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Missing data is common in electronic health records (EHR)-based obesity research. To avoid bias, it is critical to understand mechanisms that underpin missingness. We conducted a survey among bariatric surgery patients in three integrated health systems to (i) investigate predictors of disenrollment and (ii) examine differences in weight between disenrollees and enrollees at 5 years. We identified 2883 patients who had bariatric surgery between 11/2013 and 08/2014. Patients who disenrolled before their 5-year anniversary were invited to participate in a survey to ascertain reasons for disenrollment and current weight. Logistic regression was used to investigate predictors of disenrollment. Five-year percent weight change distributions were estimated using inverse-probability weighting to adjust for (un)availability of EHR weight data at 5 years among enrollees and survey (non-)response among disenrollees. Among 536 disenrolled patients, 104 (19%) completed the survey. Among 2347 patients who maintained enrollment, 384 (16%) had no weight measurement in the EHR near 5 years. Insurance, age, Hispanic ethnicity, and site predicted disenrollment. Disenrollees had slightly greater weight loss than enrollees. We found little evidence of weight loss differences by enrollment status. Collecting information through surveys can be an effective tool to investigate and adjust for missingness in EHR-based studies.

Health benefits to relatives of people at known genetic risk for hereditary cancer syndromes is key to realizing the promise of precision medicine. We conducted a qualitative study to design a patient- and family-centered program for direct contact of relatives to recommend cascade genetic testing. We conducted two rounds of data collection using focus groups followed by individual interviews with patients with HBOC or Lynch syndrome and a separate sample of people with a family history of hereditary cancers. Results indicate that U.S.-based health system-led direct contact of relatives is acceptable to patients and families, should take a programmatic approach, include consent of relatives before proband testing, complement to existing patient-mediated disclosure, and allow for relative control of information. Our findings suggest a set of requirements for U.S.-based direct contact programs that could ultimately benefit more relatives than current approaches.

Missing data is common in electronic health records (EHR)-based obesity research. To avoid bias, it is critical to understand mechanisms that underpin missingness. We conducted a survey among bariatric surgery patients in three integrated health systems to (i) investigate predictors of disenrollment and (ii) examine differences in weight between disenrollees and enrollees at 5 years.We identified 2883 patients who had bariatric surgery between 11/2013 and 08/2014. Patients who disenrolled before their 5-year anniversary were invited to participate in a survey to ascertain reasons for disenrollment and current weight. Logistic regression was used to investigate predictors of disenrollment. Five-year percent weight change distributions were estimated using inverse-probability weighting to adjust for (un)availability of EHR weight data at 5 years among enrollees and survey (non-)response among disenrollees.Among 536 disenrolled patients, 104 (19%) completed the survey. Among 2347 patients who maintained enrollment, 384 (16%) had no weight measurement in the EHR near 5 years. Insurance, age, Hispanic ethnicity, and site predicted disenrollment. Disenrollees had slightly greater weight loss than enrollees.We found little evidence of weight loss differences by enrollment status. Collecting information through surveys can be an effective tool to investigate and adjust for missingness in EHR-based studies.

Background Counseling patients with written materials relies equally on patients' health literacy to understand their disease and its treatment, and the written materials' effectiveness communicating clearly in accessible and actionable ways. Only about 12% of the US population is adequately health literate. Objectives To explore the impact of reducing the health literacy demands of written patient health information. Methods 805 patients were screened for health literacy, and recruited for balanced cohorts of adequate and low literacy, and high and normal blood pressure. Half of each patient cohort received either standard or “health literacy-friendly” drug summaries (i.e. Patient Package Inserts, or PPIs or “leaflets”) along with a standardized health literacy assessment scale. Results The literacy-friendly drug summary improved comprehension of drug-related information overall from 50% to 71% correct responses. Adequate literacy patients improved from 58% correct to 90%, while lower literacy patients improved from 42% to 52% correct in response to the health literacy-friendly PPIs. Conclusions Health literacy demands require special attention in developing and using written drug summary materials. Additionally, pharmacists should be provided additional information and counseling support materials to facilitate communications with low health literacy level patients.

Diffuse large B-cell lymphoma (DLBCL) is a non-Hodgkin's lymphoma (NHL) that is the most common and the most aggressive or fast-growing form of NHL. It can lead to death if left untreated. Cytogenetic abnormalities include rearrangements of the IgH and BCL2 genes. Herein we described a t(8;14;22)(q24;q32;q11.2) within the context of a complex karyotype involving MYC/IGH/IGL in a three-way translocation that was characterized by molecular cytogenetics. The t(8;14)(q24;q32) is a recurrent chromosome abnormality described in non-Hodgkin lymphomas (NHL), especially in 80% of Burkitt lymphoma (BL) and diffuse large B-cell lymphomas. The variant t(8;22) (q24;q11) is also seen in these cases. MYC rearrangements have been observed in up to 10% of cases of diffuse large B-cell lymphomas (DLBCL) and is usually associated with a complex pattern of genetic alterations. This particular pattern with IGH-MYC rearrangements within the context of complex karyotypes is seen in diffuse large B-cell lymphomas. Complex karyotypes are associated with genomic instability and a poor prognosis.

What physical findings should raise your suspicion? How are tumors treated and what follow-up care can you provide? Here's what you need to know.

Ghana ThinkTank has been “Developing the First World” since 2006. We collect problems in the so-called developed world, and send them to think tanks we established in Cuba, Ghana, Iran, Mexico, El Salvador, and the U.S. prison system to analyze and solve. Our network continues to grow . . .

K-12 mathematics education has undergone many changes over the past decades, sometimes driven forward by mathematicians, sometimes by mathematics educators. Those two groups have often disagreed, but we are now in a more cooperative period in which experts on both sides seem to agree more and argue less. But in reaching this rapprochement, we have left out another group of experts who offer valuable perspectives and fresh ideas—the K-12 mathematics teachers themselves. In doing so, we not only miss the opportunity to draw on different expertise but also inadvertently demean the teaching profession itself.

The sport of association football is widely known as 'the beautiful game'. The idea of football as 'the people's game' comes very much from the popular understanding of the sport's British origins, subsequent to the game's codification and development into competitions in the latter part of the 1800s, whereby football clubs are seen to be representative of particular localities. When Leicester City, unexpectedly and against considerable odds, won the 2015/2016 English Premier League, the victory was heralded as a triumph of the city of Leicester and, therefore, for the people of Leicester. The modern Premier League is the elite division of English football, the pinnacle of five national tiers comprising 116 clubs, underpinned by an extensive network of regional leagues. Traditionally, the practice of attending football matches in England was often engaged in by working-class males, and up until the late 1950s attendance was primarily confined to relatively localised support.

Martin Peters was a successful footballer whose public persona matched the way he played the game, without fuss or fanfare. A key English player of the 1960s, he does not usually feature in discussions about the connection between fashion and football in that decade. The focus is usually placed on players with celebrity status, especially George Best. This paper, working at the intersection of sport and fashion history and cultural studies, broadens the discussion by giving consideration to the non-celebrity-type player. This is done via an examination of the off-field dress and style of Martin Peters. The case is made, from studying the sartorial presentation of Peters, that we can recognize a connection between the player and other young men who favoured a low-key identification with the Mod culture of the time. This position supports a shift within the cultural historical study of British youth and masculine identity from the spectacular to the unspectacular.

Two university education courses were converted from face-to-face delivery to a blended learning delivery model. Ideally the conversion took place to leverage new pedagogical understandings and new technologies to improve student learning. The redesign of the courses also came about for economic and scheduling reasons. The result of this conversion was the creation of two new blended learning courses that were designed to be learner centered, constructivist, and reflective. In theory, two different courses were created demonstrating the possibilities available when applying theoretical practices to course redesign. In practice, this allowed pre-service teachers to experience a pedagogically appropriate course that they can use as a model later in their own professional practice. It also emphasized the importance of giving learners control of their learning, their time and valuing their input into course design.

The study focuses on guiding students through an exploration of social constructivism model as it relates to the roles of instructor and learner. It explores the use of a metaphor, the dot, to demonstrate that metaphors can support deeper understanding of difficult concepts inherent in learner-centered and constructivist pedagogies. This research was conducted to ascertain whether metaphors provide common reference points for learners that can be used to build and test new assumptions of knowledge. Additionally, the study highlights challenges that learner-centered pedagogy face when identifying preconceived constructs and moving towards the adoption of new thoughts, perspectives, and reasoning. In theory, this study identified the continuing role that metaphors play in the learning theory and how the literature can be explored further. In practice, the study identified student-centered activities, which include the learner as a contributor to knowledge, learning in a community of learners, and empowering the learner to change.

What should we conclude? Should we steadfastly maintain the status quo? Do we avoid technology altogether? Of course not.We should experiment; we should try out new things; we should tinker with technology and find better ways to communicate.