Search

* Context.--Pathologists have produced a substantial body of literature on graduate medical education (GME). However, this body of literature is diverse and has not yet been characterized. Objective.--To chart the concepts, research methods, and publication patterns of studies on GME in pathology. Data Sources.--This was a systematic scoping review covering all literature produced since 1980 in the PubMed and Embase databases. Conclusions.--Research on GME in pathology is evenly dispersed across educational topics. This body of literature would benefit from research based on theory, stronger study designs, and studies that can provide evidence to support decisions on educational policies. doi: 10.5858/arpa.2022-0365-RA, Medical residency programs are charged with certifying physicians' competency to safely practice independently after graduation through the provision of graduate medical education (GME). Ensuring that medical trainees successfully acquire specialty-specific [...]

Methods traditionally used to teach and train in STEM fields are being used to educate for careers in homeland security, Wall Street investments, and financial planning. An example of this trend is the increasing number of courses offered at institutions of higher education, such as financial engineering, computational finance, and risk analytics. These jobs draw heavily on STEM knowledge and skills, and represent some of the most rapidly growing or wealth producing sectors of the U.S. economy. To better prepare non-STEM majors entering these fields, we developed an interdisciplinary science course for nonscience majors with the goals of reducing the negative perceptions and attitudes towards the science general education curriculum. This interdisciplinary course also created a venue to teach non-science majors how to deal with real world STEM issues. By engaging students in activities which promoted skills critical in STEM fields, we designed a course that integrated a sampling of content in physical and life sciences, while at the same time increasing scientific curiosity and literacy. This new course, STEM 1200-Scientific Decisions in Everyday Life was taught employing active engagement techniques and student-centered demonstrations to increase conceptual understanding of scientific concepts. Results of a Wilcoxon Signed Rants test on a pre- and post-course assessment question showed a significant gain in students' confidence in their conceptual understanding as a result of the engaging demonstrations.

Background: Transfusion‐related acute lung injury (TRALI) is a leading cause of transfusion‐related mortality. A concern with passive surveillance to detect transfusion reactions is underreporting. Our aim was to obtain evidence‐based estimates of TRALI incidence using meta‐analysis of active surveillance studies and to compare these estimates with passive surveillance. Study Design and Methods: We performed a systematic review and meta‐analysis of studies reporting TRALI rates. A search of Medline and Embase by a research librarian identified studies published between January 1, 1991 and January 20, 2023. Prospective and retrospective observational studies reporting TRALI by blood component (red blood cells [RBCs], platelets, or plasma) were identified and all inpatient and outpatient settings were eligible. Adult and pediatric, as well as general and specific clinical populations, were included. Platelets and plasma must have used at least one modern TRALI donor risk mitigation strategy. A random effects model estimated TRALI incidence by blood component for active and passive surveillance studies and heterogeneity was examined using meta‐regression. Results: Eighty studies were included with approximately 176‐million blood components transfused. RBCs had the highest number of studies (n = 66) included, followed by platelets (n = 35) and plasma (n = 34). Pooled TRALI estimates for active surveillance studies were 0.17/10,000 (95% confidence intervals [CI]: 0.03–0.43; I2 = 79%) for RBCs, 0.31/10,000 (95% CI: 0.22–0.42; I2 = <1%) for platelets, and 3.19/10,000 (95% CI: 0.09–10.66; I2 = 86%) for plasma. Studies using passive surveillance ranged from 0.02 to 0.10/10,000 among the various blood components. Discussion: In summary, these estimates may improve a quantitative understanding of TRALI risk, which is important for clinical decision‐making weighing the risks and benefits of transfusion. [ABSTRACT FROM AUTHOR]

* Context.--Molecular analysis of lung adenocarcinoma for therapeutically important genes is standard of practice, with multiple professional organizations recommending testing of all adenocarcinomas for mutations in EGFR, ALK, and ROS1. Some organizations recommend analyzing these genes in association with a panel. Few data exist as to optimal testing method or optimal sequence of testing from a cost perspective. Objective.--To determine which order of gene testing was least costly and whether sequential, small panel, or next-generation sequencing (NGS) was cheapest. Design.--Recent recommendations propose a set of essential molecular tests (EGFR, ALK, and ROS1) and an optional set of molecular tests that may be useful for selection of clinical trials. We compared the costs of different testing sequencing strategies for both the 3 essential genes and for 5 optimal genes. Testing costs were determined by a survey of prices from large laboratories. The strategy most frequently rated as the lowest cost strategy was designated the optimal testing strategy. Results.--Sequential testing of the essential genes in the order EGFR-ROS1-ALK was optimal from a cost perspective. The expected cost of sequential testing was $2227 (95% CI, $1733-$2794). The cost of NGS was $2500. The expected cost per positive result was $11,362 using this strategy. Conclusions.--Molecular testing of lung adenocarcinomas for the set of 3 essential genes and 5 optional genes can be performed by a variety of methods and in a variety of sequences. From a cost perspective, sequential testing in the order EGFR, ROS1, then ALK is optimal. NGS would be competitive if the price was less than $2200. NGS is optimal if testing for the 3 essential genes will be followed by testing for the 5 optional genes. NGS testing is optimal if the clinician plans to test both essential and optional genes. doi: 10.5858/arpa.2018-0218-OA, Recent advances in personalized medicine have resulted in the development of a number of targeted therapies for pulmonary adenocarcinomas. The initial therapeutic targets were pulmonary adenocarcinomas associated with mutations in [...]

Background The protective effect of community water fluoridation (CWF) against dental caries may be modified by secular changes in health behaviour. We aimed to determine the contemporary association between fluoride in public water supplies (PWS) and dental caries indicators and inequalities in England. Methods We estimated exposure to CWF and PWS fluoride concentrations from national monitoring data, using Geographic Information Systems and water supply boundaries, categorizing mean period exposure into <0.1, 0.1–<0.2, 0.2–<0.4, 0.4–<0.7 and ≥0.7 mg/l. We used area-level health outcome and confounder data in multivariable regression models to determine the association between fluoride and caries outcomes and calculated preventive fractions using these coefficients. Results The odds of caries and of severe caries in 5-year-olds fell with increasing fluoride concentration in all SES quintiles (P  < 0.001 to P  = 0.003). There was a negative trend between increasing fluoride concentration and dental extractions (P  < 0.001). Compared to PWS with <0.2 mg/l, CWF prevented 17% (95% confidence interval (CI): 5–27%) to 28% (95% CI: 24–32%) of caries (high-low SES) and 56% (95% CI: 25–74%) of dental extractions. The association between fluoride concentration and caries prevalence/severity varied by socioeconomic status (SES) (P  < 0.001). Conclusions Exposure to fluoride in PWS appears highly protective against dental caries and reduces oral health inequalities. [ABSTRACT FROM AUTHOR]

Students within the Findlay, Ohio, City School District, as well as students across the country, struggle with understanding physical and chemical changes. Therefore, in this article, the authors suggest some standards-based activities to clarify misconceptions and provide formative assessments to measure your students' progress as they determine the difference between chemical and physical changes. (Contains 1 figure.)

Background: Dampness and mold problems are frequently encountered in schools. Approximately one third of US public schools require extensive repairs or need at least 1 building replaced. This study illustrates how national data can be used to identify building-related health risks in school employees and students. Methods: School employees (n = 309) in 2 elementary schools (schools A and B) with dampness and mold problems completed standardized questionnaires. Responses were compared with participant responses from the 3rd National Health and Nutrition Examination Survey and were indirectly standardized for gender, age, smoking status, and (for school B) race. Uncontrolled comparisons were made to responses from a study of office workers, as well as between responses from school employees in different sections of the school buildings designated by decade of construction. Results: Employees from both schools had excess work-related throat and lower respiratory symptoms, as well as eye, nasal, sinus, and wheezing symptoms. School B employees also had excess physician-diagnosed asthma and work-related fatigue, headache, and skin irritation. Employees in sections of the school buildings that were categorized as having greater dampness and mold contamination had more frequent upper and lower respiratory symptoms than employees working in other building sections. Conclusions: This noncostly type of analysis of indoor air quality complaints can be used to motivate and prioritize building remediation in public schools where funds for building remediation are usually limited. (Contains 3 tables.)

Administrators at Findlay City Schools had been researching methods to improve student achievement. District administrators decided to work to form professional learning communities to focus on improved student learning. Findlay High School had recently added a freshman wing to help students transition to high school and allow teachers to focus on reducing freshmen failures and expulsions and on improving attendance. The high school's secondary curriculum director and principal began planning a new form of professional development. The five-year plan the two created was designed to answer three questions: (1) What does the school want students to learn?; (2) How can it be certain all students have learned it?; and (3) How can it assist those who are not mastering the intended outcomes? The plan has four steps: (1) learning the concepts; (2) responding to what the school has learned; (3) embracing data; and (4) further analysis. (Contains 2 charts.)

Purpose: This research provides state policy makers and others interested in developing needs-based reimbursement models for Medicaid-funded assisted living with an evaluation of different methodologies that affect the structure and outcomes of these models. Design and Methods: We used assessment data from Medicaid-enrolled assisted living residents and waiver-eligible community-dwelling individuals (N = 726) in order to evaluate five methodologies in the design of these tiered needs-based models. We used ordinary least squares regression analyses in order to evaluate each model's ability to predict the time needed to care for individuals with varying needs (e.g., activities of daily living limitations, dementia, special services.) Results: These models varied in fit from 0.127 to a high of 0.357 using the adjusted R[squared] statistic. Both count and weighted models adequately predicted service needs and discriminated individuals into their appropriate tiers well. Weighted models with the largest score range worked best and provided more flexibility. Implications: Policy makers can tailor the generic tiered models developed with these methods to a state's population. Any state considering adoption of a needs-based tiered model will need to refine its model based on its assisted living population characteristics, its resources, and how the model fits its long-term care system. For the industry, these models can serve to identify levels of care needed in planning for staff time and skill mix required for assisted living as well as other long-term care populations. (Contains 5 tables and 1 figure.)

A pivotal point for students is the transition from middle school to high school. Students will decide during the first few weeks of their freshman year if they intend to continue their high school education (Hertzog & Morgan, 1999). This article provides the reader with the research surrounding this transition year, programs and practices that have been successful, and the impact the "freshman wing" concept has had on a large, comprehensive high school in Findlay, Ohio.

Background: The purpose of this scoping review was to identify available sources of evidence on the epidemiology of transfusion‐related acute lung injury (TRALI) and whether meta‐analysis on the incidence of TRALI is feasible. TRALI is a serious complication and the second leading cause of death related to blood transfusion. Estimates of the incidence of TRALI would provide a useful benchmark for research to reduce TRALI. Study Design and Methods: We searched the Medline, EMBASE, and PubMed databases for publications related to the incidence of TRALI and hemovigilance. We included all studies irrespective of language or country. Both full‐text articles and conference abstracts were included. Participants of the studies must all have received a blood transfusion. Reviews and case studies were excluded. Results: We identified 427 articles or abstracts to include for review. More than half were abstracts, and the majority were published after 2010. Reported TRALI definitions varied, but only 27.2% of studies reported any definition for TRALI. TRALI rates were reported using different denominators, such as per blood unit (54.1%), patient (34.4%), and transfusion episode (14.8%). Study populations and contexts were mostly general (75.6% and 80.3%, respectively). There was also variation in study design with most being observational (90.6%) and only 13.1% of all studies used modern donor restriction policies. Discussion: There was substantial variation in reporting in studies on TRALI incidence. Meta‐analysis of TRALI rates may be feasible in specific circumstances where reporting is clear. Future studies should clearly report key items, such as a TRALI definition. [ABSTRACT FROM AUTHOR]

Background: Non‐pathogen reduction platelet bacterial risk control strategies in the US FDA guidance include at least one culture. Almost all of these strategies have a culture hold time of ≥12 h. Studies have reported time to detection (TTD) of bacterial cultures inoculated with bacteria from contaminated platelets, but these data and estimates of risk associated with detection failures have not been synthesized. Methods: We performed a literature search to identify studies reporting TTD for samples obtained from spiked platelet components. Using extracted data, regression analysis was used to estimate TTD for culture bottles at different inoculum sizes. Detection failures were defined as events in which contaminated components are transfused to a patient. We then used published data on time of transfusion (ToT) to estimate the risk of detection failures in practice. Results: The search identified 1427 studies, of which 16 were included for analysis. TTD data were available for 16 different organisms, including 14 in aerobic cultures and 11 in anaerobic cultures. For inocula of 1 colony forming unit (CFU), the average TTD for aerobic organisms was 19.2 h while it was 24.9 h in anaerobic organisms, but there was substantial overall variation. A hold time of 12 versus 24 h had minimal effect for most organisms. Conclusion: TTD variation occurs between bacterial species and within a particular species. Under typical inventory management, the relative contribution of culture detection failures is much smaller than the residual risk from sampling failures. Increasing the hold period beyond 12 h has limited value. [ABSTRACT FROM AUTHOR]