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Undergraduate seniors at a residential liberal-arts college reflected on their experiences attending on-campus cultural events. These focus groups were transcribed, coded, and analyzed using a grounded theory-derived approach to understand how these events shaped their college experience. The resulting communication artifact revealed a variety of student outcomes tied to on-campus cultural event attendance. The findings have implications for the design, implementation, and assessment of academic and co-curricular programming, particularly in terms of articulating the purpose of such programming and enlisting faculty in its delivery.

Learning progressions (LPs) describe the development of domain-specific knowledge, skills, and understanding. Each level of an LP characterizes a phase of student thinking en route to a target performance. The rationale behind LP development is to provide road maps that can be used to guide student thinking from one level to the next. The validity of an LP cannot be taken for granted, however. LPs evolve from a synthesis of multiple research studies, subject-matter expertise, and standards documents. They are working models of student development that may require revision in light of critique and empirical evidence. The formulation of an LP is an iterative process in which expert feedback is elicited, data are collected, and the LP is revised accordingly. We developed an LP for the concept of function both because the concept of function is challenging to attain and because it is central to the study of algebra and higher mathematics. We report early findings with respect to the validity of the concept of function LP, based on small-scale cognitive interviews and expert reviews.

This article presents the author's views about the school district deconstruction in Philadelphia, Pennsylvania. He discusses his 30-year experience as a principal and central office administrator with the School District of Philadelphia and his involvement in the efforts to lead urban school reform in the country. He also describes the reform agenda of the School Reform Commission and the need for people to acknowledge that it is in their common interest to make equity and quality the cornerstones for educational reform, which can only happen if parents, students, and teachers band together to wrest control from the elites who are driving federal and state policy, and insist on schools they directly control. This, the author states, will require an Occupy Our Schools movement that has as its goals the reinvention of schooling as engaging, demanding, responsive, accessible, timely, and future-oriented.

This article reports on a study designed to examine the perceptions of house arrest (HA) and electronic monitoring (EM) among offenders who have recently experienced this criminal sentence. Data were gathered via a self-administered questionnaire and follow-up interviews with a sample of offenders. Our primary areas of interest were to assess (a) the extent to which HA and EM are perceived as punitive, (b) the extent to which this sanction impacts the offenders at home and at work, and (c) to explore the ways in which this criminal sanction impacts family members. While HA with EM was perceived as being less severe than incarceration, it is clear that HA with EM is experienced as a punitive criminal sanction. (Contains 4 tables, 2 figures, and 1 note.)

Delinquent youths' proclivity to return to school after release from placement in a juvenile residential institution has been significantly discouraged before their 18th birthday. Often, years of poor education performance and failure, discipline issues, neighborhood and family debilitation, older age, adjudication stigmatization, and other crimogenic variables become barriers to continuing their education. This study discusses public expectations and the obstacles to obtaining them. These obstacles include the economic impact of dropping out of school, un/underemployment, lower standard of living, and learning disabilities. The population for the study was 348 delinquent male youth adjudicated to residential placement at a low security youth forestry camp in Pennsylvania. A discriminate analysis was performed to explore the relationship between nine independent variables and a criterion variable. This variable was whether delinquent youth returned to school after release from residential placement in a youth forestry camp. Through the explanation of descriptive statistics about race, plans to return to school, special education identification, and age categories, an insight into the characteristics of the population is provided. The means and standard deviation for months in placement, age at release, ability scores and posttest reading and math scores are also included. These statistics are followed by an explanation of the findings from the stepwise linear discriminate analysis. The discriminate analysis found that two variables were statistically significant: student planned to return to school and age at release. It was found that these variables accounted for part of the variance in actual behavior of returning to school on release. The implications and recommendations could have significant impacts on the juvenile justice courts practices that in turn could instigate changes in legislation, state policy, and institutional procedures. These effects could be found in the overall treatment focus, education structure and delivery, institutional operations and beyond through aftercare. (Contains 2 tables.)

This article explores the roles played by state governments, and particularly governors, in dealing with an extremely disruptive event—the coronavirus global pandemic. The inquiry focuses on March and April 2020, a period characterized by significant public health challenges and severe economic stress. The coronavirus pandemic did not affect states at the same time or with the same intensity and as a consequence, governors varied somewhat in terms of when they acted and which policies they adopted. As shown in the article, gubernatorial interactions with other states were at times cooperative, in other instances they were competitive. Two states—Texas and Pennsylvania—are singled out for an examination of within-state dynamics. The article ends with brief reflections on the lessons of the coronavirus for public sector management in a federal system of government. [ABSTRACT FROM AUTHOR]

African-American (AA) adolescents (13–19 years of age) have disproportionately higher rates of suicide. In this study, to explore the nature of suicidal deaths and suicide attempts in African- American adolescents, we utilized the Youth Risk Behavior Surveys (YRBS) and the Web-Based Injury Statistics Query and Reporting System (WISQARS) database from years 2001 to 2017. The rate of AA male suicides increased by 60% and for AA females increased by 182% from 2001 to 2017. Suicides were the second leading cause of death for AA adolescents. Additionally, in 2017 alone, 68,528 AA males and 94,760 AA females made suicide attempts serious enough that they had to be treated by health professionals. Males were most likely to use firearms (52%) or to hang/suffocate themselves (34%) to commit suicide. Females used hanging/suffocation (56%) or firearms (21%) to commit suicides. The ten states with the greatest number of AA adolescent suicides (2015–2017) were: Georgia, Texas, Florida, North Carolina, Ohio, Illinois, Michigan, Pennsylvania, New York, and Missouri. There is an urgent need to further explore the changing nature and epidemiology of AA adolescent suicides and to study for whom and under what circumstances interventions can reduce suicides and suicidal behaviors in AA adolescents. [ABSTRACT FROM AUTHOR]

Background: Influenza is a contagious respiratory disease responsible for annual seasonal epidemics in temperate climates. An understanding of how influenza spreads geographically and temporally within regions could result in improved public health prevention programs. The purpose of this study was to summarize the spatial and temporal spread of influenza using data obtained from the Pennsylvania Department of Health's influenza surveillance system. Methodology and Findings: We evaluated the spatial and temporal patterns of laboratory-confirmed influenza cases in Pennsylvania, United States from six influenza seasons (2003-2009). Using a test of spatial autocorrelation, local clusters of elevated risk were identified in the South Central region of the state. Multivariable logistic regression indicated that lower monthly precipitation levels during the influenza season (OR = 0.52, 95% CI: 0.28, 0.94), fewer residents over age 64 (OR = 0.27, 95% CI: 0.10, 0.73) and fewer residents with more than a high school education (OR = 0.76, 95% CI: 0.61, 0.95) were significantly associated with membership in this cluster. In addition, time series analysis revealed a temporal lag in the peak timing of the influenza B epidemic compared to the influenza A epidemic. Conclusions: These findings illustrate a distinct spatial cluster of cases in the South Central region of Pennsylvania. Further examination of the regional transmission dynamics within these clusters may be useful in planning public health influenza prevention programs. [ABSTRACT FROM AUTHOR]

Although considerable information exists on habitat use by stream salmonids, only a small portion has quantitatively examined diurnal and nocturnal habitat variation. We examined diel variation in habitat use by age-0 and age-1+ brook trout (Salvelinus fontinalis) during summer and autumn in a headwater stream in northern Pennsylvania. Habitat variables measured included cover, depth, substrate, and velocity. The most pronounced diel variation occurred in the use of cover during both seasons. Both age-0 brook trout and age-1+ trout were associated with less cover at night. Age-0 brook trout occupied swifter water during the day than at night during both seasons, but the difference was not significant. Increased cover, depth, and substrate size governed the habitat of age-1+ brook trout. Our findings support the need for a better understanding of diel differences in habitat use of stream salmonids when considering habitat enhancement and protection. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich plasma (PRP) has been used to enhance tendon healing in clinical settings. However, the cellular mechanisms underlying PRP treatment of injured tendons remain unclear. The aim of this study was to determine the effects of PRP, in the form of PRP-clot releasate (PRCR), on tendon stem cells (TSCs), a newly discovered cell population in tendons.Hypothesis: The PRCR treatment promotes differentiation of TSCs into tenocytes that are activated to proliferate quickly and increase collagen production.Study Design: Controlled laboratory study.Methods: After PRCR treatment, cell morphology, expression of stem/progenitor cell marker nucleostemin, and population doubling time were examined. In addition, gene and protein analyses were performed using reverse transcription-polymerase chain reaction, immunocytochemistry, and Western blot to characterize the type of cells that had differentiated after PRCR treatment.Results: The TSCs without PRCR treatment were small and exhibited an irregular shape, whereas with increasing PRCR dosage, TSCs became large, well spread, and highly elongated with downregulation of nucleostemin expression. The PRCR treatment also markedly enhanced TSC proliferation, tenocyte-related gene and protein expression, and total collagen production, all of which indicated that PRCR treatment induced differentiation of TSCs into activated tenocytes.Conclusion: The PRCR treatment promotes differentiation of TSCs into active tenocytes exhibiting high proliferation rates and collagen production capability.Clinical Relevance: The findings of this study suggest that PRP treatment of injured tendons is ‘‘safe’’ as it promotes TSC differentiation into tenocytes rather than nontenocytes, which would compromise the structure and function of healing tendons by formation of nontendinous tissues. Moreover, they suggest that PRP treatment can enhance tendon healing because tenocytes induced to differentiate by PRP are activated to proliferate quickly and produce abundant collagen to repair injured tendons that have lost cells and matrix. [ABSTRACT FROM AUTHOR]

Background: In April 2009, a new pandemic strain of influenza infected thousands of persons in Mexico and the United States and spread rapidly worldwide. During the ensuing summer months, cases ebbed in the Northern Hemisphere while the Southern Hemisphere experienced a typical influenza season dominated by the novel strain. In the fall, a second wave of pandemic H1N1 swept through the United States, peaking in most parts of the country by mid October and returning to baseline levels by early December. The objective was to determine the seroprevalence of antibodies against the pandemic 2009 H1N1 influenza strain by decade of birth among Pittsburgh-area residents. Methods and Findings: Anonymous blood samples were obtained from clinical laboratories and categorized by decade of birth from 1920-2009. Using hemagglutination-inhibition assays, approximately 100 samples per decade (n = 846) were tested from blood samples drawn on hospital and clinic patients in mid-November and early December 2009. Age specific seroprevalences against pandemic H1N1 (A/California/7/2009) were measured and compared to seroprevalences against H1N1 strains that had previously circulated in the population in 2007, 1957, and 1918. (A/Brisbane/59/2007, A/Denver/1/1957, and A/South Carolina/1/1918). Stored serum samples from healthy, young adults from 2008 were used as a control group (n = 100). Seroprevalences against pandemic 2009 H1N1 influenza varied by age group, with children age 10-19 years having the highest seroprevalence (45%), and persons age 70-79 years having the lowest (5%). The baseline seroprevalence among control samples from 18-24 year-olds was 6%. Overall seroprevalence against pandemic H1N1 across all age groups was approximately 21%. Conclusions: After the peak of the second wave of 2009 H1N1, HAI seroprevalence results suggest that 21% of persons in the Pittsburgh area had become infected and developed immunity. Extrapolating to the entire US population, we estimate that at least 63 million persons became infected in 2009. As was observed among clinical cases, this sero-epidemiological study revealed highest infection rates among school-age children. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Cooley et al. (2010) Protecting health care workers: a pandemic simulation based on Allegheny County. Influenza and Other Respiratory Viruses 4(2), 61–72. Background and Objectives The Advisory Committee on Immunization Practices has identified health care workers (HCWs) as a priority group to receive influenza vaccine. Although the importance of HCW to the health care system is well understood, the potential role of HCW in transmission during an epidemic has not been clearly established. Methods Using a standard SIR (Susceptible–Infected–Recovered) framework similar to previously developed pandemic models, we developed an agent-based model (ABM) of Allegheny County, PA, that incorporates the key health care system features to simulate the spread of an influenza epidemic and its effect on hospital-based HCWs. Findings Our simulation runs found the secondary attack rate among unprotected HCWs to be approximately 60% higher (54·3%) as that of all adults (34·1%), which would result in substantial absenteeism and additional risk to HCW families. Understanding how a pandemic may affect HCWs, who must be available to treat infected patients as well as patients with other medical conditions, is crucial to policy makers’ and hospital administrators’ preparedness planning. [ABSTRACT FROM AUTHOR]

This article focuses on speeches delivered by Teedyuscung, a Delaware Indian leader, delivered at a treaty council in Easton, Pennsylvania. It says that Teedyuscung has given a speech in the city to continue peace talks. It mentions that he has censured the conflicts between natives and newcomers on scribes during his last treaty council.

The relationship between educators and residential staff in a juvenile correctional facility can he an uneasy one when the school and residential providers are independent of each other and responsible to different state agencies. The separate mandates from these agencies to provide treatment and education presents significant potential for inconsistency, and, therefore, disagreement and confusion, in communication, coordination, operations and goals between the respective staffs, and with the youth. This article describes the challenges in the development of an ongoing and successful administrative and practical relationship for the operation of a school between the Justice Resource Institute Inc. and Appalachia Intermediate Unit # 8 at the Cresson Secure Treatment Unit. The unit is a high security facility with 52 beds for adjudicated adolescent males in Cresson, Pennsylvania. [ABSTRACT FROM AUTHOR]

This paper reports a study of the use of information sources by farm operation in the farm practice adoption process and develops a model to account for the differential use of sources as farmers progress toward adoption. Utilizing a less-structured interviewing technique, the findings from this study of 175 Pennsylvania dairy farmers lend support to previous investigations of the use of information sources in the various stages of the adoption process. The model constructed to account for the differential use of information sources as farmers progress toward adoption involves five considerations: (1) institutionalization of information sources, (2) the temporal sequence of sources, (3) the possibility of negative recommendations, (4) scheduling limitations, and (5) the need for local legitimation. A reasonably good fit was obtained between model and data. A prediction derived from the model, that farmers citing peer influences as sources in the early stages of the adoption process would make less progress toward adoption than farmers citing other sources, was also supported by the data. [ABSTRACT FROM AUTHOR]

The article discusses depression and pre-depression marriage rates in Philadelphia, Pennsylvania. Survey reports that most of the people in Philadelphia, Pennsylvania classified as of Russian nationality are Russian Jews. Seventeen census tracts were selected in which the native-born white of foreign parentage plus the foreign-born white predominated among the marriageable males, and in which Russians predominated overwhelmingly among all males in the tracts. In these tracts, 32,920 are marriageable males. In 16 of them, the marriage rate rose during the depression. In one, a tract of higher economic status, it fell slightly. The composite predepression rate for the 17 tracts was 35.3; the depression rate was 45.4. Marked variations seem to coincide with changes in the racial and nationality make-up of the marriageable males. So far as Philadelphia is concerned, the conclusion is inescapable that the presence in large proportions of Negroes, Russian Jews, and, to a lesser extent, of Italians, among the marriageable males of areas in the city, coincide with a rise in the marriage rates of those areas during the depression; while a preponderance of older native-white stock, and of northern and western European stock, coincides with a lowering of the rates.

The article discusses an August 1865 letter to the Huntington County, Pennsylvania, "Globe" newspaper. The article states that the letter was written by a surgeon in York, Pennsylvania, regrading the case of Union army sergeant Michael M. Logan of the 16th Pennsylvania Cavalry. The letter details Logan's several wounds during the U.S. Civil War, particularly at the battle of Middleburg in Loudon County, Virginia, on June 19, 1863. The article also discusses Logan's many returns to battle following being wounded, which the author suggests demonstrates a general trait among Union soldiers that contributed to the Union's ultimate victory. The article also states that the letter from Logan's doctor describes Civil War medical practice.

Proposed by Linnaeus in 1753, Phlox ovata was a name of long-standing use until Reveal et al. established that an illustration cited in the Linnaean protologue and designated as the type of the species by a later monographer was based on a species from a different family, seemingly rendering P. ovata L. invalid and making P. latifolia Michx. the proper name. The issue was processed through a series of taxonomic papers that resolved the typification issue and ultimately ruled in favor of retaining P. ovata, but floristic and ecological workers have mostly used P. latifolia for this species since 1982. The correct name for the Allegheny phlox is Phlox ovata. [ABSTRACT FROM AUTHOR]

Examines the contamination of individuals by radon daughters in Pennsylvania. Risk factors of lung cancer; Use of gamma spectroscopy; Variables in radon risk assessment.

Objectives: Antibiotic overuse is a significant problem in nursing homes (NHs). Strategies to improve antibiotic prescribing practices in NHs are a critical need. In this study, we analyzed antibiotic prescribing workflows to identify strategies for improving antibiotic prescribing in NHs., Design: Qualitative descriptive study using prospective field-based assessment of workflows., Setting: Six NHs in Wisconsin (n = 3) and Pennsylvania (n = 3)., Participants: A total of 44 interviews with 68 NH professionals, including leadership, nurses, and prescribers., Measurements: During a 1-day field visit in each NH, we conducted semistructured interviews with NH professionals, collected artifacts (policies, procedures, and documentation and communication tools), and observed clinical meetings. Study participants were interviewed (30-60 minutes) about antibiotic prescribing workflows in their facility. Information collected during site visits was used to create a representative workflow map of NH antibiotic prescribing. The workflow map guided thematic analysis to identify barriers corresponding to workflow steps across multiple NHs., Results: The representative antibiotic preprescribing workflow map included 17 steps, beginning with resident change in condition and ending with the decision to prescribe an antibiotic. Thematic analysis identified common step-specific barriers to antibiotic stewardship centering on three themes: (A) information barriers, comprising (A1) inconsistent nurse assessment report and (A2) misalignment between the work and tools of information sharing within the facility, (B) communication barriers, comprising (B1) mismatched perception of prescriber information needs and (B2) difficulty reaching prescribers for direct interaction, and (C) professional barriers, comprising (C1) low prescriber confidence in nurse assessment report and (C2) nurse reluctance to express their professional opinions., Conclusion: Strategies addressing workflow barriers are important targets for antibiotic stewardship. Such strategies include structured information tools, nurse and prescriber education, and organizational improvement. Future research can build on combinations of existing and new strategies to measure their effects in improving antibiotic prescribing. J Am Geriatr Soc 68:2222-2231, 2020., (© 2020 The American Geriatrics Society.)

Background: Antibiotic overuse and misuse is a common problem in nursing homes. Antibiotic time-out (ATO) interventions have led to improvements in antibiotic uses in hospitals, but their impact in nursing homes remain understudied., Objective: To evaluate the impact of a stewardship intervention, promoting use of ATOs on the frequency and types of antibiotic change events (ACEs) in nursing homes., Design: Controlled before-and-after intervention study., Setting: Nursing homes in Wisconsin and Pennsylvania., Method: Data on antibiotic prescriptions in 11 nursing homes were collected for 25 months. We categorized ACEs as (1) early discontinuation, (2) class modification, or (3) administration modification. Class modification ACEs were further classified based on whether the change narrowed, expanded, or had no effect on bacterial spectrum coverage. Analyses were performed using a difference-in-difference (DiD) approach., Result: Of 2,647 antibiotic events initiated in study nursing homes, 376 (14.2%) were associated with an ACE. The overall proportion of ACEs did not significantly differ between intervention and control nursing homes. Early discontinuation ACEs increased in intervention nursing homes (DiD, 2.5%; P = .01), primarily affecting residents initiated on broad-spectrum antibiotics (DiD, 2.9%; P < .01). Class modification ACEs decreased in intervention nursing homes but remained unchanged in control nursing homes., Conclusion: The impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. More research on the potential value of ATO interventions in nursing homes is warranted.

Using data from the Health, Aging, and Body Composition study, we examined whether low 25-hydroxyvitamin D (25[OH]D) concentrations were associated with prevalent or incident cognitive impairment. Serum 25(OH)D concentrations were measured in 2,786 older adults and categorized as <20 ng/mL, 20 to <30 ng/mL, or ≥30 ng/mL. Cognitive impairment was defined as a score >1.5 standard deviations below race and education specific means on either digit symbol substitution test or modified mini-mental state test. Logistic regression determined the odds of cognitive impairment at baseline and year 5 by 25(OH)D category. 25(OH)D concentrations were <30 ng/mL in 57.3% of whites and 84.6% of blacks. After excluding participants with baseline cognitive impairment (n = 340), 13% of whites and 13% of blacks developed cognitive impairment by year 5. In whites, 25(OH)D concentrations <30 ng/mL were not associated with prevalent or incident cognitive impairment. Black participants with 25(OH)D concentrations <20 ng/mL had a higher odds of prevalent, but not incident cognitive impairment (OR (95% CI): 2.05 (1.08-3.91), p = 0.03) compared to participants with 25(OH)D concentrations ≥30 ng/mL. Low 25(OH)D concentrations were associated with twofold higher odds of prevalent cognitive impairment in blacks.

It has been proposed that fragments of an asteroid or comet impacted Earth, deposited silica- and iron-rich microspherules and other proxies across several continents, and triggered the Younger Dryas cooling episode 12,900 years ago. Although many independent groups have confirmed the impact evidence, the hypothesis remains controversial because some groups have failed to do so. We examined sediment sequences from 18 dated Younger Dryas boundary (YDB) sites across three continents (North America, Europe, and Asia), spanning 12,000 km around nearly one-third of the planet. All sites display abundant microspherules in the YDB with none or few above and below. In addition, three sites (Abu Hureyra, Syria; Melrose, Pennsylvania; and Blackville, South Carolina) display vesicular, high-temperature, siliceous scoria-like objects, or SLOs, that match the spherules geochemically. We compared YDB objects with melt products from a known cosmic impact (Meteor Crater, Arizona) and from the 1945 Trinity nuclear airburst in Socorro, New Mexico, and found that all of these high-energy events produced material that is geochemically and morphologically comparable, including: (i) high-temperature, rapidly quenched microspherules and SLOs; (ii) corundum, mullite, and suessite (Fe(3)Si), a rare meteoritic mineral that forms under high temperatures; (iii) melted SiO(2) glass, or lechatelierite, with flow textures (or schlieren) that form at > 2,200 °C; and (iv) particles with features indicative of high-energy interparticle collisions. These results are inconsistent with anthropogenic, volcanic, authigenic, and cosmic materials, yet consistent with cosmic ejecta, supporting the hypothesis of extraterrestrial airbursts/impacts 12,900 years ago. The wide geographic distribution of SLOs is consistent with multiple impactors.

Objectives: The purpose of this study was to determine to what extent school-aged children can learn hygiene-based nonpharmaceutical interventions (NPIs) and persist in these behavioral changes over the duration of an influenza season. If this can be done successfully, it may be a preferable pandemic mitigation strategy to much more disruptive strategies such as whole-scale school closure., Methods: The Pittsburgh Influenza Prevention Project (PIPP) is a prospective, controlled, randomized trial of the effectiveness of a suite of hygiene-based NPIs in controlling influenza and related illnesses in elementary schools in the City of Pittsburgh. During the 2007-08 school year, the project measured adoption of NPIs by students in five elementary schools through surveys of home-room teachers before, during, and after influenza season., Results: Results showed highly statistically significant improvement in students' daily practice of nearly all of the NPIs, including hand washing and sanitizer use and covering coughs and sneezes., Conclusions: The study provides evidence that children can learn, implement, and persist in the behaviors of a multilayered suite of NPIs over a typical flu season. These results will be useful to public health policy makers and practitioners considering methods of infectious disease prevention in school-based settings.

Objective: Lung transplantation is a viable, life-saving intervention for several primary pulmonary disorders complicated by severe lung dysfunction. This study was undertaken to evaluate whether patients with systemic sclerosis (scleroderma), a systemic autoimmune rheumatic disorder, would receive similar benefit from this intervention., Methods: Survival following lung transplantation was examined at 2 university medical centers among 29 patients with scleroderma as compared with 70 patients with idiopathic pulmonary fibrosis (IPF) and 38 with idiopathic pulmonary arterial hypertension (IPAH), the latter groups representing pathologically related primary pulmonary disorders. The end point was death from any cause. Risk of mortality in patients with scleroderma was compared with that in patients with IPF or IPAH, with adjustment for demographic and clinical parameters., Results: During 2 years of followup, 11 patients with scleroderma (38%), 23 with IPF (33%), and 14 with IPAH (37%) died. Cumulative survival at 6 months posttransplantation was 69% in the scleroderma group compared with 80% in the IPF group (log-rank P = 0.21) and 79% in the IPAH group (P = 0.38). The estimated risk of mortality at 6 months was increased in patients with scleroderma compared with those with IPF (relative risk [RR] 1.70, 95% confidence interval [95% CI] 0.74-3.93) and those with IPAH (RR 1.52, 95% CI 0.59-3.96), but the differences were not statistically significant. Over the following 18 months, there was convergence in the survival rates such that cumulative survival at 2 years was comparable, at approximately 64%, among all 3 groups., Conclusion: Patients with scleroderma who are recipients of lung transplantation experience similar rates of survival 2 years after the procedure compared with those with IPF or IPAH. Lung transplantation may represent a viable therapeutic option to consider for patients with end-stage lung disease due to scleroderma.

Context: Effective pathology practice increasingly requires familiarity with concepts in medical informatics that may cover a broad range of topics, for example, traditional clinical information systems, desktop and Internet computer applications, and effective protocols for computer security. To address this need, the University of Pittsburgh (Pittsburgh, Pa) includes a full-time, 3-week rotation in pathology informatics as a required component of pathology residency training., Objective: To teach pathology residents general informatics concepts important in pathology practice., Design: We assess the efficacy of the rotation in communicating these concepts using a short-answer examination administered at the end of the rotation. Because the increasing use of computers and the Internet in education and general communications prior to residency training has the potential to communicate key concepts that might not need additional coverage in the rotation, we have also evaluated incoming residents' informatics knowledge using a similar pretest., Data Sources: This article lists 128 questions that cover a range of topics in pathology informatics at a level appropriate for residency training. These questions were used for pretests and posttests in the pathology informatics rotation in the Pathology Residency Program at the University of Pittsburgh for the years 2000 through 2002. With slight modification, the questions are organized here into 15 topic categories within pathology informatics. The answers provided are brief and are meant to orient the reader to the question and suggest the level of detail appropriate in an answer from a pathology resident., Results: A previously published evaluation of the test results revealed that pretest scores did not increase during the 3-year evaluation period, and self-assessed computer skill level correlated with pretest scores, but all pretest scores were low. Posttest scores increased substantially, and posttest scores did not correlate with the self-assessed computer skill level recorded at pretest time., Conclusions: Even residents who rated themselves high in computer skills lacked many concepts important in pathology informatics, and posttest scores showed that residents with both high and low self-assessed skill levels learned pathology informatics concepts effectively.

Background: Most lung transplant recipients experience improvement in their underlying pulmonary condition but are faced with the threat of allograft rejection, the primary determinant of long-term survival. Several studies examined predictors of rejection, but few focused on the early period after transplantation., Objectives: To describe the pattern and predictors of early rejection during the first year after transplantation to guide the development of interventions to facilitate earlier detection and treatment of rejection., Methods: Data for donor, recipient, and posttransplant variables were retrieved retrospectively for 250 recipients of single or double lung transplants., Results: Most recipients (85%) had at least 1 episode of acute rejection; 33% had a single episode; 23% had recurrent rejection; 3% had persistent rejection; 13% had refractory rejection; and 14% had clinicopathological evidence of chronic rejection. Serious rejection (refractory acute rejection or chronic rejection) developed in 27% of recipients. Compared with other recipients, recipients who had serious rejection had more episodes of acute rejection (P = .004), and the first acute episodes occurred sooner after transplantation (P = .01) and were of a higher grade (P = .002)., Conclusions: Recipients who experienced higher grades for their first episode of acute rejection (P = .03) and higher cumulative rejection scores (P = .004) were significantly more likely than other recipients to have serious rejection during the first year after transplantation.

The University of Pittsburgh lung transplantation program began in 1982 and through 2002 we have performed 576 lung and 101 heart-lung transplants. One-, 3- and 5-year survival rates over the past decade have been 77%, 62% and 55%, respectively, comparing favorably to ISHLT registry outcomes of 73%, 57% and 46%. We continue to utilize a very thorough evaluation process but have been flexible and aggressive with potential recipients with regard to age, coronary artery disease and disease state (eg., scleroderma). Despite worldwide progress in the field of lung transplantation, many difficulties remain. The limited number of lungs deemed acceptable for transplantation continues to hinder application to a greater number of patients. Our efforts in this regard have focused on cooperation with our OPO in education and detailed donor management protocols. Chronic rejection also remains a major difficulty frequently leading to death. Recent work utilizing aerosol cyclosporine in patients with established chronic rejection suggests that this therapy may prolong life. We are also hopeful that recently initiated therapies utilizing T-cell induction strategies may contribute to further improvement in outcomes.