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Purpose: To characterize changes in subfoveal choroidal thickness in preterm infants from 30 to 60 weeks' postmenstrual age (PMA). Design: The prospective, observational Study of Eye Imaging in Preterm infantS (BabySTEPS) enrolled infants eligible for retinopathy of prematurity screening per the American Association of Pediatrics guidelines. Subjects: Infants imaged with an investigational, handheld OCT at ≥ 4 distinct imaging sessions between 30 to 60 weeks' PMA as part of BabySTEPS. Methods: Average choroidal thickness across the central subfoveal 1 mm in each eye at each time point was measured using custom segmentation software, and errors were manually corrected by a trained grader. We prospectively collected birth history data. A segmented mixed model was used to analyze the change in choroidal thickness as a function of PMA, birth weight, and gestational age (GA). Main Outcome Measures: Characterization of normative subfoveal choroidal thickness values and choroidal growth rate between 30 to 60 weeks' PMA. Results: We included 592 imaging sessions of 79 preterm infants (152 eyes). Mean (± standard deviation) GA was 27.5 ± 2.5 weeks. Mean choroidal thickness was 141.4 ± 34.5 μm at 30 weeks, 272.2 ± 83.9 μm at 38 weeks, and 306.2 ± 77.4 μm between 56 and 60 weeks. Between 30 and 60 weeks' PMA, choroidal growth followed a biphasic model, with a linear growth rate of 14.8 μm per week (95% confidence interval [CI], 13.6–16.0) from 30 until 38.4 weeks, then cessation of growth, with a growth rate of 0.3 μm per week (95% CI, −1.1 to 1.6) from 38.4 to 60 weeks. Infants with extremely low birth weight (ELBW; < 1000 g) and extremely preterm (GA < 28 weeks) infants had significantly slower initial growth rates compared with very low and low birth weight and very preterm and preterm infants (ELBW 13.0 vs. 21.0 μm per week; P < 0.0001 and extremely preterm 13.2 vs. 18.0 μm per week; P = 0.003). Conclusions: Preterm infant choroidal thickness experiences rapid linear growth from 30 to 38 weeks' PMA, at which time growth nearly stops. These foundational measurements and identification of the impact of extremes of low birth weight and prematurity on choroidal development will be essential as researchers begin to understand the role of choroidal development in ocular and retinal health in human infants. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

With the rising demand for virtual learning, districts are establishing virtual schools to offer more flexible education. This study investigates K-12 virtual learner characteristics, examines trends and issues in virtual academies, and outlines opportunities and challenges faced by stakeholders in a southeastern U.S. state. The study used a mixed-method design, combining quantitative survey data and qualitative interviews with virtual academy leaders. Results reveal that virtual learners opt for this mode of schooling due to busy extracurricular schedules, a desire to avoid crowded schools or health concerns. These students include those with special needs and high-achieving individuals. Collaboration between parents and teachers plays a crucial role. Essential factors include reliable internet access, teacher tech proficiency, and diverse curriculum development approaches. However, diverse curricular methods require additional implementation support. Balancing instructional flexibility with accountability poses a significant challenge. Virtual teachers need resources, professional development, and time, especially when transitioning from traditional to digital curriculum. Effective communication and interpersonal interactions are vital. Involving home learning coaches and community partnerships enhances the educational experience. While virtual schools offer flexible and personalized support, they encounter challenges related to resource access, social isolation, and student motivation.

There are too few teachers and schools to meet the need for quality universal basic education. Therefore, alternative approaches to education provision need to be explored, such as open and distance learning methods and development and provision of curriculum-based Open Educational Resources (OER). However, distribution of printed materials is increasingly costly, and distribution of digital resources remains a challenge in areas with little or no connectivity. This case study explores the potential of using offline strategies to share digital OER. It suggests it is possible to provide access to digital learning resources even in the most remote areas by using appropriate technology, like the Commonwealth of Learning's Aptus device.

The COVID-19 pandemic has had both short- and long-term impacts on the institution of schooling, as well as on teachers and students who experienced it. While much has been learned about the impact of the pandemic, including in physical education, less is known about how physical education teachers navigated the sociopolitical realities of their work as they were socialized through the pandemic. Adopting occupational socialization theory, the purpose of this study was to examine the experiences of Midwestern US physical educators during the COVID-19 pandemic and the lasting implications for their careers. Participants were 30 in-service physical education teachers (20 female and 10 male) from one state in the US Midwest who each participated in a semi-structured interview. Semi-structured interviews were audio-recorded and analyzed using a multiphase collaborative qualitative analysis method grounded in analytic induction and deduction and focused on thematic development. Data analysis resulted in four themes: (a) changing instructional modalities was challenging but prompted creativity and growth; (b) resources were scarce, and marginalization was intensified through the pandemic; (c) recognizing and responding to changes in teacher and student health; and (d) stressors associated with COVID-19 may influence teachers' career trajectories. This study not only adds to the literature related to COVID-19 but also is important for understanding how the schools' culture changes through times of crisis. It is likely that other local, regional, national, or international events will cause disruptions in teachers' work and the nature of student learning in the future.

To broaden efforts for improving diversity, equity, and inclusion (DEI) in biomedical engineering (BME) education--a key area of emphasis is the integration of inclusive teaching practices. While BME faculty generally support these efforts, translating support into action remains challenging. This project aimed to address this need through a 3-phase inclusive teaching training, consisting of graduate students, faculty, and engineering education consultants. In Phase I, graduate students and faculty participated in a 6-week learning community on inclusive teaching ("Foundational Learning"). In Phase II, graduate students were paired with faculty to modify or develop new inclusive teaching materials to be integrated into a BME course ("Experiential Learning"). Phase III was the implementation of these materials. To assess Phases I & II, graduate student participants reflected on their experiences on the project. To assess Phase III, surveys were administered to students in IT-BME-affiliated courses as well as those taking other BME-related courses. Phases I & II: graduate students responded positively to the opportunity to engage in this inclusive teaching experiential learning opportunity. Phase III: survey results indicated that the incorporation of inclusive teaching practices in BME courses enhanced the student learning experience. The IT-BME project supported graduate students and faculty in learning about, creating, and implementing inclusive teaching practices in a collaborative and supportive environment. This project will serve to both train the next class of instructors and use their study of inclusive teaching concepts to facilitate the creation of ideas and materials that will benefit the BME curriculum and students.

* Context.-Machine learning applications in the pathology clinical domain are emerging rapidly. As decision support systems continue to mature, laboratories will increasingly need guidance to evaluate their performance in clinical practice. Currently there are no formal guidelines to assist pathology laboratories in verification and/or validation of such systems. These recommendations are being proposed for the evaluation of machine learning systems in the clinical practice of pathology. Objective.-To propose recommendations for performance evaluation of in vitro diagnostic tests on patient samples that incorporate machine learning as part of the pre-analytical, analytical, or post-analytical phases of the laboratory workflow. Topics described include considerations for machine learning model evaluation including risk assessment, predeployment requirements, data sourcing and curation, verification and validation, change control management, human-computer interaction, practitioner training, and competency evaluation. Data Sources.-An expert panel performed a review of the literature, Clinical and Laboratory Standards Institute guidance, and laboratory and government regulatory frameworks. Conclusions.-Review of the literature and existing documents enabled the development of proposed recommendations. This white paper pertains to performance evaluation of machine learning systems intended to be implemented for clinical patient testing. Further studies with real-world clinical data are encouraged to support these proposed recommendations. Performance evaluation of machine learning models is critical to verification and/or validation of in vitro diagnostic tests using machine learning intended for clinical practice. (Arch Pathol Lab Med. 2024;148:e335-e361; doi: 10.5858/arpa.2023-0042-CP), Institution of machine learning (ML) in the pathology clinical domain has gained momentum and is rapidly advancing. As ML-based clinical decision support (CDS) systems continue to mature, laboratories will increasingly [...]

OBJECTIVES: Long-term benzodiazepine use is common despite known risks. In the original Eliminating Medications Through Patient Ownership of End Results (EMPOWER) Study set in Canada, patient education led to increased rates of benzodiazepine cessation. We aimed to determine the effectiveness of implementing an adapted EMPOWER quality improvement (QI) initiative in a US-based healthcare system. DESIGN: We used a pre-post design with a non-randomised control group. SETTING: A network of primary care clinics. PARTICIPANTS: Patients with ≥60 days supply of benzodiazepines in 6 months and ≥1 risk factor (≥65 years of age, a concurrent high-risk medication prescribed or a diazepam equivalent daily dose ≥10) were eligible. INTERVENTION: In March 2022, we engaged 22 primary care physicians (PCPs), and 308 of their patients were mailed an educational brochure, physician letter and flyer detailing benzodiazepine risks; the control group included 4 PCPs and 291 of their patients. PRIMARY AND SECONDARY MEASURES: The primary measure was benzodiazepine cessation by 9 months. We used logistic regression and a generalised estimating equations approach to control for clustering by PCP, adjusting for demographics, frailty, number of risk factors, and diagnoses of arthritis, depression, diabetes, falls, and pain. RESULTS: Patients in the intervention and control groups were comparable across most covariates; however, a greater proportion of intervention patients had pain-related diagnoses and depression. By 9 months, 26% of intervention patients (81 of 308) had discontinued benzodiazepines, compared with 17% (49 of 291) of control patients. Intervention patients had 1.73 greater odds of benzodiazepine discontinuation compared with controls (95% CI: 1.09, 2.75, p=0.02). The unadjusted number needed to treat was 10.5 (95% CI: 6.30, 34.92) and the absolute risk reduction was 0.095 (95% CI: 0.03 to 0.16). CONCLUSIONS: Results from this non-randomised QI initiative indicate that patient education programmes using the EMPOWER brochures have the potential to promote cessation of benzodiazepines in primary care.

Introduction Alopecia areata (AA) is an autoimmune noncicatricial alopecia. Many treatments are available but with variable results. Few studies have reported fractional carbon dioxide (FCO2) laser and cryotherapy in treating AA through various mechanisms. Objective This study aimed to assess the efficacy and safety of FCO2 laser in comparison to cryotherapy in the treatment of AA. Patients and methods This prospective self-controlled comparative study included 22 patients with patchy AA (3 patches). The three patches in each patient were treated by one of the following methods by simple randomization: FCO2 laser, cryotherapy, and the third patch was left without treatment as a control. The sessions were repeated every 2 weeks for six sessions. Results Comparison of single-blinded dermatologist assessment of clinical response between the three groups revealed a statistically significantly better response with FCO2 laser and cryotherapy compared with control patches, but there was no statistically significant difference between the FCO2 laser group versus the cryotherapy group (P=1). Comparison between trichoscopic hair parameters before and after treatment showed a significant decrease in black dots, yellow dots, and exclamation mark hair count in both cryotherapy and FCO2 groups. Short vellus hair count showed a significant increase after treatment in the FCO2 group. Exclamation mark hair count before treatment was significantly higher than after treatment in the control group. Conclusion Both cryotherapy and FCO2 laser therapy are effective and safe in patchy AA treatment with nearly similar efficacy.

Scholars have recommended hybrid learning to combat education problems in emerging economies due to their challenging contexts. It potentially offers a means to address growing demand without sacrificing quality or increasing costs. In this article we report on a new "hybrid" distance teacher education programme in which we sought to address the requirements of new policies (both institutional and national) by combining the blended and distance education approach. We adopted a pragmatic qualitative approach, rooted in a communitarian perspective and distance education theory. Although progressing slower than expected, the programme's implementation to date has provided lessons that bolster the value of blended learning theory and practice in a hybrid model. The study also highlighted the critical role that the mode adopted for teacher training can play in shaping teachers' practice. However, to work more effectively in an emerging economy, a more substantial teaching presence is suggested, coupled with modularised and ongoing information and communication technology (ICT) training and support for staff and students as areas for further research.

Md Muntasir Zitu,1 Margaret E Gatti-Mays,2 Kai C Johnson,2 Shijun Zhang,1 Aditi Shendre,1 Mohamed I Elsaid,1 Lang Li1 1Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA; 2Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, 43210, USACorrespondence: Lang Li, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA, Email lang.li@osumc.eduPurpose: We developed an artificial intelligence (AI) model to detect immunotherapy -related adverse events (irAEs) from clinical narratives of electronic health records (EHRs) at the patient level.Patients and Methods: Training data, used for internal validation of the AI model, comprised 1230 clinical notes from 30 patients at The Ohio State University James Cancer Hospital− 20 patients who experienced irAEs and ten who did not. 3256 clinical notes of 50 patients were utilized for external validation of the AI model.Results: Use of a leave-one-out cross-validation technique for internal validation among those 30 patients yielded accurate identification of 19 of 20 with irAEs (positive patients; 95% sensitivity) and correct dissociation of eight of ten without (negative patients; 80% specificity). External validation on 3256 clinical notes of 50 patients yielded high sensitivity (95%) but moderate specificity (64%). If we improve the model’s specificity to 100%, it could eliminate the need to manually review 2500 of those 3256 clinical notes (77%).Conclusion: Combined use of this AI model with the manual review of clinical notes will improve both sensitivity and specificity in the detection of irAEs, decreasing workload and costs and facilitating the development of improved immunotherapies.Keywords: immunotherapy, cancer, adverse events, machine learning, natural language processing, artificial intelligence, electronic health records

Refugee children often face disruptions to their education before and during displacement. However, little is known about either levels or predictors of refugee children's literacy or about their attitudes toward reading in low- or middle-income countries. To address this, we conducted in-home literacy assessments using the Holistic Assessment of Learning and Development Outcomes with 322 Syrian refugee mother-child dyads who lived in Jordan (child age range 4-8 years, M = 6.32 years, 50% female). Overall, the children had quite low levels of literacy, although they indicated a strong enthusiasm for reading. Child age, maternal education, and maternal ability to read all predicted child literacy, although maternal literacy predicted it only among children enrolled in school. Among those enrolled in school (64.9% of the total sample, 88.7% of those aged [greater than or equal to] 6), students attending hybrid classes had better literacy than those attending either solely in-person or solely online, although the frequency of school attendance did not predict literacy. A less consistent pattern emerged for predicting children's attitudes toward reading. Our results suggest an urgent need to improve literacy skills among refugee children in Jordan, as well as a need for validated measures of attitudes toward reading for use with Arabic-speaking youth.

ImportancePolypharmacy is associated with mortality, falls, hospitalizations, and functional and cognitive decline. The study of polypharmacy-related interventions has increased substantially, prompting the need for an updated, more focused systematic overview.ObjectiveTo systematically evaluate and summarize evidence across multiple systematic reviews (SRs) examining interventions addressing polypharmacy.Evidence reviewA search was conducted of MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects for articles published from January 2017-October 2022, as well as those identified in a previous overview (January 2004-February 2017). Systematic reviews were included regardless of study design, setting, or outcome. The evidence was summarized by 4 categories: (1) medication-related process outcomes (eg, potentially inappropriate medication [PIM] and potential prescribing omission reductions), (2) clinical and functional outcomes, (3) health care use and economic outcomes, and (4) acceptability of the intervention.FindingsFourteen SRs were identified (3 from the previous overview), 7 of which included meta-analyses, representing 179 unique published studies. Nine SRs examined medication-related process outcomes (low to very low evidence quality). Systematic reviews using pooled analyses found significant reductions in the number of PIMs, potential prescribing omissions, and total number of medications, and improvements in medication appropriateness. Twelve SRs examined clinical and functional outcomes (very low to moderate evidence quality). Five SRs examined mortality; all mortality meta-analyses were null, but studies with longer follow-up periods found greater reductions in mortality. Five SRs examined falls incidence; results were predominantly null save for a meta-analysis in which PIMs were discontinued. Of the 8 SRs examining quality of life, most (7) found predominantly null effects. Ten SRs examined hospitalizations and readmissions (very low to moderate evidence quality) and 4 examined emergency department visits (very low to low evidence quality). One SR found significant reductions in hospitalizations and readmissions among higher-intensity medication reviews with face-to-face patient components. Another meta-analysis found a null effect. Of the 7 SRs without meta-analyses for hospitalizations and readmissions, all had predominantly null results. Two of 4 SRs found reductions in emergency department visits. Two SRs examined acceptability (very low evidence quality), finding wide variation in the adoption of polypharmacy-related interventions.Conclusions and relevanceThis updated systematic overview noted little evidence of an association between polypharmacy-related interventions and reduced important clinical and health care use outcomes. More evidence is needed regarding which interventions are most useful and which populations would benefit most.