Population screening shows risk of inherited cancer and familial hypercholesterolemia in Oregon.

The Healthy Oregon Project (HOP) is a statewide effort that aims to build a large research repository and influence the health of Oregonians through providing no-cost genetic screening to participants for a next-generation sequencing 32-gene panel comprising genes related to inherited cancers and familial hypercholesterolemia. This type of unbiased population screening can detect at-risk individuals who may otherwise be missed by conventional medical approaches. However, challenges exist for this type of high-throughput testing in an academic setting, including developing a low-cost high-efficiency test and scaling up the clinical laboratory for processing large numbers of samples. Modifications to our academic clinical laboratory including efficient test design, robotics, and a streamlined analysis approach increased our ability to test more than 1,000 samples per month for HOP using only one dedicated HOP laboratory technologist. Additionally, enrollment using a HIPAA-compliant smartphone app and sample collection using mouthwash increased efficiency and reduced cost. Here, we present our experience three years into HOP and discuss the lessons learned, including our successes, challenges, opportunities, and future directions, as well as the genetic screening results for the first 13,670 participants tested. Overall, we have identified 730 pathogenic/likely pathogenic variants in 710 participants in 24 of the 32 genes on the panel. The carrier rate for pathogenic/likely pathogenic variants in the inherited cancer genes on the panel for an unselected population was 5.0% and for familial hypercholesterolemia was 0.3%. Our laboratory experience described here may provide a useful model for population screening projects in other states.

Improving Students' Evaluation of Informal Arguments.

Evaluating the structural quality of arguments is a skill important to students' ability to comprehend the arguments of others and produce their own. The authors examined college and high school students' ability to evaluate the quality of 2-clause (claim-reason) arguments and tested a tutorial to improve this ability. These experiments indicated that college and high school students had difficulty evaluating arguments on the basis of their quality. Experiments 1 and 2 showed that a tutorial explaining skills important to overall argument evaluation increased performance but that immediate feedback during training was necessary for teaching students to evaluate the claim-reason connection. Using a Web-based version of the tutorial, Experiment 3 extended this finding to the performance of high-school students. The study suggests that teaching the structure of an argument and teaching students to pay attention to the precise message of the claim can improve argument evaluation.

Impact of Tranexamic Acid on Blood Loss and Need for Blood Transfusions in Total Knee and Total Hip Arthroplasty.

Use of tranexamic acid during total knee and total hip arthroplasty procedures may safely and effectively reduce blood loss and the need for transfusions in patients.

Wide variation in episode costs within a commercially insured population highlights potential to improve the efficiency of care.

Reforming payment methods to move away from fee-for-service reimbursement is widely seen as a crucial step toward controlling health care costs. Although there is a good deal of evidence about variability in costs under Medicare, little has been published about the variability of costs for care that is financed by private insurance. We examined both quality and actual medical costs for episodes of care provided by nearly 250,000 US physicians serving commercially insured patients nationwide. Overall, episode costs for a set of major medical procedures varied about 2.5-fold, and for a selected set of common chronic conditions, episode costs varied about 15-fold. Among doctors meeting quality and efficiency benchmarks, however, costs for episodes of care were on average 14 percent lower than among other doctors. Some markets exhibited much higher variation in episode costs, but there was essentially no correlation between average episode costs and measured quality across markets. The overall analysis suggests that changing incentives through payment reforms could help to improve performance, but providers are at different stages of readiness for such reforms and thus will often need support in order to succeed.