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The article discusses the study regarding the perspectives of a group of teacher activists on their interpretation of and interaction with the new Every Student Succeeds Act (ESSA) in the U.S., wherein a subcommittee from the Badass Teachers Association, Inc. (BATs) has been formed to review ESSA. Topics discussed include the views and priorities of teachers in making sense of ESSA, the engagement and responds of teachers to ESSA, and the influence of ESSA to teacher's activism and advocacy.

The article discusses issues related to a story that has been in circulation concerning the attitudes of some local linguists in the U.S. to linguist Roman Jakobson soon after his arrival in New York, fleeing from Nazi-ridden Europe, in 1941. One linguist noted that the initial reception accorded Jakobson by the American linguistic world was not entirely hospitable and that the differences in methodology, or perhaps the fear of competition for the available positions, may have been responsible for this coolness.

The concept of applying constraints on individual sources to a small fraction of the public dose limit has been deemed inappropriate when shielding the medical X-ray sources. This represents a broad-based consensus of medical physics and radiological societies in the United States, and the report series on the shielding design for medical X-ray sources (including dental, X-ray imaging and therapeutic X ray) from the National Council on Radiation Protection and Measurements (NCRP) utilises 1 mSv y-1 as a source control limit. In the present study, the rationale for such a conclusion is discussed, and a somewhat critical look at the current model of radiation protection of the public is made. [ABSTRACT FROM AUTHOR]

Introduction: The Eastern Association for the Surgery of Trauma mission includes fostering research and providing career development opportunities. Eastern Association for the Surgery of Trauma has awarded for 20 years a research scholarship to a promising young investigator. The research mentorship efforts were expanded 5 years ago with the INVEST-C Hack-a-thon. INVEST-C provides an intensive, short-term engagement to propel junior faculty toward establishing research independence. This study investigates the impact of these programs on academic productivity., Methods: Pubmed records, National Institutes of Health (NIH) Reporter data, and SCOPUS h-index were acquired for all scholarship (SCH) awardees from 2002 to 2021 (n = 20) and all INVEST-C (INV) participants (2017-2020, n = 19). Current type of practice, total number of funding awards, and timing of first award were ascertained. INVEST-C participants were also surveyed on an annual basis to track their progress. Medians (interquartile range [IQR]) are reported and compared (analysis of variance)., Results: Median publications (PUBs) of SCH awardees were 56 (IQR, 33-88), h-index was 16 (IQR, 12-21), and 25% of awardees have ≥1 NIH grant since their SCH. Among the last 10 awardees with a minimum of 2 years from SCH, 40% have received an NIH award compared with a mean NIH funding rate of 18.5% over the same period. For those remaining in academics (90% SCH), PUBs were higher for those >5 years (66 [IQR, 51-115]) versus <5 years from their SCH (33 [22-59]; p = 0.05), but there was no difference in h-index (16 [IQR, 14-25] vs. 15 [9-19], p = NS). Comparing the most recent 5 years of SCH to INV group, there was no difference in academic productivity as measured by total PUBs (SCH, 33 [IQR, 22-59] vs. INV, 34 [IQR, 18-44]; p = 0.7) or h-index (INV, 9 [IQR, 5-14]; p = 0.1). However, no attendee held research funding before INV, but 31.6% (6 of 19 attendees) have subsequently acquired ≥1 funding award (11 non-NIH, 1 NIH) in the short interval since participation., Conclusion: Investments in research activities have translated to significant extramural funding. Those in the last 5 years have been particularly fruitful with INV participants already achieving equal median academic productivity to SCH recipients., Level of Evidence: Prognostic and Epidemiologic; Level III., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Gastroenterologists at all levels of practice benefit from formal mentoring. Much of the current literature on mentoring in gastroenterology is based on expert opinion rather than data. In this study, we aimed to identify gender-related barriers to successful mentoring relationships from the mentor and mentee perspectives., Methods: A voluntary, web-based survey was distributed to physicians at 20 academic institutions across the United States. Overall, 796 gastroenterology fellows and faculty received the survey link, with 334 physicians responding to the survey (42% response rate), of whom 299 (90%; 129 women and 170 men) completed mentorship questions and were included in analysis., Results: Responses of women and men were compared. Compared with men, more women preferred a mentor of the same gender (38.6% women vs 4.2% men, P < 0.0001) but less often had one (45.5% vs 70.2%, P < 0.0001). Women also reported having more difficulty finding a mentor (44.4% vs 16.0%, P < 0.0001) and more often cited inability to identify a mentor of the same gender as a contributing factor (12.8% vs 0.9%, P = 0.0004). More women mentors felt comfortable advising women mentees about work-life balance (88.3% vs 63.8%, P = 0.0005). Nonetheless, fewer women considered themselves effective mentors (33.3% vs 52.6%, P = 0.03). More women reported feeling pressured to mentor because of their gender (39.5% vs 0.9% of men, P < 0.0001). Despite no gender differences, one-third of respondents reported negative impact of the COVID-19 pandemic on their ability to mentor and be mentored., Discussion: Inequities exist in the experiences of women mentees and mentors in gastroenterology, which may affect career advancement and job satisfaction., (Copyright © 2021 by The American College of Gastroenterology.)

Transforming a hospital's culture leads to improved patient satisfaction and physician loyalty.

Objective: To investigate the relative impact of physician groups and health plans on quality of care measures., Design: Secondary data analysis of receipt of preventive care services included in the Health Plan Employer Data and Information Set (HEDIS) among 10 758 patients representing 21 health maintenance organizations and 22 large provider groups in the San Francisco and Los Angeles, California, areas in 1997. Each patient was eligible for (at least) one of six HEDIS-measured services. Data identify whether or not the service was provided, the patient's health plan, and the provider group responsible for the care. We used logistic regression to examine variations across plans in HEDIS rates, and whether variations persist after controls for provider groups are included., Setting: Patients from 21 health maintenance organizations serving San Francisco and Los Angeles, California, in 1997., Main Outcome Measures: Breast cancer screening, childhood immunizations, cervical cancer screening, diabetic retinal exam, prenatal care in the first trimester, and check-ups after delivery among patients for whom these services are appropriate., Results: There are statistically significant differences across health plans in utilization rates for the six services examined. These differences are not substantially affected when we control for the provider group that cared for the patient. That is, controlling for provider group does not explain variations across plans, consistent with the view that health plans have an impact on HEDIS quality measures independent of the providers that they contract with., Conclusions: There are activities that plans can undertake which influence their HEDIS scores. On the face of it, these results suggest that plans can independently improve quality, in contrast to hypotheses that plans would be "too far" from patients to have an influence. Continued attention to collecting plan-level data is warranted. Further work should address other possible sources of variations in HEDIS scores, such as variability in the quality of plan administrative databases.

Objective: The goal of expanding access to individuals with disabilities to scientific and medical conferences is supported by both the Americans with Disabilities Act and the National Institutes of Health., Design: Live-streaming video broadcast over the internet is widely available, although it has been used only in a limited fashion by the medical community. A consumer-oriented medical and rehabilitation conference concerning the rare disabling disease, fibrodysplasia ossificans progressiva, was broadcast via the world wide web. The address of a web page was announced before the conference to three computer users' groups that were considered likely to have an interest in the conference. The web page presented a live-streaming video broadcast of the conference. A phone line was installed, thereby allowing viewers to ask questions of the presenters during the question and answer periods., Results: Sixteen users logged in 83 times to view the conference over a 2-day period. Five (23%) of 22 members of a fibrodysplasia ossificans progressiva internet users' group tuned in from distant places as The Netherlands and Israel., Conclusions: The internet is a viable tool to expand access to and increase the participation of individuals with disabilities in scientific and medical conferences. This technology should be used routinely in conferences of interest.

Realistic estimates about the potential misallocation of health service resources, in relation to the cost-beneficial use of blood products, is enabled by tracing manufacturing costs, through product specification elements to corresponding post-transfusion outcomes. This quality-associated costing (QAC) philosophy is completed in this article by understanding the issues that surround the manufacture of platelets, and by its comparison with the generally used but arbitrary methods for blood product costing. Without QAC, cost-beneficial platelet therapy will not be realized, due to an estimated Western underfunding of approximately one quarter of a billion pounds per annum by arbitrary methods. A reciprocal consequence of such platelet QAC is a significant reduction in the currently perceived cost of source plasma. Western estimates, based upon this, demonstrate that the not-for-profit fractionation of source plasma into purified proteins is probably underfunded by approximately one fifth of a billion pounds per annum through the use of arbitrary costing methods.

Tennessee is fortunate to have a comprehensive Medicaid program involving some 22 optional services, all financed through a combination of state revenues. These range from general state revenues to provider-donated funds, provider-specific taxes, and recently, a privilege tax. The state pays approximately $920 million to participate in Medicaid; the state's share generates $1.9 billion in federal dollars. The current system for financing the state's Medicaid program is unsustainable. Because Tennessee is relatively poor, legislators cannot afford to continue to increase its share of Medicaid expenditures at a rate 10 times greater than the general revenue increase from the entire state. To continue a comprehensive Medicaid program, Tennessee must move forward with alternative strategies to control Medicaid expenditures and manage resources.

Hospital administrators already know that diversification will be a key to success in the future. Applying that philosophy to long-term care of the elderly is just one way to capture a growing consumer market. In the following article, the author addresses three potential variations for delivering such care by the hospital to this group.

Nosocomial infection data from a mean of 81 hospitals has been reported to the National Nosocomial Infections Study (NNIS) each year since 1970. Surveillance has been conducted by the hospitals on an average of 1.16 million patients annually. The median nosocomial infection rate is 341 per 10,000 patients discharged, ranging from 312 in 1970 to 358 in 1975. Since 1975, the rate has steadily declined to 329 in 1979. By category of hospital, infection rates for community-teaching and municipal hospitals have declined in recent years whereas those for community and university hospitals have not. Infection rates for patients on the surgical service have declined steadily since 1975 to the lowest levels reported, 457 per 10,000 surgical patients discharged in 1979, primarily due to a decrease in the rate of surgical wound infections. On obstetrics, infection rates have increased steadily since 1970, also primarily due to surgical wound infections. Bacteremias have increased in frequency, particularly those associated with infection at other sites. No major shifts have been noted in the relative frequency of the most common sites of infection or pathogens causing infections.

Epidemics account for a small proportion of preventable infections acquired in hospitals, but they have been important in defining sources, modes of spread, and methods for prevention and control of nosocomial infections. To characterize hospital-based epidemics, 265 consecutive outbreaks investigated by the Center for Disease Control between 1956 and 1979 were reviewed. Pseudoepidemics were found in 11 percent of the investigations, most often resulting from errors in processing microbiologic specimens or from surveillance artifacts. In 223 actual epidemics, the pathogens most commonly involved were Staphylococcus aureus (19 percent), tribe Klebsielleae (14 percent), Salmonella (13 percent), hepatitis B virus (8 percent), enteropathogenic Escherichia coli (5 percent), Pseudomonas (4 percent) and group A streptococci (4 percent). Sites of epidemic infection were closely linked to the responsible pathogens. Gastroenteritis (21 percent), skin infection (18 percent), bacteremia (12 percent), meningitis (11 percent) and hepatitis (10 percent), infrequent causes of endemic nosocomial infections, were frequently involved in epidemics. Over the 25-year period reviewed, staphylococcal epidemics and outbreaks of gastroenteritis due to Salmonella and Esch. coli declined in frequency and those due to gram-negative bacilli and hepatitis B virus increased. Since 1970, clusters of primary bacteremia were the most frequently investigated type of epidemic. Many epidemic strains of staphylococci obtained since 1975 or Enterobacteriaceae obtained since 1970 exhibited unusual drug resistance. Specific site-pathogen combinations were closely associated with characteristic reservoirs and modes of spread.

As the AIDS virus spreads into the general population, protecting the public, health workers and patients from possible infection becomes increasingly important. The Surgeon General recommends testing all surgery patients for the presence of AIDS prior to surgery; however, it is often impossible to complete these tests on emergency surgery, labor and delivery and emergency department patients because of the emergent nature of the admission. As the author notes, these patients require special precautions. In this article, the author summarizes the effective disinfection procedures for AIDS recommended by CDC and offers a detailed procedure to be used for cleaning the surgical/delivery suites and emergency room. This procedure upgrades the standards already in existence.

The U.S.'s efforts to improve its regulation of toxic substances presently have their focus in the administration of the Toxic Substance Control Act (TSSC), the Cancer Policy of the regulatory agencies, and the Drug Regulation Reform Act. By improving interagency communication and cooperation as well as establishing a coherent federal approach to the control of toxic substances with public and industrial input, the U.S. government should significantly strengthen the functioning of its regulatory agencies while decreasing the financial burden for everyone involved.

One hundred thirty-nine patients receiving outpatient chemotherapy kept diaries of nonmedical expenses resulting from their disease and its treatment. Diaries were kept for both treatment and nontreatment weeks. Results showed that the mean cost to patients and their families for treatment weeks was $72.81, and for nontreatment weeks it was $45.88. Approximately 45% of these costs were out-of-pocket expenses, and 55% were wages lost. Transportation and food were the largest out-of-pocket expenses. Patients living at greater distance from treatment had higher out-of-pocket costs, and younger patients reported more wages lost. Fourteen percent of the patients were estimated to be spending more than 50% of their weekly incomes on nonmedical expenses, and these patients were found largely in the lower-income categories. A method is proposed for using these data to estimate total nonmedical expenses for different treatment regimens, and also for estimating cancer patients' total nonmedical costs nationally.

Since January, 1970, the Center for Disease Control (CDC) has corridnated surveillance of nosocomial infections in a group of voluntarily cooperating hispitals in the United States. In 1970, this surveillance system failed to realize one of its major goals: detection of a nationwide epidemic of septicemia caused by contaminated intravenous products. However, retrospective review of infections reported to CDC revealed that the data received were sufficient for the outbreak to have been recognized. Beginning in July, 1970, one month after the contaminated products were first distributed and five months before the outbreak was actually detected. CDC data showed a persistent increase in the incidence of Enterobacter and Erwinia (presently designated Enterobacter agglomerans) bacteremia. Furthermore, monthly rates of cases of bacteremia caused by these organisms were higher in hospitals using the contaminated intravenous products than for hospitals not using them. Failure to detect this outbreak at the time of its occurrence was due to delays in data processing and insufficiently sophisticated data analysis. Based on this experience, CDC has modified the surveillance system to aid recognition of future outbreaks.

Radiology is being affected by many new requirements which are being imposed both by government regulatory agencies and by organizations responsible for setting standards (e.g. JCAHO and NCRP). The purpose of this article is to provide some rationale for these rules and to give administrators a logical basis for their policies and procedures.

A two-stage process is proposed for a uniform framework for Federal agency decisions regarding the identification, characterization, and control of potential human carcinogens. Stage I would include the identification, through epidemiologic and/or laboratory studies, of chemicals that represent a potential carcinogenic risk and the characterization of that risk. Stage II would encompass the actual regulatory decision-making process regarding control of potential carcinogens. Stage I relies predominantly on scientific activity and judgment. Centralized management could enhance the efficiency and effectiveness of this process. The new National Toxicology Program may be able to perform this function. Stage II judgments are social and political. Centralization of stage II decision-making is not possible under current law.

To determine research priorities in infectious diseases, the impact of infections on hospital care in the United States is estimated from the number of infectious diseases observed in hospitals that cooperate with the Center for Disease Control in surveillance of community-acquired and nosocomial infections. Each year, over 3 million community-acquired infections require persons to be hospitalized, and over 2 million nosocomial infections are acquired. Approximately 90% of the infections treated in hospitals are bacterial. These infections account for an estimated 29 million days of acute hospital care, which is approximately 10% of the patient days in United States acute-care hospitals. The direct hospitalization costs for treating infectious diseases are estimated to be over $4.8 billion. Treatment of infectious diseases accounts for a major portion of hospital care in the United States.

To evaluate one aspect of the impact of respiratory tract infections in the United States, national survey data were used to estimate direct and indirect economic costs. Overall, upper and lower respiratory tract infections are estimated to be responsible for approximately $15 billion in direct treatment costs. Physician charges account for about one half and hospital care accounts for approximately one quarter of these costs. An estimated 1.25 million patients are hospitalized yearly for community-acquired respiratory tract infections, and charges for their care are projected to exceed $4 billion. Almost 300 thousand patients acquire nosocomial respiratory infections yearly, and charges for treating these infections are approximately $470 million. Although costs associated with hospital care are substantial, approximately $10 billion (67 percent of the total estimated cost of these infections) results from treatment of patients in ambulatory settings. It is not possible to calculate the full magnitude of the indirect costs of respiratory infections, but losses in income of employed persons who miss work because of infection are calculated to be more than $9 billion per year.