Cognitive factors impacting patient understanding of laboratory test information.

Laboratory testing can provide information useful to promote patient health literacy and ultimately patient well-being. The human state of mind involves not only cognition but also emotion and motivation factors when receiving, processing, and acting upon information. The cognitive load for patients acquiring and processing new information is high. Modes of distribution can affect both attention to and receipt of information. Implicit unconscious biases can affect whom and what patients believe. Positive wording and framing of information with salience for patients can evoke positive emotions. Providing patients with the gist, or essential meaning, of information can positively influence decision-making. What laboratorians provide as information helps to combat mis- and disinformation. Laboratorians can actively participate in measures to improve the patient experience in health care by developing and contributing to high-quality information to enable timely, meaningful communication and interpretation of test results.

A review of web-based application of online learning in pathology and laboratory medicine.

Web-based learning applications can support health sciences education, including knowledge acquisition in pathology and laboratory medicine. Websites can be developed to provide learning content, assessments, and products supporting pathology education. In this paper, we review informatics principles, practices, and procedures involved with educational website development in the context of existing websites and published studies of educational website usage outcomes, including that of the authors. We provide an overview with analysis of potential results of usage to inform how such websites may be used, and to guide further development. We discuss the value of educational websites for individual users, educational institutions, and professional organizations. Educational websites may offer assessments that are formative, for learning itself, as practice, preparation, and self-assessment. Open access websites have the advantage of worldwide availability 24/7, particularly aiding persons in low resource settings. Commercial offerings for educational support in formal curricula are beyond the scope of this review. This review is intended to guide those interested in website development to support non-commercial educational purposes for users seeking to improve their knowledge and diagnostic skills supporting careers in pathology.

The Human Interface of Biomedical Informatics.

Biomedical informatics is the science of information, where information is defined as data with meaning. This definition identifies a fundamental challenge for informaticians: connecting with the healthcare team by enabling the acquisition, retrieval, and processing of information within the cognitive capabilities of the human brain. Informaticians can become aware of the constraints involved with cognitive processing and with workplace factors that impact how information is acquired and used to facilitate an improved user interface providing information to healthcare teams. Constraints affecting persons in the work environment include as follows: (1) cognitive processing of information; (2) cognitive load and memory capacity; (3) stress-affecting cognition; (4) cognitive distraction, attention, and multitasking; (5) cognitive bias and flexibility; (6) communication barriers; and (7) workplace environment. The human brain has a finite cognitive load capacity for processing new information. Short-term memory has limited throughput for processing of new informational items, while long-term memory supplies immediate simultaneous access to multiple informational items. Visual long-term memories can be extensive and detailed. Attention may be task dependent and highly variable among persons and requires maintaining control over distracting information. Multitasking reduces the effectiveness of working memory applied to each task. Transfer of information from person to person, or machine to person, is subject to cognitive bias and environmental stressors. High-stress levels increase emotional arousal to reduce memory formation and retrieval. The workplace environment can impact cognitive processes and stress, so maintaining civility augments cognitive abilities. Examples of human-computer interfaces employing principles of cognitive informatics inform design of systems to enhance the user interface.

Web-based pathology practice examination usage.

CONTEXT: General and subject specific practice examinations for students in health sciences studying pathology were placed onto a free public internet web site entitled web path and were accessed four clicks from the home web site menu. SUBJECTS AND METHODS: Multiple choice questions were coded into. html files with JavaScript functions for web browser viewing in a timed format. A Perl programming language script with common gateway interface for web page forms scored examinations and placed results into a log file on an internet computer server. The four general review examinations of 30 questions each could be completed in up to 30 min. The 17 subject specific examinations of 10 questions each with accompanying images could be completed in up to 15 min each. The results of scores and user educational field of study from log files were compiled from June 2006 to January 2014. RESULTS: The four general review examinations had 31,639 accesses with completion of all questions, for a completion rate of 54% and average score of 75%. A score of 100% was achieved by 7% of users, ≥90% by 21%, and ≥50% score by 95% of users. In top to bottom web page menu order, review examination usage was 44%, 24%, 17%, and 15% of all accessions. The 17 subject specific examinations had 103,028 completions, with completion rate 73% and average score 74%. Scoring at 100% was 20% overall, ≥90% by 37%, and ≥50% score by 90% of users. The first three menu items on the web page accounted for 12.6%, 10.0%, and 8.2% of all completions, and the bottom three accounted for no more than 2.2% each. CONCLUSIONS: Completion rates were higher for shorter 10 questions subject examinations. Users identifying themselves as MD/DO scored higher than other users, averaging 75%. Usage was higher for examinations at the top of the web page menu. Scores achieved suggest that a cohort of serious users fully completing the examinations had sufficient preparation to use them to support their pathology education.

The effect of intermediate clothing targets on shotgun ballistics.

The ballistic properties of shotgun shells are complex because of multiple projectiles fired simultaneously that interact and spread out to affect their energy relayed to a human target. Intermediate targets such as clothing can affect penetration into tissues. We studied the effect of common clothing fabrics as intermediate targets on penetration of shotgun shell pellets, using ordnance gelatin to simulate soft tissue and thin cowhide to simulate skin. A standard 12-gauge shotgun with modified choke was used with no. 8 shot ammunition. We found that protection afforded by fabrics to reduce penetration of shotgun pellets into tissues was greater at increasing distance from the muzzle beyond 40 yd (36.6 m). The thicker denim and cotton fabrics provided slightly greater protection than polyester. This study demonstrates that clothing modifies the potential wound patterns to victims of shotgun injuries.

HE4 (WFDC2) Promotes Tumor Growth in Endometrial Cancer Cell Lines.

HE4, also known as WFDC2, is a useful biomarker for ovarian cancer when either used alone or in combination with CA125. HE4 is also overexpressed in endometrial cancer (EC), but its function in cancer cells is not clear. In this study, we investigate the role of HE4 in EC progression. An HE4-overexpression system was established by cloning the HE4 prototypic mRNA variant (HE4-V0) into a eukaryotic expression vector. Following transfection, stable clones in two EC cell lines were selected. The effects of HE4 overexpression on cell growth and function were measured with the use of cell proliferation assay, matrigel invasion, and soft agar gel colony formation assays. HE4-induced cancer cell proliferation in vivo was examined in a mouse xenograft model. HE4 overexpression significantly enhanced EC cell proliferation, matrigel invasion, and colony formation in soft agar. Moreover, HE4 overexpression promoted tumor growth in the mouse xenograft model. HE4 overexpression enhanced several malignant phenotypes in cell culture and in a mouse model. These results are consistent with our previous observation that high levels of serum HE4 closely correlate with the stage, myometrial invasion and tumor size in patients with EC. This study provides evidence that HE4 overexpression directly impacts tumor progression in endometrial cancer.

How much is too much reading for medical students? Assigned reading and reading rates at one medical school.

PURPOSE: To determine how medical students' reading rates affect their ability to complete assigned reading. METHOD: The authors calculated the total amount of reading assigned during 71 weeks in 12 modules of the preclinical basic science curriculum at Mercer University School of Medicine for the 2009-2010 academic year. In September 2010, they surveyed the 351 enrolled students, asking them to estimate their reading rates, number of hours spent reading each day, and the amount of the assigned reading they had completed. The authors used the data collected to estimate time required to complete the reading assignments over a range of reading rates and compared these rates with previously published reading rates. RESULTS: Faculty assigned 29,239 pages of reading across the modules. The 104 respondents (30% response rate) reported they could read an average of 6 hours per day. The authors calculated that 17% of the students read no faster than 150 words per minute (WPM), whereas another 66% did not exceed 100 WPM. If students reserved the last week of each module for review prior to an examination, they would need to read 496 pages per week, which would require 28 to 41 hours per week at these rates, to complete the assigned reading only once. CONCLUSIONS: Medical students require significant time to complete assigned reading just once at the reading rates required to comprehend the cognitively challenging material. Before assigning reading, faculty should consider the amount that could reasonably be accomplished by their students.

A 3-year medical curriculum.

The cost of medical education keeps rising while physician shortages loom, student diversity is threatened, and maldistribution continues to affect the physician workforce. The author discusses the rationale for a 3-year undergraduate medical curriculum with reduced costs and proposes a structure with funding for it. Medical educators may consider the issues raised and continue scholarly discussion to promote sustainable, cost effective medical education to address future physician workforce needs.

An immunophenotypic comparison of metanephric metaplasia of Bowman capsular epithelium with metanephric adenoma, Wilms tumor, and renal development: a case report and review of the literature.

Metanephric metaplasia of the parietal epithelium of the Bowman capsule is a rare pathologic finding of unknown pathogenesis that has occurred in patients with widespread malignant neoplasms of various types. We report this finding in a 25-year-old woman with partial expression of the Carney triad who died of a disseminated gastrointestinal stromal tumor, specifically a gastric stromal sarcoma. The metaplasia involved both kidneys diffusely. It originated in the parietal epithelium of the Bowman capsule, extended into the proximal tubules, and focally surrounded the glomeruli in a semicircular manner Immunohistochemical analysis revealed that the cells of metanephric metaplasia expressed the Wilms tumor gene product, bcl-2 protein, and CD57 and cytokeratin 7 and keratin AE1/AE3 focally, but not CD56. This immunophenotype parallels that of metanephric adenoma, Wilms tumor, and nephrogenic rests and overlaps with antigen expression in certain periods of renal development.

Highly active antiretroviral therapy and cardiovascular complications in HIV-infected patients.

Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself causes in a high proportion of patients a metabolic syndrome, characterized by lipodystrophy/ lipoatrophy, dyslipidemia and insulin resistance that may be associated with an increase in peripheral artery and coronary artery diseases. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. All HIV-infected patients who are either candidates to antiretroviral therapy or who are already under treatment should undergo an assessment that includes the evaluation of the cardiovascular risk with the available guidelines and the interactions between antiretrovirals and drugs commonly used to treat cardiovascular disease.

HIV infection and the cardiovascular system.

Better treatment and supportive care are prolonging the lives of patients with HIV, which is resulting in a higher prevalence of long-term effects of HIV. Autopsy and echocardiography studies support frequent involvement of the heart in advanced stages of HIV infection. The most common cardiac manifestations of HIV are dilated cardiomyopathy, myocarditis, pulmonary hypertension, pericardial effusion, endocarditis, HIV-associated malignant neoplasms, and drug-related cardiotoxicity. Highly active antiretroviral therapy (HAART) has prolonged many patients' lives, but many cardiac sequelae of HIV are not affected by HAART and continue to develop even with treatment. In addition, HAART itself may be associated with an increase in peripheral artery and coronary artery diseases. This review focuses on the most recent knowledge about HIV-associated cardiovascular disease. Careful cardiovascular evaluation in the course of HIV disease can identify cardiac complications early enough to treat. In addition, the study of HIV-related cardiovascular disease may shed light on the mechanisms of non-HIV-related cardiovascular disease.