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SUMMARY: Background: To address the low levels of hand hygiene compliance (HHC) at our academic medical centre, we developed an annual patient safety course required for all incoming third‐year medical students. Based on previous observations of medical students, it was determined that hand hygiene (HH) would be a central component of the course. Methods: Over a 1‐year period (2015/16), we observed third‐ and fourth‐year medical students who had participated in the annual patient safety course entering three intensive care units (ICUs) at two teaching hospitals. A total of 150 medical students failed to perform HH on entry and were subsequently asked why they did not comply. Results: Of the 150 medical students observed entering an ICU without performing HH, 74.7% were male and 25.3% were female. Males cited inadequate time (21.4%), lack of role models (10.7%) and provided incorrect information regarding HH requirements (58.9%). Females cited concerns about dry or cracked skin (34.2%) and forgetting (23.7%). Discussion: Our study demonstrates that even when medical students receive intensive HH education, compliance remains low. Of note, males and females offered different reasons for why they failed to perform HH. To address the suboptimal HHC, we developed an annual patient safety course required for all third‐year medical students immediately prior to beginning clinical rotations. In this study, we sought to understand why medical students' HH remains suboptimal even after an intensive course. [ABSTRACT FROM AUTHOR]

Objective: Because of the indolent nature of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP) and potential requisite for a more conservative treatment, it is crucial to identify features of this entity preoperatively. Our group recently published findings that there are several cytomorphological features that may be used as clues to distinguish NIFTP, papillary thyroid carcinoma (PTC) and follicular adenoma (FA) on fine needle aspiration. Therefore, we aimed to determine the interobserver reproducibility of these findings. Methods: Presurgical fine‐needle aspiration slides from NIFTP (n = 30), classic PTC (n = 30) and FA (n = 30) collected from 1/2013‐8/2016 were reviewed by seven cytopathologists blindly. Presence of selected cytomorphological features was recorded and compared to determine percent agreement and inter‐rater reliability among study cytopathologists using Gwet's AC1 statistics. Results: For all the cytomorphological features, the overall percent agreement amongst the pathologists ranged between 65.1% and 86.8% (Gwet's AC1 0.30‐0.80). There was substantial or almost perfect agreement (Gwet's AC1 > 0.60) in seven cytomorphological features in the classic PTC group, in six features in the NIFTP group and in five features in the FA group. There were no features with poor agreement (Gwet's AC1 < 0.0). Conclusions: The current study supports the reproducibility of our previous findings. The high level of agreement amongst pathologists for these groups, and particularly the NIFTP group, supports the notion that when viewed in combination as a cytological profile, these cytomorphological features may assist the cytopathologist in raising the possibility of NIFTP preoperatively. This can potentially aid clinicians in deciding whether more conservative treatment may be appropriate. Because of the indolent nature and potentially conservative treatment of NIFTP ‐ recently removed from the malignant papillary thyroid carcinoma (PTC) category ‐ identifying features of this entity pre‐operatively is important. The current study supports the authors' previous findings, namely the reproducibility of determining the presence or absence of a panel of cytomorphologic features in FNA cytology of NIFTP cases as compared to PTC and follicular adenoma (FA) cases. [ABSTRACT FROM AUTHOR]

Social victimization refers to being targeted by behaviors intended to harm one's social status or relationships (Underwood, 2003), including malicious gossip, friendship manipulation, and social exclusion (both verbal and non-verbal). The current study examined social victimization experiences longitudinally from middle childhood through late adolescence. Participants (N = 273, 139 females) reported on their social victimization experiences in grades 4-11 (ages 9 to 16 years). Using mixture (group-based) modeling, four social victimization trajectories were identified: low, medium decreasing, medium increasing, and elevated. High parent-child relationship quality decreased the odds of being in the elevated group compared to the low group; however, parent-child relationship quality was no longer a significant predictor when emotional dysfunction was added to the model. Higher emotional dysfunction and male gender increased the odds of being in the elevated group and medium increaser group relative to the low group even after controlling for parent-child relationship quality. Implications for intervention and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Background Permanent pacemaker electrograms record a variety of arrhythmias, including nonsustained ventricular tachycardia (NSVT). Little has been reported regarding incidence and clinical significance of NSVT in pacemaker patients after long-term monitoring. Methods Records from all patients implanted with Medtronic pacemakers (Medtronic, Minneapolis, MN, USA) at a single institution from January 1, 2009 to February 27, 2012 were reviewed. Demographic characteristics, imaging studies, pacemaker interrogations, and the Social Security Death Index were examined in patients older than 18 years of age who had ≥ 2 follow-up device interrogations. Results A total of 262 patients with an ejection fraction (EF) >40% were included in the final analysis with a mean follow-up of 29.2 months. Of these patients, 83.2% (n = 218) had hypertension (HTN) and 45.4% (n = 119) had NSVT. Among patients with an EF ≥ 55%, hypertensive patients had a NSVT burden 2.46 times greater than normotensive patients (incidence rate ratio: 2.46, 95% confidence interval: 1.10-5.50; P < 0.028). NSVT was not associated with increased mortality (P < 0.1229). Conclusion In this cohort of patients, there was a high prevalence of HTN and while hypertensive subjects had a significantly higher NSVT burden, NSVT was not associated with an increased mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND The annual incidence of urothelial carcinoma continues to increase, and it is projected that greater than 70,000 new cases will occur in the year 2015. However, as much as 23% of cytologic specimens will demonstrate some degree of atypia without meeting the criteria for urothelial carcinoma and thus will be reported as atypical. METHODS The authors conducted 2 laboratory information searches and 1 survey. In total, 311 patients who had atypical cytology-biopsy pairs available were identified from the initial data search. The second data search identified 942 patients who had fluorescence in situ hybridization (FISH) results available. RESULTS There was fair agreement between FISH results and cytology results (κ = 0.34; 95% confidence interval, 0.27-0.41). The analysis did not reveal any benefits of using additional atypical subcategories beyond the 2 suggested in the literature. It was determined that 2 strategies would provide an optimal balance: standardizing patient management and facilitating the adoption of universally recognized templates. CONCLUSIONS When combining cytology and the 2-tiered atypical classification system with FISH testing, a marked increase in sensitivity and an accompanying decrease in specificity were observed compared with either test individually. Thus, highly sensitive FISH testing may help to identify high-risk patients among those in the group with uncertain atypical findings. Cancer Cytopathol 2016;124:188-195. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND The Bethesda system (TBS) for the reporting of thyroid cytopathology established the category of atypia of undetermined significance (AUS) with a 7% target rate and a 5% to 15% implied malignancy risk. Recent literature has reported a broad range of AUS rates, subsequent malignancy rates, and discrepant results from repeat fine-needle aspiration (FNA) versus surgical follow-up. Therefore, this study examined AUS data from the Hofstra North Shore-LIJ School of Medicine to determine the best clinical follow-up. METHODS Thyroid aspirates interpreted as AUS in 2012-2014 at the Hofstra North Shore-LIJ School of Medicine were collected. Repeat FNA and surgical follow-up data were tabulated to establish AUS, secondary AUS (diagnosed upon repeat FNA follow-up of a primary FNA AUS diagnosis), atypia of undetermined significance/malignancy (AUS:M) ratios (according to the TBS categories), and malignancy rates for AUS. RESULTS The AUS rate was 8.5% (976/11,481), and there was follow-up data for 545 cases. The AUS:M ratio was 2.0. Repeat FNA was performed for 281 cases; 57 proceeded to surgical intervention. Repeat FNA reclassified 71.17% of the cases. The malignancy rates for AUS cases proceeding directly to surgery and for those receiving a surgical intervention after a repeat AUS diagnosis were 33.33% and 43.75%, respectively. CONCLUSIONS Repeat FNA resulted in definitive diagnostic reclassification for 67.61% of primary AUS cases and reduced the number of patients triaged to surgery, with 56.58% of the cases recategorized as benign. Cases undergoing surgery after repeat AUS had a higher malignancy rate than those going straight to surgery, and this emphasizes the value of repeat FNA in selecting surgical candidates. In addition, this study highlights the utility of AUS rate monitoring as a quality measure that has contributed to the ability of the Hofstra North Shore-LIJ School of Medicine to adhere closely to TBS recommendations. Cancer (Cancer Cytopathol) 2016;124:37-43. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND Cadherin-17 (intestinal peptide-associated transporter) and SATB2 (SATB homeobox 2) immunoexpression has recently been described in surgical pathology to have value in establishing the colorectal origin of metastatic adenocarcinoma. However, to the authors' knowledge, the role of these markers in metastatic colorectal adenocarcinoma (MCA) in cytology has not been addressed to date. In the current study, the authors evaluated the contribution of cadherin-17 and SATB2 to the diagnosis of MCA in cytology specimens and compared these two novel markers with the standard gastrointestinal immunohistochemistry panel in an attempt to identify the optimal panel. METHODS A total of 43 MCA cytology cases and 68 metastatic noncolorectal adenocarcinoma (non-MCA) cytology controls were stained for SATB2; cadherin-17; and the standard panel of cytokeratin (CK) 7, CK20, and Caudal-Type Homeobox Transcription Factor 2 (CDX2). Staining intensity and percentage of positive cells were recorded. Sensitivity and specificity values for immunostains individually and in combination were computed and compared. RESULTS Despite specificities of 83.8% and 91.2%, respectively, for cadherin-17 and SATB2, when critically examining the new immunostains together with the standard panel, there was no significant difference noted with regard to prediction of MCA (vs non-MCA) compared with the standard panel alone ( P < .6). CONCLUSIONS The results of the current study reinforce that the standard gastrointestinal immunohistochemistry panel remains the gold standard for distinguishing MCA from non-MCA in cytology. Cancer (Cancer Cytopathol) 2015;123:706-12. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

BACKGROUND At a high-volume center, it became necessary to provide benchmarks for the accuracy and risk of malignancy per urine cytology diagnostic category. The additive sensitivity for the determination of the residual risk of disease was calculated with the goal of determining the performance of cytology and optimal triage, including the number of urine samples, before the detection of malignancy in surveillance patients. METHODS A 2-year laboratory information system-based search was conducted, and it yielded 587 subjects (695 biopsy and cytology pairs) with histological follow-up. The sensitivity and specificity of cytology for urothelial malignancy, the risk of malignancy per diagnostic category, the additive sensitivity, and the time for conversion from a negative initial cytology result to a positive cytology result were examined. RESULTS The overall average sensitivity and specificity of cytology were 48.9% and 83.0%, respectively. The additive sensitivity increased with each subsequent cytology and peaked with the third cytology. A median conversion time of 22.2 months from a negative initial cytology result to a positive cytology result and a decline in predictive positive cytology after the fourth cytology were noted. Subcategorization of the atypical category failed to show statistical significance in predicting outcomes of biopsy. Surveillance subjects, as compared to primary subjects, showed a higher sensitivity for the detection of high and low grade cancers. CONCLUSIONS The findings suggest that atypia favoring malignancy is being appropriately flagged. However, further definition of the atypical category is needed to increase specificity with a better qualitative or quantitative morphological algorithm. This study provides a risk of malignancy for each category for benchmarking and clinical triage. The data suggest that follow-up should include at least 4 consecutive urine specimens over a period of 22.2 months. Cancer (Cancer Cytopathol) 2015;123:10-8. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the research rotation experience affects the career path of otolaryngology residents.Study Design/setting: Two web-based surveys were disseminated by the AAO-HNS; one to current and former resident trainees and the other to current residency program directors.Subjects and Methods: A web-based survey was disseminated to all AAO-HNS members classified as otolaryngology residents or residency graduates within the last 6 years, regarding their research rotation and its potential influence on their career path. A second web-based survey was delivered simultaneously to program directors to evaluate their perception of the need for research in a training program and their role in the rotation. Chi-square tests for independence as well as multivariate analyses were conducted to determine whether aspects of the resident research rotation related to career path.Results: The resident survey was completed by 350 respondents (25% response rate), and 39 program directors completed the second survey (37% response rate). Multiple factors were examined, including federal funding of faculty, mentorship, publications prior to residency, success of research project measured by publication or grant submission, and type of research. Multivariate analyses revealed that factors most predictive of academic career path were intellectual satisfaction and presence of a T32 training grant within the program (P < .05).Conclusion: The composition and quality of the residency research rotation vary across institutions. Factors that enhance stronger intellectual satisfaction and the presence of T32 grant, which demonstrates an institution's commitment to research training, may promote pursuit of a career in academia versus private practice. [ABSTRACT FROM AUTHOR]

BACKGROUND GATA3 (GATA-binding protein 3) expression in urothelial carcinoma (UC) and mammary carcinomas has been recently reported. However, to the authors' knowledge, studies examining GATA3 staining of metastatic UC (MUC) in cytology specimens are lacking. Delta Np63 (p40) has been shown to be expressed highly selectively in squamous cell carcinomas (SCCs) but the literature concerning the expression of p40 in UC is limited and controversial. In the current study, the authors evaluated the usefulness of GATA3 and p40 in the diagnosis of MUC in cytology specimens. METHODS Thirty-two MUC cytology cases and 44 controls (22 UC cases and 22 SCC cases) were stained for GATA3, p40, and p63 and nuclear staining intensity and the percentage of positive cells were recorded and compared. RESULTS MUC cytology cases stained positive for GATA3, p40, and p63 in 78.13%, 80.65%, and 61.29% of cases, respectively, with moderate/strong staining intensity. MUC cases had a significantly higher percentage of GATA3 positivity compared with SCC controls ( P < .001), but GATA3 positivity was not found to be significantly different from UC controls (90.91%) ( P = .28). For p40 positivity, there was no significant difference observed between MUC cases, UC controls (95.45%), and SCC controls (90.91%) ( P = .29). p63 positivity was found to be significantly lower in MUC cases compared with UC controls (95.45%) and SCC controls (95.45%) ( P < .01). CONCLUSIONS The results of the current study demonstrate that GATA3 is useful in confirming the diagnosis of MUC in cytology specimens and in distinguishing between MUC and SCC. p40 is a valuable adjunct to GATA3 in the diagnosis of MUC in cytology specimens, especially when SCC is not part of the clinical differential diagnosis. Cancer (Cancer Cytopathol) 2014;122:468-473. © 2014 American Cancer Society. [ABSTRACT FROM AUTHOR]

Within T-cell-dependent germinal centers, p53 gene transcription is repressed by Bcl-6 and is thus less vulnerable to mutation. Malignant lymphomas within inflamed extranodal sites exhibit a relatively high incidence of p53 mutations. The latter might originate from normal B-cell clones manifesting activation-induced cytosine deaminase (AID) and up-regulated p53 following T-cell-independent (TI) stimulation. We here examine p53 gene transcription in such TI clones, with a focus on modulatory effects of prostaglandin E2 (PGE2), and evaluate progeny for p53 mutations. Resting IgM+IgD+CD27- B cells from human tonsils were labeled with CFSE and stimulated in vitro with complement-coated antigen surrogate, IL-4, and BAFF ± exogenous PGE2 (50 nM) or an analog specific for the EP2 PGE2 receptor. We use flow cytometry to measure p53 and AID protein within variably divided blasts, qRT-PCR of p53 mRNA from cultures with or without actinomycin D to monitor mRNA transcription/stability, and single-cell p53 RT-PCR/sequencing to assess progeny for p53 mutations. We report that EP2 signaling triggers increased p53 gene transcriptional activity in AID+ cycling blasts (P<0.01). Progeny exhibit p53 mutations at a frequency (8.5xl0-4) greater than the baseline error rate (<0.8x10-4). We conclude that, devoid of the repressive influences of Bcl-6, dividing B lymphoblasts in inflamed tissues should display heightened p53 transcription and increased risk of p53 mutagenesis. [ABSTRACT FROM AUTHOR]

Background Obesity is a major epidemic and may present a significant barrier to living kidney donation. The purpose of our study was to determine the frequency of obesity as an exclusion factor and assess how often these donors lose weight and donate. Methods A single center, retrospective analysis of 104 potential living kidney donors between 2008 and 2012. Results Of the 104 donors, 19 (18%) had a normal body mass index ( BMI) of <25. Eighty-five of the 104 (82%) donors spanned the overweight to morbidly obese classifications. Thirty-eight (37%) were overweight ( BMI 25-29.9). Twenty-four (23%) were categorized as class I obesity ( BMI 30-34.9), 17 (16%) as class II obesity ( BMI 35-39.9), and six (6%) as class III obesity ( BMI >40). There were a total of 23 donors (22%) who were considered moderately and morbidly obese ( BMI >35). Of these, only three (13%) succeeded at losing weight and donating. Conclusions Obesity may be a frequent barrier to living kidney donation, directly leading to exclusion as a potential kidney donor in about one in five instances. Successful weight loss leading to donation appears to be infrequent, suggesting need to address obesity in the donor population. [ABSTRACT FROM AUTHOR]

Background: We developed a course to introduce incoming third-year medical students to the subject of patient safety, to focus their attention on teamwork and communication, and to create an awareness of patient-safe practices that will positively impact their performance as clinicians. Methods: The course, held prior to the start of clinical rotations, consisted of lectures, web-based didactic materials, small group activities and simulation exercises, with an emphasis on experiential learning. First, students inspected a 'room of horrors', which is a simulated clinical environment riddled with errors. Second, we used lenticular puzzles in small groups to elicit teamwork behaviours that parallel real-life interactions in health care. Each team was given 8 minutes to complete a 48-piece puzzle, with five pieces removed at random and given to other teams. The salient teaching point of this exercise is that for a team to complete the task, team members must communicate with members of their own team as well as with other teams. Last, simulation scenarios provided a clinical context to reinforce the skills introduced through the puzzle exercise and lectures. The students were split into groups of six or seven members and challenged with two scenarios. Both scenarios focused on a 56-year-old man in respiratory distress. The teams were debriefed on both clinical management and teamwork. Results: The vast majority of the students (93%) agreed that the course improved their patient safety knowledge and skills. Discussion: The positive response from students to the introductory course is an important step in fostering a culture of patient safety. [ABSTRACT FROM AUTHOR]

Background: When learning objectives do not specifically dictate the use of one simulation modality over another, we sought to answer the question of which modality is preferred. We also assessed the impact of debriefing, and the frequency of participants asserting their leadership, as well as self-reported comfort and competence, and the ability to generate differential diagnoses when either a standardised patient (SP) or high-technology simulator (HTS) was used. Methods: One hundred and forty medical students participated in a simulation-based activity focusing on teamwork, task delegation, role clarity and effective communication. Two similar clinical scenarios were presented, and either an HTS or an SP was used. Following each scenario, participants were surveyed on the realism of the simulation and the patient, and also on their self-assessed comfort and competence. They were also asked to indicate which role they played, to list possible differential diagnoses for the case and, following the second scenario, which modality they preferred. Results: The surveys indicated that 91 per cent (127) of students preferred the SP. The perceived realism of the simulation was higher for the second scenario than for the first. Scenarios with an SP were found to be significantly more realistic than the scenarios where the HTS was used. Comfort and competence scores were higher following the second scenario. No differences in the ability of participants to generate a list of differentials were found, and nearly twice as many participants reported taking the leadership role during their second simulation. Discussion: We have found low and high technology to have similar effectiveness for achieving learning objectives and for the demonstration of skills; however, students clearly preferred the SPs. [ABSTRACT FROM AUTHOR]

For a sample followed from age 9–13 (N=281), this investigation examined developmental trajectories for social and physical aggression as measured by teacher ratings. Trajectories for both forms of aggression were estimated first separately, then jointly. Mean levels of both social and physical aggression decreased over time for the overall sample, but with high variability of individual trajectories. Subgroups followed high trajectories for both social and physical aggression. Joint estimation yielded six trajectories: low stable, low increasers, medium increasers, medium desisters, high desisters, and high increasers. Membership in the high increaser group was predicted by male gender, unmarried parents, African American ethnicity, and maternal authoritarian and permissive parenting. Permissive parenting also predicted membership in the medium increaser group. This is one of the first studies to examine social aggression longitudinally across this developmental period. Though the results challenge the claim that social aggression is at its peak in early adolescence, the findings emphasize the importance of considering different developmental trajectories in trying to understand origins and outcomes of aggression. Aggr. Behav. 35:357–375, 2009. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The cover image is based on the Original Article Noninvasive follicular thyroid neoplasm with papillary‐like nuclear features: An interobserver study of key cytomorphological features from a large academic medical centre by Tamar C. Brandler et al, DOI: 10.1111/cyt.12632. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with a survey which investigated physicians' knowledge and practice regarding dental care and older adults.

The article presents an obituary for G. Alfred "Fred" Hess, past president of the Council on Anthropology and Education.