Detecting a Possible Correlation between Hands-On Experimentation and Scientific Data Analysis in 8th Grade Students

This Practitioner Perspective reports on action research that examined the impact of integrating hands-on experimentation on eighth- grade students skills of scientific data analysis and interpretation in a science middle school class. The intervention given to the treatment group was tasking students with completing scientific experiments during their daily lessons, along with collecting and analyzing data from those experiments. Collected data through both control and treatment groups indicated that there was no significant difference in mean test scores between the two groups. Discussions and suggestions for future studies were included

New oral anticoagulants for the treatment of venous thromboembolism: understanding differences and similarities.

Venous thromboembolism (VTE) is a major cause of morbidity, mortality, and healthcare expenditure. In the United States, approximately 0.1 % of the population experiences an initial VTE event each year. Anticoagulation therapy is the cornerstone of acute VTE treatment and for prevention of recurrent VTE events. Conventional anticoagulants, including heparin, low-molecular-weight heparins, fondaparinux, and vitamin K antagonists are widely used but have limitations. Newer oral anticoagulant agents, including direct thrombin inhibitors (e.g., dabigatran etexilate) and direct factor Xa inhibitors (e.g., rivaroxaban, apixaban, and edoxaban) have been developed to attempt to overcome some of the limitations of conventional anticoagulant therapy. These new oral agents have been evaluated for safety and efficacy in large, randomized clinical trials in the treatment and secondary prevention of VTE with results that are comparable to conventional therapy. Dabigatran, rivaroxaban, apixaban, and edoxaban are important new treatment options for patients with VTE. In this review, we compare these new agents and their associated clinical trials in VTE treatment

Ticagrelor: pharmacokinetics, pharmacodynamics, clinical efficacy, and safety.

Dual antiplatelet therapy, composed of aspirin plus a P2Y12 -receptor antagonist, is the cornerstone of treatment for patients with acute coronary syndrome (ACS). A number of U.S. Food and Drug Administration-approved P2Y12 -receptor antagonists are available for treating patients with ACS, including the thienopyridine compounds clopidogrel and prasugrel. Ticagrelor, the first of a new class of antiplatelet agents, is a noncompetitive, direct-acting P2Y12 -receptor antagonist. Unlike the thienopyridine compounds, ticagrelor does not require metabolism for activity. Also, whereas clopidogrel and prasugrel are irreversible inhibitors of the P2Y12 receptor, ticagrelor binds reversibly to inhibit receptor signaling and subsequent platelet activation. In pharmacodynamic studies, ticagrelor demonstrated faster onset and more potent inhibition of platelet aggregation than clopidogrel. These properties of ticagrelor may contribute to reduced rates of thrombotic outcomes compared with clopidogrel, as demonstrated in a phase III clinical trial. However, in addition to bleeding, distinctive adverse effects of this new chemical entity have not been reported with the thienopyridine P2Y12 -receptor inhibitors. Although ticagrelor represents an advancement in P2Y12 -receptor inhibition therapy, a thorough understanding of this compound as an antiplatelet therapy remains to be elucidated

Clinical use of rivaroxaban: pharmacokinetic and pharmacodynamic rationale for dosing regimens in different indications.

Target-specific oral anticoagulants have become increasingly available as alternatives to traditional agents for the management of a number of thromboembolic disorders. To date, the direct Factor Xa inhibitor rivaroxaban is the most widely approved of the new agents. The dosing of rivaroxaban varies and adheres to specific schedules in each of the clinical settings in which it has been investigated. These regimens were devised based on the results of phase II dose-finding studies and/or pharmacokinetic modeling, and were demonstrated to be successful in randomized, phase III studies. In most cases, the pharmacodynamic profile of rivaroxaban permits once-daily dosing. A once-daily dose is indicated for the prevention of venous thromboembolism (VTE) in patients undergoing hip or knee replacement surgery, the long-term prevention of stroke in patients with non-valvular atrial fibrillation, and the long-term secondary prevention of recurrent VTE. Twice-daily dosing is required in the acute phase of treatment in patients with VTE and in the combination of rivaroxaban with standard single or dual antiplatelet therapy for secondary prevention after acute coronary syndrome events. This article reviews the empirical and clinical rationale supporting the dose regimens of rivaroxaban in each clinical setting

Direct Oral Anticoagulants for the Prevention of Stroke in Patients with Nonvalvular Atrial Fibrillation: Understanding Differences and Similarities.

The presence of atrial fibrillation (AF), the most common sustained cardiac arrhythmia, significantly increases the risk for stroke. Current guidelines recommend that the vitamin K antagonist warfarin or direct oral anticoagulants (DOACs), such as the approved direct thrombin inhibitor dabigatran and the approved direct factor Xa inhibitors apixaban, rivaroxaban, and edoxaban, should be used for thromboprophylaxis in patients with nonvalvular AF at risk for stroke or systemic embolic events (SEE). Warfarin, the mainstay of stroke prevention in AF, increases the risk of major bleeding. Furthermore, warfarin therapy comes with several limitations including frequent monitoring and the need for dose adjustments, unpredictable pharmacokinetics and pharmacodynamics, and the potential for significant drug-drug and food-drug interactions. The DOACs were developed to overcome these limitations while maintaining or surpassing warfarin\u27s efficacy and safety profiles. All four DOACs have similar or better efficacy and safety compared with warfarin and are therefore valuable alternatives for the prevention of stroke and SEE in patients with nonvalvular AF. Understanding the subtle differences in the DOACs\u27 pharmacology, phase 3 study designs, and trial outcomes will allow for a more tailored approach in selecting the right oral anticoagulant for each patient

A Meta-Analytic Study of the Effectiveness of ​Clinical Decision-Making Interventions Among Medical Professionals​

In this study, we explore the effectiveness of Clinical decision-making (CDM) interventions on diagnostic accuracy among medical professionals. Diagnostic errors are one the most prominent issues in healthcare systems and tackling this issue is of great importance. Our results showed a positive effect between CDM interventions and diagnostic accuracy. Therefore, the implementation of CDM interventions is key to improving the quality of care in our health care systems and patient-provider relationships

Science Interest and Confidence in Middle School Aged Students

In the middle school science classroom, students begin to decide whether or not they like science. This decision has long term impacts on their interests, future studies, and ultimately career goals. Further, the impact of this decision can be felt by the STEM field when fewer and fewer students are interested in pursuing jobs within the field. To explore the attitudes and confidence of these students towards science and math, the CURE survey and Math Anxiety Scale were adapted to gather data from a group of middle school students after attending a Middle School Science Day event. Through the research, we wanted to get a look at why some students lose interest in science around the time they are in middle school. At the event, students worked in groups to complete an engineering challenge and had the opportunity to see various science demonstrations. After the day’s activities, students were asked to complete the surveys. Surprisingly, our surveys displayed a lack of connection between math anxiety and science interest at the middle school level. This research will be useful to teachers at the middle school level as well as above and below, as they work to engage students in science class and make the content interesting and relevant, in addition to encouraging their students to be curious about science. Further, the research has laid groundwork for using an adapted form of the CURE survey at the middle school level

COLECTOMY OUTCOMES IN PATIENTS OVER 65 WITH ULCERATION COLITIS

Introduction: There are limited data regarding surgical outcomes for elderly patients with Ulcerative Colitis, and we sought to examine the post operative outcomes in this population. Methods: The ACS NSQIP was queried for all patients with a diagnosis of ulcerative colitis and compared elderly patients (those aged 65 and older) to younger patients under age 65. Univariate and multivariate logistic regression was done to evaluate differences in morbidity and mortality rates. Results: 2,699 patients were analyzed, of which 493 (18.3%) were defined as elderly. Elderly patients had more comorbidities compared to younger patients but were less likely to be on preoperative steroids (47.1% vs 74.2%, p\u3c0.0001). Elderly patients had a higher proportion of emergent cases (27.6% vs 8.2%, p\u3c0.0001) and an average 3 day longer hospital stay, (p\u3c0.0001). There were no significant differences in the rates of anastomotic leak, surgical site infections or 30-day readmission. Elderly patients had a higher rate of morbidity (47.3% vs 26.8%, p\u3c0.0001) and mortality (8.9% vs 1.2%, p\u3c0.0001). Multivariate analysis showed elderly patients had significantly increased odds for morbidity (OR 2.45, 95% CI: 2.00-2.99, p\u3c0.0001) and 30-day mortality (OR 7.91, 95% CI: 4.85-12.91, p\u3c0.001). Preoperative sepsis significantly increased the risk of morbidity (OR 3.457, 95% CI: 2.27-5.26, p \u3c0.0001) and mortality (OR 3.11, 95% CI: 1.48-6.57, p\u3c0.003). Conclusions: Elderly patients with Ulcerative Colitis that undergo a colectomy are at increased risk for both morbidity and mortality. Optimizing these patients may reduce the risk, but further prospective trials are warranted to further elucidate the ideal optimization strategies.https://scholarlycommons.henryford.com/sarcd2021/1009/thumbnail.jp

Impact of a high-fat meal on assessment of clopidogrel-induced platelet inhibition in healthy subjects.

BACKGROUND: Ideal conditions for platelet reactivity testing are critical for optimal selection of a P2Y12 inhibitor. Data are inconsistent regarding the impact of high-fat meals on test assessment. METHODS: Participants included 12 healthy subjects not taking antiplatelet drugs after a 12-hour fast. After baseline assessment, subjects were given a 600 mg dose of clopidogrel. Four hours later, maximum platelet inhibition was tested in the fasting state by light transmission aggregometry (LTA), VerifyNow P2Y12, vasodilator-stimulated phosphoprotein (VASP), and whole blood aggregometry (WBA). Subjects were then provided a high-fat meal, and platelet function was evaluated two hours later. Change in measured platelet aggregation by LTA was the primary endpoint of the study. The Wilcoxon Rank Sum test was used to compare the change in platelet reactivity between fasting and non-fasting conditions. The Spearman rho (ρ) correlation coefficient was used to evaluate the association between fasting platelet reactivity and the change following a high-fat meal. RESULTS: No significant change occurred in maximal light transmission, as assessed by LTA with 5 μM ADP (p = 0.15) and with 20 μM ADP (p = 0.07). There was a significant change in the area under the curve with 5 μM ADP (p = 0.03) but not with 20 μM ADP (p = 0.18). Although there was no significant change with the VerifyNow P2Y12 assay (p = 0.16), the change was correlated with the initial fasting value (Spearman\u27s rho p = 0.008). The VASP assay and WBA varied minimally. CONCLUSION: The high-fat meal did not significantly alter platelet function assessment of commonly used platelet function tests. Greater intra-subject variability existed for the optically-dependent compared with non-optically dependent tests. TRIAL REGISTRATION: NCT01307657