Implementing a Challenge-Based Learning Curriculum at the Alborada School

Unidad Educativa Particular Alborada is a K-12 private school in Cuenca, Ecuador, which challenges students to develop a greater understanding of the world. Challenge-Based Learning (CBL) is an adaptive learning framework, encouraging students to solve real-world problems and integrating High-Impact Teaching (HIT). We piloted a CBL curriculum for 4th, 5th, and 6th grade students. We assessed both teacher and student attitudes to our CBL lessons examining the feasibility of continuing to teach it. Also, we provided sample CBL lesson plans and a set of recommendations for the Alborada faculty in regards to implementing CBL

Impact of port site scar on perception of patients with breast cancer: patient-reported outcomes.

PURPOSE: As the number of survivors continues to increase with improvements in breast cancer treatment, greater emphasis has been placed on the aesthetic outcome following breast surgery. Effort is made to minimize scarring on the breast, yet patients who require a port for treatment inevitably have a scar on the upper chest from the port itself. We hypothesized that patients with breast cancer are conscious of their port scars, and if given a choice would prefer placement of the port in the arm rather than the chest. METHODS: Female breast cancer patients treated at our Breast Center who had a port placed from 2009 to 2015 were asked to complete a 20-question, anonymous survey via SurveyMonkey® reporting demographics and treatment information, and a validated Patient Scar Assessment Questionnaire (PSAQ). RESULTS: Of 139 identified, 105 had email information available for contact, and 67 (64%) patients responded. Of the 67, 37 (55%) had undergone arm placement and 30 (45%), chest. Sixty (92%) patients report noticing their scars; 44 (69%) believed that their scar was noticeable to others; and 22 of the 44 (50%) made an effort to hide their scar. Thirty-seven patients were offered options for port site placement, and 24 (65%) chose placement in the arm (p = 0.057). CONCLUSION: Most patients are conscious of their port scars and if offered the choice choose placement in the arm rather than the chest. Upper extremity port placement should be further explored as an alternative approach for patients with breast cancer to improve port scar consciousness

Disparities in Risk Reduction Therapy Recommendations for Young Women With Lobular Carcinoma In-Situ.

BACKGROUND: Endocrine therapy (ET) significantly reduces the risk of breast cancer development in high-risk patients diagnosed with lobular carcinoma in situ (LCIS). However, the variables impacting recommendation and use of ET in young adults (YAs) is not well-studied. We examined the role of provider recommendation and patient acceptance for ET for YAs with LCIS. MATERIALS AND METHODS: The National Cancer Database was queried for women aged \u3c 40 years with primary LCIS between 2000 and 2012. Socioeconomic, demographic, and treatment variables were examined to determine their impact on ET provider recommendation and initial patient acceptance of risk-reducing therapy. RESULTS: Among 1650 YA patients with LCIS, only 749 (45.4%) were recommended ET. On multivariable analysis, women \u3e 30 years of age were more likely recommended ET than women \u3c 30 years (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.10-2.47), African Americans more than other ethnicities (OR, 1.48; 95% CI, 1.1-2.0), and YAs treated in New England were more likely than those in the rest of the country (OR, 3.26; 95% CI, 2.0-5.2). Among YA women recommended ET, only 20.2% had a documented refusal. Only geography appeared to independently impact the likelihood of refusal, with YAs in the Southeastern-Central United States being most likely to refuse ET (OR, 5.4; 95% CI, 1.2-24.0). CONCLUSION: ET is underutilized for risk-reduction in YAs with LCIS. This underuse appears dependent on disparities in provider recommendation practices rather than non-acceptance of therapy. This may reflect regional practice patterns, community standards of care, or provider bias regarding the significance of LCIS as a risk factor for development of invasive cancer