Reasons for unsuccessful research submissions to JAAPA.

OBJECTIVE: PA authors face many barriers to publication and may benefit from additional transparency in the editorial decision-making process. This study examined the most common reasons for rejection of original research submissions to JAAPA. METHODS: Senior JAAPA editors conducted a thematic analysis of reviewer and editor comments and used these broad themes to classify the reasons for rejection of original research manuscripts submitted to JAAPA. RESULTS: From October 2015 through December 2018, 77 research manuscripts were submitted to JAAPA. Fifty-six manuscripts were rejected, resulting in an overall rejection rate of 73.7%. Common reasons for rejection included: methodologic issues (55.4%), content outside the journal's scope (42.9%), poor writing quality (17.9%), guideline nonadherence (3.6%), lack of novelty (3.6%), and author(s) declining to revise the manuscript (1.8%). CONCLUSION: The most common reasons for manuscript rejection can be overcome through research planning and manuscript preparation.

Reasons PAs leave their jobs.

PURPOSE: Employee turnover is an important indicator that carries a heavy financial cost for healthcare organizations. Although previous research has highlighted some factors associated with turnover, the reasons physician assistants (PAs) leave their jobs are not fully understood. This study aimed to determine the most common reasons behind PA turnover. METHODS: In 2019, the American Academy of PAs (AAPA) distributed a survey to all PAs with an eligible email address. The survey included a question asking respondents if they had left or changed their job in the past year. Respondents answering this question in the affirmative were asked a follow-up multiple-choice question to determine the reason behind this change. RESULTS: A total of 13,088 PAs responded to the AAPA salary survey; of these, 1,261 reported leaving a job within the past year. The most common reasons provided for leaving a job were: better work/life balance (n = 209, 16.8%), moved (n = 208, 16.7%), better management/leadership/environment (reasons related to toxic/abusive environment) (n = 170, 13.6%), and better compensation/benefits (n = 148, 11.9%). CONCLUSION: Employers should focus on common reasons for turnover that can be reasonably addressed. Of the top three reasons behind PA turnover, those related to toxic/abusive work environments may be the most practical and important to address.

Utility of targeted gene sequencing to differentiate myeloid malignancies from other cytopenic conditions.

The National Heart, Lung, and Blood Institute-funded National MDS Natural History Study (NCT02775383) is a prospective cohort study enrolling patients with cytopenia with suspected myelodysplastic syndromes (MDS) to evaluate factors associated with disease. Here, we sequenced 53 genes in bone marrow samples harvested from 1298 patients diagnosed with myeloid malignancy, including MDS and non-MDS myeloid malignancy or alternative marrow conditions with cytopenia based on concordance between independent histopathologic reviews (local, centralized, and tertiary to adjudicate disagreements when needed). We developed a novel 2-stage diagnostic classifier based on mutational profiles in 18 of 53 sequenced genes that were sufficient to best predict a diagnosis of myeloid malignancy and among those with a predicted myeloid malignancy, predict whether they had MDS. The classifier achieved a positive predictive value (PPV) of 0.84 and negative predictive value (NPV) of 0.8 with an area under the receiver operating characteristic curve (AUROC) of 0.85 when classifying patients as having myeloid vs no myeloid malignancy based on variant allele frequencies (VAFs) in 17 genes and a PPV of 0.71 and NPV of 0.64 with an AUROC of 0.73 when classifying patients as having MDS vs non-MDS malignancy based on VAFs in 10 genes. We next assessed how this approach could complement histopathology to improve diagnostic accuracy. For 99 of 139 (71%) patients (PPV of 0.83 and NPV of 0.65) with local and centralized histopathologic disagreement in myeloid vs no myeloid malignancy, the classifier-predicted diagnosis agreed with the tertiary pathology review (considered the internal gold standard).

Intelligent discussion on HIV vaccine serves as a small consolation for slow progress. Bicentennial Symposium.

Despite great public interest and desperate need, progress toward a viable human immunodeficiency virus (HIV) vaccine remains incredibly slow. Since Merck began its HIV vaccine research in 1985, the pharmaceutical company has yet to produce a vaccine capable of passing Phase II testing. Merck Laboratories President Peter S. Kim recently delivered a speech at Yale University that detailed his company's previous attempts to create an HIV vaccine and outlined a possible strategy for the future. By Kim's own admission, Merck will not produce a viable vaccine in the near future. However, the speech served as an important endorsement for HIV vaccine development from a highly respected leader in the pharmaceutical industry, which, historically, has produced drugs aimed at management rather than prevention.