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Discussion Boards are at the heart of an Asynchronous Online Learning or Distance Education Environment and can have a great impact on the learning experience. Understanding the individual factors that create a high quality discussion board experience for students and their interrelationships is critical to continuous improvement in distance education. Research which contributes to increased effectiveness of virtual Discussion Boards for both instructors and students can result in greater student involvement and success in learning new skills. This paper discusses Phase 1 and 2 of a multi phase applied research effort on improving the quality of virtual Discussion Boards. "Applied research is defined as systematic study to gain knowledge or understanding necessary to determine the means by which a recognized and specific need may be met" ("Research and development," 2010, para 4). The study was completed in two phases with additional phases to be developed as the data analysis continues to yield results. In Phase 1, a literature review was completed and qualitative data employing a focus group methodology was completed. The focus group was comprised of full time faculty from a large, proprietary, online university with significant experience in the use of Discussion Boards. The data was collected from the focus group and was analyzed to create hypotheses for additional research on the topic. Phase 2 focused on collecting data utilizing a quantitative research methodology supported by continued research of the literature on this topic. The results of the data analyzed during these phases will become the basis for additional studies on recommended best practices in discussion board participation as it applies to both the student and the instructor.

The purpose of this descriptive paper was to explore and synthesize literature related to understanding modular learning and how it can be implemented effectively so faculty members embrace its use. An in-depth review of literature addressed topics including, Educational Theories supporting modular learning, the development of modular learning, and innovations in education and technology. Researchers analyzed language patterns used in the literature to develop a common language for and understanding of the concept. Analysis and recommendations as well as a proposed definition of modular learning are included.

The purpose of the study was to listen to reactions of key stakeholders experiencing profound organizational change. A case study was used to gather data from participants' interview responses. Data analysis identified research-supported reactions; in addition, two unique themes were identified: constructive critique and ill-effects of good intentions. Listening to, understanding, and appreciating reactions and emotions during change provide valuable insights that help build organizational community and enhance the success of a change initiative.

Cardiac troponin is the preferred biomarker for defining the acute coronary syndrome and acute myocardial infarction. Currently, the only decision limit formally endorsed with regard to the cardiac troponins is the 99th percentile. This is a 'rule-in' criterion, intended to ensure that only persons with the acute coronary syndrome are reviewed. The 99th percentile is an arbitrary cut point and there are many problems associated with its application, including defining a truly healthy population, the difficulty of standardisation of cardiac troponin assays, especially but not only cardiac troponin I, and the effects of age and sex on this parameter. The Emergency Department (ED) screens many more persons for possible acute coronary syndromes than actually have the condition and their needs are best met by a 'rule-out' test that enables them to clear their busy departments of the many persons who do not actually have the condition. The needs of the ED are not optimally met using the 99th percentile. The index of individuality for the cardiac troponins is small and significant changes consistent with an acute coronary syndrome can occur without the 99th percentile being exceeded. It appears that the ED may be better served by use of delta troponin changes rather than the 99th percentile, but there are problems with this approach, particularly in persons who present late when troponin release has plateaued. In addition, there are many non-acute coronary syndrome causes for cardiac troponin release. The needs of the cardiologist and the ED physician are so different that it may be inappropriate for both groups to use the same diagnostic criteria for cardiac troponin, and it is of great importance that cardiac troponin measurement be used as only one part of the assessment of the person presenting with possible acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Surveys by the RCPA PITUS Project have shown significant variations in report rendering between Australasian Pathology Providers. The same project collected anecdotal evidence that this variation has led to the misunderstanding and misreading of results - a clinical safety issue. Recommendations are given for the rendering of reference limits on pathology reports, determination and rendering of result flags, and the documentation of sub-population partitions for reference intervals. These recommendations apply equally for paper or electronic reporting, but should not limit the use of novel techniques within electronic reports to convey additional meaning. PITUS Working Group 4 will publish draft recommendations for peer review and comment in relation to the above in the second half of 2014.

Serum free light chain (FLC) assay is an important advance in the diagnosis and monitoring of monoclonal light chain diseases and a complementary test to serum protein electrophoresis and immunofixation. Immunoturbidimetric and immunonephelometric assays for serum FLC are available on routine chemistry analysers and can detect FLC down to approximately 1 mg/L. These assays use polyclonal anti-human FLC antisera and require acceptable imprecision, specificity, accuracy, and reproducibility between reagent batches to prevent under- or over-estimation of FLC concentration. Assay imprecision determined between reagent lots has a variation of 8-45% for FLC concentrations and 17-32% for the calculated kappa/lambda FLC ratio. Dilution studies indicate some over-recovery of FLC, which may depend upon the dilution matrix. However, greater discrepancies are underestimation from nonlinear reactions and overestimation possibly from interferences or multi-reactivity to polymeric FLC. Nonlinear monoclonal FLC give concentrations which are 2- to 6-fold increased at higher sample dilution and FLC measured on different platforms may not give the same results. Laboratory staff and clinicians should be aware of the analytical limitations of the FLC assay. Assay imprecision, especially with different lots of FLC reagent, may have a significant effect on changes in the FLC concentration and kappa/lambda FLC ratio. Sample dilution anomalies have the potential to confound result interpretation for patients with monoclonal light chain disease. These issues, if not adequately appreciated, have the potential to mislead clinical diagnosis and assessment of response to therapy.

Aim: We studied the characteristics of small abnormal protein bands (APB) (including oligoclonal bands and new apparent monoclonal bands) that are frequently detected by serum protein electrophoresis (SPEP) and isoelectric focusing (IEF) in the post-autologous stem cell transplant setting., Methods: In a retrospective analysis of patients with multiple myeloma undergoing transplantation, paraprotein identity and quantification were performed using standard immunofixation electrophoresis. The nature of any new bands was determined by IEF which distinguished between oligoclonal bands and apparent monoclonal bands., Results: Of 49 myeloma cases, the median follow-up was 33.7 months (range, 5.6-97.5 months) and 24 patients had relapsed. Thirty six (73%) developed APB. 22 patients had more than one episode of APB and 6 patients had more than 2 episodes resulting in a total of 69 episodes of APB observed post-transplant. IEF demonstrated 54 of these APB were oligoclonal bands and 15 appeared to be monoclonal. Of the 15 episodes of apparent monoclonal bands, 10 had differing heavy or light chain restriction compared to the original myeloma paraprotein and 5 had the same heavy and light chain restriction but different band location in the SPEP lane. Ten of these apparent monoclonal bands resolved, 5 persisted, and only one represented true disease progression. The presence of APB impacted favourably on event-free survival (p=0.05)., Conclusion: Small APB are very frequent post-transplant for myeloma, and IEF can identify these APB as oligoclonal or monoclonal. Apparent monoclonal bands may represent relapsed disease, but in the vast majority of cases it does not, and most likely represents a transient phenomenon representing regeneration of a limited immune response.