Impacts of Scheduling Recess Before Lunch in Elementary Schools: A Case Study Approach of Plate Waste and Perceived Behaviors

Purpose/Objectives Recess Before Lunch (RBL) for elementary students is considered a best practice related to increased nutrient intakes at lunch, decreased afternoon behavioral issues, and increased afternoon learning efficiency; however, school characteristics, such as amount of time for lunch, offer vs. serve, and scheduling factors can influence implementation. A qualitative study to examine impacts of RBL on plate waste and school stakeholders’ perceptions of third grade students’ behaviors in three school districts in one Midwest state was conducted. The results were used to develop a guide that includes tools and best practices to assist schools in determination of recess scheduling. Methods Digital photography and weight-based assessment of plate waste by meal component were collected among third-graders in three geographically distinct, independent school districts with varying student enrollments. Data were collected on two occasions in fall when recess was scheduled after lunch and again in spring when recess was scheduled before lunch. Following completion of a short survey, interviews with multiple stakeholders at each school building were conducted in fall and spring to assess views of the benefits and challenges associated with changing to recess before lunch. Results Plate waste and fluid milk consumption varied between sites. Findings suggest other environmental influences affect food and milk consumption beyond scheduling of recess. Digital photography method of plate waste estimation was validated with comparisons to actual weights and measures. Application to Child Nutrition Professionals Findings from this study were utilized to develop a guide to assist decision makers considering moving recess before lunch. The guide includes tools and best practices to assist schools in the determination of making the change to recess before lunch. The guide is located on the USDA State Sharing Center webpage and available as a resource to all interested parties

Lorlatinib Exposed: A Far From Optimal Dose

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/172839/1/cpt2579_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/172839/2/cpt2579.pd

Targeted randomization dose optimization trials enable fractional dosing of scarce drugs.

Administering drug at a dose lower than that used in pivotal clinical trials, known as fractional dosing, can stretch scarce resources. Implementing fractional dosing with confidence requires understanding a drug's dose-response relationship. Clinical trials aimed at describing dose-response in scarce, efficacious drugs risk underdosing, leading dose-finding trials to not be pursued despite their obvious potential benefit. We developed a new set of response-adaptive randomized dose-finding trials and demonstrate, in a series of simulated trials across diverse dose-response curves, these designs' efficiency in identifying the minimum dose that achieves satisfactory efficacy. Compared to conventional designs, these trials have higher probabilities of identifying lower doses while reducing the risks of both population- and subject-level underdosing. We strongly recommend that, upon demonstration of a drug's efficacy, pandemic drug development swiftly proceeds with response-adaptive dose-finding trials. This unified strategy ensures that scarce effective drugs produce maximum social benefits

Real World Outcomes versus Clinical Trial Results of Durvalumab Maintenance in Veterans with Stage III Non-Small Cell Lung Cancer

One year of durvalumab following concurrent chemoradiotherapy improves progression-free (PFS) and overall survival (OS) for patients with stage III non-small cell lung cancer (NSCLC). However, the real-world efficacy of durvalumab has not been determined. We conducted a multi-center observational cohort study across the Veterans Health Administration, including patients with stage III NSCLC who received concurrent chemoradiotherapy and durvalumab, compared to patients who received concurrent chemoradiotherapy alone. Kaplan–Meier and Cox regression approaches were used to identify factors associated with PFS and OS. We calculated a hazard ratio and efficacy-effectiveness factor to compare OS of veterans to the referenced clinical trial population. A total of 1006 patients with stage III NSCLC who received concurrent chemoradiotherapy and at least one dose of durvalumab from November 2017 to April 2021 were compared to 989 patients who received concurrent chemoradiotherapy alone from January 2015 to December 2016. Adjuvant durvalumab was associated with higher PFS (HR 0.62, 95% CI 0.55–0.70, p p p = 0.02: EE gap 0.73). OS of veterans with stage III NSCLC treated with adjuvant durvalumab is improved compared to a modern comparator but is reduced compared to the PACIFIC population

Visual arts in the clinical clerkship: a pilot cluster-randomized, controlled trial

Abstract Background Arts exposure is associated with positive psychological constructs. To date, no randomized, controlled studies have integrated art into clinical medical education or measured its effects on positive psychological constructs or educational outcomes. In this study, we assessed the possibility and potential benefits of integrating visual arts education into a required internal medicine (IM) clinical clerkship. Methods We conducted a controlled trial in an academic healthcare system with an affiliated art museum. IM students were assigned to one of three interventions: museum-based arts (n = 11), hospital-based arts (n = 10), or hospital-based conventional education (n = 13). Arts groups explored empathy, resilience, and compassion in works of art during facilitator-guided discussions. We assessed pre- and post-intervention measures of empathy, mindfulness, tolerance of ambiguity, and grit and tracked National Board of Medical Examiners IM shelf exam performance to capture changes in educational outcomes. Focus group discussions with participants in the arts-based interventions were performed at the study’s conclusion. Results Arts education was successfully integrated into a busy clinical clerkship in both hospital and art museum settings. Focus group participants reported increased implicit bias cognizance and time for reflection, but no significant differences in psychometric or educational outcomes were identified. While most students felt positively toward the experience; some experienced distress from missed clinical time. Conclusions This pilot study demonstrates the feasibility of integrating visual arts education into the clerkship. Although observable quantitative differences in measures of positive psychological constructs and educational outcomes were not found, qualitative assessment suggested benefits as well as the feasibility of bringing fine arts instruction into the clinical space. A larger, multi-center study is warranted.http://deepblue.lib.umich.edu/bitstream/2027.42/173618/1/12909_2020_Article_2386.pd