Development of a rapid, multi-organisational, multi-modal assessment of a newly available disposable respirator.

BACKGROUND: A rapid large-scale evaluation of a newly available duckbill style P2/N95 respirator, the Care Essentials (CE) MSK-003, was required to determine its suitability for deployment into the Victorian healthcare service. The aims of this study were to assess the feasibility of establishing a rapid, multi-organisational and multi-modal evaluation of the respirator, and to investigate whether this respirator would meet the needs of healthcare workers. METHODS: The evaluation was a collaboration among three healthcare organisations - two tertiary hospitals in metropolitan Melbourne and a rural-based hospital. Participants were healthcare workers undertaking their routine fit tests. They were required to complete quantitative fit testing and a usability assessment survey on the CE MSK-003 respirator. The a priori performance criteria were set as fit test pass rate of >70%, plus satisfactory subjective overall comfort and performance assessments, defined as a rating of adequate, good, or very good in >90% of the cohort. RESULTS: A total of 1070 participants completed the multi-modal assessment within a month. Seventy-eight percent of participants passed their quantitative fit test. Over 90% of survey respondents reported that the CE MSK-003 was adequate, good or very good in terms of its overall comfort and performance assessments. CONCLUSION: We demonstrated that a multi-modal evaluation of a new respirator can be rapidly conducted with a high level of participation in a controlled, consistent manner across multiple organisations. The evaluation results of the CE MSK-003 respirator exceeded our predetermined (a priori) minimal criteria, making it suitable for broad distribution to healthcare organisations.

Pharmacist Avoidance or Reductions in Medical Costs in Critically and Emergently Ill Pediatrics: PHARM-PEDS Study.

OBJECTIVES: To comprehensively classify interventions performed by pediatric critical care clinical pharmacists and quantify cost avoidance (CA) generated through their accepted interventions. DESIGN: A multicenter, prospective, observational study performed between August 2018 and January 2019. SETTING: Academic and community hospitals in the United States with pediatric critical care units. SUBJECTS: Pediatric clinical pharmacists. INTERVENTIONS: Pharmacist recommendations were classified into one of 38 total intervention categories associated with CA. MEASUREMENTS AND MAIN RESULTS: Nineteen pediatric pharmacists at five centers documented 1,458 accepted interventions during 112 shifts on 861 critically ill pediatric patients. This calculated to an associated CA of $450,590. The accepted interventions and associated CA in the six established categories included as follows: adverse drug event prevention (155 interventions, $118,901 CA), resource utilization (267 interventions; $59,020), individualization of patient care (898 interventions, $217,949 CA), prophylaxis (8 interventions, $453 CA), hands-on care (30 interventions, $35,509 CA), and administrative/supportive tasks (108 interventions, $18,758 CA). The average associated CA was $309 per accepted intervention, $523 per patient day, and $4,023.13 per pediatric clinical pharmacist shift. The calculated potential annualized CA of accepted interventions from a pediatric pharmacist was $965,550, resulting in a potential monetary-associated CA-to-pharmacist salary ratio between $1.5:1 and $5.2:1. CONCLUSIONS: There is potential for significant avoidance of healthcare costs when pediatric pharmacists are involved in the care of critically and emergently ill pediatric patients, with a monetary potential CA-to-pediatric pharmacist salary ratio to be between $1.5:1 and $5.2:1.

Multilevel Community Engagement to Inform a Randomized Clinical Trial.

OBJECTIVE: To explore how patients, community-based perinatal support professionals, and health system clinicians and staff perceived facilitators and barriers to implementation of a randomized clinical trial (RCT) designed to optimize Black maternal heart health. METHODS: This article describes the formative work that we believed needed to occur before the start of the Change of H.E.A.R.T (Here for Equity, Advocacy, Reflection and Transformation) RCT. We used a qualitative, descriptive design and community-based, participatory approach, the latter of which allowed our team to intentionally focus on avoiding harm and equalizing power dynamics throughout the research process. Data were collected between November 2021 and January 2022 through six semistructured focus groups that included attending physicians and midwives (n=7), residents (n=4), nurses (n=6), support staff (n=7), community-based perinatal support professionals (n=6), and patients (n=8). RESULTS: Four primary themes emerged. The first three themes were present across all groups and included: 1) Trauma in the Community and Health System, 2) Lack of Trust, and 3) Desire to Be Heard and Valued. The fourth theme, Hope and Enthusiasm, was expressed predominantly by patients, community-based perinatal support professionals, residents, and support staff, and less so by the attending physician group. CONCLUSION: Participants articulated a number of key sentiments regarding facilitators and barriers to implementing Change of H.E.A.R.T. We noted variability in perceptions from different groups. This has important implications for health equity efforts in similarly underresourced health systems where Black birthing people experience the greatest morbidity and mortality. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05499507.

The cost savings of the rural accelerated chest pain pathway for low-risk chest pain in rural general practice: a cost minimisation analysis.

Introduction The rural accelerated chest pain pathway (RACPP) has been shown to safely reduce the number of transfers to hospital for patients who present with chest pain to rural general practice. Aim This study aimed to estimate the costs associated with assessing patients with low-risk chest pain using the RACPP in rural general practice compared with transporting such patients to a distant emergency department (ED). Methods This was a retrospective cost minimisation analysis. All patients with low-risk chest pain that were assessed in New Zealand (NZ) rural general practice using the RACPP between 1 June 2018 and 31 December 2019 were asked to participate. The costs incurred by patients were determined by an online survey. Patients were also asked to estimate the costs if they would have been transferred to ED. System costs were obtained from the relevant healthcare organisations. The main outcome measure was the total cost for patients who present with low-risk chest pain. Results In total, 15 patients (22.7% response rate) responded to the survey. Using the RACPP in general practice resulted in a median cost saving of NZ$1184 (95% CI: $1111 to $1468) compared with transferring the same patient to ED. Discussion Although limited by low enrolment, this study suggests that there are significant savings if the RACPP is used to assess patients with low-risk chest pain in rural NZ general practice.

A Clinical Nurse Leader-Guided Behavior Management Consult Team to Impact Workplace Violence Against Nurses.

BACKGROUND: Violence against nurses is a growing problem. Minimizing violence against nurses will contribute to a safer clinical environment. LOCAL PROBLEM: An increase in violence against nurses was identified at a regional medical center in the Midwest. METHODS: A clinical nurse leader (CNL)-led behavior management consult team was developed to support the clinical team with aggressive, disruptive, or violent patients. The team consulted, assigned interventions to address potential source(s) of agitation, provided clinical support and guidance, and developed clinical tools to manage future patients with similar behavior patterns. RESULTS: Between April 2019 and January 2023, a total of 108 behavior management consults were completed. Staff appreciated the additional support from the team. CONCLUSIONS: Implementation of a CNL-led behavior management consult team was found to be beneficial; other health care systems should consider implementing a similar consult team.

The M-CHooSe pilot: the acceptability and utilisation of the nurse-led, general practice clinic co-located 'Mater CALD Healthcare Coordinator Service' for patients from multicultural backgrounds.

BACKGROUND: Patients from culturally and linguistically diverse (CALD) backgrounds often have unmet healthcare coordination needs. We aimed to evaluate the acceptability, utilisation and perceived benefits of the Mater CALD Health Coordinator Service (M-CHooSe), a pilot, nurse-led, general practice co-located, healthcare coordination service for patients from CALD backgrounds. METHODS: M-CHooSe began in March 2020 at five Brisbane (Queensland) sites. Process and service user data were collected over 12months at one site. A survey evaluated primary healthcare professionals' perceived benefits of the service. Another survey of M-CHooSe nurses examined indicators of service complexity. RESULTS: In total, 206 individuals accessed M-CHooSe over the 12-month period. Commonly delivered services included health service advocacy, chart reviews and health system navigation, including addressing social determinants. M-CHooSe nurses reported frequently performing tasks such as following up with external health services and performing health and social care system coordination. M-CHooSe benefits reported by primary healthcare professionals included better patient access to external health services and improved patient understanding of their conditions and treatments. CONCLUSION: Patients were accepting of referrals to M-CHooSE. Primary healthcare professionals also reported a variety of benefits to themselves and their patients because of M-CHooSe. M-ChooSe highlights the potential of a healthcare coordination service for multicultural patients to improve healthcare equity, accessibility, and system efficiency. This project demonstrates the potential value of coordination services to increase patient access and uptake of existing health and social care services for modern Australian communities, thus improving the efficiency and effectiveness of our health system. Further investigations, including user experience, opinions and cost analyses, will be required to confirm the promising benefits of embedding M-CHooSe into usual care.

Assessment of the individual and compounding effects of marginalization factors on injury severity, discharge location, recovery, and employment outcomes at 1 year after traumatic brain injury.

Objective: The aim of this study is to examine the effect of eight distinct marginalized group memberships and explore their compounding effect on injury severity, recovery, discharge location, and employment outcomes 1-year after traumatic brain injury (TBI). Methods: Individuals with medically confirmed, complicated mild-severe TBI (N = 300) requiring inpatient rehabilitation care between the ages of 18 and 65 were recruited at two urban (public and private) health systems between 2013 and 2019. Data were collected from self-report and medical record abstraction. Marginalized group membership (MGM) includes racial and ethnic minority status, less than a high school diploma/GED, limited English proficiency, substance abuse, homelessness, psychiatric hospitalizations, psychiatric disorders, and incarceration history. Membership in four or more of these groups signifies high MGM. In addition, these factors were explored individually. Unadjusted and adjusted linear and logistic regressions and Kruskal-Wallis tests were used to assess the associations of interest in RStudio. Results: After adjusting for age, sex, and cause of injury, compared to TBI patients with low MGM, those with high MGM experience significantly longer post-traumatic amnesia (95% CI = 2.70, 16.50; p = 0.007) and are significantly more likely to have a severe TBI (per the Glasgow-Coma Scale) (95% CI = 1.70, 6.10; p ≤ 0.001) than a complicated mild-moderate injury. Individuals with high MGM also are significantly less likely to be engaged in competitive paid employment 1 year after injury (95% CI = 2.40, 23.40; p = 0.001). Patients with high MGM are less likely to be discharged to the community compared to patients with low MGM, but this association was not significant (95% CI = 0.36, 1.16; p = 0.141). However, when assessing MGMs in isolation, certain associations were not significant in unadjusted or adjusted models. Conclusion: This exploratory study's findings reveal that when four or more marginalization factors intersect, there is a compounding negative association with TBI severity, recovery, and employment outcomes. No significant association was found between high MGM and discharge location. When studied separately, individual MGMs had varying effects. Studying marginalization factors affecting individuals with TBI has critical clinical and social implications. These findings underline the importance of addressing multidimensional factors concurrent with TBI recovery, as the long-term effects of TBI can place additional burdens on individuals and their economic stability.

Sustainability and Justice: Challenges and Opportunities for an Open STEM Education.

Open educational resources, or OER, are teaching materials that reside in the public domain and are available under an open license. While the creation of high-quality materials and cyberinfrastructure to share these resources is important, OER are much more than static resource repositories. Vibrant OER communities function as collaboration hubs and often include librarians, instructional technologists, instructors, education researchers, funders, open-source software developers, and college administrators. Together, these individuals work as a community to respond to changes in the education landscape, support student learning impacts both in terms of cost savings and student retention, and solve issues related to broadly sharing open resources on the web. This essay provides general information about OER, describes communities developing OER for science, technology, engineering, and mathematics education, and presents insights about sustainability challenges. The sustainability challenges are organized according to multiple dimensions: cultural and social, economic and financial, and technological and environmental. In addition, OER provide important opportunities to address and promote social justice and open and accessible education philosophies. Knowing more about the OER landscape, sustainability challenges, and educational justice opportunities can help instructors use and contribute to this growing movement to reshape the landscape of undergraduate education.

Deployment of Health Equity Strike Teams to Address COVID-19 Vaccine Disparities in Arkansas, 2021.

Minority populations have been disproportionately affected by the COVID-19 pandemic, and disparities have been noted in vaccine uptake. In the state of Arkansas, health equity strike teams (HESTs) were deployed to address vaccine disparities. A total of 13 470 vaccinations were administered by HESTs to 10 047 eligible people at 45 events. Among these individuals, 5645 (56.2%) were African American, 2547 (25.3%) were White, and 1068 (10.6%) were Hispanic. Vaccination efforts must specifically target populations that have been disproportionately affected by the pandemic. (Am J Public Health. 2022;112(1):29-33. https://doi.org/10.2105/AJPH.2021.306564).

Use of Community-Based Participatory Research Partnerships to Reduce COVID-19 Disparities Among Marshallese Pacific Islander and Latino Communities - Benton and Washington Counties, Arkansas, April-December 2020.

Marshallese and Latino communities in Benton and Washington counties, Arkansas, were disproportionately affected by COVID-19. We evaluated the effectiveness of a comprehensive community-based intervention to reduce COVID-19 disparities in these communities. We examined all laboratory-confirmed COVID-19 cases in the 2 counties reported from April 6, 2020, through December 28, 2020. A 2-sample serial t test for rate change was used to evaluate changes in case rates before and after implementation of the intervention. After implementation, the proportions of cases among Marshallese and Latino residents declined substantially and began to align more closely with the proportions of these 2 populations in the 2 counties. Infection rates remained lower throughout the evaluation period, and weekly incidence also approximated Marshallese and Latino population proportions. Leveraging community partnerships and tailoring activities to specific communities can successfully reduce disparities in incidence among populations at high-risk for COVID-19 .

Developing the geographic classification for health, a rural-urban classification for New Zealand health research and policy: A research protocol.

INTRODUCTION: Rural-urban health inequities, exacerbated by deprivation and ethnicity, have been clearly described in the international literature. To date, the same inequities have not been as clearly demonstrated in Aotearoa New Zealand despite the lower socioeconomic status and higher proportion of Maori living in rural towns. This is ascribed by many health practitioners, academics and other informed stakeholders to be the result of the definitions of 'rural' used to produce statistics. AIMS: To outline a protocol to produce a 'fit-for-health purpose' rural-urban classification for analysing national health data. The classification will be designed to determine the magnitude of health inequities that have been obscured by use of inappropriate rural-urban taxonomies. METHODS: This protocol paper outlines our proposed mixed-methods approach to developing a novel Geographic Classification for Health. In phase 1, an agreed set of community attributes will be used to modify the new Statistics New Zealand Urban Accessibility Classification into a more appropriate classification of rurality for health contexts. The Geographic Classification for Health will then be further developed in an iterative process with stakeholders including rural health researchers and members of the National Rural Health Advisory Group, who have a comprehensive 'on the ground' understanding of Aotearoa New Zealand's rural communities and their attendant health services. This protocol also proposes validating the Geographic Classification for Health using general practice enrolment data. In phase 2, the resulting Geographic Classification for Health will be applied to routinely collected data from the Ministry of Health. This will enable current levels of rural-urban inequity in health service access and outcomes to be accurately assessed and give an indication of the extent to which older classifications were masking inequities.

The Arkansas Minority Barber and Beauty Shop Health Initiative: Meeting People Where They Are.

INTRODUCTION: The Office of Health Equity at the Arkansas Department of Health created the Arkansas Minority Barber & Beauty Shop Health Initiative (ARBBS) to address cardiovascular disease (CVD) among racial/ethnic minority populations. The objective of this study was to describe CVD-related screening results for ARBBS participants and their knowledge of CVD-related risk factors, signs, and symptoms before and immediately after participation in a screening event. METHODS: ARBBS screening events were held from February 2016 through June 2019 at barber and beauty shops in 14 counties in Arkansas. During each event, participants were screened for hypertension, high cholesterol, and diabetes; surveys on CVD-related knowledge were administered before (pretest) and after (posttest) screening. Onsite public health practitioners reviewed surveys and identified abnormal screening results. Participants with abnormal screening results were counseled and given a referral to follow up with a primary care physician, wellness center, or charitable clinic. The nurse coordinator followed up to confirm that a visit or appointment had been made and provide case-management services. RESULTS: During the study period, 1,833 people were screened. The nurse coordinator followed up with 320 (55.7%) of 574 unique referrals. Of the 574 referrals, 418 (72.8%) were for hypertension, 156 (27.2%) for high cholesterol, and 120 (20.9%) for diabetes. The overall knowledge of risk factors and symptoms of heart attack and stroke increased significantly by 15.4 percentage points from pretest to posttest (from 76.9% to 92.3%; P < .001). The follow-up approach provided anecdotal information indicating that several participants discovered they had underlying medical conditions and were given medical or surgical interventions. CONCLUSION: Through referrals and follow-ups, ARBBS participants gained greater knowledge of chronic disease prevention and risk factors. Additionally, this program screened for and identified people at risk for CVD.

Multidisciplinary Community-Based Investigation of a COVID-19 Outbreak Among Marshallese and Hispanic/Latino Communities - Benton and Washington Counties, Arkansas, March-June 2020.

By June 2020, Marshallese and Hispanic or Latino (Hispanic) persons in Benton and Washington counties of Arkansas had received a disproportionately high number of diagnoses of coronavirus disease 2019 (COVID-19). Despite representing approximately 19% of these counties' populations (1), Marshallese and Hispanic persons accounted for 64% of COVID-19 cases and 57% of COVID-19-associated deaths. Analyses of surveillance data, focus group discussions, and key-informant interviews were conducted to identify challenges and propose strategies for interrupting transmission of SARS-CoV-2, the virus that causes COVID-19. Challenges included limited native-language health messaging, high household occupancy, high employment rate in the poultry processing industry, mistrust of the medical system, and changing COVID-19 guidance. Reducing the COVID-19 incidence among communities that suffer disproportionately from COVID-19 requires strengthening the coordination of public health, health care, and community stakeholders to provide culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.

Evolving Indications for Lower Limb Amputations in South Africa Offer Opportunities for Health System Improvement.

BACKGROUND: Rapid urbanization and westernization have precipitated dramatic changes in the profile and prevalence of surgical diseases in sub-Saharan Africa. Disease of lifestyle is now common. We aimed to review our experience with lower-limb amputations at our surgical service in South Africa. METHODS: A single-center retrospective review of a prospectively collected database was performed of all patients who underwent a lower limb amputation. Inferential and descriptive statistics were performed. Patient demographics, indication, type of amputation, and management were reviewed. The primary outcome was 30-day in-patient mortality rate. RESULTS: Over a 5-year period (2013-2018), 348 patients underwent lower limb amputations. The median age was 61.5 years. 53.7% were diabetic and 56.3% were hypertensive. 53.2% had associated peripheral vascular disease and 8% preexisting cardiac disease. 30.7% smoked. Guillotine below-knee amputation was frequently performed (44.5% of amputations). 16.1% of these patients required a further operation. The in-hospital mortality rate was 8%. Underlying renal disease was an independent risk factor for mortality (p = 0.004). CONCLUSION: Currently, the most common indications for LLA in South Africa are diabetes mellitus and atherosclerosis. This reflects the changing pattern of disease in the country. There is a major problem with access to health care in rural areas in South Africa with significant delays in getting patients to tertiary units for evaluation by specialists. Foot care and prevention at a primary health care level is also lacking. Global improvements in the healthcare system are needed to improve LLA rates in South Africa.

Medical electives: exploring the determinants of placement and access variables between 2010 and 2016 at the University of Auckland.

BACKGROUND: Medical electives undertaken during sixth year at medical school provide an opportunity for students to work in an overseas or New Zealand health facility to gain exposure to a health system outside their training facility. Previous work suggests that the elective experience can be profound, exposing global health inequities, or influencing future career decisions. This study assessed patterns within elective choice by students' socio demographic and programme entry characteristics. METHODS: A retrospective analysis of student elective records from 2010 to 2016 was undertaken using a Kaupapa Maori research framework, an approach which prioritises positive benefits for Maori (and Pacific) participants and communities. A descriptive analysis of routinely collected de-identified aggregate secondary data included demographic variables (gender, age group, ethnicity, secondary school decile, year and route of entry), and elective site. Route of entry (into medical school) is via general, MAPAS (Maori and Pacific Admissions Scheme) and RRS (Regional and Rural Scheme). Multivariable logistic regression analysis determined the odd ratios for predictors of going overseas for elective and electives taking place in a "High" (HIC) compared to "Low- and middle-income countries" (LMIC). RESULTS: Of the 1101 students who undertook an elective (2010-2016) the majority undertook their elective overseas; the majority spent their elective within a high-income country. Age (younger), route of entry (general) and high school decile (high) were associated with going overseas for an elective. Within the MAPAS cohort, Pacific students were more likely (than Maori) were to go overseas for their elective; Maori students were more likely to spend their elective in a HIC. CONCLUSION: The medical elective holds an important, pivotal opportunity for medical students to expand their clinical, professional and cultural competency. Our results suggest that targeted support may be necessary to ensure equitable access, particularly for MAPAS students the benefit of an overseas elective.

GenBio-MAPS: A Programmatic Assessment to Measure Student Understanding of Vision and Change Core Concepts across General Biology Programs.

The Vision and Change report provides a nationally agreed upon framework of core concepts that undergraduate biology students should master by graduation. While identifying these concepts was an important first step, departments also need ways to measure the extent to which students understand these concepts. Here, we present the General Biology-Measuring Achievement and Progression in Science (GenBio-MAPS) assessment as a tool to measure student understanding of the core concepts at key time points in a biology degree program. Data from more than 5000 students at 20 institutions reveal that this instrument distinguishes students at different stages of the curriculum, with an upward trend of increased performance at later time points. Despite this trend, we identify several concepts that advanced students find challenging. Linear mixed-effects models reveal that gender, race/ethnicity, English-language status, and first-generation status predict overall performance and that different institutions show distinct performance profiles across time points. GenBio-MAPS represents the first programmatic assessment for general biology programs that spans the breadth of biology and aligns with the Vision and Change core concepts. This instrument provides a needed tool to help departments monitor student learning and guide curricular transformation centered on the teaching of core concepts.

Performance of Noninvasive Assessment in the Diagnosis of Right Heart Failure After Left Ventricular Assist Device.

Right heart failure (RHF) after left ventricular assist device (LVAD) is associated with poor outcomes. Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) defines RHF as elevated right atrial pressure (RAP) plus venous congestion. The purpose of this study was to examine the diagnostic performance of the noninvasive Intermacs criteria using RAP as the gold standard. We analyzed 108 patients with LVAD who underwent 341 right heart catheterizations (RHC) between January 1, 2006, and December 31, 2013. Physical exam, echocardiography, and laboratory data at the time of RHC were collected. Conventional two-by-two tables were used and missing data were excluded. The noninvasive Intermacs definition of RHF is 32% sensitive (95% cardiac index (CI), 0.21-0.44) and 97% specific (95% CI, 0.95-0.99) for identifying elevated RAP. Clinical assessment failed to identify two-thirds of LVAD patients with RAP > 16 mm Hg. More than half of patients with elevated RAP did not have venous congestion, which may represent a physiologic opportunity to mitigate the progression of disease before end-organ damage occurs. One-quarter of patients who met the noninvasive definition of RHF did not actually have elevated RAP, potentially exposing patients to unnecessary therapies. In practice, if any component of the Intermacs definition is present or equivocal, our data suggest RHC is warranted to establish the diagnosis.

Phys-MAPS: a programmatic physiology assessment for introductory and advanced undergraduates.

We describe the development of a new, freely available, online, programmatic-level assessment tool, Measuring Achievement and Progress in Science in Physiology, or Phys-MAPS ( http://cperl.lassp.cornell.edu/bio-maps ). Aligned with the conceptual frameworks of Core Principles of Physiology, and Vision and Change Core Concepts, Phys-MAPS can be used to evaluate student learning of core physiology concepts at multiple time points in an undergraduate physiology program, providing a valuable longitudinal tool to gain insight into student thinking and aid in the data-driven reform of physiology curricula. Phys-MAPS questions have a modified multiple true/false design and were developed using an iterative process, including student interviews and physiology expert review to verify scientific accuracy, appropriateness for physiology majors, and clarity. The final version of Phys-MAPS was tested with 2,600 students across 13 universities, has evidence of reliability, and has no significant statement biases. Over 90% of the physiology experts surveyed agreed that each Phys-MAPS statement was scientifically accurate and relevant to a physiology major. When testing each statement for bias, differential item functioning analysis demonstrated only a small effect size (<0.008) of any tested demographic variable. Regarding student performance, Phys-MAPS can also distinguish between lower and upper division students, both across different institutions (average overall scores increase with each level of class standing; two-way ANOVA, P < 0.001) and within each of three sample institutions (each ANOVA, P ≤ 0.001). Furthermore, at the level of individual concepts, only evolution and homeostasis do not demonstrate the typical increase across class standing, suggesting these concepts likely present consistent conceptual challenges for physiology students.

EcoEvo-MAPS: An Ecology and Evolution Assessment for Introductory through Advanced Undergraduates.

A new assessment tool, Ecology and Evolution-Measuring Achievement and Progression in Science or EcoEvo-MAPS, measures student thinking in ecology and evolution during an undergraduate course of study. EcoEvo-MAPS targets foundational concepts in ecology and evolution and uses a novel approach that asks students to evaluate a series of predictions, conclusions, or interpretations as likely or unlikely to be true given a specific scenario. We collected evidence of validity and reliability for EcoEvo-MAPS through an iterative process of faculty review, student interviews, and analyses of assessment data from more than 3000 students at 34 associate's-, bachelor's-, master's-, and doctoral-granting institutions. The 63 likely/unlikely statements range in difficulty and target student understanding of key concepts aligned with the Vision and Change report. This assessment provides departments with a tool to measure student thinking at different time points in the curriculum and provides data that can be used to inform curricular and instructional modifications.

Lost in translation: Medication labeling for immigrant families.

OBJECTIVES: To identify the patient-safety hazards of current medication labeling standards for immigrant and language-minority families. SUMMARY: The Latino population in the United States has increased by more than 40% over the past decade and the total child population born to Latino parents will surpass one-half of the population in many states. With recent health care and immigration policies, this demographic shift has a disproportional effect on the Latino families. Research shows that recent Latin American immigrants face disparities when encountering the U.S. pharmacy system. A review of these disparities shows how new policies should be informed when considering new pharmacy regulations to better address the cultural needs of recent Latin American families to improve medication understanding and adherence. CONCLUSION: To date, research and regulatory requirements for medication safety in the United States have attended insufficiently to the patient-safety risk inherent in providing complex English-language labels to non-English-speaking families, many of whom have limited literacy in their native language. As families move, this patient-safety risk is increased by shifts in pharmacies, which often have different medication-labeling standards. It is important to examine how recent immigrant parents are addressing the medication needs for their children based on their cultural norms and how those cultural practices and acculturation into the U.S. health care system may affect their risk for injury. New research and policy efforts may help to address these barriers to safe medication use.