Search

BACKGROUND A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. OBJECTIVE This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. METHODS Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants’ blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants’ group membership. The primary outcome was a feasibility analysis of recruitment and retention. RESULTS The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients’ reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. CONCLUSIONS Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education.

Background Early college high schools, small schools that blur the line between high school and college, have been obtaining very strong results. This paper uses the frame of student engagement to posit an explanation for the success of these schools. Purpose This paper examines the impact of early college high schools on indicators and facilitators of engagement in the ninth-grade. The paper also looks at how early college students perceive these facilitators of engagement. Participants The main sample for this study includes students who applied to an early college high school and went through a lottery process. Student who were accepted through the lottery are the treatment students and those who were not accepted form the control group. Intervention Early colleges are small schools, often located on college campuses, that aim to provide a rigorous course of study with the goal of ensuring that all students graduate with a high school diploma and two years of university transfer credit or an associate's degree. Serving students in Grades 9-12 (or 13), the schools are targeted at students who typically are under-represented in college. Data Collection and Analysis The study uses administrative data submitted to the North Carolina Department of Instruction, including suspensions and attendance data. The study team also administered an original survey to treatment and control students that included scales on indicators and facilitators of engagement. Both the administrative and survey data were analyzed using multiple regression. Finally, the study team collected qualitative data from interviews with early college students. Results Early college students had better attendance, lower suspensions, and higher levels of engagement than control students. Compared to the control students, early college students also reported higher levels of all of the facilitators of engagement examined, including better relationships with teachers, more rigorous and relevant instruction, more academic and affective support, and higher expectations. Conclusions Students in early colleges experienced overall higher levels of engagement on a variety of dimensions. The qualitative data suggest that early colleges make concerted and purposeful efforts to engage students in school. These efforts seem to almost require that students are active participants in school; in other words, early colleges can be seen as essentially “mandating engagement.”

As implemented in North Carolina, Early College High Schools are small, autonomous schools designed to increase the number of students who graduate from high school and are prepared for postsecondary education. Targeted at students who are underrepresented in college, these schools are most frequently located on college campuses and are intended to provide students with 2 years of college credit upon graduation from high school. This article reports on preliminary 9th-grade results from 285 students in 2 sites participating in a longitudinal experimental study of the impact of the model. These early results show that significantly more Early College High School students are enrolling and progressing in a college preparatory course of study. This expanded access, however, is associated with somewhat lower pass rates for some courses, suggesting the need for strong academic support to accompany increased enrollment in more rigorous courses. Implementation data collected on one school indicate that it is suc...

Purpose: The aim of this research was to compare different methods of calibrating multiple choice question (MCQ) and clinical decision making (CDM) components for the Medical Council of Canada’s Qualifying Examination Part I (MCCQEI) based on item response theory. Methods: Our data consisted of test results from 8,213 first time applicants to MCCQEI in spring and fall 2010 and 2011 test administrations. The data set contained several thousand multiple choice items and several hundred CDM cases. Four dichotomous calibrations were run using BILOG-MG 3.0. All 3 mixed item format (dichotomous MCQ responses and polytomous CDM case scores) calibrations were conducted using PARSCALE 4. Results: The 2-PL model had identical numbers of items with chi-square values at or below a Type I error rate of 0.01 (83/3,499 or 0.02). In all 3 polytomous models, whether the MCQs were either anchored or concurrently run with the CDM cases, results suggest very poor fit. All IRT abilities estimated from dichotomous calibration designs correlated very highly with each other. IRT-based pass-fail rates were extremely similar, not only across calibration designs and methods, but also with regard to the actual reported decision to candidates. The largest difference noted in pass rates was 4.78%, which occurred between the mixed format concurrent 2-PL graded response model (pass rate= 80.43%) and the dichotomous anchored 1-PL calibrations (pass rate= 85.21%). Conclusion: Simpler calibration designs with dichotomized items should be implemented. The dichotomous calibrations provided better fit of the item response matrix than more complex, polytomous calibrations.

Amyloidosis is an idiopathic disease that is characterized by the extracellular deposition of fibrillar proteins. The disease can be categorized as primary or secondary where deposits occur in conjunction with chronic diseases such as rheumatoid arthritis or tuberculosis. The deposits can be localized or systemically distributed. It can mimic, and also be associated with underlying malignancy. Primary amyloidosis is a rare cause of a nasopharyngeal lesion, and less so of a secondary middle ear effusion. Its association with underlying chronic and malignant disease must not be over-looked if serious complications are to be avoided. It is, therefore, important to consider this as a differential diagnosis in such patients.

The probability of infection during air travel was determined by assuming randomised events (sneezing, coughing, vomiting) and the Well-Riley model for the infectivity rate. The potential of using an Excimer laser operating at 248 nm to decontaminate air was experimentally investigated.