High-Impact Practices: An Analysis of Select University and Business School Programs

Colleges and universities are finding new ways to enhance the academic environment with high-impact programs such as student-based research, internships and international study abroad programs. Research has shown that students learn most when they are more engaged in the experience rather than passive participants. This exploratory study examines high-impact opportunities for undergraduate university students in the U.S. Web sites and other materials from 90 randomly selected AACSB and ACBSP member schools were reviewed to determine how each incorporates high-impact educational practices into their overall university programs and in their business school programs. Three high-impact programs were examined: undergraduate research, internships and global learning opportunities. Recommendations for future high-impact educational practices are discussed. High Impact (HI) programs are prevalent in U.S. colleges and universities. There is a significant positive relationship between high-impact activities and graduation rates. Institutions that have healthier high impact practices have better graduation rates. Larger schools and schools with AACSB accreditation also have stronger high impact practices devoted specifically to business schools. Doctoral granting institutions scored higher in all three practices analyzed in this study. Undergraduate research is the area in which high-impact ratings were the lowest

Suicide Fads: Frequency and Characteristics of Hydrogen Sulfide Suicides in the United States

Objective: To assess the frequency of hydrogen sulfide (H2S) suicides and describe the characteristics of victims in the United States (U.S.) since the technique became common in Japan in 2007.Methods: To ascertain the frequency of intentional H2S related deaths in the U.S. prior to the start of the Japanese trend in 2007, we searched the multiple-cause-of-death data from the National Vital Statistics System. To collect as much information about the victims as possible, we sent an email to the National Association of Medical Examiners (NAME) listserv asking for their cooperation in identifying cases of H2S suicide. To identify cases that were not voluntarily reported by medical examiners but were reported by the media, we conducted Google searches using the search terms: “hydrogen sulfide suicide,” “H2S suicide,” “detergent suicide,” “chemical suicide,” and “suicide fad.” We obtained all available autopsy reports and abstracted information, including the site of the incident, the presence of a note warning others about the toxic gas and the demographic characteristics of the victims. We contacted medical examiners who potentially had custody of the cases that were identified through media reports and requested autopsies of these victims. When unable to obtain the autopsies, we gathered information from the media reports.Results: Forty-five deaths from H2S exposure occurred in the U.S. from 1999 to 2007, all unintentional. Responses from the NAME listserv yielded autopsy reports for 11 victims, and Google searches revealed an additional 19 H2S suicides in the U.S. since 2008. Overall (n=30), two cases were identified during 2008, 10 in 2009, and 18 in 2010. The majority of victims were white males, less than 30-years-old, left a warning note, and were found in cars. There were five reports of injuries to first responders, but no secondary fatalities.Conclusion: H2S suicides are increasing in the U.S., and their incidence is probably underestimated by public health officials and physicians. First responders are at risk when assessing these victims due to the severe toxicity of the gas. Emergency providers must be aware of H2S suicides to educate others and care for the rare survivor. [West J Emerg Med. 2011;12(3):300-304.

Incorporating Tailored Interactive Patient Solutions Using Interactive Voice Response Technology to Improve Statin Adherence: Results of a Randomized Clinical Trial in a Managed Care Setting

Abstract The current study presents the impact of a behavior change program to increase statin adherence using interactive voice response (IVR) technology. Subjects were affiliated with a large health benefit company, were prescribed a statin (index) and had no lipid-lowering pharmacy claims in the previous 6 months, and were continuously enrolled in the plan for 12 months prior and 6 months post index statin. Potential subjects (1219) were contacted by the IVR system; 497 gave informed consent. Subjects were asked to respond to 15 questions from the IVR that were guided by several behavior change theories. At the conclusion of the questions, subjects were randomly assigned to either a control group (n=244), who received generic feedback at the conclusion of the call and were then mailed a generic cholesterol guide, or an experimental group (n=253), who received tailored feedback based on their cholesterol-related knowledge, attitudes, beliefs, and perceived barriers to medication adherence, and were mailed a tailored guide that reinforced similar themes. Subjects in the experimental group had the opportunity to participate in 2 additional tailored IVR support calls. The primary dependent variable was 6-month point prevalence, defined as claims evidence of a statin on days 121-180 post index statin. Subjects in the experimental group had a significantly higher 6-month point prevalence than the controls (70.4% vs. 60.7%, P<0.05). Results of this study suggest that a behavioral support program using IVR technology can be a cost-effective modality to address the important public health problem of patient nonadherence with statin medication. (Population Health Management 2009;12:241-254)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78104/1/pop.2008.0046.pd

Anticipatory Waivers of Consent for Pediatric Biobanking

As pediatric biobank research grows, additional guidance will be needed about whether researchers should always obtain consent from participants when they reach the legal age of majority. Biobanks struggle with a range of practical and ethical issues related to this question. We propose a framework for the use of anticipatory waivers of consent that is empirically rooted in research that shows that children and adolescents are often developmentally capable of meaningful deliberation about the risks and benefits of participation in research. Accordingly, bright‐line legal concepts of majority or competency do not accurately capture the emerging capacity for autonomous decision‐making of many pediatric research participants and unnecessarily complicate the issues about contacting participants at the age of majority to obtain consent for the continued or first use of their biospecimens that were obtained during childhood. We believe the proposed framework provides an ethically sound balance between the concern for potential exploitation of vulnerable populations, the impetus for the federal regulations governing research with children, and the need to conduct valuable research in the age of genomic medicine

Validation of a new measure of concept of a good death

BACKGROUND: The concept of a good death is central to end-of-life care research. Despite its importance and the high interest in the topic, there are few measures currently available for use in clinical research. PURPOSE: The present work describes the development and testing of a set of items intended to measure the importance of several components posited to be critical to the concept of a good death. It is intended for use with health care providers and lay people in the context of end-of-life care research and education. POPULATION: Four cohorts (n = 596) were recruited to participate, representing two helping profession disciplines, nonhelping professionals, and a range of ages, specifically: (1) undergraduate medical students; (2) master\u27s degree students in nursing; (3) graduate students from the life sciences; and (4) practicing hospice nurses. METHODS: Participants completed self-report questionnaires at baseline and retest. Psychometric analyses included item frequency distributions, factor analysis, alpha reliability, intraclass correlation, and measures of association. RESULTS: The new Concept of a Good Death measure demonstrated good item frequency distributions, acceptable internal consistency reliability, and test-retest stability. Its factor structure revealed that three distinct domains are measured, reflecting the psychosocial/spiritual, physical, and clinical aspects of a good death. An examination of patterns of correlations showed differential associations with death anxiety, spiritual beliefs and practices, anxious mood, and sociodemographic characteristics. CONCLUSIONS: The new Concept of a Good Death instrument appears to measure three distinct factors which people consider important to a Good Death. Ratings of the importance of these factors are reliable and valid. The instrument has the advantage of being a brief, self-report index for use in end-of-life care research

Suppression of Integrin Activation: A Novel Function of a Ras/Raf-Initiated MAP Kinase Pathway

AbstractRapid modulation of ligand binding affinity (“activation”) is a central property of the integrin cell adhesion receptors. Using a screen for suppressors of integrin activation, we identified the small GTP-binding protein, H-Ras, and its effector kinase, Raf-1, as negative regulators of integrin activation. H-Ras inhibited the activation of integrins with three distinct α and β subunit cytoplasmic domains. Suppression was not associated with integrin phosphorylation and was independent of both mRNA transcription and protein synthesis. Furthermore, suppression correlated with activation of the ERK MAP kinase pathway. Thus, regulation of integrin affinity state is a novel, transcription-independent function of a Ras-linked MAP kinase pathway that may mediate a negative feedback loop in integrin function

Robust Detection of Rare Species Using Environmental DNA: the Importance of Primer Specificity

Environmental DNA (eDNA) is being rapidly adopted as a tool to detect rare animals. Quantitative PCR (qPCR) using probe-based chemistries may represent a particularly powerful tool because of the method\u27s sensitivity, specificity, and potential to quantify target DNA. However, there has been little work understanding the performance of these assays in the presence of closely related, sympatric taxa. If related species cause any cross-amplification or interference, false positives and negatives may be generated. These errors can be disastrous if false positives lead to overestimate the abundance of an endangered species or if false negatives prevent detection of an invasive species. In this study we test factors that influence the specificity and sensitivity of TaqMan MGB assays using co-occurring, closely related brook trout (Salvelinus fontinalis) and bull trout (S. confluentus) as a case study. We found qPCR to be substantially more sensitive than traditional PCR, with a high probability of detection at concentrations as low as 0.5 target copies/ml. We also found that number and placement of base pair mismatches between the Taqman MGB assay and non-target templates was important to target specificity, and that specificity was most influenced by base pair mismatches in the primers, rather than in the probe. We found that insufficient specificity can result in both false positive and false negative results, particularly in the presence of abundant related species. Our results highlight the utility of qPCR as a highly sensitive eDNA tool, and underscore the importance of careful assay design

Vertebral bone marrow fat, bone mineral density and diabetes : The Osteoporotic Fractures in Men (MrOS) study

Elevated vertebral bone marrow fat (BMF) among individuals with osteoporosis has been established in histomorphometric studies. Several studies have found a negative correlation between BMF and bone mineral density (BMD) at the spine in men and women across different age groups. Animal studies have also observed bone loss with increased BMF in mice with induced diabetes. Our study objective was to test the hypothesis that the association between BMF and BMD varies by diabetic status. We performed a cross-sectional study of 156 men aged 74-96years from the Osteoporotic Fractures in Men study at the Pittsburgh clinical site. All men had spine BMF scans using proton magnetic resonance spectroscopy and spine and hip BMD scans by dual-energy X-ray absorptiometry. BMF was expressed as lipid to "lipid+water" ratio (%). Men were considered diabetic if they self-reported a physician diagnosis of diabetes, diabetes medication or had a fasting glucose ≥126mg/dl. Men with diabetes (n=38) had a significantly higher spine BMF (58.9 vs. 54.6%, p=0.0035), spine BMD (1.20 vs. 1.10g/cm(2), P=0.007) and total hip BMD (1.00 vs. 0.94g/cm(2), p=0.04) than those without, while no differences were observed for body weight, body mass index or waist circumference. Pearson correlation tests showed no significant correlation of spine BMF with age or BMD in non-diabetics. Significant inverse correlations were observed between BMF and BMD (-0.30 for femoral neck and -0.39 for total hip) among diabetic men. In conclusion, men with diabetes had a higher BMF compared to non-diabetic men. The correlation between BMF and BMD differed by diabetes status. Further investigation of the association of diabetes with BMF and BMD may provide a better understanding of the high fracture rates among individuals with diabetes despite their higher BMD

Incorporating Breast Cancer Recurrence Events Into Population-Based Cancer Registries Using Medical Claims: Cohort Study.

BACKGROUND: There is a need for automated approaches to incorporate information on cancer recurrence events into population-based cancer registries. OBJECTIVE: The aim of this study is to determine the accuracy of a novel data mining algorithm to extract information from linked registry and medical claims data on the occurrence and timing of second breast cancer events (SBCE). METHODS: We used supervised data from 3092 stage I and II breast cancer cases (with 394 recurrences), diagnosed between 1993 and 2006 inclusive, of patients at Kaiser Permanente Washington and cases in the Puget Sound Cancer Surveillance System. Our goal was to classify each month after primary treatment as pre- versus post-SBCE. The prediction feature set for a given month consisted of registry variables on disease and patient characteristics related to the primary breast cancer event, as well as features based on monthly counts of diagnosis and procedure codes for the current, prior, and future months. A month was classified as post-SBCE if the predicted probability exceeded a probability threshold (PT); the predicted time of the SBCE was taken to be the month of maximum increase in the predicted probability between adjacent months. RESULTS: The Kaplan-Meier net probability of SBCE was 0.25 at 14 years. The month-level receiver operating characteristic curve on test data (20% of the data set) had an area under the curve of 0.986. The person-level predictions (at a monthly PT of 0.5) had a sensitivity of 0.89, a specificity of 0.98, a positive predictive value of 0.85, and a negative predictive value of 0.98. The corresponding median difference between the observed and predicted months of recurrence was 0 and the mean difference was 0.04 months. CONCLUSIONS: Data mining of medical claims holds promise for the streamlining of cancer registry operations to feasibly collect information about second breast cancer events

Bone Mass and Strength in Older Men With Type 2 Diabetes: The Osteoporotic Fractures in Men Study

The effects of type 2 diabetes mellitus (T2DM) on bone volumetric density, bone geometry, and estimates of bone strength are not well established. We used peripheral quantitative computed tomography (pQCT) to compare tibial and radial bone volumetric density (vBMD, mg/cm3), total (ToA, mm2) and cortical (CoA, mm2) bone area and estimates of bone compressive and bending strength in a subset (n = 1171) of men (≥65 years of age) who participated in the multisite Osteoporotic Fractures in Men (MrOS) study. Analysis of covariance–adjusted bone data for clinic site, age, and limb length (model 1) and further adjusted for body weight (model 2) were used to compare data between participants with (n = 190) and without (n = 981) T2DM. At both the distal tibia and radius, patients with T2DM had greater bone vBMD (+2% to +4%, model 1, p < .05) and a smaller bone area (ToA −1% to −4%, model 2, p < .05). The higher vBMD compensated for lower bone area, resulting in no differences in estimated compressive bone strength at the distal trabecular bone regions. At the mostly cortical bone midshaft sites of the radius and tibia, men with T2DM had lower ToA (−1% to −3%, p < .05), resulting in lower bone bending strength at both sites after adjusting for body weight (−2% to −5%, p < .05) despite the lack of difference in cortical vBMD at these sites. These data demonstrate that older men with T2DM have bone strength that is low relative to body weight at the cortical-rich midshaft of the radius despite no difference in cortical vBMD. © 2010 American Society for Bone and Mineral Researc