Start Of Course Research Articles

Person Centred Dementia Care Made Simple

Abstract Background This poster will outline the development and rollout of our person-centred dementia care microlearning course for all patient-facing staff based in St. James's Hospital, Dublin. Person centred care (PCC) appears to make a difference to how well people with dementia manage on hospital wards (Scerri et al., 2020). The term PCC is used widely in healthcare services and the approach is embedded in St James's nursing professional practice model, standards and policies. Yet there are health professionals who find PCC difficult to define and demonstrate in their practice (Byrne et al., 2020). Through our interactions with staff on wards and in nursing homes, Dementia Services Information Development Centre (DSiDC) are aware that healthcare staff can face difficulties in establishing a rapport with a patient with dementia. Therefore, we identified the need to design a course to facilitate the continued development of meaningful interactions between hospital staff and people with dementia. The course was divided into four stand-alone modules using clear, uncomplicated language and demonstrates how staff can use key elements of Kitwood’s PCC approach in their daily practice. Methods It is becoming harder for hospital staff to be released for onsite training courses due to increasing demands on their time. With this in mind, the DSiDC team sought innovative time-efficient ways to provide dementia education to hospital staff and so a microlearning educational tool was adopted. Microlearning delivers short pieces of content in easily understandable ways utilising a variety of methods such as: video, short written text and quizzes. Accessed by a QR code, staff can complete the course on their mobile phone at a time and place that suits the individual. A pilot study of the course was conducted among staff in a nursing home and on a key ward in St. James’s Hospital. Results 73% of participants found the content ‘extremely helpful’. At start of course, 21% of participants rated their knowledge about person centred dementia care as ‘excellent’. On completion of course, this increased to 50%. One outcome of the pilot study identified an improvement of course design to three modules as opposed to four. Conclusion As a result of the positive outcomes from pilot study, it was decided as part of the wider dissemination of the course across St. James’s Hospital, to conduct a focus group to further measure the impact of the training.

Positive Student Outcomes from Embedding Mental Wellness Trainings in an Advanced Undergraduate Physiology Course

Despite the rising prevalence of reported mental illness among college students, mental wellness programs delivered to college students show improvements in distress, depression, and anxiety. However, participation in these programs is often quite low and the long-term effcacy is unknown. Therefore, the purpose of this study was to determine if a course-based mental wellness program administered to undergraduate physiology students would improve academic and overall perceived stress during the intervention and at longitudinal follow up the next academic year. We hypothesized the intervention would improve self-reported academic and overall perceived stress of undergraduate physiology students. Methods: In spring 2022, students (n=167) enrolled in a junior level undergraduate advanced physiology course (Course 1) were given six 30-minute training sessions by campus clinicians during class time. At the start of the following semester (fall 2022), a subset of these students (n=44) enrolled in a rigorous, senior level pathophysiology course (Course 2) and received one 30-minute refresher training session. All students completed the Perception of Academic Stress Scale (including subdimensions for perceived academic expectations, faculty workload expectations, and self-perceptions of academic stress) and Cohen’s Perceived Stress Scale at the start and end of both semesters. Statistical analysis included 2x2 repeated measure ANOVAs to compare trends in survey scores across the semester based on eventual grade in Course #1, as well compare semester-wide trends in Course #1 and Course #2 in students that completed both courses. Pairwise comparisons were corrected using Tukey HSD. Results: In Course 1, there was a significant decrease across the semester in academic stress (54.94 ± 0.94 vs. 57.18 ± 0.94, p<0.001), including students’ self-perceptions of academic stress (21.22 ± 0.38 vs. 22.48 ± 0.38, p<0.01). This decrease was driven primarily by A/B students (p<0.05), while C/D students reflected no change. Compared with C/D students, A/B students in Course 1 reported lower academic stress (p<0.01), including lower perceived academic expectations, faculty workload expectations, and self-perceptions of academic stress post semester (p<0.01), and overall perceived stress (p<0.05), at both timepoints. Students who continued to Course 2 reported significantly lower overall stress (p<0.05) and academic stress (p<0.05) at the start of Course 2 compared with the start of Course 1. Conclusion: Mental wellness training embedded into rigorous physiology courses can positively impact undergraduate physiology students’ mental wellbeing, which may persist into the next academic year and may be mediated by academic success (i.e., course grades). Division of Exercise Physiology, WVU. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Research: Learning to Teach Writing by Becoming a Writer: An Examination of Preservice Teachers’ Engagement with the Writing Process

Finding ways to develop preservice teachers (PSTs) as both writers and teachers of writing can be a heavy lift for teacher education programs. This article presents a portion of the data from a larger study undertaken as longitudinal, formative design research. Data were gathered from 410 PSTs over a three-year period across four courses in teacher education and English language arts at a private liberal arts university in a southwestern state. Two research questions guided the study: (1) How do preservice teachers engage in practices grounded in process discourse in the context of their teacher education courses?; and (2) How do preservice teachers’ beliefs about their writing self-efficacy change during a semester of engaging in writing with a focus on process discourse? Key findings of the study included PSTs engaging in prewriting activities (e.g., reading, researching) but engaging less in writing while preparing to write (e.g., quicklist, webs). Furthermore, the PSTs utilized peers in revising writing but did not visit those with the most knowledge and skill in supporting writing (e.g., professor, writing center). Finally, PSTs’ confidence in their writing, which was higher at the start of courses than previous research often indicates, decreased across their time in the courses.

A Multicenter Comparison of Rates of Central Venous Catheter-Associated Bloodstream Infections By Central Venous Catheter Type Among Pediatric Patients Receiving Treatment for Newly Diagnosed Acute Myeloid Leukemia

▪Therapy for pediatric acute myeloid leukemia (AML) requires long term central vascular access, which puts patients at risk for central line-associated bloodstream infections and their associated morbidity and mortality. Options for central venous catheter (CVC) access include tunneled external catheters, implanted ports, or peripherally inserted central catheters (PICC). Multiple studies provide conflicting reports on which CVC type is least likely to be associated with bloodstream infections in pediatric hematology-oncology patients. This multicenter cohort of pediatric AML patients is the first to investigate the course-specific incidence of positive CVC blood cultures by line type.The study included patients receiving frontline chemotherapy for AML between 1/1/2012 and 6/30/2017 at 12 US institutions. Trained personnel completed manual chart abstraction from 12/1/2015 to 07/15/2017 to obtain information on demographics, diagnosis, treatment, antibacterial prophylaxis, CVC type at the start of each course, neutropenia duration, and blood culture results obtained from CVC. Abstractors followed a standardized protocol and were required to achieve >95% concordance with trainer before starting formal chart review.Course-specific follow-up began the first day absolute neutrophil count (ANC) fell below 200 cells/uL and continued to the earliest of first positive CVC culture (overall and separately for gram-positive and gram-negative species), ANC recovery, start of conditioning for stem cell transplant, relapse, death or start of next course. Per National Healthcare Safety Network guidance, common commensals were not considered true events with the exception of viridans group streptococci (VGS). Nonbacterial pathogens were also excluded. Covariate distributions were compared by CVC type using chi-square tests. Variability in CVC type by site was examined graphically. Incidence rates for CVC positive blood cultures were reported by line type as per 1000 neutropenic days. Multivariate Poisson regression with log of neutropenia duration as offset was used to compute adjusted rate ratios (aIRR) comparing rates of positive CVC blood cultures by line type, controlling for covariates itemized in Table 1. General estimating equation methods were used to account for non-independence of observations from patients from the same institution.The study population included 357 patients who received 1,164 chemotherapy courses. Median course duration was 38 days (IQR: 34-44) with a median neutropenia duration of 19 days (IQR: 14-25). CVC were present in all patients at the start of each course, with the exception of 11 (3.3%) patients lacking a CVC at the start of Induction I. While tunneled CVC were most prevalent representing 59.1% of courses, PICC and implanted ports were utilized in 28.9% and 11.6% of courses, respectively. There was considerable variation in the distribution of CVC type by treating institution (Figure 1). Age, race, and ethnicity distributions varied by line type (Table 1). Antibacterial prophylaxis was utilized in 47% of courses.In total, there were 300 (25.8%) courses in 199 (55.7%) patients complicated by a positive CVC blood culture during the neutropenic period. The overall incidence rate of positive CVC blood cultures was 6.5 per 1000 neutropenic days. Rates increased over the course of frontline treatment from 3.1 per 1000 neutropenic days in Induction I to 9.6 per 1000 neutropenic days in Intensification II. The rate of gram-positive events (4.2 per 1000 neutropenic days) was higher than gram-negative events (2.0 per 1000 neutropenic days). The most common isolated organisms were VGS at 57.3% and less than 1% of events were polymicrobial infections. Overall rates of positive CVC blood cultures were higher for PICC relative to tunneled CVC (aIRR=1.19, 95% CI: 1.02, 1.38), while rates for implanted ports and tunneled CVC were similar (aIRR=1.06, 95% CI: 0.75, 1.51).While bacteremia is an expected complication during post-chemotherapy neutropenia and not always due to the presence of a CVC, the risk for a positive CVC blood culture is significantly increased for children with PICC compared with those with tunneled CVC or implanted port. Also, the risk was higher after Induction I and increased with age. Given the notable practice variation in line choice, these data highlight an opportunity for standardization with a goal to reduce infectious complications. [Display omitted] DisclosuresFisher:Pfizer: Research Funding; Merck: Research Funding. Gramatges:Bristol Meyer Squibb: Research Funding.

Perception on research methods course’s online environment and self-regulated learning during the COVID-19 pandemic

The COVID-19 pandemic brought an education crisis that forced schools to abruptly shift to online distance learning. Regardless of the challenges in this migration, the teaching–learning process should continue. Self-regulated learning skills are essential in learning in an online environment; hence, the study aims to explore learners’ perception in an online learning environment, self-regulated learning skills, and academic achievement during a research methods course. Perception on the online learning environment, self-regulated learning skills, and academic achievement were collected periodically throughout the online course. The analysis included repeated measures of ANOVA to examine the trends between periods of measurement. A linear regression analysis was used to determine the impact of perception on the online learning environment to self-regulated learning. Results of repeated measures of ANOVA suggest a subtle decrease in the perception of the online learning environment at the start of the course. Still, ratings consistently increased viewing online distance learning the same with pre-quarantine set-up. On the other hand, self-regulated learning remained virtually the same throughout the implementation of research methods online course. A rise in the learning playlist scores has been observed at the start of the research methods course, but scores began to decline at the latter phases of the course. Results of regression analysis imply the influence of perception on the online learning environment on self-regulated learning skills. However, perception does not affect learners’ academic achievement. The study recommends using strategies to further develop perseverance in adjusting to online learning amid initial setbacks. Also, interventions specific to improving learners’ self-regulated learning skills are highly recommended.

Evaluation of newly introduced structured foundation course in MBBS curriculum at entry level in India: Students’ perspective

Background: One-month structured foundation course is an integral component of the newly designed CBME curriculum as proposed in “Graduate Medical Education Regulations-2019” by Medical Council of India. Purpose of this program is to assist fresh MBBS students in acclimatising to the new challenging environment of medical profession and in acquiring basic skills and professional attributes.
 Aims and Objective: Study was aimed to evaluate the students’ perception regarding the knowledge and importance of different modules of the foundation course and to assess the effectiveness and quality of the program.
 Materials and Methods: A cross-sectional study was carried out among 120 first year MBBS students using pre-validated questionnaires. Pre questionnaire having three sections and post questionnaire having four sections were distributed at the start of course and towards the end of first year respectively using Google forms. Data was analyzed using SPSS version 22.0 and tests were done at a significance level of 5%.
 Results: Mean scores of perceptions of knowledge and importance for all the modules increased after the course except for importance of Enhancement of language and computer skills module and the difference was statistically significant. Professionalism and ethics module was the most practically implemented module throughout the first year. Over-all rating of this one- month course was 3.31±0.78.
 Conclusion: Feedback responses from students were indicative of the effectiveness of this program. This study sheds light on the significance of the foundation course in making the medical graduate an effective health care provider and physician of first contact of the community.

Associations between neutrophil recovery time, infections and relapse in pediatric acute myeloid leukemia.

Children with acute myeloid leukemia (AML) treated similarly show different toxicity and leukemic responses. We investigated associations between neutrophil recovery time after the first induction course, infection and relapse in children treated according to NOPHO-AML 2004 and DB AML-01. Newly diagnosed patients with AML with bone marrow blast<5% between day 15 after the start of the treatment and the start of second induction course, and in complete remission after the second induction course were included (n=279). Neutrophil recovery time was defined as the time from the start of the course to the last day with absolute neutrophil count<0.5×109 /l. Linear and Cox regressions were used to investigate associations. Neutrophil recovery time after the first induction course was positively associated with neutrophil recovery time after the remaining courses, and longer neutrophil recovery time (≥25 days) was associated with increased risk of grade 3-4 infections (hazard ratio 1.4, 95% confidence interval [CI], 1.1-1.8). Longer neutrophil recovery time after the first induction (>30 days) was associated with the increased risk of relapse (5-year cumulative incidence: 48% vs. 42%, hazard ratio 1.7, 95% CI, 1.1-2.6) for cases not treated with hematopoietic stem cell transplantation in first complete remission. Longer neutrophil recovery time after the first induction course was associated with grade 3-4 infections and relapse. If confirmed, this knowledge could be incorporated into risk stratification strategies in pediatric AML.

Nursing and midwifery students' perceptions of spirituality, spiritual care, and spiritual care competency: A prospective, longitudinal, correlational European study

BackgroundNurses and midwives care for people at some of the most vulnerable moments of their lives, so it is essential that they have the skills to give care which is compassionate, dignified, holistic and person-centred. Holistic care includes spiritual care which is concerned with helping people whose beliefs, values and sense of meaning, purpose and connection is challenged by birth, illness or death. Spiritual care is expected of nurses/midwives but they feel least prepared for this part of their role. How nursing and midwifery students can be prepared for spiritual care is the focus of this study. Objectives1. To describe undergraduate nursing and midwifery student's perceptions of spirituality/spiritual care, their perceived competence in giving spiritual care and how these perceptions change over time. 2. To explore factors contributing to development of spiritual care competency. MethodsProspective, longitudinal, multinational, correlational survey design. A convenience sample of 2193 undergraduate nursing and midwifery students (69% response rate, dropping to 33%) enrolled at 21 universities in eight countries completed questionnaires capturing demographic data (purpose designed questionnaire) and measuring perception of spirituality/spiritual care (SSCRS), spiritual care competency (SCCS), spiritual wellbeing (JAREL) and spiritual attitude and involvement (SAIL) on 4 occasions (start of course n = 2193, year 2 n = 1182, year 3 n = 736, end of course n = 595) between 2011 and 2015. Data were analysed using descriptive, bivariate and multivariate analyses as appropriate. ResultsPerceived competency increased significantly over the course of students' study which they attributed to caring for patients, events in their own lives and teaching/discussion in university. Two factors were significantly correlated with perceived spiritual care competency: perception of spirituality/spiritual care, where a broad view was preferable, and personal spirituality, where high spiritual wellbeing (JAREL) and spiritual attitude and involvement (SAIL) scores were preferable. ConclusionsWe have provided the first international evidence that perceived spiritual care competence is developed in undergraduate nursing and midwifery students and that students' perceptions of spirituality and personal spirituality contribute to that development. Implications for teaching and learning and student selection are discussed. The study is limited by attrition which is common in longitudinal research.

Four versus five chemotherapy courses in patients with low risk acute myeloid leukemia: A Children’s Oncology Group report.

10515 Background: For pediatric patients with low risk (LR) acute myeloid leukemia (AML), the Children’s Oncology Group (COG) trial AAML1031 used a 4-course chemotherapy backbone consisting of two induction courses of cytarabine/daunorubicin/etoposide, a third course of cytarabine/etoposide and a fourth course of cytarabine/mitoxantrone. The prior COG trial, AAML0531, included the same four courses plus a fifth course of high dose cytarabine. Removal of course 5 from AAML1031 was based in part on prior studies that suggested no benefit from a fifth course. Methods: We compared overall survival (OS), disease free survival (DFS), and relapse risk (RR) for LR patients receiving four versus five chemotherapy courses in a pooled analysis of comparable patients treated on AAML0531 and AAML1031. LR was defined as the presence of inv(16)/t(16;16) or t(8;21) cytogenetic features, NPM1 or CEBPA mutations, or MRD &lt; 0.1% post-Induction I in those with no high risk features. AAML0531 patients assigned to gemotuzumab were excluded. Follow-up for outcomes began at the start of course 4. Cox (OS and EFS) and risk (RR) regressions were used to estimate unadjusted hazard ratios (HR) comparing outcomes for patients who received only four versus five chemotherapy courses. Start of a fifth chemotherapy course was assessed as a time-varying exposure in all analyses to avoid exposure misclassification. Results: A total of 921 LR patients (225 from AAML0531, 696 from AAML1031) were included; 191 (21%) received a fifth course. There were no significant differences in distributions of sex, age, race, or ethnicity between patients treated with four or five courses. Median times to absolute neutrophil count and platelet count recovery after course 4 were also comparable. Patients who received only four courses had significantly lower OS (HR = 1.83, 95% CI: 1.22-2.74, p = 0.003), DSF (HR = 1.49, 95% CI: 1.13-1.97, p = 0.005), and higher RR (HR = 1.42, 95% CI: 1.08-1.88, p = 0.013) compared to those who received five courses. Conclusions: Removal of a fifth cytarabine-containing course appears to result in worse OS, DFS, and RR in pediatric patients with LR AML. Multivariable analyses to further refine the estimates are ongoing.

A comparison of skills competency test scores among Philippine-educated nursing students after an intensive medical-surgical course

Objective : This study examined the effect of a 10-week intensive medical-surgical course on ability to perform 16 common, acute care skills among Philippine educated nursing students seeking licensure in California. The aims of the study were to (1) determine competency in performing skills at the start of the medical-surgical course and (2) evaluate the effectiveness of the medical-surgical course in improving skill competency. Methods : Twenty-three Philippine educated nursing students participated in a 4-hour skills competency test procedure that involved 4 patient care stations and 16 common acute care skills. During the last week of the 10-week medical-surgical course that included 24 open simulation lab practice hours, these same 23 students repeated the testing procedure. Results : At the start of the course skill competency scores were low with many of the participants unable to complete the skills stations. A significant improvement occurred in scores for 14 of the 16 skills when tested in the final week of the medical-surgical nursing course under the same conditions ( p < .05). Conclusions : Conducting the nursing skills competency testing procedure at the start of the course informed faculty about the abilities of Philippine educated nursing student participants. Because of potential differences in nursing education abroad, graduates of nursing programs in the Philippines might benefit from competency testing to evaluate initial skill levels, followed by intensive review of commonly performed nursing skills in the United States, if warranted by initial results.

Second Bacteremia During Antibiotic Treatment in Children With Acute Myeloid Leukemia: A Report From the Canadian Infections in Acute Myeloid Leukemia Research Group.

The risk of second bacteremia during antibiotic treatment for initial bacteremia is unknown in high-risk populations. Our objectives were to describe the prevalence of second bacteremia during treatment and identify risk factors in children with acute myeloid leukemia (AML). We conducted a retrospective, population-based cohort study that included children and adolescents with de novo, non-M3 AML who were diagnosed and treated between January 1, 1995 and December 31, 2004 at 15 Canadian centers. Patients were monitored for bacteremia during chemotherapy until completion of treatment, hematopoietic stem cell transplantation, relapse, refractory disease, or death. There were 290 episodes of bacteremia occurring in 185 (54.3%) of 341 children. Eighteen (6.2%) had a second bacteremia while receiving antibiotic treatment. Two episodes of second bacteremia were complicated by sepsis; there were no infection-related deaths. Eleven episodes (61.1%) had either an initial Gram-positive and subsequent Gram-negative bacteremia or initial Gram-negative followed by Gram-positive bacteremia. Days receiving corticosteroids (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.12; P < .0001), cumulative dose of corticosteroids (OR, 1.04; 95% CI, 1.00-1.08; P = .035), and days of neutropenia from start of course to initial bacteremia (OR, 1.07; 95% CI, 1.02-1.12; P = .007) were significantly associated with second bacteremia. In pediatric AML, 6% of patients will experience a second bacteremia during antibiotic treatment; duration of corticosteroid exposure and neutropenia are risk factors. These patients remain at high risk for second bacteremia after identification of the initial bacteremia and warrant continued broad-spectrum treatment during profound neutropenia.

Prediction Of CR On Reinduction In Patients With Newly Diagnosed Acute Myeloid Leukemia Given Intensive Induction Regimens: A Report From SWOG and Cleveland Clinic

3+7” (3 days of daunorubicin or idarubicin + 7 of cytarabine) is the most frequently used intensive induction regimen for newly diagnosed AML. While it is common practice to reinduce patients (pts) who do not achieve marrow ablation by day 14 with the same agents, it remains unclear whether any particular disease or treatment-related factors can predict for CR with such a strategy, or can identify pts who should more appropriately be considered to have primary refractory disease at day 14 and treated with different agents.This analysis was designed to address this question. MethodsWe analyzed 1505 pts given 3+7 on SWOG studies S8600 (n = 534), S9031 (n= 215), S9333 (n = 161), and S0106 (n = 595) and 235 treated at Cleveland Clinic from 2006-2010 of whom 54 were reinduced with anthracycline-based therapy. In the SWOG cohort, 49% of pts achieved CR on course 1. Of the 734 patients who were alive at day 28 but did not achieve CR on course 1, 336 (53%) had received a reinduction course of 3+7. We used multivariate logistic regression to identify covariates associated with achievement of CR to reinduction in these 336 pts. The area under receiver operating characteristic curves (AUC) were used to quantify the effectiveness of the multivariate models at predicting CR in reinduction (AUC 1.0 = perfect prediction, AUC 0.5 = “coin flip”). Numerical covariates examined were [median (range)]: age (51, 15-83), day the first post-induction marrow was examined (hereafter “day 14”, 15, 7-48), day 14 blasts % (20, 0-95), day 14 % cellularity (37, 1-85), and their product (infiltrate, 5, 0-74), change in % blasts from day 1 (-44, -96,50), change in cellularity from day 1 (-5, -99-80), change in infiltrate from day 1 (-2, 93-41), and days from start of course 1 to start of course 2 (21, 13-67). Categorical covariates examined were: pre-treatment performance status (PS, ECOG scale) and pre-treatment cytogenetics (SWOG criteria). Results40% of the 336 SWOG pts achieved CR to 3+7 reinduction, while 14% died during the first 28 days following reinduction, and 45% neither died during this time nor achieved CR (resistant). Age was associated with reinduction CR rate (median 47 for CR, 56 for no CR, p<0.001), as was day of reinduction (median 24 for CR, 20 for no CR, p=0.005), cytogenetics (CR rates 75% for favorable, 35% for intermediate, 18% for unfavorable, and 9% for unknown, p=0.04), and AML status (CR rate 42% for de novo and 16% for secondary AML). However, the AUC for age was 0.63, day of second induction was 0.59, cytogenetics was 0.60, and AML status was 0.53. Day 14 marrow blast % was similar in pts who did and did not achieve CR to reinduction (medians 20% and 22% respectively, p = 0.8). Similarly, day 14 cellularity, day 14 infiltrate, change in blast %, cellularity, infiltrate from pretreatment, and day when course 2 began were not associated with reinduction CR rate. On multivariate analysis, none of these covariates nor SWOG protocol was associated with second course CR rate, and the AUC for this multivariate model was only 0.70. There was no evidence that the effects of covariates differed in the different protocols. In the Cleveland Clinic cohort, 53% of pts achieved a CR on their reinduction or 3rd induction course, 11% died during the first 28 days of reinduction, and 33% were resistant. In this cohort, no covariates were associated with CR on reinduction or 3rd induction and AUC values were uniformly low and similar to the SWOG cohort. ConclusionIn AML pts treated with 3+7 regimens, our findings indicate that bone marrow parameters, specifically day 14 blasts %, marrow cellularity, and treatment-related changes do not predict for subsequent CR with a reinduction Perhaps too few patients not in CR after a first course of 3+7 receive reinduction with 3+7.ClinicalTrials.gov Identifier: NCT00085709 (others precede registry reporting) FundingThis work was supported by PHS Cooperative Agreement grants awarded by the National Cancer Institute, CA32102 and CA38926 Disclosures:No relevant conflicts of interest to declare.

Second Bacteremia During Antibiotic Treatment In Children With Acute Myeloid Leukemia: A Report From The Canadian Infections In AML Research Group

Abstract Background The risk of second bacteremia during antibiotic treatment for initial bacteremia is unknown in high-risk populations. Objectives were to describe the prevalence of second bacteremia during treatment and identify risk factors in children with acute myeloid leukemia (AML). Methods We conducted a retrospective, population-based cohort study that included children and adolescents with de novo, non-M3 AML who were diagnosed and treated between January 1, 1995 and December 31, 2004 at 15 Canadian centers. Patients were monitored for bacteremia during chemotherapy until completion of treatment, hematopoietic stem cell transplantation, relapse, refractory disease, or death. Results There were 290 episodes of bacteremia occurring in 185 (54.3%) of 341 children. Eighteen (6.2%) had a second bacteremia while receiving antibiotic treatment. Two episodes of second bacteremia were complicated by sepsis; there were no infection-related deaths. Eleven episodes (61.1%) had either an initial Gram-positive and subsequent Gram-negative bacteremia or initial Gram-negative followed by Gram-positive bacteremia. Days receiving corticosteroids (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.07-1.12; P&lt;0.0001), cumulative dose of corticosteroids (OR 1.04, 95% CI 1.00-1.08; P=0.035) and days of neutropenia from start of course to initial bacteremia (OR 1.07, 95% CI 1.02-1.12; P=0.007) were significantly associated with second bacteremia. Conclusion In pediatric AML, 6% will experience a second bacteremia during antibiotic treatment; duration of corticosteroid exposure and neutropenia are risk factors. These patients remain at high risk for second bacteremia after identification of the initial bacteremia and warrant continued broad-spectrum treatment during profound neutropenia. Abbreviations CONS: coagulase negative Staphylococcus ; VGS: viridans group Streptococcus; Amp: ampicillin; Cz: ceftazidime; Cef: cefotaxime; Cipro: ciprofloxacin; Clin: clindamycin; Clox: cloxacillin; G: gentamicin; Metro: metronidazole; Mero: meropenem; O: oxacillin; Pip: piperacillin; Ta: piperacillin/tazobactam; Tm:ticarcillin/clavulanate; To: tobramycin; V: vancomycin. Disclosures: No relevant conflicts of interest to declare.

Multi-media Global Human Factors Distance Education

In the fall semester of 2009, we had the unique opportunity to develop and teach a human factors course presented to students simultaneously at Penn State University (PSU) in the USA and Seoul National University (SNU) in South Korea. This was partially in response to both department strategic plans for a greater focus on global engineering and to increasing numbers of graduating students working for multinational companies. This paper presents some of the logistical and multicultural issues that arose with the first offering of the course and some insights for those universities and faculty members who may be attempting to prepare similar courses in the future. Pre- and post-course surveys showed that intercultural awareness levels increased over the duration of the course, especially for PSU students. Intercultural anxiety was relatively high for both groups of students at the start of course, but decreased over the duration of the course, for SNU students. In terms of on-line communication channels, e-mail and Skype were preferred over Wiggio. In the future, we will also rely more on Skype. Also, the course at PSU was first tested for graduate students. To increase international collaboration, especially for native-born American students, the course was later opened to undergraduate students. The course is now offered for the third time.

Kinetics of Bone Marrow Blasts during Remission Induction Course in Acute Myeloid Leukemia: Effect on Complete Remission and Relapse-Free Survival.

Achievement of complete remission (CR) is crucial to prolong survival in acute myeloid leukemia (AML). The definition of CR has been well established; however, there are no objective measures for deciding when the probability of achieving CR has become so low that a patient's disease can be considered resistant to therapy. In particular, it can be difficult to distinguish patients with resistant disease from those with persistent disease but who subsequently will enter CR, a distinction that underlies the decision to start a second course or change therapy. We attempted to facilitate this decision by examining the relation between the % marrow blasts 21 days, and later, after start of course 1 of initial induction therapy and the subsequent probability of CR on course 1. Our database consisted of the 593 adults with AML (≥20% blasts, acute promyelocytic leukemia excepted) who had bone marrow examined 21 days after beginning induction therapy including cytarabine at cumulative dose of 5–6 g/m2 at M. D. Anderson Cancer Center from 1995 to 2004. 340 of the 593 patients had an additional bone marrow examination between day 22 and day 28 (day 22–28) of course 1; similarly, day 29–35 marrows were done in 185 patients, day 36–42 marrows in 89 patients and so on. Bone marrows were categorized as morphologic leukemia-free state (MLFS; <5% blasts), persistent disease (PD; ≥5% blasts), or too few cells to count (TFTC). 197 of the 593 patients (33%) had an MLFS on day 21. This conferred a 94% probability of CR on course 1, independent of cytogenetic group. 275 patients (47%) had PD on day 21 and 57% of these 275 entered CR on course 1, with the probability of subsequent CR being predictable from the combination of cytogenetics, day 21 bone marrow blasts, and day 21 platelet and neutrophil counts. Patients with PD on day 21, but who achieved an MLFS on day 28 were highly likely to enter CR (40/47). However, those with PD beyond day 28 were very unlikely to enter CR on course 1, and no CR was observed in patients with PD after day 43. 121 patients (20%) had a TFTC marrow on day 21, with this finding associated with a CR rate of 72% on course 1 (p<0.001 vs MLFS, and p<0.001 vs PD). Not surprisingly given the respective CR rates, patients with MLFS on day 21 had significantly longer survival than patients with PD and patients with TFTC marrow (p<0.001). However, Relapse-free survival was not different among the 3 groups (p=0.109), which was also confirmed by multivariate analysis accounting for cytogenetics, antecedent hematologic disorder, and age. These results appear useful in management of AML, and recommend that bone marrow be examined on day 28, in patients with PD on day 21 and a <50% probability of subsequent CR and in patients with TFTC on day 21. Should PD persist on day 28, and especially on day 35, a second course should be started or new therapy instituted.

The Influence of Nutrition Education on the Dietary Intake and Percent Ideal Body Weight of College Students

Sixty-one students, enrolled in an introductory nutrition course maintained a two-day food record at the start and then again at the end of a semester. Change in nutrient intake for each student was calculated using the NutriQuest diet analysis program. As explanatory variables, student data was also collected on age. gender, height (self-reported), weight (self-reported), self perceived assessment of own diet at start of course, weekly dollars spent on food, and place of residence. The grade that the student received in the course was also recorded. Using change in nutrient intake, change in weight, and progress towards ideal body weight as dependent variables, multiple regression analysis was used to determine if grade received in the course (holding all other explanatory variables constant) significantly influenced the different dependent variables. Of most interest is the significant finding (p < 0.03) that a one-unit increase in grade received in the course (i.e., from a 3.0 to a 4.0), holding other explanatory variables constant, resulted in 1.5 percent improvement towards ideal body weight. Other significant findings (p < 0.10) related to student achievement was that among identical students in respect to the other explanatory variables, the ones who received higher grades increased their intake of iron and decreased their intake of vitamin C and calcium. Grade had no other significant effects on the other dependent variables considered. These results provide evidence that students with a stronger mastery of the nutritional knowledge provided in a college introductory course are more likely to move toward their ideal body weight in the short duration of a semester. Further improvements towards ideal body weight after the semester ended were not measured, but may be more likely for students who did better in the course. Though with the exception of iron consumption, there is little evidence that performance in such an introductory course exerts an influence on nutrient intake.

The effects of physical exercise training and cardiac education on levels of anxiety and depression in the rehabilitation of coronary artery bypass graft patients

to evaluate whether an exercise and education-based rehabilitation programme is sufficient treatment for individuals with clinically significant levels of anxiety or depression following coronary artery bypass graft (CABG) surgery. follow-up and repeated assessment after surgery. outpatient cardiac rehabilitation programme. all 88 attenders after CABG surgery. structured interview and Hospital Anxiety and Depression (HAD) scale (using 8 as the cut-off) administered by rehabilitation nurses at start of course and HAD repeated at 12 weeks and 6 and 12 months (by post after discharge). return rates of 76 and 80% at 6- and 12-month assessments, respectively; statistically significant reductions in levels of anxiety and depression found between first and all subsequent assessments; subdividing into groups revealed significant reduction in anxiety and depression in the anxious and depressed groups at 12 weeks and 6 months, respectively, but at 12 months there was no significant reduction. there is a need to address the problems of anxiety and depression directly by screening and treatment, and to provide more psychologically-orientated cardiac rehabilitation programmes.

How much does the end user need an intermediary?

INSEAD, the European Institute for Business Administration, at Fontainebleau, near Paris, offers advanced management education for over 400 students a year, mainly through the MBA course. The Library first set up online access in 1984, and now has extensive online training facilities for students, as well as services for professors, researchers and administrative staff. As demand for online training from students has increased, some professors have encouraged Library online specialists to give brief presentations at the start of courses, helping students to aim their information searching directly towards project needs. In 1987, with pressure on the present three online specialists, we started to explore ways of increasing the participation of staff and student end users in their own searching. More attention was given to existing online menu‐driven systems like Textline, while the growth of professional datafiles on France's Minitel videotex system made it worthwhile to explore their potential as subsidiary search options. In 1988, to develop direct end user searching further, two CD‐ROM workstations were installed, which now offer six disc databases on free access. There has also been an exploration of the role of databases issued on floppy disk as offline alternatives. To help campus users understand the range of database options available, a booklet listing by subject major databases accessible on campus, on both online and offline media, was recently issued. Currently, a prototype simple expert system is being developed from this to help users to move between offline and online searching more easily. The present efforts are aimed at a more user‐oriented information access as the Library prepares to transfer next year to a new building.

Statistics and the news‐vendor

The paper considers the well‐aired problem of the seller of a single‐issue evening newspaper who has to decide how many copies to order each day. A mathematical model is constructed, and solved with the aid of material normally covered near the start of courses in probability and statistics. The author's concern is, not so much to encourage paper‐sellers to make more profit, as to help pupils, through their teachers, to see some purpose in their early statistical studies. Suggestions are made for extending the basic problem to provide topics for further study as pupils become better acquainted with the subject.

IX.—Firstfruits of a Geological Examination of Snowdon

Ars longa, vita brevis. This is especially true when one reaches the age of 64. I therefore commit to paper some of the results of a geological investigation of Snowdon on which I am engaged. I start of course from the work of Messrs. Ramsay and Selwyn embodied in the Geological Survey Map of Snowdon and Ramsay's memoir on North Wales. To make what I have to say clear I may state that the rocks of Snowdon are by Ramsay and Selwyn divided into three principal groups, viz.: A, an upper felsitic lava ; an intermediate band (B) of bedded fossiliferous rocks of Bala age, containing much volcanic material, called the calcareo-felspathic ashy series ; and a lower mass (C) of felsitic rocks. This lower mass is in some places divided by sedimentary bands consisting of slates and grits. Below C come blue slates and grits, with occasional volcanic bands, D; and below D the great mass of volcanic rocks (E) which form Glyder Fach and Y Tryfan.