Environmental factors affecting retention and graduation in Mlt /Clt programs

The quality of education delivered to medical laboratory technician/clinical laboratory technician (MLT/CLT) students has been an evolving concern for the clinical laboratory sciences profession. This situation prompted consideration of various factors in MLT/CLT education to determine if student/program characteristics affected student performance; Principles extracted from Alexander Astin\u27s Input-Environment-Output (I-E-O) model were used as a foundation for considering the factors that affect MLT/CLT program student outcomes. Input, environmental, and outcome variables related to MLT/CLT programs were identified for study; A literature review was conducted to gather information relevant to the development of clinical laboratory science practice and education, curriculum development and evaluation, MLT/CLT student and program characteristics, program accreditation and graduate certification; The primary data source was a survey instrument sent to program directors of the sample MLT/CLT programs, as identified by the Health Professions Career and Education Directory 2002-2003 (American Medical Association, 2002). A fifty-five question survey was developed and distributed to the sample MLT/CLT programs. All survey requests originated from the Cannon Center for Survey Research at the University of Nevada, Las Vegas. All survey responses went directly to the data center, where they were organized and tabulated. Data were received, analyzed, and used as the basis for discussion; Factors influencing student success included program size, English-speaking ability, enrollment status, course sequence, faculty-student ratio, clinical preceptor quality, and portfolio submission. Students in smaller programs were more likely to stay enrolled, pass the certification examination, and gain employment. Non-native English-speaking students were more likely to voluntarily withdraw from the professional program than their English-speaking counterparts. Full-time students enrolled in a structured sequence of professional courses were more likely to complete the program and pass the national certification examination. Students were also more likely to remain enrolled when full-time faculty-student ratios were low. Clinical preceptor academic level also contributed to retention. Attrition increased when portfolio submission was required as a component of performance assessment

Validez del Ages & Stages questionnaires para predecir el desempeño cognitivo en los primeros años de educación escolar

ResumenIntroducciónEl Ages and Stages questionnaires (ASQ) fue validado en nuestro país para el tamizaje del desarrollo psicomotor. El objetivo es evaluar la validez del ASQ para predecir un menor rendimiento cognitivo en los primeros años de educación escolar.Pacientes y métodoEstudio de pruebas diagnósticas en una muestra de niños de nivel socioeconómico medio alto evaluados previamente con ASQ a los 8, 18 y/o 30 meses, y luego con la Escala de inteligencia para niños de Wechsler-tercera edición (WISC-III) entre los 6 y 9 años de edad. Cada evaluación con ASQ se contabilizó en forma independiente. La Escala de WISC-III fue estandarizada para la muestra, considerando rendimiento bajo cuando el puntaje total estaba bajo una desviación estándar de la media.ResultadosSe incluyeron 123 niños, correspondientes a 174 evaluaciones ASQ (42 de 8; 55 de 18; 77 de 30 meses de edad). El área bajo la curva ROC fue 80,7%, siendo superior a los 8 meses (98,0%) que a los 18 y 30 meses (78,1 y 79,3%, respectivamente). Considerando distintos criterios de corte con ASQ se obtuvo sensibilidad baja (27,8% a 50,0%), pero especificidad elevada (78,8% a 96,2%); el valor predictivo positivo varió entre 21,4% y 45,5%, mientras que el valor predictivo negativo fue 92,0-93,2%.ConclusiónEl ASQ tiene baja sensibilidad pero excelente especificidad para predecir un menor rendimiento cognitivo durante los primeros años de educación escolar, siendo una buena alternativa para monitorizar el desarrollo psicomotor de niños que se atienden en el sector privado de salud de nuestro país.AbstractIntroductionThe Ages and Stages questionnaires (ASQ) has been recently validated in our country for developmental screening. The objective of this study is evaluate the validity of ASQ to predict low cognitive performance in the early years of schooling.Patients and methodDiagnostic test studies conducted on a sample of children of medium-high socioeconomic level were evaluated using ASQ at least once at 8, 18 and/or 30 months old, and later, between 6 and 9 years old, reevaluated using the Wechsler Intelligence Scale for Children-third edition (WISC-III). Each ASQ evaluation was recorded independently. WISC-III was standardized, considering underperformance when the total score were under -1 standard deviationResults123 children, corresponding to 174 ASQ assessments (42 of them were 8 months old, 55 were 18 months and 77 were 30 months of age) were included. An area under the ROC curve of 80.7% was obtained, showing higher values at 8 months (98.0%) compared to 18 and 30 months old (78.1 and 79.3%, respectively). Considering different ASQ scoring criteria, a low sensitivity (27.8 to 50.0%), but a high specificity (78.8 to 96.2%) were obtained; the positive predictive value ranged between 21 and 46%, while the negative value was 92.0-93.2%.ConclusionASQ has low sensitivity but excellent specificity to predict a low cognitive performance during the first years of schooling, being a good alternative to monitor psychomotor development in children who attend the private sector healthcare in our country

Universal Approximation of a Class of Interval Type-2 Fuzzy Neural Networks in Nonlinear Identification

Neural networks (NNs), type-1 fuzzy logic systems (T1FLSs), and interval type-2 fuzzy logic systems (IT2FLSs) have been shown to be universal approximators, which means that they can approximate any nonlinear continuous function. Recent research shows that embedding an IT2FLS on an NN can be very effective for a wide number of nonlinear complex systems, especially when handling imperfect or incomplete information. In this paper we show, based on the Stone-Weierstrass theorem, that an interval type-2 fuzzy neural network (IT2FNN) is a universal approximator, which uses a set of rules and interval type-2 membership functions (IT2MFs) for this purpose. Simulation results of nonlinear function identification using the IT2FNN for one and three variables and for the Mackey-Glass chaotic time series prediction are presented to illustrate the concept of universal approximation

Deletion of the protein tyrosine phosphatase PTPN22 for adoptive T cell therapy facilitates CTL effector function but promotes T cell exhaustion

Background Adoptive cell therapy (ACT) is a promising strategy for treating cancer, yet it faces several challenges such as lack of long term protection due to T cell exhaustion induced by chronic TCR stimulation in the tumor microenvironment. One benefit of ACT, however, is that it allows for cellular manipulations, such as deletion of the phosphotyrosine phosphatase non-receptor type 22 (PTPN22), which improves CD8+ T cell anti-tumor efficacy in ACT. We tested whether Ptpn22KO cytolytic T cells (CTL) were also more effective than Ptpn22WT CTL in controlling tumors in scenarios that favor T cell exhaustion. Methods Tumor control by Ptpn22WT and Ptpn22KO CTL was assessed following adoptive transfer of low numbers of CTL to mice with subcutaneously implanted MC38 tumors. Tumor infiltrating lymphocytes were isolated for analysis of effector functions. An in vitro assay was established to compare CTL function in response to acute and chronic re-stimulation with antigen-pulsed tumor cells. The expression of effector and exhaustion-associated proteins by Ptpn22WT and Ptpn22KO T cells was followed over time in vitro and in vivo using the ID8 tumor model. Finally, the effect of PD-1 and TIM-3 blockade on Ptpn22KO CTL tumor control was assessed using monoclonal antibodies and CRISPR/Cas9-mediated knockout. Results Despite having improved effector function at the time of transfer, Ptpn22KO CTL became more exhausted than Ptpn22WT CTL, characterized by more rapid loss of effector functions, and earlier and higher expression of inhibitory receptors (IRs), particularly the terminal exhaustion marker TIM-3. TIM-3 expression, under the control of the transcription factor NFIL3, was induced by IL-2 signaling which was enhanced in Ptpn22KO cells. Anti-tumor responses of Ptpn22KO CTL were improved following PD-1 blockade in vivo, yet knockout or antibody-mediated blockade of TIM-3 did not improve but further impaired tumor control, indicating TIM-3 signaling itself did not drive the diminished function seen in Ptpn22KO CTL. Conclusions This study questions whether TIM-3 plays a role as an IR and highlights that genetic manipulation of T cells for ACT needs to balance short term augmented effector function against the risk of T cell exhaustion in order to achieve longer term protection. What is already known on this topic • T cell exhaustion in the tumor microenvironment is a major factor limiting the potential success of adoptive cell therapy (ACT) in the treatment of solid tumors. • Deletion of the phosphatase PTPN22 in CD8+ T cells improves their response to tumors, but it is not known whether this influences development of exhaustion. What this study adds • Under conditions which promote exhaustion, CTL lacking PTPN22 exhaust more rapidly than WT cells, despite displaying enhanced effector function in their initial response to antigen. • Ptpn22KO CTL express high levels of the inhibitory receptor TIM-3, but TIM-3 signaling does not directly contribute to Ptpn22KO CTL dysfunction. • Ptpn22KO T cells are more responsive to IL-2 through JAK-STAT signaling, which induces TIM-3 expression via the transcription factor NFIL3. How this study might affect research, practice or policy • Strategies aimed at augmenting T cell effector function for ACT should balance improved responses against an increased risk of T cell exhaustion

Single-Blind, Randomized, Controlled Trial of Pelvic Floor Muscle Training, Electrical Stimulation, Vaginal Cones, and No Active Treatment in the Management of Stress Urinary Incontinence

PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (p<0.001), and a significant improvement in the quality of life (p<0.001) in subjects who used pelvic floor exercises, electrical stimulation, and vaginal cones compared to the control group. No significant difference was found between groups in the urodynamic parameters. In the subjective evaluation, 58%, 55%, and 54% of women who had used pelvic floor exercises, electrical stimulation, and vaginal cones, respectively, reported being satisfied after treatment. In the control group, only 21% patients were satisfied with the treatment. CONCLUSION: Based on this study, pelvic floor exercises, electrical stimulation, and vaginal cones are equally effective treatments and are far superior to no treatment in women with urodynamic stress urinary incontinence

Single-blind, randomized, controlled trial of pelvic floor muscle training, electrical stimulation, vaginal cones, and no active treatment in the management of stress urinary incontinence

PURPOSE: To compare the effectiveness of pelvic floor exercises, electrical stimulation, vaginal cones, and no active treatment in women with urodynamic stress urinary incontinence. PATIENTS AND METHODS: One hundred eighteen subjects were randomly selected to recieve pelvic floor exercises (n=31), ES (n=30), vaginal cones (n=27), or no treatment (untreated control) (n=30). Women were evaluated before and after completion of six months of treatment by the pad test, quality of life questionnaire (I-QOL), urodynamic test, voiding diary, and subjective response. RESULTS: In the objective evaluation, we observed a statistically significant reduction in the pad test (p=0.003), in the number of stress urinary episodes (

First record of Megaselia rufipes (Meigen, 1804) (Diptera: Phoridae) from Uruguay with notes on biology

Megaselia rufipes (Meigen, 1804) is recorded for the first time in Uruguay, extending the Neotropical distribution of this taxon. The specimens were collected in a cemetery in Montevideo with ball-traps baited with carrion, placed inside crypts, from June to November 2011. Records of M. rufipes for the Neotropical Region tend to be sparse, but it is known from Brazil and Chile. According with its current distribution, M. rufipes tends to favour milder climates; our record from the more southern, cooler, part of the Neotropical Region is consistent with this perception

Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence

AbstractDuring recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices

HSD3B1 genotype identifies glucocorticoid responsiveness in severe asthma

Asthma resistance to glucocorticoid treatment is a major health problem with unclear etiology. Glucocorticoids inhibit adrenal androgen production. However, androgens have potential benefits in asthma. HSD3B1 encodes for 3β-hydroxysteroid dehydrogenase-1 (3β-HSD1), which catalyzes peripheral conversion from adrenal dehydroepiandrosterone (DHEA) to potent androgens and has a germline missense-encoding polymorphism. The adrenal restrictive HSD3B1(1245A) allele limits conversion, whereas the adrenal permissive HSD3B1(1245C) allele increases DHEA metabolism to potent androgens. In the Severe Asthma Research Program (SARP) III cohort, we determined the association between DHEA-sulfate and percentage predicted forced expiratory volume in 1 s (FEV1PP). HSD3B1(1245) genotypes were assessed, and association between adrenal restrictive and adrenal permissive alleles and FEV1PP in patients with (GC) and without (noGC) daily oral glucocorticoid treatment was determined (n = 318). Validation was performed in a second cohort (SARP I&II; n = 184). DHEA-sulfate is associated with FEV1PP and is suppressed with GC treatment. GC patients homozygous for the adrenal restrictive genotype have lower FEV1PP compared with noGC patients (54.3% vs. 75.1%; P < 0.001). In patients with the homozygous adrenal permissive genotype, there was no FEV1PP difference in GC vs. noGC patients (73.4% vs. 78.9%; P = 0.39). Results were independently confirmed: FEV1PP for homozygous adrenal restrictive genotype in GC vs. noGC is 49.8 vs. 63.4 (P < 0.001), and for homozygous adrenal permissive genotype, it is 66.7 vs. 67.7 (P = 0.92). The adrenal restrictive HSD3B1(1245) genotype is associated with GC resistance. This effect appears to be driven by GC suppression of 3β-HSD1 substrate. Our results suggest opportunities for prediction of GC resistance and pharmacologic intervention

COVID-19 in long-term care facilities in Brazil: serological survey in a post-outbreak setting

This cross-sectional seroepidemiological survey presents the seroprevalence of SARS-CoV-2 in a population living in 15 Long-Term Care Facilities (LTCFs), after two intra-institutional outbreaks of COVID-19 in the city of Botucatu, Sao Paulo State, Brazil. Residents were invited to participate in the serological survey performed in June and July 2020. Sociodemographic and clinical characterization of the participants as well as the LTCF profile were recorded. Blood samples were collected, processed and serum samples were tested using the rapid One Step COVID-19 immunochromatography test to detect IgM and IgG anti-SARS-CoV-2. Among 209 residents, the median of age was 81 years old, 135 (64.6%) were female and 171 (81.8%) self-referred as being white. An overall seroprevalence of 11.5% (95% CI: 7.5% – 16.6%) was found. The highest seroprevalences of 100% and 76.9% were observed in LTCFs that had experienced COVID-19 outbreaks. Most residents with positive immunochromatography tests (70.8%) referred previous contact with a confirmed COVID-19 case. Although there was a relatively low seroprevalence of COVID-19 in the total number of elderly people, this population is highly vulnerable and LTCFs are environments at higher risk for COVID-19 dissemination. A well-established test for COVID-19 policies, the adequate characterization of the level of interaction between residents and the healthcare provider team and the level of complexity of care are crucial to monitor and control the transmission of SARS-CoV-2 in these institutions