Cost-Benefit Analysis of a Pediatric Patient Blood Management Program

Introduction Red blood cell (RBC) transfusions can be a life-saving and important intervention used to replace blood loss or manage anemia, but they also come with risks from transfusion-associated adverse events (TAAEs). Patient blood management (PBM) involves a multidisciplinary approach to optimize care of patients who may need a transfusion, including blood conservation modalities, patient-centered decision making, among others. The impact of PBM in the pediatric setting is not well understood, particularly the impact on TAAEs and the economic impact of these programs. The following specific aims were pursued: (1) To investigate the effect of a PBM program on transfusion utilization and the incidence of TAAEs, and (2) to compare the costs related to supporting a health-system level PBM program to the costs of transfusion utilization. Methods This study used a retrospective cohort design to evaluate the impact of a PBM program on patient outcomes in a pediatric hospital system. Clinical and demographic information from pediatric patients between the ages of four months and eighteen years who had an inpatient hospitalization were compared for the year prior to the program (2015) and the year post-implementation (2019). Transfusion utilization was compared before and after the program using generalized estimating equation. A cost-benefit analysis examined program costs and compared them to program outputs. Results This study examined a total of 35,245 hospitalizations and over 3,800 transfusions in the pre- and post-intervention years. The post-intervention year had lower pre-transfusion hemoglobin values and smaller volumes of RBC transfusions ordered, and this was statistically significant (p\u3c0.01). While this study did not see a statistically significant difference in the incidence of TAAEs, fewer hospitalizations had RBC transfusions ordered in 2019 when compared to 2015. When examining transfusion utilization while adjusting for potential confounders, group year was not statistically significant (p = 0.11). Overall, activity-based transfusion costs based on projections were higher in the post-intervention year. Conclusion This study explored the impact of a PBM program on pediatric hospitalized patients at a large tertiary academic medical center. The results suggest that this work was effective in reducing the mean hemoglobin pre-transfusion for RBC transfusion and reduced the mean volume of transfusion when adjusted for severity of illness and length of stay. The results of the cost-benefit analysis suggest that this investment in safety did not correspond with decreased utilization costs, but there were limitations in the analysis. More research is needed to understand the impact of reductions in transfusion-associated adverse events and their true cost

Does Practice Make Perfect? A Randomized Control Trial of Behavioral Rehearsal on Suicide Prevention Gatekeeper Skills

Suicide is the third leading cause of death among 10-24-year-olds and the target of school-based prevention efforts. Gatekeeper training, a broadly disseminated prevention strategy, has been found to enhance participant knowledge and attitudes about intervening with distressed youth. Although the goal of training is the development of gatekeeper skills to intervene with at-risk youth, the impact on skills and use of training is less known. Brief gatekeeper training programs are largely educational and do not employ active learning strategies such as behavioral rehearsal through role play practice to assist skill development. In this study, we compare gatekeeper training as usual with training plus brief behavioral rehearsal (i.e., role play practice) on a variety of learning outcomes after training and at follow-up for 91 school staff and 56 parents in a school community. We found few differences between school staff and parent participants. Both training conditions resulted in enhanced knowledge and attitudes, and almost all participants spread gatekeeper training information to others in their network. Rigorous standardized patient and observational methods showed behavioral rehearsal with role play practice resulted in higher total gatekeeper skill scores immediately after training and at follow-up. Both conditions, however, showed decrements at follow-up. Strategies to strengthen and maintain gatekeeper skills over time are discussed

The Vehicle, 1966, Vol. 8

Vol. 8 Table of Contents CommentaryBill Moser & Avis Eaglestonpage 3 The Vengeance of the DeadStephen W. Gibbspage 5 Ode To A MeadowKathleen McCormackpage 12 Row OnDavid Helmpage 13 Sonnet 63R.L. Hudsonpage 14 UntitledKathleen McCormackpage 14 The Pure GoldDavid Helmpage 15 CommunionDavid Helmpage 15 PreludeMichael Baldwinpage 15 The AlbatrossKaren Cooleypage 16 The Albatross (photo)DeWittpage 17 Ruff and the VaseDavid Helmpage 18 LaBelleKathleen McCormackpage 19 Not Quite SoR.L. Hudsonpage 20 Feeling (no number)David Reifpage 21 Song at DuskDavid Helmpage 21 Arcadia RuminationsR.L. Hudsonpage 22 The BarWayne Johnsonpage 25 HelloWilliam Framepage 26 The ProcessJerry DeWittpage 27 The KillingAdrian Beardpage 30 The Amusement Park GameStephen W. Gibbspage 38 DamnMel Tylerpage 40 PainWilliam Framepage 40 UntitledSusan Champlinpage 41 Portrait of A Scholar As A Young ManStephen W. Gibbspage 42 The TimesW.D.Mpage 46 ParadoxW.D.M.page 46 MankindDavid Helmpage 47https://thekeep.eiu.edu/vehicle/1014/thumbnail.jp

The Vehicle, 1966, Vol. 8

Vol. 8 Table of Contents CommentaryBill Moser & Avis Eaglestonpage 3 The Vengeance of the DeadStephen W. Gibbspage 5 Ode To A MeadowKathleen McCormackpage 12 Row OnDavid Helmpage 13 Sonnet 63R.L. Hudsonpage 14 UntitledKathleen McCormackpage 14 The Pure GoldDavid Helmpage 15 CommunionDavid Helmpage 15 PreludeMichael Baldwinpage 15 The AlbatrossKaren Cooleypage 16 The Albatross (photo)DeWittpage 17 Ruff and the VaseDavid Helmpage 18 LaBelleKathleen McCormackpage 19 Not Quite SoR.L. Hudsonpage 20 Feeling (no number)David Reifpage 21 Song at DuskDavid Helmpage 21 Arcadia RuminationsR.L. Hudsonpage 22 The BarWayne Johnsonpage 25 HelloWilliam Framepage 26 The ProcessJerry DeWittpage 27 The KillingAdrian Beardpage 30 The Amusement Park GameStephen W. Gibbspage 38 DamnMel Tylerpage 40 PainWilliam Framepage 40 UntitledSusan Champlinpage 41 Portrait of A Scholar As A Young ManStephen W. Gibbspage 42 The TimesW.D.Mpage 46 ParadoxW.D.M.page 46 MankindDavid Helmpage 47https://thekeep.eiu.edu/vehicle/1014/thumbnail.jp

Heliogyro Solar Sail Research at NASA

The recent successful flight of the JAXA IKAROS solar sail has renewed interest within NASA in spinning solar sail concepts for high-performance solar sailing. The heliogyro solar sail, in particular, is being re-examined as a potential game-changing architecture for future solar sailing missions. In this paper, we present an overview of ongoing heliogyro technology development and feasibility assessment activities within NASA. In particular, a small-scale heliogyro solar sail technology demonstration concept will be described. We will also discuss ongoing analytical and experimental heliogyro structural dynamics and controls investigations and provide an outline of future heliogyro development work directed toward enabling a low cost heliogyro technology demonstration mission ca. 2020

Factors influencing the approaches to studying of preclinical and clinical students and postgraduate trainees

<p>Abstract</p> <p>Background</p> <p>Students can be classified into three categories depending on their approaches to studying; namely, deep approach (DA), strategic approach (SA) and surface apathetic or superficial approach (SAA). The aim of this study was to identify factors affecting the approaches to studying among Sri Lankan medical undergraduates and post graduate trainees and to analyze the change in the pattern of study skills with time and experience.</p> <p>Method</p> <p>Pre-clinical and clinical students of the Faculty of Medicine, University of Colombo and postgraduate trainees in Surgery at the National Hospital of Sri Lanka were invited to complete the Approaches and Study Skills Inventory for Students (ASSIST) questionnaire.</p> <p>Results</p> <p>A total of 187 pre clinical (M: F = 96:91), 124 clinical (M: F = 61:63) and 53 post graduate trainees (M: F = 50:3) participated in the study. Approaches of male and female students were similar. SA was significantly affected by age among the preclinical students (p = 0.01), but not in other groups. Among pre-clinical students, males preferred a teacher who supported understanding (p = 0.04) but females preferred a passive transmission of information (p < 0.001). This, too, was not visible among other groups. A linear regression performed on group (batch), gender, island rank at GCE Advance Level (AL) examination, self appraisal score and the preference scores of type of teacher only managed to explain 35% or less of variance observed for each approach in individual groups.</p> <p>Conclusion</p> <p>Different factors affect the approach to studying in different groups but these explain only a small fraction of the variance observed.</p

Estimating Genetic Variability in Non-Model Taxa: A General Procedure for Discriminating Sequence Errors from Actual Variation

Genetic variation is the driving force of evolution and as such is of central interest for biologists. However, inadequate discrimination of errors from true genetic variation could lead to incorrect estimates of gene copy number, population genetic parameters, phylogenetic relationships and the deposition of gene and protein sequences in databases that are not actually present in any organism. Misincorporation errors in multi-template PCR cloning methods, still commonly used for obtaining novel gene sequences in non-model species, are difficult to detect, as no previous information may be available about the number of expected copies of genes belonging to multi-gene families. However, studies employing these techniques rarely describe in any great detail how errors arising in the amplification process were detected and accounted for. Here, we estimated the rate of base misincorporation of a widely-used PCR-cloning method, using a single copy mitochondrial gene from a single individual to minimise variation in the template DNA, as 1.62×10−3 errors per site, or 9.26×10−5 per site per duplication. The distribution of errors among sequences closely matched that predicted by a binomial distribution function. The empirically estimated error rate was applied to data, obtained using the same methods, from the Phospholipase A2 toxin family from the pitviper Ovophis monticola. The distribution of differences detected closely matched the expected distribution of errors and we conclude that, when undertaking gene discovery or assessment of genetic diversity using this error-prone method, it will be informative to empirically determine the rate of base misincorporation

11β-Hydroxysteroid Dehydrogenase type 1 is expressed in neutrophils and restrains an inflammatory response in male mice

Endogenous glucocorticoid action within cells is enhanced by prereceptor metabolism by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), which converts intrinsically inert cortisone and 11-dehydrocorticosterone into active cortisol and corticosterone, respectively. 11β-HSD1 is highly expressed in immune cells elicited to the mouse peritoneum during thioglycollate-induced peritonitis and is down-regulated as the inflammation resolves. During inflammation, 11β-HSD1-deficient mice show enhanced recruitment of inflammatory cells and delayed acquisition of macrophage phagocytic capacity. However, the key cells in which 11β-HSD1 exerts these effects remain unknown. Here we have identified neutrophils (CD11b(+),Ly6G(+),7/4(+) cells) as the thioglycollate-recruited cells that most highly express 11β-HSD1 and show dynamic regulation of 11β-HSD1 in these cells during an inflammatory response. Flow cytometry showed high expression of 11β-HSD1 in peritoneal neutrophils early during inflammation, declining at later states. In contrast, expression in blood neutrophils continued to increase during inflammation. Ablation of monocytes/macrophages by treatment of CD11b-diphtheria-toxin receptor transgenic mice with diphtheria toxin prior to thioglycollate injection had no significant effect on 11β-HSD1 activity in peritoneal cells, consistent with neutrophils being the predominant 11β-HSD1 expressing cell type at this time. Similar to genetic deficiency in 11β-HSD1, acute inhibition of 11β-HSD1 activity during thioglycollate-induced peritonitis augmented inflammatory cell recruitment to the peritoneum. These data suggest that neutrophil 11β-HSD1 increases during inflammation to contribute to the restraining effect of glucocorticoids upon neutrophil-mediated inflammation. In human neutrophils, lipopolysaccharide activation increased 11β-HSD1 expression, suggesting the antiinflammatory effects of 11β-HSD1 in neutrophils may be conserved in humans

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts