Guidelines for Assessment and Instruction in Statistics Education (GAISE) College Report 2016

In 2005 the American Statistical Association (ASA) endorsed the Guidelines for Assessment and Instruction in Statistics Education (GAISE) College Report. This report has had a profound impact on the teaching of introductory statistics in two- and four-year institutions, and the six recommendations put forward in the report have stood the test of time. Much has happened within the statistics education community and beyond in the intervening 10 years, making it critical to re-evaluate and update this important report. For readers who are unfamiliar with the original GAISE College Report or who are new to the statistics education community, the full version of the 2005 report can be found at http://www.amstat.org/education/gaise/GaiseCollege_full.pdf and a brief history of statistics education can be found in Appendix A of this new report. The revised GAISE College Report takes into account the many changes in the world of statistics education and statistical practice since 2005 and suggests a direction for the future of introductory statistics courses. Our work has been informed by outreach to the statistics education community and by reference to the statistics education literature

Pulmonary Artery Catheter Use and Mortality in the Cardiac Intensive Care Unit.

BACKGROUND: The appropriate use of pulmonary artery catheters (PACs) in critically ill cardiac patients remains debated. OBJECTIVES: The authors aimed to characterize the current use of PACs in cardiac intensive care units (CICUs) with attention to patient-level and institutional factors influencing their application and explore the association with in-hospital mortality. METHODS: The Critical Care Cardiology Trials Network is a multicenter network of CICUs in North America. Between 2017 and 2021, participating centers contributed annual 2-month snapshots of consecutive CICU admissions. Admission diagnoses, clinical and demographic data, use of PACs, and in-hospital mortality were captured. RESULTS: Among 13,618 admissions at 34 sites, 3,827 were diagnosed with shock, with 2,583 of cardiogenic etiology. The use of mechanical circulatory support and heart failure were the patient-level factors most strongly associated with a greater likelihood of the use of a PAC (OR: 5.99 [95% CI: 5.15-6.98]; P < 0.001 and OR: 3.33 [95% CI: 2.91-3.81]; P < 0.001, respectively). The proportion of shock admissions with a PAC varied significantly by study center ranging from 8% to 73%. In analyses adjusted for factors associated with their placement, PAC use was associated with lower mortality in all shock patients admitted to a CICU (OR: 0.79 [95% CI: 0.66-0.96]; P = 0.017). CONCLUSIONS: There is wide variation in the use of PACs that is not fully explained by patient level-factors and appears driven in part by institutional tendency. PAC use was associated with higher survival in cardiac patients with shock presenting to CICUs. Randomized trials are needed to guide the appropriate use of PACs in cardiac critical care

Thin ice, deep snow and surface flooding in Kotzebue Sound: landfast ice mass balance during two anomalously warm winters and implications for marine mammals and subsistence hunting

The inaugural data from the first systematic program of sea ice observations in Kotzebue Sound, Alaska, in 2018 coincided with the first winter in living memory when the Sound was not choked with ice. The following winter of 2018-19 was even warmer and characterized by even less ice. Here we discuss the mass balance of landfast ice near Kotzebue (Qikiktagruk) during these two anomalously warm winters. We use in-situ observations and a 1-D thermodynamic model to address three research questions developed in partnership with an Indigenous Advisory Council. In doing so, we improve our understanding of connections between landfast ice mass balance, marine mammals, and subsistence hunting. Specifically, we show: i) Ice growth stopped unusually early due to strong vertical ocean heat flux, which also likely contributed to early start to bearded seal hunting; ii) Unusually thin ice contributed to widespread surface flooding. The associated snow ice formation partly offset the reduced ice growth, but the flooding likely had a negative impact on ringed seal habitat; iii) Sea ice near Kotzebue during the winters of 2017-18 and 2018-19 was likely the thinnest since at least 1945, driven by a combination of warm air temperatures and a persistent ocean heat flux.

Defining levels of care in cardiogenic shock

BackgroundExpert opinion and professional society statements have called for multi-tier care systems for the management of cardiogenic shock (CS). However, little is known about how to pragmatically define centers with different levels of care (LOC) for CS.MethodsEleven of 23 hospitals within our healthcare system sharing a common electronic health record were classified as different LOC according to their highest mechanical circulatory support (MCS) capabilities: Level 1 (L-1)—durable left ventricular assist device, Level 1A (L-1A)—extracorporeal membrane oxygenation, Level 2 (L-2)—intra-aortic balloon pump and percutaneous ventricular assist device; and Level 3 (L-3)—no MCS. All adult patients treated for CS (International Classification of Diseases, ICD-10 code R57.0) between 2016 and 2022 were included. Etiologies of CS were identified using associated diagnostic codes. Management strategies and outcomes across LOC were compared.ResultsHigher LOC centers had higher volumes: L-1 (n = 1): 2,831 patients, L-1A (n = 4): 3,452, L-2 (n = 1): 340, and L-3 (n = 5): 780. Emergency room admissions were more common in lower LOC (96% at L-3 vs. 46% L-1; p < 0.001), while hospital transfers were predominant at higher LOC (40% at L-1 vs. 2.7% at L-3; p < 0.001). Men comprised 61% of the cohort. Patients were younger in the higher LOC [69 (60–78) years at L-1 vs. 77 (67–85) years at L-3; p < 0.001]. Patients with acute myocardial infarction (AMI)-CS and acute heart failure (AHF)-CS were concentrated in higher LOC centers while other etiologies of CS were more common in L-2 and L-3 (p < 0.001). Cardiac arrest on admission was more prevalent in lower LOC centers (L-1: 2.8% vs. L-3: 12.1%; p < 0.001). Patients with AMI-CS received more percutaneous coronary intervention in lower LOC (51% L-2 vs. 29% L-1; p < 0.01) but more coronary arterial bypass graft surgery at higher LOC (L-1: 42% vs. L-1A: 23%; p < 0.001). MCS use was consistent across levels for AMI-CS but was more frequent in higher LOC for AHF-CS patients (L-1: 28% vs. L-2: 10%; p < 0.001). Despite increasing in-hospital mortality with decreasing LOC, no significant difference was seen after multivariable adjustment.ConclusionThis is the first report describing a pragmatic classification of LOC for CS which, based on MCS capabilities, can discriminate between centers with distinct demographics, practice patterns, and outcomes. This classification may serve as the basis for future research and the creation of CS systems of care

A History of Universalism: Conceptions of the Internationality of Science from the Enlightenment to the Cold War

That science is fundamentally universal has been proclaimed innumerable times. But the precise geographical meaning of this universality has changed historically. This article examines conceptions of scientific internationalism from the Enlightenment to the Cold War, and their varying relations to cosmopolitanism, nationalism, socialism, and 'the West'. These views are confronted with recent tendencies to cast science as a uniquely European product

Le Prytanée français et les écoles de Paris (1798-1802)

Palmer Robert R., Julia Dominique. Le Prytanée français et les écoles de Paris (1798-1802). In: Annales historiques de la Révolution française, n°243, 1981. De l’Ancien Régime à l’Empire. Problèmes de l’enseignement. pp. 123-152

Alaska Beluga Whale Committee—a unique model of co-management

The Alaska Beluga Whale Committe (ABWC) was formed in 1988 to conserve beluga whales (Delphinapterus leucas) and manage beluga subsistence hunting in western and northern Alaska in cooperation with the National Marine Fisheries Service (NMFS). When the ABWC was formed, there was no consistently funded research or management programme for belugas in Alaska, and co-management was a new concept. The ABWC brought together representatives from beluga hunting communities; federal, state, tribal and local governments; and beluga researchers to develop and implement a programme to manage belugas. With funding from NMFS and others, the ABWC has collected data necessary for informed management decisions including the following: harvest data; aerial surveys of belugas in Bristol Bay and the eastern Bering and Chukchi seas; beluga tracking studies, including training hunters to attach transmitters; a pioneering genetics study of beluga stock identity that has facilitated collection of >2000 beluga skin samples; and a genetics-based mark–recapture study to estimate beluga abundance in Bristol Bay and validate aerial survey estimates. The ABWC is currently engaged in regional management planning in Kotzebue Sound and the eastern Bering Sea. It produces results that are scientifically valid, locally accepted and cost-effective and is an example of what can be achieved when Native hunters, scientists and managing agencies respect and listen to one another and work together. However, the current NMFS co-management funding process has fundamentally altered the relationship between NMFS and ABWC, with NMFS now acting more like a funding agency than a partner

Case-Based Specialty Training for Medical Students to Elicit Social Determinants of Health

Introduction Without explicit education and training on how social determinants of health (SDoH) impact patient care and health outcomes, medical schools are failing to effectively equip future physicians to serve their patients. We created this workshop on health equity with a focus on SDoH to help students more effectively communicate with diverse populations. Methods Third-year medical students and faculty were provided with class guides, learning objectives, role-play vignettes containing clerkship-specific history and physical exams, schedules, and discussion questions during a 2-hour session centered on SDoH. The workshop's impact was measured through mixed-methods analysis of surveys. Results Based on pre- and postsurvey results from 87 participants, medical students strongly agreed that (1) SDoH factor more into a patient's health outcomes than the clinical encounter (pre: 67%, post: 87%), (2) it is their duty to gather information about SDoH (pre: 86%, post: 97%), (3) neighborhood safety is one of the key SDoH (pre: 88%, post: 97%), (4) they understood the impact of upstream interventions (pre: 35%, post: 93%), (5) they could efficiently screen all patients for SDoH at every medical encounter (pre: 27%, post: 86%), and (6) they could find preliminary resources to quickly assist patients in need of help regarding particular SDoH (pre: 26%, post: 85%). Discussion This was the first iteration of this workshop; challenges involved piloting the content, time restraints, and organizational structure of the workshop design. Future directions include making SDoH curricula an integral part of undergraduate medical education and diverse clinical environments