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Cancer mortality risks for Wisconsin white male farmers were examined during the years 1981 to 1990. Four malignancies were studied: Non-Hodgkin's lymphoma, melanoma, colon cancer, and rectal cancer. Occupation coded deaths were segmented into farmer and nonfarmer groups and population counts for the groups were estimated from 1980 and 1990 Bureau of the Census data. Standardized mortality ratios (SMRs) were constructed from the ratio of observed farmer deaths and the expected number of farmer deaths. Expected deaths were generated from the underlying statewide nonfarmer rate for the malignancy multiplied into the farmer population at risk. Farmers had significantly lower mortality risks for melanoma (SMR: 0.659; 95% CI: 0.993-0.326) and colon cancer (SMR: 0.763; 95% CI: 0.928-0.599). Farmers also exhibited a nonsignificant decrement for non-Hodgkin's lymphoma (SMR: 0.930; 95% CI: 1.214-0.645). For rectal cancer, farmers experienced a slightly higher but essentially the same risk as nonfarmers (SMR: 1.013; 95% CI: 1.418-0.608)--the SMR was not significant. This study corroborates a number of cancer incidence and mortality investigations demonstrating that farmers generally experience the same or lower mortality risks for these malignancies. [ABSTRACT FROM AUTHOR]

Cumulative sun exposure has been linked to about 95 percent of all skin cancers. Farmers and their families, by nature of their occupations, are exposed to an abundance of sun over a long period of time and, therefore, are at an increased risk for skin cancer. Because education is known to be a primary means of health, Future Farmers of America (FFA) peer facilitators (teen educators) provided third graders in rural communities sun protection education with the hope that the message would reach the entire family. The FFA facilitators (n = 217) from 39 FFA organizations throughout Wisconsin were trained with skin cancer and sun protection information. The FFA facilitators then gave presentations on sun protection to third graders (n = 2,007) in their school districts. Control schools included 57 facilitators and 669 third graders. Evaluation involved pre-, post-, and six-month follow-up surveys testing knowledge gained by the third graders. Students who correctly responded to a question on the post-survey after incorrectly answering it on the pre-survey were said to have had a knowledge gain for that question. By using chi-square tests, the intervention group demonstrated a statistically significant (P < 0.001) higher proportion of students experiencing knowledge gain than did the control group from pre- to post-surveys for nine of the 10 questions. Summary statistics were used to describe the study population. In addition to skin cancer knowledge questions, the survey of facilitators included sun protection behavior and attitude questions. This intervention was able to use peer educators as instructors to demonstrate knowledge gain in the youths of the target population. The pilot project materials costs were +0.55 per third grade student and +3.50 per facilitator. Using a school-based organization such as FFA provided a cost-effective means of reaching the rural population. [ABSTRACT FROM AUTHOR]

Hispanic migrant agricultural workers' exposure to pesticides and other agrichemicals places them at increased risk for a variety of acute and chronic conditions, including cancer. As a socioeconomically disadvantaged group, migrant workers also face many barriers to effective cancer control. In 1992, a series of focus groups was held with 55 Hispanic migrant agricultural workers (22 women, 33 men) in central Wisconsin to gather information on their knowledge and attitudes regarding cancer etiology and treatment, their practices regarding cancer screening and early detection, and their concerns regarding occupational exposure to pesticides. Beliefs that pesticides are toxic and can cause health problems were common among participants. In addition, however, participants reported that they are reluctant to demand occupational protections to which they are entitled because they are afraid of losing their jobs. Study results also suggest that barriers to effective primary and secondary prevention of cancer in this Hispanic migrant agricultural worker population include knowledge and information barriers, cultural barriers, and socioeconomic barriers. A lack of knowledge and information regarding the causes of cancer, its prevention, and its early detection and treatment was evident among participants, which in turn was reflected in strong fatalistic attitudes toward the disease. Cultural barriers included attitudes of embarrassment and shame associated with physical examinations and women's strong discomfort with male clinicians. Socioeconomic barriers to secondary prevention included the cost of obtaining health services, time constraints associated with the need to work and long working days, and a lack of transportation. Efforts to improve cancer screening as well as other preventive health services in the Hispanic migrant agricultural worker population must acknowledge these barriers and address as many of them as possible to be successful. [ABSTRACT FROM AUTHOR]

Introduction: A benefit of a milestone or Entrustable Professional Activity (EPA) assessment framework is the ability to capture longitudinal performance with growth curves using multi-level modelling (MLM). Growth curves can inform curriculum design and individualised learning. Residency programmes have found growth curves to vary by resident and by milestone. Only one study has analysed medical students' growth curves for EPAs. Analysis of EPA growth curves is critical because no change in performance raises concerns for EPAs as an assessment framework., Methods: Spencer Fox Eccles School of Medicine-University of Utah students' workplace-based assessment ratings for 7 EPAs were captured at 3 time-points in years 3-4 of AY2017-2018 to AY2020-2021. MLM was used to capture EPA growth curves and determine if variation in growth curves was explained by internal medicine (IM) clerkship order., Findings: A curvilinear slope significantly captured 256 students' average ratings overtime for EPA1a-history-taking, EPA2-clinical reasoning, EPA3-diagnostics, EPA5-documentation and EPA6-presentation, and a linear slope significantly captured EPA9-teamwork ratings, p ≤ 0.001. Growth curves were steepest for EPA2-clinical reasoning and EPA3-diagnostics. Growth curves varied by students, p < 0.05 for all EPA ratings, but IM clerkship rotation order did not significantly explain the variance, p > 0.05., Discussion: The increase in ratings from Year 3 to Year 4 provides validity evidence for use of EPAs in an assessment framework. Students may benefit from more curriculum/skills practice for EPA2-clinical reasoning and EPA3-diagnostics prior to year 3. Variation in student's growth curves is important for coaching and skill development; a one size fits all approach may not suffice., (© 2023 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Phenomenon: There is an abundance of literature on Entrustable Professional Activities (EPAs) in theory, but there are few studies on the EPAs in practice for undergraduate clinical education. In addition, little is known about the degree to which the EPAs are or are not aligned with physician assessors' performance schemas of the clerkship student. Investigating the degree to which physician assessors' performance schemas are already aligned with the activities described by the EPAs is critical for effective workplace assessment design. Approach: We sampled 1,032 areas of strength (strength) and areas for improvement (improvement) written evaluation comments by 423 physician assessors for clerkship students' performance in academic years 2014-15 and 2015-16 at the University of Utah School of Medicine. Two researchers independently categorized each comment by EPA and/or coded by non-EPA topic. The proportion of comment types was compared between strength comments and improvement comments with the Wilcoxon Signed-Rank Test. Findings : The most frequently mentioned EPAs in comments were about history gathering/physical exam, differential diagnosis, documentation, presentation, and interprofessional collaboration; few mentioned diagnostic tests, patient handovers, recognition of urgent patient care, and patient safety, and none mentioned orders/prescriptions and informed consent. The most frequent non-EPA topics were about medical knowledge, need to read more, learning attitude, work ethic, professionalism/maturity, and receptiveness to feedback. The proportion of comments aligned with an EPA only, a non-EPA topic only, or both an EPA and non-EPA topic was significantly different for clerkship students' strength compared to improvement. Insights: Physician assessors' performance schemas for clerkship students were aligned with EPAs to varying degrees depending on the specific EPA and whether describing strength or improvement. Of interest, the frequently mentioned non-EPA comments represented some of the competencies that contribute to effectively performing particular EPAs and are Accreditation Council for Graduate Medical Education (ACGME) core competencies (e.g., medical knowledge, professionalism), used in residency programs. Because physician assessors for undergraduate medical education often also participate in graduate medical education, the frequency of non-EPA topics aligned to ACGME competencies may suggest influence of graduate medical education evaluative frameworks on performance schemas for clerkship students; this could be important when considering implementation of EPAs in undergraduate medical education.

Background: Feedback is a critical element of graduate medical education. Narrative comments on evaluation forms are a source of feedback for residents. As a shared mental model for performance, milestone-based evaluations may impact narrative comments and resident perception of feedback., Objective: To determine if milestone-based evaluations impacted the quality of faculty members' narrative comments on evaluations and, as an extension, residents' perception of feedback., Design: Concurrent mixed methods study, including qualitative analysis of narrative comments and survey of resident perception of feedback., Participants: Seventy internal medicine residents and their faculty evaluators at the University of Utah., Approach: Faculty narrative comments from 248 evaluations pre- and post-milestone implementation were analyzed for quality and Accreditation Council for Graduate Medical Education competency by area of strength and area for improvement. Seventy residents were surveyed regarding quality of feedback pre- and post-milestone implementation., Key Results: Qualitative analysis of narrative comments revealed nearly all evaluations pre- and post-milestone implementation included comments about areas of strength but were frequently vague and not related to competencies. Few evaluations included narrative comments on areas for improvement, but these were of higher quality compared to areas of strength (p < 0.001). Overall resident perception of quality of narrative comments was low and did not change following milestone implementation (p = 0.562) for the 86% of residents (N = 60/70) who completed the pre- and post-surveys., Conclusions: The quality of narrative comments was poor, and there was no evidence of improved quality following introduction of milestone-based evaluations. Comments on areas for improvement were of higher quality than areas of strength, suggesting an area for targeted intervention. Residents' perception of feedback quality did not change following implementation of milestone-based evaluations, suggesting that in the post-milestone era, internal medicine educators need to utilize additional interventions to improve quality of feedback.

A process for the development, characterization and correlation of composite materials for 3D printing is presented, alongside the processing of a polymer-ceramic functional composite using fused deposition modeling (FDM). The composite was developed using acrylonitrile butadiene styrene (ABS) as the matrix material filled with barium titanate (BT) micro-powder up to 35 vol % (74.2 wt %). The ABS-BT composites exhibited a shear thinning behavior with increasing ceramic content. The composite was 3D printed into structural and functional test samples using FDM by adapting and optimizing the print parameters. Structural characterization revealed increasingly brittle behavior at higher filler ratios, with the ultimate tensile strength falling from 25.5 MPa for pure ABS to 13.7 MPa for the ABS-35 vol % BT composite. Four-point flexural tests showed a similar decrease in flexural strength with increasing ceramic content. Functional characterization revealed an increase in the relative permittivity at 200 kHz from 3.08 for pure ABS to 11.5 for the composite with 35 vol % BT. These results were correlated with the Maxwell-Garnett and Jayasundere-Smith effective medium models. The process described in this work can be used for other 3D printing processes and provides a framework for the rapid prototyping of functional composites into functional parts with reliable properties. The ABS-BT composite shows promise as a functional dielectric material, with potential applications as capacitors and light-weight passive antennas.

In this work, a 3D printed polymer-metal soft-magnetic composite was developed and characterized for its material, structural, and functional properties. The material comprises acrylonitrile butadiene styrene (ABS) as the polymer matrix, with up to 40 vol. % stainless steel micropowder as the filler. The composites were rheologically analyzed and 3D printed into tensile and flexural test specimens using a commercial desktop 3D printer. Mechanical characterization revealed a linearly decreasing trend of the ultimate tensile strength (UTS) and a sharp decrease in Young's modulus with increasing filler content. Four-point bending analysis showed a decrease of up to 70% in the flexural strength of the composite and up to a two-factor increase in the secant modulus of elasticity. Magnetic hysteresis characterization revealed retentivities of up to 15.6 mT and coercive forces of up to 4.31 kA/m at an applied magnetic field of 485 kA/m. The composite shows promise as a material for the additive manufacturing of passive magnetic sensors and/or actuators., Competing Interests: The authors declare no conflict of interest.

Biomedical research cannot succeed without funding, knowledgeable staff, and appropriate infrastructure. There are however equally important but intangible factors that are rarely considered in planning large multidisciplinary endeavors or evaluating their success. The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial required extensive collaborations between individuals from many fields, including clinicians, clinical trialists, and administrators; it also addressed questions across the spectrum of cancer prevention and control. In this manuscript, we examine the experiences and opinions of trial staff regarding the building of successful relationships in PLCO. We summarize, in narrative form, data collected using open-ended questionnaires that were administered to the National Cancer Institute project officers, coordinating center staff, screening center principal investigators, and screening center coordinators in 2015, about 3 years after publication of the final primary trial manuscript. Trust, respect, listening to others, and in-person interaction were frequently mentioned as crucial to building successful relationships.

There were significant recruitment challenges specific to the PLCO Cancer Screening Trial. Large numbers of participants were to be randomized from ten catchment areas nationwide within time and budgetary constraints. The eligible population was elderly and had to meet health and behavioral thresholds. Informed consent was required to participate and be randomized to screening for three cancers at periodic clinic visits or to a usual care arm that included no clinical visits. Consenting required special efforts to fully explain the trial and its potential scientific benefit to future patients with potentially no benefits but possible harms to PLCO participants. Participation would include continued follow-up for at least 13 years after randomization. Strong collaborative investments were required by the NCI and screening centers (SCs) to assure timely recruitment and appropriate racial participation. A trial-wide pilot phase tested recruitment and protocol follow through at SCs and produced a vanguard population of 11,406 participants. NCI announced the trial nationally in advance of the pilot and followed with an even more intense collaborative role with SCs for the main phase to facilitate trial-wide efficient and timely recruitment. Special efforts to enhance recruitment in the main phase included centralized and local monitoring of progress, cross-linking SCs to share experiences in problem solving, centralized training, substantial additional funding dedicated to recruitment and retention, including specialized programs for minority recruitment, obtaining national endorsement by the American Cancer Society, launching satellite recruitment and screening centers, including minority focused satellites, and adding a new SC dedicated to minority recruitment.

Background: The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) is a US National Cancer Institute (NCI)-funded randomized controlled trial designed to evaluate whether certain screening tests reduce mortality from prostate, lung, colorectal, and ovarian cancer. To obtain adequate statistical power, it was necessary to enroll over 150,000 healthy volunteers. Recruitment began in 1993 and ended in 2001., Purpose: Our goal is to evaluate the success of recruitment methods employed by the 10 PLCO screening centers. We also provide estimates of recruitment yield and cost for our most successful strategy, direct mail., Methods: Each screening center selected its own methods of recruitment. Methods changed throughout the recruitment period as needed. For this manuscript, representatives from each screening center provided information on methods utilized and their success., Results: In the United States between 1993 and 2001, ten screening centers enrolled 154,934 study participants. Based on participant self-report, an estimated 95% of individuals were recruited by direct mail. Overall, enrollment yield for direct mail was 1.0%. Individual center enrollment yield ranged from 0.7% to 3.8%. Cost per enrolled participant was $9.64-35.38 for direct mail, excluding personnel costs., Limitations: Numeric data on recruitment processes were not kept consistently at individual screening centers. Numeric data in this manuscript are based on the experiences of 5 of the 10 centers., Conclusions: Direct mail, using rosters of names and addresses from profit and not-for-profit (including government) organizations, was the most successful and most often used recruitment method. Other recruitment strategies, such as community outreach and use of mass media, can be an important adjunct to direct mail in recruiting minority populations.

The Lung Screening Study (LSS) was a pilot study designed to assess the feasibility of conducting a large scale randomized controlled trial (RCT) of low radiation dose spiral computed tomography (LDCT) versus chest X-ray (CXR) for lung cancer screening. Baseline results of LSS have been previously reported. Here, we report on the findings at the year one screen and on the final results of the LSS study. A total of 1660 subjects were randomized to the LDCT arm and 1658 to the CXR arm. Compliance with screening declined from 96% at baseline to 86% at year one in the LDCT arm and declined from 93% at baseline to 80% at year one in the CXR arm. Positivity rates for the year one screen were 25.8% for LDCT and 8.7% for CXR. Cancer yield was significantly less at year one for LDCT, 0.57%, than at baseline, 1.9%; cancer yield for CXR increased from 0.45% at baseline to 0.68% at year one. Forty lung cancers in the LDCT arm and 20 in the CXR arm were diagnosed over the study period. Stage I cancers comprised 48% of cases in the LDCT arm and 40% in the CXR arm. A total of 16 stage III-IV cancers were observed in the LDCT arm versus nine in the CXR arm. The LSS has established the feasibility of a RCT comparing annual spiral CT to chest X-ray for lung cancer screening.

The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial has a total enrollment goal of almost 150,000 participants. These participants are being recruited at ten screening centers across the United States. All screening centers tested recruitment methodologies during a 1-year pilot phase. The main phase of recruitment was planned to take place over a 3-year period. The majority of participants are being recruited during the main phase of the study. Each of the screening centers tailors recruitment to its individual catchment area. Recruitment strategies in the PLCO trial are described. As the trial began, several protocol changes were made to help to increase enrollment. The National Cancer Institute (NCI) initiated recruitment efforts at the national level. The individual screening centers describe some of the specific recruitment experiences encountered. As the study progressed, the NCI implemented special initiatives to increase the enrollment of minority participants.

Background: Providing medical services to rural residents results in unique challenges to providers and patients. Cancer screening (CS) and early detection services (EDS) are frequently underutilized with rural residents often presenting with advanced cancer at diagnosis. A comprehensive approach to determine barriers and overcome them constitutes "The Greater Marshfield Experience.", Methods: Focus groups with rural residents determined the greatest barriers to receipt of CS and EDS were distance, cost, time from work and self-reliant behavior. Directives to address these concerns were to keep information simple and provide services at the workplace. In response, Marshfield Clinic and its research division developed a collaborative research partnership with public health agencies (PHA), federally funded government programs and volunteer agencies., Results: In-house activities to remove barriers for providing CS and EDS included the development of a separate screening unit for these activities. Reminder systems were employed to notify patients of the need and availability of preventative services. Co-payments for health screening services were eliminated from the clinic owned health plan. Area residents near poverty level were encouraged to enroll in federally subsidized health plans that promoted and paid for CS and EDS. Federally funded cancer screening studies were implemented that funded breast and cervical cancer screening and evaluated the benefits of screening for prostate, lung, colorectal and ovarian cancers (PLCO). Outreach activities included developing partnerships with local PHA and minority groups and providing mobile screening services to remote areas., Conclusion: Concentrated, collaborative efforts to develop in-house systems and outreach activities resulted in delivery of CS and EDS in remote areas.

The Healthy People 2000-National Health Promotion and Disease Prevention Objectives call for an increase in breast health education to the public to increase women's knowledge about breast cancer and the benefits of screening. A breast health outreach education intervention for community health professionals was designed, implemented, and evaluated. The barriers to continuing education of health professionals of rural areas were addressed. Low-cost, county-based seminars using a comprehensive breast health education curriculum were provided for community health professionals. The intervention demonstrated an increase in a professional's knowledge about breast cancer and breast cancer screening, and an increase in their breast self-examination skills. Six months after intervention, community health professionals reported an increase in the frequency of their breast self-examination performance.

Results from a quasi-experimental project indicate that skin cancer prevention and sun protection education can successfully be promoted by using peer educators. Senior high students (40) facilitated and taught a sun protection curriculum to third-grade students (508) enrolled at the experimental sites. The curriculum's effects were assessed with pre-program, post-program, and 6-month follow-up survey-instruments. The experimental sites using high school (peer) facilitators were effective in conveying knowledge to younger students based on knowledge gained on the post-program surveys. Overall, the intervention group demonstrated a mean improvement of 3.4 questions on the post-program survey, while the control group improved 0.1 questions (p < 0.01). Additional benefits included a knowledge gain by the peer facilitators, a self-reported possible increase in desired behavior change, and an improved attitude about sun protection. Implications for pediatric clinical practice are noted.

Established methods of health promotion for the general population are not as effective with rural populations, in part because conventional health education delivery systems may not penetrate isolated rural areas. In particular, the self-reliant behaviors of farmers make them less likely to seek traditional forms of health care, including health promotional activity. Yet farmers place a great deal of trust in their veterinarian and highly rate veterinarian integrity. Wisconsin veterinarians expressed an interest in the health of their human clients as well as the health of the animals in their care. An education demonstration project was developed to determine farmers' acceptance of veterinarians delivering human health information to their workplace (farms). Thirteen veterinarians who provide services in one north central Wisconsin county delivered skin cancer and sun protection information to farmers as part of their routine herd health checks. Participating farmers reported this to be an acceptable way to receive information about human health issues. This novel method of education delivery may be an effective means to disseminate human health information to difficult-to-reach rural populations.

To respond to major needs expressed by 15 farm family focus group participants, education interventions were designed to overcome barriers to primary prevention for skin cancer. Farmers are at high risk for developing skin cancer because of occupational exposure. In an attempt to increase skin cancer prevention education in a rural population, three demonstration projects were developed and field tested. Projects were designed to overcome barriers defined by the focus groups. One project evaluated a school-based education intervention. A second project evaluated a family-based education intervention. Knowledge gain was the evaluation endpoint of these two projects. Significant knowledge gain was demonstrated for these projects. A third project was designed to deliver skin cancer information directly to farmers using veterinarians. Farmers found this method of delivery acceptable.