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Severe combined immunodeficiency (SCID) is T cell development disorders in the immune system and can be detected at birth. As of December 2018, all 53 newborn screening (NBS) programs within the United States and associated territories offer universal screening for SCID. The Association of Public Health Laboratories (APHL), along with the Immune Deficiency Foundation (IDF), surveyed public health NBS system laboratory and follow-up coordinators regarding their NBS program’s screening methodologies and targets, protocols for stakeholder notifications, and long-term follow-up practices. This report explores the variation that exists across NBS practices, revealing needs for efficiencies and educational resources across the NBS system to ensure the best outcomes for newborns.

Newborn screening (NBS) is a state-based public health program that aims to identify newborns at risk of certain disorders in the first days after birth to prevent permanent disability or death. Disorders on the Health and Human Services Federal Advisory Committee&rsquo, s Recommended Uniform Screening Panel (RUSP) have been adopted by most state NBS programs, however, each state mandates specific disorders to be screened and implements their own system processes. Congenital adrenal hyperplasia (CAH) was added to the RUSP in 2005, and currently all 53 NBS programs universally screen for it. This paper provides a landscape of CAH screening in the United States, utilizing data voluntarily entered by state NBS programs in the Newborn Screening Technical assistance and Evaluation Program data repository. Data reported encompasses NBS state profile data (follow-up, disorder testing and the reporting of processes and methodologies for screening), quality indicator data (timeliness of CAH NBS) and confirmed cases. This comprehensive landscape analysis compares the CAH NBS systems across the US. This is vital in ultimately ensuring that newborns with CAH at risk of salt crisis receive appropriate intervention in a timely manner.

Importance Individuals with documented disabilities may receive accommodations on the Medical College Admission Test (MCAT). Whether such accommodations are associated with MCAT scores, medical school admission, and medical school performance is unclear. Objective To determine the comparability of MCAT scores obtained with standard vs extra administration time with respect to likelihood of acceptance to medical school and future medical student performance. Design, Setting, and Participants Retrospective cohort study of applicants to US medical schools for the 2011-2013 entering classes who reported MCAT scores obtained with standard time (n = 133 962) vs extra time (n = 435), and of students who matriculated in US medical schools from 2000-2004 who reported MCAT scores obtained with standard time (n = 76 262) vs extra time (n = 449). Exposures Standard or extra administration time during MCAT. Main Outcomes and Measures Primary outcome measures were acceptance rates at US medical schools and graduation rates within 4 or 5 years after matriculation. Secondary outcome measures were pass rates on the United States Medical Licensing Examination (USMLE) Step examinations and graduation rates within 6 to 8 years after matriculation. Results Acceptance rates were not significantly different for applicants who had MCAT scores obtained with standard vs extra time (44.5% [59 585/133 962] vs 43.9% [191/435]; difference, 0.6% [95% CI, −4.1 to 5.3]). Students who tested with extra time passed the Step examinations on first attempt at significantly lower rates (Step 1, 82.1% [344/419] vs 94.0% [70 188/74 668]; difference, 11.9% [95% CI, 9.6% to 14.2%]; Step 2 CK, 85.5% [349/408] vs 95.4% [70 476/73 866]; difference, 9.9% [95% CI, 7.8% to 11.9%]; Step 2 CS, 92.0% [288/313] vs 97.0% [60 039/61 882]; difference, 5.0% [95% CI, 3.1% to 6.9%]). They also graduated from medical school at significantly lower rates at different times (4 years, 67.2% [285/424] vs 86.1% [60 547/70 305]; difference, 18.9% [95% CI, 15.6% to 22.2%]; 5 years, 81.6% [346/424] vs 94.4% [66 369/70 305]; difference, 12.8% [95% CI, 10.6% to 15.0%]; 6 years, 85.4% [362/424] vs 95.8% [67 351/70 305]; difference, 10.4% [95% CI, 8.5% to 12.4%]; 7 years, 88.0% [373/424] vs 96.2% [67 639/70 305]; difference, 8.2% [95% CI, 6.4% to 10.1%]; 8 years, 88.4% [375/424] vs 96.5% [67 847/70 305]; difference, 8.1% [95% CI, 6.3% to 9.8%]). These differences remained after controlling for MCAT scores and undergraduate grade point averages. Conclusions and Relevance Among applicants to US medical schools, those with MCAT scores obtained with extra test administration time, compared with standard administration time, had no significant difference in rate of medical school admission but had lower rates of passing the USMLE Step examinations and of medical school graduation within 4 to 8 years after matriculation. These findings raise questions about the types of learning environments and support systems needed by students who test with extra time on the MCAT to enable them to succeed in medical school.