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The beginning of the COVID-19 pandemic presented a huge challenge to healthcare workers. Doctors struggled to predict how different patients would fare under treatment against the novel SARS-CoV-2 virus. Deciding how to triage medical resources when presented with very little information took a mental and physical toll on caregivers as the pandemic progressed.

To ease this burden, researchers at Pacific Northwest National Laboratory (PNNL), Stanford University, Virginia Tech, and John Snow Labs developed TransMED, a first-of-its-kind artificial intelligence (AI) prediction tool aimed at addressing issues caused by emerging or .

"As COVID-19 unfolded over 2020, it brought a number of us together into thinking how and where we could contribute meaningfully," said chief scientist Sutanay Choudhury. "We decided we could make the most impact if we worked on the problem of predicting ."

"COVID presented a unique challenge," said Khushbu Agarwal, lead author of the study published in Nature Scientific Reports. "We had very limited patient data for training an AI model that could learn the underlying COVID patient trajectories."

The multi-institutional team developed TransMED to address this challenge, analyzing data from existing diseases to predict outcomes of an emerging disease.

Answering a call to help

When the COVID-19 pandemic began, PNNL researchers confronted the new challenge head-on. Choudhury found himself working on a team using AI to generate structures for molecules that could be potential candidates for against SARS-CoV-2.

He also felt an intense empathy towards the healthcare workers at the frontlines of the COVID-19 battle. "It was clear we needed to build more effective tools to protect both patients and caregivers better during the next crisis," said Choudhury.

Choudhury and Agarwal enlisted the help of Colby Ham, and Robert Rallo, director of the Advanced Computing, Mathematics, and Data Division at PNNL, as well as computer scientists from Stanford University, Virginia Tech, and John Snow Labs to build such a tool.

Suzanne Tamang was one of those scientists. She previously worked with Choudhury, Agarwal, and Rallo on a healthcare analytics project. She was eager to participate in this research endeavor to apply her knowledge for providing to healthcare workers.

"We all saw a need to contribute," said Tamang, assistant faculty director, Data Science, at the Stanford Center for Population Health Science and Instructor at the Department of Biomedical Data Science, Stanford University School of Medicine. "We could leverage our abilities to build a tool with immediate value and utility for ."

Tamang is no stranger to such altruism. As part of Stanford University's Statistics for Social Good club, she regularly donates her time and skills to solving problems across a variety of social issues. "Sometimes, the best science occurs when researchers are driven by a desire to help," said Tamang.

A new approach to combatting unknown diseases

Early results indicate that TransMED outperforms current patient outcome prediction models, particularly for rarer outcomes. Agarwal partly attributes this to TransMED's ability to scrutinize a wide variety of medical information, including other .

"TransMED considers nearly all types of electronic healthcare records data such as , drugs, procedures, laboratory measurements, and information from clinical notes," said Agarwal. "Taking this holistic view of the patient allows TransMED to make predictions much in the same way a clinician would."

The other factor contributing to TransMED's success is transfer learning. Essentially, transfer learning works by having a machine learning model work on solving a problem where a lot of data exists. The model then transfers this knowledge to solving similar problems. In the case of TransMED, researchers trained the model on known severe respiratory disease patient outcomes and applied that knowledge to predicting COVID-19 outcomes.

"Given a patient's latest medical history, TransMED can predict a patient's need for ventilators, or other rare outcomes 5 to 7 days out into the future," said Choudhury.

Application of AI in real-world healthcare settings is in its infancy, but this work is a promising first step towards building a useful model for predicting patient outcomes. Though TransMED is yet to be tested in a clinical setting, it offers an encouraging glimpse into the future of healthcare.

Additional authors on this paper are Sindhu Tipirneni and Chandan K Reddy from Virginia Tech; Pritam Mukherjee, Matthew Baker, Siyi Tang, and Olivier Gevaert from Stanford University; and Veysel Kocaman from John Snow Labs. This work was supported by a PNNL Laboratory Directed Research and Development program.

More information: Khushbu Agarwal et al, Preparing for the next pandemic via transfer learning from existing diseases with hierarchical multi-modal BERT: a study on COVID-19 outcome prediction, Scientific Reports (2022). DOI: 10.1038/s41598-022-13072-w

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Whenever health-centric regulations like the 21st Century Cures Act appear on the horizon, they frequently bring up challenges and questions, along with the advancements. For example, while this legislation and other latest developments are making it easier for patient registries to gather and share patient data, many still struggle with how to best put that data to appropriate use.

To learn more about how latest regulations can be of use to stakeholders in research and drug development, Outsourcing-Pharma recently spoke with Angela Kennedy, director of strategic operations for medical special societies at IQVIA.

OSP: What is a medical specialty society?

AK: A medical specialty society, also referred to as a provider association, is a membership organization representing a specific group of healthcare professionals, for example, the American College of Surgeons. Medical specialty societies perform many important functions and services for their members, including education, advocacy, and health policy.

Medical specialty societies help Improve and facilitate quality, effective, and accessible patient care, leveraging member experience to research, develop, and implement the highest standards and practices. They also help set standards for excellence in their profession through clinical practice guidelines, quality measures, and quality improvement programs, most through the use of clinician-led clinical data registries.

OSP: How can the 21st Century Act help in collecting, sharing, and using patient data?

AK: The US 21st Cures Act (Cures Act) was signed into law by President Barack Obama on Dec. 13, 2016. The bipartisan legislation seeks to increase choice and access for patients and providers. Among many parts of its parts, The Cures Act seeks to ease regulatory burdens associated with the use of electronic health record (EHR) systems and health information technology (IT).

After the Cures Act was signed into law, it was passed to the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) for review. ONC and CMS produced two sets of rules based on the Cures Act’s interoperability, patient access, and information blocking provisions. These rules guide members of the industry, such as providers, payers, and technology vendors, as they design their health IT systems. Both the ONC and CMS rules fulfill the interoperability and information-blocking provisions of the Cures Act and are designed for increased patient access to their own information and guarantee a standard of interoperability across systems.

The Cures Act resulted in new regulations that fundamentally change how patient data is accessed and repurposed. It contains provisions focused on advancing interoperability and requiring developers not to engage in information blocking — or preventing or interfering with the access, exchange, or use of electronic health information (EHI). ONC defines EHI in their final rule as “the electronic protected health information (ePHI) in a designated record set (as defined in the Health Insurance Portability and Accountability Act (HIPAA) regulations) regardless of whether the records are used or maintained by or for a covered entit​y.”

For the purposes of information blocking, EHI is limited to the data elements represented in the US Core Data for Interoperability (USCDI). In a major step forward, the USCDI aims to Improve interoperability of various medical data systems and enable data exchange between stakeholders such as physicians, insurers, labs, clinical data registries, and patients themselves. The final rule also has an array of requirements for standards-based application programming interfaces (APIs), with the goal to support a patient's access and control of their electronic health information.

ONC published its Information Blocking Final Rule in May 2020. The rule defines information blocking as any practice that interferes with the access, exchange, or use of EHI. The Information Blocking Rule strengthens the rights that patients have in terms of obtaining their electronic health data in the modern health IT environment. It also holds EHR vendors accountable for ensuring that health information is accessible.

The rule went into full effect on April 5, 2021, requiring providers, vendors, and any “actor” in the healthcare sector that takes part in health information exchanges to comply. At the root of the Information Blocking Rule is the desire to make electronic health data more accessible for patients or other entities as permitted by HIPAA. The Final Rule calls for the industry to support standards adoption using secure Application Programming Interface (API) functionality, the leading standard for the exchange of health information is Fast Healthcare Interoperability Resources (FHIR), and the Cures Act proposes the use of FHIR as the standard format.

Although the rule went into effect in April, healthcare organizations are not required to migrate to Fast Healthcare Interoperability Resources (FHIR) v4 APIs until December 31, 2022. As the FHIR v4 API deadline approaches, health IT vendors and providers will have to make decisions about how to operate from a clinical perspective while staying in line with the Information Blocking Rule.

CMS finalized the Interoperability and Patient Access Final Rule in March 2020, shepherding in the next phase for the Cures Act. CMS calls the new rules – which hold public and private entities accountable for enabling easy electronic access to health information – the most extensive healthcare data-sharing policies yet implemented by the federal government.

The rule requires CMS-regulated payers to implement patient access application program interfaces and provider directories, as well as increase data sharing with other payers. Together, these rules attempt to make it easier for patients to have access to and control over their health data. These final rules represent significant changes in how health care providers, health IT developers, and health plans use health IT.

OSP: Are there any ways in which the 21st Century Cares Act and other legislation/agencies might fall short in supporting and guiding?

AK: Even though the Cures Act interoperability and information-blocking requirements and subsequent regulations are designed to move the healthcare industry towards greater data access, the long phase-in of these provisions comes with challenges. The requirement is to move towards a more transparent system, but a significant amount of specific guidance compliance and enforcement details are not yet established.

More than a year after the public release of the Final Rule, confusion about information blocking remains widespread. CMS has not yet provided clarity about the potential penalties that could be imposed on providers for noncompliance, and the Office of Inspector General (OIG) has not finalized its proposed penalties for certified EHR vendors and health information exchanges. Finalization of some of those enforcement aspects and a lot more clarity is absolutely essential.

OSP: Why is capturing a more complete picture of a patient’s health history help innovation in drug development? Also, how can it help Improve efficiency in various aspects of drug development?

AK: In November 2021, Congress introduced Cures Act 2.0. In Section 309 of the Cures 2.0 Act, which seeks to increase the use of real-world evidence and support the use of data from clinical care data repositories and patient registries to fulfill post-approval study requirements for products regulated by the Food and Drug Administration. This legislation is designed to modernize the health care delivery system and better utilize real-world data and real-world evidence across federal agencies. 

Cures 2.0 also discusses the acceptance of decentralized trials. Clinical trials are necessary to bring safe and effective drugs and devices to the market. However, many drugs and devices are developed on small populations in laboratory-controlled settings that may not be reflective of real-life experience with a disease. Decentralized clinical trials, on the other hand, are conducted in a study participant’s home using digital tools. These can include more sensitive, objective measures with greater density of information, and can include many more study participants.

Although fully decentralized trials are not appropriate for all research, in many instances, decentralized trials can deeply enrich a study and the FDA should support the use of such trials.

Digital tools should not be validated by the FDA alone, but in collaboration with an appropriate medical specialty society, clinical expert, or physician informaticist to reinforce physician trust in the tool. Use and validation of digital health tools are two of the most critical areas for physicians to successfully realize the potential of these technologies.

OSP: Then, how can capturing more complete patient health stories Improve patient engagement and care?

AK: The Cures 2.0 Act builds upon provisions of the 21st Century Cures Act that underscore how clinician-led clinical data registries are uniquely positioned to drive quality improvement initiatives. Cures 2.0 incorporates the 21st Century Cures Act’s definition of “clinician-led clinical data registry” as a clinical data repository that is established or operated by a clinician-led or controlled, medical specialty society or other similar organization; designed to collect detailed, standardized data on an ongoing basis for medical procedures, services, or therapies for particular diseases, conditions, or exposures; provides feedback to participating data sources; and meets certain quality standards.

Section 411 in the Cures 2.0 Act, which would ensure that clinician-led clinical data registries have meaningful access to real-world data (RWD) to better track patient outcomes over time, expand their ability to assess the safety and effectiveness of medical treatments, and provide them with the information necessary to assess the cost-effectiveness of therapies.  This legislation would allow clinician-led clinical data registries to link their outcomes data with claims data in a way that would help ascertain the value of new medical technologies and therapies and assist in the development of effective alternative payment models (“APMs”).

Thu, 04 Aug 2022 04:32:00 -0500 en-GB text/html https://www.outsourcing-pharma.com/Article/2022/08/04/medical-specialty-societies-can-benefit-from-regulatory-progress
Killexams : Virginia Tech Carilion’s class of 2026 sets school records No result found, try new keyword!Virginia Tech Carilion School of Medicine welcomed its newest class to the Star City this week. “This is one of my favorite weeks at the medical school because we get to welcome our next class of ... Sat, 30 Jul 2022 08:27:00 -0500 en-us text/html https://www.msn.com/en-us/money/careersandeducation/virginia-tech-carilion-e2-80-99s-class-of-2026-sets-school-records/ar-AA106z0m Killexams : From low pay to workplace culture, obstacles litter the path to diversity in EMS

A single mother, Tashina Hosey quit her job at a Pittsburgh post office when she was assigned to work a seventh consecutive day just as her second daughter was about to be born. Desperate to find her next paycheck, she stumbled upon a free 10-week emergency medical technician course.

Called Freedom House 2.0, the program trains people like Hosey – unemployed, single parents, low income – following in the footsteps of the original Freedom House, a pioneering Pittsburgh ambulance service staffed by predominantly disadvantaged Black residents that was at the vanguard of efforts to modernize the delivery of pre-hospital care in America in the 1960s and 1970s.

Emergency medical services have since become predominantly white, as well as mostly male, in Pittsburgh and nationally. Programs like Freedom House 2.0 have sprouted across the nation in an effort to diversify EMS. As of 2000, less than 5% of certified EMS professionals were African Americans, and that proportion remained until 2017. As of 2019, it had increased slightly: non-Hispanic Black people accounted for 8% of EMTs and 5% of paramedics.


When the race of EMS crews doesn’t match the population they serve, studies show inequities in care proliferate – strokes are overlooked in Black women, and Black children are less likely to receive pain medications for long bone fractures. There are even differences in hospital transport destinations for Black and Hispanic patients in comparison with their white counterparts.

“A lot of those health inequities: stroke recognition delays, trauma care delays, and pain control differences, start to go away when you have a workforce that looks similar to your patient population,” said Ben Weston, medical director of the Milwaukee County Office of Emergency Management.


Yet the diversity efforts face big challenges. EMS is notorious for low pay, long hours, limited career-advancement potential, and high turnover; many services are staffed by volunteers looking for experience before going into firefighting, police work, or medicine. Gallows humor and bullying disguised as banter are part of the culture in many EMS workplaces, and in a 2021 survey, 61% of female EMS workers said sexual misconduct was a major issue in the industry.

During her 10 weeks in the Freedom House 2.0 program, Hosey woke up at 6 a.m. in her apartment on a street with nothing but a Rite Aid and “heavy, heavy, heavy drug activity.” She’d pack diaper bags, bottles, and leftover dinner for lunch before waking her children up from the bed she shared with them.

“They call it a two-bedroom but I’m gonna say it was one and a half because the other one was not possibly big enough to be a bedroom,” she said.

Battling heavy traffic in her white 2014 Chevy Malibu, she’d drop her kids off at daycare before driving to the Hill District to learn about injuries, medications, and triage skills from 8 a.m. to 4:30 p.m. five days a week. After retracing her morning commute, she’d finish errands and sometimes only begin studying at 11 p.m. Still, she loved ride-alongs and began to think being an EMT “is something I can do.”

Upon graduation, however, Hosey did not take the EMT licensing exam, even with the program covering all fees and offering a $250 stipend. In fact, of the 30 graduates from the first four cohorts of Freedom House 2.0, only one is an EMT. Of the 22 who are employed, 10 are patient care technicians, five are medical assistants, three entered other allied health fields, and three became community health workers, including Hosey.

“They were starting out at maybe $14 [hourly pay],” Hosey said. “With me being a single mom with two children and a car and rent and all types of bills, it just didn’t seem like something that would be beneficial to me. They do 12-hour days … it would have never worked.”

Instead, she helps other single mothers move out of mice-infested homes and navigate the intricacies of obtaining housing subsidies. The regular hours, remote-work option when her kids are sick, and increase in pay allowed her to purchase a 2,474-square-foot, three-bedroom home with a basement and attic – luxuries she never imagined having before Freedom House.

Before Freedom House, police officers and morticians used to transport patients, but the death of the Pennsylvania governor from a heart attack en-route to the hospital in 1966 cast a spotlight on avoidable deaths. In Pittsburgh, Freedom House saw an opportunity to Improve care for its neighborhood while providing training and jobs for its poor, unemployed Black residents.

After completing a 32-week, 300-hour course, 25 paramedics previously deemed “unemployable,” most of them Black men, were assigned to two ambulances. They were pioneers of CPR, intubation, and IV administration in the field and helped pave the way for national standards for pre-hospital emergency care.

But within a few years, the city’s EMS crews became almost entirely white.

“EMS started in Pittsburgh on the backs of African American men and women from the Hill District,” said Sylvia Owusu-Ansah, the diversity and inclusion director of the National Association of EMS Physicians. “A new regime came in the early ‘70s that basically, through the acts of racism, eliminated probably the most elite, astute paramedics that were there at the time.”

Members of the Freedom House ambulance service outside Presbyterian University Hospital in Pittsburgh on their first day, June 16, 1968. (Gift of Virginia “Ginny” Caligiuri) Heinz History Center

The city terminated funding of the Freedom House service and built a new paramedic force from scratch. Driven by police officers eager to maintain control of ambulances, the Freedom House crews were split up, despite the city originally agreeing not to do so. Those with criminal backgrounds were fired or reassigned non-medical work, and tests on material they had not been taught were used to dismiss others. Their replacements were all white, and white employees with less experience began to take on leadership roles. By the late ‘90s, Pittsburgh’s paramedic program was 98% white.

Owusu-Ansah said the picture nationally is similar. EMS is clearly “very much an old boys club,” especially in EMS-fire services, she said. “I’m pretty much on the national committee of every EMS organization that exists out there, and over 90% of the time, I’m one of the few women, I’m the only person of color, and I’m the youngest person.”

Because EMS in most places is a part of the fire or police agency, it has a similar culture and draws recruits from the same pool of applicants. “There’s a lot of fraternity involved in the way of ‘my uncle did this’ or ‘my grandfather did this,’” Owusu-Ansah said.

Much like Hosey, Douglas Randell – now division chief of EMS in Plainfield, Ind. – was married with a young kid trying to “make ends meet” when he joined an EMT program through a scholarship for disadvantaged students.

“When you have the exposure of something generation after generation, it almost becomes an expectation that you follow the path,” he said. “For Blacks, especially in urban areas, we didn’t have that exposure.”

There is also a widespread perception that EMS is a part of law enforcement, and that deters Black applicants and others from communities that have long been victims of police violence. Meg Marino, director of New Orleans EMS, turned on her Zoom camera mid-interview to show how her uniform and badge look like a police uniform. Even small visual cues like wearing a pride pin or Black Lives Matter shirt can increase patient trust in EMS providers, she said.

While the paramilitary structure of EMS promotes organization and high performance, it comes with deep-seated cultural values such as not questioning authority and “toughing it out” that may also make the job less appealing.

“We can do all the recruitment in the world” but it is meaningless without changes to workplace culture,” said Jordan Rudman, a former EMT who is now an emergency medicine resident physician at Beth Israel Deaconess Medical Center in Boston. Referring to the hierarchical structure of EMS agencies and cases of sexual assault, he said, “It’s pretty hard for me with a straight face to say: come work here. It’s gonna be great.”

Hosey saw first-hand the difference a diverse workforce, and its absence, can make in the way patients are treated on ambulances in low-income neighborhoods in Pittsburgh. Once on a ride along, Hosey remembers the team visited a mental health facility that was “almost like a jail.”

“The guy we picked up was a Black guy and you can tell that he was suffering from some type of mental illness,” she said. “But they [the EMTs] chose not to listen to him. It was just like ‘shut up’ and ‘you don’t know what you’re talking about,’” she said.

“I wasn’t an EMT at the time so I couldn’t pinpoint what the issue was, but I was vocal about the way that they chose to talk to him,” she said, adding that the EMTs were receptive and apologetic.

Diversity can Improve communication with patients, whose accounts are often as useful to ambulance crews as clinical examinations. A bilingual EMT can be invaluable, especially since translators are not practical given the need for speedy treatment.

Even without perfect provider-patient racial concordance, a more diverse workforce can indirectly benefit patients. Randell says conversations he has with white providers in the station – about barber shops, soul food, and his favorite TV shows – makes them a bit more comfortable with treating patients who don’t look like them.

“When we go into a house and it is predominantly Black, I am the lead person because I know the environment,” Randell said. When someone asks for albuterol for their asthma in a poor neighborhood, he says he has “a level of compassion” and is willing to believe they couldn’t afford to get it filled while someone without his background might think the patient is just abusing the system.

Ambulances are seen in the garage of Pittsburgh EMS Medic 4 in Pittsburgh’s Fineview neighborhood. Nate Smallwood for STAT

Alongside Freedom House 2.0, EMS agencies across the country – in New Orleans, Chicago, Milwaukee, Durham, N.C. – are implementing efforts to diversify their workforces, but it can be slow-going and providers of color feel the extra work of promoting diversity frequently falls on them.

With a million-person county, 125,000 EMS encounters per year, and 14 fire-EMS stations, Milwaukee’s service is one of the largest in the United States. In early 2020, it found that race and ethnicity status of patients was recorded less than 50% of the time, which made it difficult to study inequities in care. “The data was garbage,” said Weston, the county emergency management medical director. After making it a required field in the patient care records system, he said, the agency was able to identify and show providers specific disparities in patient care.

“It’s not just data from other systems, but showing that right here in Milwaukee County, our system also has disparities in how we care for patients,” Weston said. Rather than making blanket statements about improving patient care, this focuses the conversation on how to Improve care for patients from disadvantaged racial and ethnic groups. The issue is framed at the population-level so providers don’t feel like their medical competence is being called into question, nor that they are being attacked for bias.

Joshua Parish, assistant chief of EMS in the Milwaukee Fire Department, said traditional recruitment efforts involve highlighting the job – the fires and trucks – at career fairs, which attracted people who were willing to commit immediately.

Now, when speaking with someone from an underrepresented group, he tries to “anchor our recruiting messaging in what my target audience already understands.” He asks people what they like in their current job, what differentiates a job from a career, and how money factors into their family’s current situation. He gives them time to think about the decision.

He’s hyper-intentional about visual images: a feminine silhouette or a child wearing a hijab on flyers, websites, and photos can serve as psychological cues for inclusivity “without having to say ‘we’re inclusive,’” he said. Younger firefighters – who have dreadlocks and cornrows and get their hair done – are serving as a recruiting tool for the next generation to enter into this space, he says.

EMS certification is equivalent to an associate’s degree, and Parish said learning so much content quickly can be a barrier to entering the profession. For non-university-educated students unfamiliar with anatomy, or without any exposure to Latin, making sense of medical prefixes is not easy. Parish worked on making the EMT curriculum more accessible to under-resourced students by finding ways to teach basic numeracy and health literacy.

“This is so much harder than I thought it would be,” he said. “I was sitting in some high school classrooms and I realized that that’s where the deficit was.” The training program started teaching students structured note-taking and implemented academic probation for those with less than a B average, which led to students seeking additional help; though labor intensive for the leaders, it was beneficial to push students.

Now, the firefighters he is recruiting and promoting are the most diverse the department has ever seen; over 50% of new hires in the last five years have been women and people of color, but it will take time for that diversity to be reflected in leadership.

“[People] who just got promoted today, that’s because I hired them seven years ago,” Parish said. “They’re going to be my cultural trendsetters. So it’s my job, when they want to do something out of the norm and they get crap from our old guys to go, ‘No, that’s cool. Let them roll.’”

Workers are evaluated using objective metrics like the speed and accuracy of taking patient vital signs, Parish said, as opposed to an officer “telling you that you did a bad job because they think you did.” He said he assigns the “old guys” to work alongside colleagues from different backgrounds — say, a younger woman of color. After a while, he added, the older workers will accept that “people who look like her and sound like her can be EMTs.”

In New Orleans, EMS Director Marino said her agency has blinded hiring decisions and promotion reviews in an attempt to overcome unconscious bias or overt instances of candidates being excluded because of an “ethnic name” on a resume.

She said she’s not deterred by pushback from some veteran employees. The old guys’ pejorative whispers about the “diversity agenda,” she predicted, will be phased out by a workforce that wants to include maternity pants for pregnant providers, ask questions about pronouns for trans patients, and make diversity a core part of their agenda.

Sun, 31 Jul 2022 20:35:00 -0500 en-US text/html https://www.statnews.com/2022/08/01/obstacles-litter-path-to-ems-diversity/
Killexams : She had it better than most Arizona prisoners, but says she still faced racism and labor abuse.

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Killexams : IVUS Useful in Many Peripheral Intervention Scenarios, Consensus Document

The use of IVUS imaging can guide operators in a variety of clinical scenarios involving lower-extremity arterial and venous peripheral interventions, according to a new international consensus document. In writing, its authors faced a slim evidence base.

Currently, there has only been one publication of a RCT on the use of IVUS in peripheral interventions. That single-center study, published earlier this year, showed that compared with angiography alone, the routine use of IVUS changed treatment decisions in nearly 80% of cases and was associated with less binary restenosis at 1 year.

Acknowledging the gap in high-quality data, the document seeks to add the collective experience and opinion of dozens of vascular experts. The goal, said lead author Eric Secemsky, MD (Beth Israel Deaconess Medical Center, Boston, MA), is to provide a road map for the responsible adoption of IVUS in clinical practice.

“We felt that it was critical to come together to highlight where the consensus lies in terms of the use of IVUS during peripheral intervention, and also to highlight areas where IVUS can be important in improving outcomes similar to what we see in the coronary intervention space,” he told TCTMD. The multidisciplinary document included participants from all specialties that participate in the field. Representatives from interventional cardiology, interventional radiology, vascular medicine, and vascular surgery took part, with separate groups voting on appropriateness of IVUS for arterial and venous scenarios.

Among the recommended clinical scenarios where IVUS was judged “appropriate” were all femoropopliteal, tibial, and iliofemoral intraprocedural and postintervention situations as well as all preintervention tibial and iliofemoral situations.  While some preintervention iliac and femoropopliteal uses also received a recommendation of “appropriate,” others were judged “may be appropriate.”

“On the arterial side, it was quite prevalent that there was consensus that IVUS should be a much more routinely used adjunct for peripheral artery intervention,” Secemsky noted. “One thing that stood out was that among operators who are doing complex lower-extremity critical limb ischemia revascularization, in particular involving vessels below the knee, IVUS was unanimously supported as an adjunct in all phases of the revascularization procedure to help Improve outcomes.”

Published online this week in JACC: Cardiovascular Interventions, the consensus document was accompanied by a separate paper that injects a note of caution about IVUS use, however, with post hoc data from the CAPSICUM trial suggesting a potential safety signal.

An editorial written by Debabrata Mukherjee, MD (Texas Tech University Health Sciences Center, El Paso, TX), and Christopher J. White, MD (University of Queensland and Ochsner Health System, New Orleans, LA), addresses both papers and urges operators to take heed of the unknowns: “For now, clinicians should consider IVUS or other adjunctive imaging as a useful part of their repertoire for selective peripheral arterial and venous interventional cases, but it is premature to recommend routine IVUS guidance for all peripheral interventional cases.”

Opinions ‘Fit’ With What Many Operators Believe

Led by Secemsky, the consensus document was created from the results of two anonymous surveys created by the 12-person writing committee: a 72-question survey on lower extremity arterial interventions and a 40-question survey on iliofemoral venous interventions.

For each clinical scenario, the interventional phases were broken down into preintervention, intraprocedure, and postintervention optimization. Each survey was sent to 15 vascular experts, such that a total of 30 experts from the United States, Australia, New Zealand, the Netherlands, and Germany were asked to grade the appropriateness of IVUS use in each scenario.

Regarding the tibial and iliofemoral questions, IVUS was deemed appropriate for all phases and clinical scenarios, including preintervention vessel sizing, minimizing contrast, determination of next therapeutic step, vessel sizing for device during the procedure, and stent optimization/postdilation.

For the femoropopliteal questions, only preintervention occlusion and plaque morphology received ratings of “may be appropriate for specific indication,” with all other femoropopliteal scenarios judged as “appropriate for specific indication.” The latter include: filling defects, preintervention vessel sizing, minimizing contrast, location of crossing track, determination of next therapeutic step, vessel sizing for device during the procedure, assessing residual stenosis/plaque after debulking postprocedure, stent optimization/postdilation, and detection of dissection.

To TCTMD, Secemsky said the results fit with what many vascular intervention specialists know, including how hard it is to size small vessels below the knee and how that can be improved with guidance from IVUS.

“Above the knee, when we looked at the iliac and femoropopliteal artery vessels, we still saw a really nice consensus that in the majority of situations, IVUS can be a useful adjunct during the procedure,” he added. “This is really highlighted by areas such as examining poststent implants, looking at dissections, and understanding residual disease.”

The document’s authors add that IVUS “is rarely associated with adverse events, and the safety associated with this device may have in part contributed to higher appropriate use ratings.” However, they acknowledge that more study is needed regarding whether the results are generalizable to other countries with restrictions on reimbursement for peripheral IVUS.

New Safety and Efficacy Questions Raised

In the same issue of the journal, investigators from Japan raise a potential safety issue in their analysis of the CAPSICUM trial. The data show a higher 1-year incidence of aneurysmal degeneration in symptomatic PAD patients who received a DES for femoropopliteal lesions when IVUS was used compared with when it was not used (19.8% vs 7.1%; P < 0.001).

The study authors, led by Takuya Tsujimura, MD (Kansai Rosai Hospital, Amagasaki, Japan), say that while “the exact mechanisms responsible for aneurysmal degeneration after femoropopliteal-DES implantation are unclear, vascular inflammation caused by sustained paclitaxel release, polymer, or the constant outward self-expanding force of the stent” can cause infiltration of CD3+ and CD56+ T cells. Another possibility, they say, is that IVUS use leads to selection of larger devices, which may increase the risk of vascular injury and aneurysmal degeneration.

In their editorial addressing both the consensus paper and the CAPSICUM results, Mukherjee and White say the frequency of aneurysmal degeneration in the IVUS group is “concerning.” They also point out that there was no difference in restenosis rates at 1 year in CAPSICUM in the IVUS versus no IVUS groups, which they say “raises concerns about the true effectiveness of IVUS” in peripheral interventions.

More evidence is anticipated soon from ongoing peripheral intervention RCTs studying IVUS, including IGuideU, iVEST, and DEVELOP. But in the meantime, Secemsky said many operators believe that there is sufficient enough data to recommend IVUS in agreed-upon situations and “move forward with how we're using this in our practices now, and not delay things for a trial that may not really change clinical practice.”

As for the issues raised by CAPSICUM, Secemsky pointed out that IVUS was used more often in patients with complex disease and that the study itself was underpowered. Further, he said the clinical impact of aneurysmal degeneration on a patient with symptomatic PAD is unclear, as is the explanation of how IVUS was the mediator between the intervention and the outcome.

Fri, 05 Aug 2022 09:00:00 -0500 en text/html https://www.tctmd.com/news/ivus-useful-many-peripheral-intervention-scenarios-consensus-document
Killexams : Vocational options grow at local high schools Over the past few years, New Braunfels ISD and Comal ISD have seen growth in high school student participation in career and technical education, or CTE, courses and certifications.

Unlike traditional high school courses, these programs provide a more technical knowledge base for specific professional fields and practical training and certification that helps students hone in on specializations earlier in their careers, according to the Texas Education Agency.

Rachel Behnke, director of CTE programs at NBISD, said Texas as a whole has been pushing for districts to develop these programs in latest years.

“The Texas Education Agency developed these programs of study. In school districts, we made them applicable to our local courses in what we offer,” Behnke said. “The intent there is to kind of have multiple entry and exit points. So for example, if a student went through a program at high school and decided they want to go directly to work, they could go into that position. Or if a student wanted to keep furthering their education, they already have a leg up in a career route.”

A variety of state and federal funding is available to school districts for these programs through the continued reauthorization of the Carl Perkins Career and Technical Education Act of 2006, most recently reauthorized by Congress in 2018, according to the U.S. Department of Education.

State and federal funding is then allocated by the TEA based on local needs assessments submitted by school districts that gather data on local economic considerations, jobs available and student needs.

Advance CTE, a national nonprofit organization that represents state directors of CTE education and tracks data, found that in a 2022 survey of more than 300 employers, 77% hired an employee due to their CTE experience, and 84% reported it was “easy” to find qualified candidates based on their CTE experience.

In the most latest school year, students in NBISD earned more than 500 certifications, and in CISD students earned over 1,500.

“We’re trying to increase the number of industry certifications that are available to students. Those are really prevalent in health science,” Behnke said.

Renee Martinez, director of career readiness in CISD, said the programs have grown partly because they are not monolithic, but instead offer several degrees of involvement—from clear sequences of courses throughout high school to students electing to take a course or two out of interest.

“CTE covers a lot of areas. If you have a kid that’s not in band, choir or athletics, their only other elective options fall in CTE, and even then you might have a kid that’s involved in one of these programs randomly taking a CTE class [such as] accounting or principles of health science,” Martinez said.

CISD offers more than 140 CTE courses throughout the district, and within those there are 35 programs of study that students can pursue through high school.

In NBISD there are more than 80 courses and 20 programs of study.

Career pathways

The specialization of CTE programs provides for a variety of paths into the workforce, and many students find themselves employed in their field of choice directly out of high school. Others use their experience to guide them down a path they might not have fully figured out while in high school, but the programs give them a leg up in finding the right career, according to the program directors at NBISD and CISD.

“Some kids come into my classroom having no idea what they want to do,” said Jennifer Thompson, a CTE teacher at New Braunfels High School who teaches courses in criminal justice, law enforcement, public safety, forensic science and other related courses. “They realized I don’t just focus on law enforcement. There’s other things in the criminal justice field that they could do. So it kind of gives them a brighter perspective of what they could actually do with their degree if they go into criminal justice.”

Thompson added that through her sequences of classes, former students have gone on to all aspects of law enforcement, such as working as a 911 dispatcher while studying criminal justice at Texas State University as well as several who became military police.

Jake Waldrip, a 2014 graduate of New Braunfels High School, said he always knew he would pursue a career in agriculture, and through the Future Farmers of America programs he had shown cattle since he was a child. He graduated from Texas State with a degree in animal science and now works for both his family’s business—Waldrip Bros. Cattle Co.—and in livestock trailer sales at D&D Texas Outfitters.

While Waldrip grew up in the trade, he said many students took some of the agriculture classes with him without any background.

“I had high school friends that didn’t grow up around it necessarily, and they showed some other species, but they would come and help us with the show cattle throughout the whole process ... as much as in depth as they wanted to get into, we were always willing to help and always had open arms,” Waldrip said. “So long as somebody is willing to show up and get their hands dirty and work hard, there’s a ton of people that are willing to teach and get kids involved in all aspects of the game.”

Mike Newkirk, an automotive tech teacher at Canyon High School, said some of his students go directly into the industry while others pursue postsecondary work in the field.

His students typically go through four years of automotive tech, from basic principles of the mechanics of cars to more advanced coursework. His classroom also serves as an auto shop for teachers and staff to bring their own parts and have the students work on their vehicles.

“I put them to work straight after school if they don’t want to go to postsecondary or college or you know if they want to do something else in life,” Newkirk said. “If they don’t want to go to college, I have industry leaders here [at] local dealerships from San Antonio to South Austin that will hire my guys as they come out of my program because we are accredited.”

One of those latest graduates is James Robinson, who received a scholarship to UTI but chose instead to go right to work at Griffith Ford.

“Mr. Newkirk gave me the opportunity to get every certification I could at my age. I came out of the Canyon High School automotive program with over 20 certifications,” Robinson said.

“I wanted to just make money immediately; I didn’t want to have to owe it. So I decided that rather than having to wait to start my career and start at the bottom, I can start at the bottom now rather than in four years,” he said.

Careers in college

CTE pathways also provide a door into fields that allow students to work within the field they are pursuing a higher degree in to gain experience.

Sanjay Patel graduated from NBHS in 2016, and while in school knew he wanted to be in the medical field and took pre-dental coursework.

“I was aspiring to be a dentist, [but] I realized that dentistry is not where I want to be. I still knew I wanted to be somewhere in the health care field, and that’s when I started exploring what the different options I had in health care. I started looking toward administration,” Patel said.

After earning a bachelor’s degree in public health from the University of Texas at San Antonio and a master’s in business, he is now interning at a hospital in Carrollton.

The CTE course he took on medical terminology was also helpful, he said.

“[It helped] me learn more about the terminology that medical practices often use. I’d say the practicum course helped me out a lot. Close to my junior year and at the end of my junior year, I received my registered dental assistant certification. So during my senior year in high school, I was also working as a dental assistant in the office while doing school,” he said.

For students looking to enter the teaching profession, CTE programs such as Ready, Set Teach place high school students in a classroom a few hours a week to learn from current teachers and interact with students.

“I had kind of always known that I wanted to work with kids, but I wasn’t full-on sure if it was teaching I wanted to do, so I joined it my junior year, and I got to be in a classroom four days a week for two hours,” said Valerie Grona, a 2017 graduate of Smithson Valley High School and now a kindergarten teacher at Johnson Ranch Elementary School.

Grona said the experience showed her what being a teacher is all about and affirmed her interest in pursuing teaching as a career.

While participating in the Ready, Set Teach program, Grona was able to work at the elementary school she went to and now teaches in.

“That kind of came full circle for me,” she said “But really, it just kind of showed me what teachers do every single day and gave me a taste of it. It’s probably one of my most memorable things of high school was being ready to teach because it was the thing I looked forward to every day.”

Sun, 07 Aug 2022 02:00:00 -0500 en text/html https://communityimpact.com/austin/new-braunfels/education/2022/08/07/vocational-options-grow-at-local-high-schools/
Killexams : A 48-Hour Ultrasound: New Wearable Tech Says Yes

Getting an ultrasound could soon become as easy as putting on a Band-Aid®, thanks to latest innovations by a team at the Massachusetts Institute of Technology (MIT).


Researchers have developed a new bioadhesive ultrasound device, or “ultrasound sticker,” that can provide 48 hours’ worth of ultrasound images of organs, muscles, and tissues. Eventually the sticker may be used at home, providing benefit for anyone, but being particularly valuable for care of pregnant women and athletes.

Conventional ultrasound technology is only available in hospitals and requires large, bulky equipment that provides images from one brief session. Now the same technology could be available as a small, wearable patch.

“It'll be a game changer in the field of medical imaging, especially ultrasound imaging, and the field of wearable devices,” says Xuanhe Zhao, PhD, part of the team at MIT and senior author of the latest Science paper.

A Look Inside

To image with traditional ultrasound, a gel is first applied to the skin to help transmit ultrasound waves. These waves are produced by a stick-like probe that is pressed into the desired area. The waves bounce off the body’s internal organs and are echoed back and picked up by the probe, creating an image.

Instead of gel and a stick, Zhao and his team invented a thin patch probe that pairs with a Jell-O-like “couplant” that facilitates the transfer of ultrasonic waves. The sticker is 2 centimeters square, and 2-3 millimeters thick — about the size and thickness of a nickel. The patch allows for imaging both close to the surface and up to 20 centimeters deep.

Stuck on You

The sticker was tested on 15 subjects in different body areas — including the arm, neck, and chest — which highlighted just some of its potential benefits. Participants were monitored over the course of 48 hours and engaged in everyday activities like walking, jogging, and bicycling.

When applied to the arm, for example, the ultrasound sticker was able to continuously image the biceps over a 48-hour period. It was sensitive enough for Zhao to monitor the microdamage in these muscles during and after a 1-hour weightlifting session. “In the future, potentially coupling it with some image processing algorithm, the ultrasound sticker will warn you when the exercise is sufficient,” says Zhao, which could prevent injuries or help guide rehab.

When placed on the neck, the sticker was able to monitor blood pressure (BP). BP measured with a cuff is difficult to make wearable, reliable, and long term, says Zhao. This device could continuously monitor the diameter of the carotid artery and warn patients and physicians of elevated blood pressure.

When placed on the chest, the sticker imaged the heart, offering potential new management options for those with heart problems. According to Zhao, the ultrasound can be applied directly on the chest and send images or video to clinicians.

Another feature — not tested in the study, says Zhao, but having potential — is the ability to monitor fetuses. Generally women have two to three ultrasounds during pregnancy. The ultrasound sticker could allow a mother and her physician to see her fetus as often as needed to ensure good health.

Next Steps

Currently, the sticker is connected to a data box via wires. Zhao and his team are working to create a second-generation sticker that is wireless and able to connect to the user’s smartphone. He estimates 2-5 years for the integrated system to be made wireless and receive Food and Drug Administration approval for medical use in the United States.

These are the first steps in what he hopes will be a major move forward in wearable tech, with the eventual goal of “better health for the whole world,” he says.

For more news, follow Medscape on  Facebook,   Twitter,   Instagram, and  YouTube.

Fri, 29 Jul 2022 08:29:00 -0500 en text/html https://www.medscape.com/viewarticle/978266
Killexams : Government Eyes Collecting More Data on Americans to Address Pay Discrimination

The federal government collected data on 100 million Americans from 70,000 employers to prioritize investigations for what a report calls “systemic” pay discrimination.

The government also is open to more expansive data collection in the future to address pay disparities.

“Is this going to be a smoking gun that definitively answers whether there is pay discrimination? That was never the intent, and I would be surprised if that was ever the result,” Charlotte A. Burrows, chairwoman of the Equal Employment Opportunity Commission, said Thursday during a press conference.

“We really can make a lot of use of it in deciding how to focus our resources,” said Burrows, a Democrat on the five-member commission since 2015 who was appointed chairwoman by President Joe Biden last year.

The EEOC completed its collection of 2017 and 2018 pay data under court order in 2020. That year, the agency contracted with the National Academies of Sciences, Engineering, and Medicine to study the pay data collected from private employers. 

The national academies recommend the most effective uses for the pay data in a report released ahead of the press conference. 

The report on the data collected for the EEOC also recommends pay data collection for the future. 

But EEOC member Andrea Lucas, a Republican, said she is concerned that expanded data collection could become intrusive for employees. [Lucas is not related to The Daily Signal reporter who filed this news story.]

In a public statement, Lucas said:

That potential mandatory data collection by the EEOC could include: each individual employee’s race and ethnicity; sex, gender identity (including non-binary and transgender identification), and sexual orientation; age, disability status, and veteran status; occupation and individual-level job titles; individual-level pay data (including wages, tips, and non-taxable earnings, including earnings that contribute to medical insurance and retirement accounts, as well as hours worked, weeks worked, fulltime/part-time status, and overtime classification status); and other pay-affecting factors including education, job experience, and employment tenure.

“Not only could this lead to a significant invasion of privacy for individual employees by their employers,” the Republican EEOC member added, “but in some instances it may be in violation of the laws that the EEOC is charged with enforcing—all for data that only may be more useful.”

Employers gathered the data from employees, then provided it to the Equal Employment Opportunity Commission. The commission itself didn’t collect the data, Burrows stressed. 

“I wouldn’t presume to speak for all private sector employees, but I want to be clear, we did not collect individualized, personal information—[such as] Joe Smith’s salary,” Burrow told The Daily Signal during the press conference, when asked about concerns with the handling of sensitive employee information. 

However, Burrows, an attorney, said that direct collection of data on American workers by the government could be helpful for employers in the future. 

“What we did is have the company provide it to us in a form that we thought would be a useful in a more aggregate way,” Burrows said, adding:

We did not collect individualized pay data with folks, although that is one of the things that the National Academy of Sciences has recognized would make such a collection—if we were to pursue it—less burdensome for the employers. I don’t have an opinion, and I’m not going to speak to where we might go in the future.

But Lucas argued that data collection still would require employers to collect sensitive information from employees. 

“In pursuit of solving a speculative wage gap, the National Academies recommends an unprecedented, mandatory government collection of a detailed, individual snapshot of almost every private sector employee’s professional and personal life,” Lucas, also an attorney, said in her public statement. “The tangible—and intangible—costs of such a revised and aggressively expanded data collection could be severe.” 

The National Academies of Sciences, Engineering, and Medicine concluded that collecting pay data is necessary to assess pay practices and differences in compensation by sex, race, and ethnicity. 

The report says that the pay data would enable the Equal Employment Opportunity Commission to pursue a more data-driven approach to investigations and identify systemic discrimination. 

The response rate from employers, meaning they submitted pay data to the government, was about 90%, officials said. 

The report concludes that the EEOC should expand its data collections and recommended several improvements to make it easier for employers to produce the information.

The report also notes that data collection was “not well suited to measure pay equity by EEOC or by employers.”

But nevertheless, the report calls for the agency to double down on data collection, Lucas said. 

“In other words, the collection was a failure,” the Republican commissioner said. “The report identified significant issues not only with the data collection process but also the reliability and accuracy of the data collected by the EEOC, issues rendering the data practically useless.”

The initial data collection cost companies more than half a billion dollars, she said, and a subsequent expansion would likely be more costly:

Before the EEOC gambles on a potentially billion-dollar burden on our nation’s private employers, and incentivizes the intrusive collection of sensitive information from employees, at a minimum the agency must undertake a formal notice and comment rulemaking and a public hearing to ensure robust public comment and input.

The report identifies unnamed Silicon Valley tech companies that have pay disparities based on race and gender. 

One unnamed tech firm had a pay gap of -51.3% for black men compared to white men. Another had a pay gap of -52.3% for Hispanic female employees compared to white males. 

One Silicon Valley company had a pay gap of -52.4% for Asian female technicians compared to white male technicians.

Have an opinion about this article? To sound off, please email letters@DailySignal.com and we’ll consider publishing your edited remarks in our regular “We Hear You” feature. Remember to include the url or headline of the article plus your name and town and/or state.

Fri, 29 Jul 2022 11:22:00 -0500 text/html https://www.dailysignal.com/2022/07/28/government-eyes-collecting-more-data-on-americans-to-address-pay-discrimination/
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