomingTopics:0,issn:"2631-8261",doi:"10.5772/intechopen.72796",isOpenForSubmission:!0}],hsSeriesList:[{id:"3",title:"Dentistry",numberOfPublishedBooks:8,numberOfPublishedChapters:129,numberOfOpenTopics:0,numberOfUpcomingTopics:2,issn:"2631-6218",doi:"10.5772/intechopen.71199",isOpenForSubmission:!1},{id:"6",title:"Infectious Diseases",numberOfPublishedBooks:13,numberOfPublishedChapters:107,numberOfOpenTopics:3,numberOfUpcomingTopics:1,issn:"2631-6188",doi:"10.5772/intechopen.71852",isOpenForSubmission:!0},{id:"13",title:"Veterinary Medicine and Science",numberOfPublishedBooks:11,numberOfPublishedChapters:104,numberOfOpenTopics:3,numberOfUpcomingTopics:0,issn:"2632-0517",doi:"10.5772/intechopen.73681",isOpenForSubmission:!0}],sshSeriesList:[{id:"22",title:"Business, Management and Economics",numberOfPublishedBooks:1,numberOfPublishedChapters:12,numberOfOpenTopics:2,numberOfUpcomingTopics:1,issn:"2753-894X",doi:"10.5772/intechopen.100359",isOpenForSubmission:!0},{id:"23",title:"Education and Human Development",numberOfPublishedBooks:0,numberOfPublishedChapters:0,numberOfOpenTopics:2,numberOfUpcomingTopics:0,issn:null,doi:"10.5772/intechopen.100360",isOpenForSubmission:!1},{id:"24",title:"Sustainable Development",numberOfPublishedBooks:0,numberOfPublishedChapters:11,numberOfOpenTopics:4,numberOfUpcomingTopics:1,issn:null,doi:"10.5772/intechopen.100361",isOpenForSubmission:!0}],testimonialsList:[{id:"6",text:"It is great to work with the IntechOpen to produce a worthwhile collection of research that also becomes a great educational resource and guide for future research endeavors.",author:{id:"259298",name:"Edward",surname:"Narayan",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/259298/images/system/259298.jpeg",slug:"edward-narayan",institution:{id:"3",name:"University of Queensland",country:{id:null,name:"Australia"}}}},{id:"13",text:"The collaboration with and support of the technical staff of IntechOpen is fantastic. The whole process of submitting an article and editing of the submitted article goes extremely smooth and fast, the number of reads and downloads of chapters is high, and the contributions are also frequently cited.",author:{id:"55578",name:"Antonio",surname:"Jurado-Navas",institutionString:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRisIQAS/Profile_Picture_1626166543950",slug:"antonio-jurado-navas",institution:{id:"720",name:"University of Malaga",country:{id:null,name:"Spain"}}}}]},series:{item:{id:"22",title:"Business, Management and Economics",doi:"10.5772/intechopen.100359",issn:"2753-894X",scope:"\r\n\tThis series will provide a comprehensive overview of recent research trends in business and management, economics, and marketing. Topics will include asset liability management, financial consequences of the financial crisis and covid-19, financial accounting, mergers and acquisitions, management accounting, SMEs, financial markets, corporate finance and governance, managerial technology and innovation, resource management and sustainable development, social entrepreneurship, corporate responsibility, ethics and accountability, microeconomics, labour economics, macroeconomics, public economics, financial economics, econometrics, direct marketing, creative marketing, internet marketing, market planning and forecasting, brand management, market segmentation and targeting and other topics under business and management. This book series will focus on various aspects of business and management whose in-depth understanding is critical for business and company management to function effectively during this uncertain time of financial crisis, Covid-19 pandemic, and military activity in Europe.
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