Objectives This study compares the effectiveness of an interactive e-learning module with a traditional text-based method for teaching peripheral blood smear analysis. Methods Pathology trainees at Accreditation Council for Graduate Medical Education residency programs were asked to participate. Participants completed a multiple-choice test on peripheral blood smear findings. Trainees were randomized into completing an e-learning module or a PDF reading exercise with the same educational content. Respondents rated their experience and completed a postintervention test composed of the same questions. Results In total, 28 participants completed the study; 21 improved their score in the posttest (mean, 21.6 correct answers) compared with the pretest (19.8; P < .001). This improvement was seen in both the PDF (n = 19) and interactive (n = 9) groups, with no difference in performance between the 2 groups. Trainees with less clinical hematopathology experience showed a trend of having the largest performance improvement. Most participants completed the exercise within 1 hour, rated the exercise as easy to navigate, were engaged, and reported learning new information about peripheral blood smear analysis. All participants indicated that they would likely complete a similar exercise in the future. Conclusions This study suggests that e-learning is an effective tool for hematopathology education and equivalent to traditional narrative-based methods. This module could easily be incorporated into a curriculum.

Morphology-based classification of cells in the bone marrow aspirate (BMA) is a key step in the diagnosis and management of hematologic malignancies. However, it is time-intensive and must be performed by expert hematopathologists and laboratory professionals. We curated a large, high-quality dataset of 41,595 hematopathologist consensus-annotated single-cell images extracted from BMA whole slide images (WSIs) containing 23 morphologic classes from the clinical archives of the University of California, San Francisco. We trained a convolutional neural network, DeepHeme, to classify images in this dataset, achieving a mean area under the curve (AUC) of 0.99. DeepHeme was then externally validated on WSIs from Memorial Sloan Kettering Cancer Center, with a similar AUC of 0.98, demonstrating robust generalization. When compared to individual hematopathologists from three different top academic medical centers, the algorithm outperformed all three. Finally, DeepHeme reliably identified cell states such as mitosis, paving the way for image-based quantification of mitotic index in a cell-specific manner, which may have important clinical applications.

Rare cases of human herpesvirus 8 (HHV8)-negative effusion-based large B-cell lymphoma (EB-LBCL) occur in body cavities without antecedent or concurrent solid mass formation. In contrast to HHV8 + primary effusion lymphoma (PEL), EB-LBCL has no known association with HIV or HHV8 infection. However, the small sample sizes of case reports and series worldwide, especially from non-Japanese regions, have precluded diagnostic uniformity. Therefore, we conducted a retrospective, multi-institutional study of 55 cases of EB-LBCL and performed a comprehensive review of an additional 147 cases from the literature to identify distinct clinicopathologic characteristics. In our study, EB-LBCL primarily affected elderly (median age 80 years), immunocompetent patients and manifested as lymphomatous effusion without a solid component. The lymphomatous effusions mostly occurred in the pleural cavity (40/55, 73%), followed by the pericardial cavity (17/55, 31%). EB-LBCL expressed CD20 (53/54, 98%) and PAX5 (23/23, 100%). Most cases (30/36, 83%) were of non-germinal center B-cell subtype per the Hans algorithm. HHV8 infection was absent (0/55, 0%), while Epstein-Barr virus was detected in 6% (3/47). Clinically, some patients were managed with drainage alone (15/34, 44%), while others received rituximab alone (4/34, 12%) or chemotherapy (15/34, 44%). Eventually, 56% (22/39) died with a median overall survival (OS) of 14.9 months. Our findings were similar to those from the literature; however, compared to the non-Japanese cases, the Japanese cases had a significantly higher incidence of pericardial involvement, a higher rate of chemotherapy administration, and longer median OS. Particularly, we have found that Japanese residence, presence of pericardial effusion, and absence of MYC rearrangement are all favorable prognostic factors. Our data suggest that EB-LBCL portends a worse prognosis than previously reported, although select patients may be managed conservatively. Overall, EB-LBCL has distinct clinicopathologic characteristics, necessitating the establishment of separate diagnostic criteria and consensus nomenclature.

Background The appearance of bite cells associated with methemoglobinemia can be caused by oxidizing drugs such as dapsone in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency or high drug serum levels. Bite cells are often pathognomonic for oxidant injury in patients with G6PD deficiency and suggest active hemolysis.Case Presentation We report a case of a woman with no prior history of G6PD deficiency who presented with anemia, methemoglobinemia and bite cells on peripheral blood smear after dapsone therapy for new onset idiopathic urticaria. Laboratory tests for G6PD, blood count and liver function were within normal limits prior to initiation of therapy. During the patient's hospital course, moderate methemoglobinemia and anemia were identified despite mildly increased serum G6PD level. These pathologies were reversed upon stopping dapsone therapy.Conclusion This case highlights the potential for therapeutic levels of dapsone to induce side effects in patients without G6PD deficiency and highlights the importance of routine blood monitoring for anemia and hemolysis during the course of drug therapy.

Primary cutaneous marginal zone lymphoproliferative disorder (PCMZL) and primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder (CD4 + TLPD) are indolent lymphoproliferative disorders. However, cases with overlapping features can be challenging. We identified 56 CD4 + TLPD and 38 PCMZL cases from our pathology archives. Clinical, morphologic, and immunophenotypic features were reviewed. Polymerase chain reaction for immunoglobulin (IG) and T-cell receptor gamma (TRG) gene rearrangements were analyzed. Next-generation sequencing studies were performed on 26 cases with adequate material, 19 with CD4 + TLPD, and 7 with PCMZL. CD4 + TLPD presented mostly (91%) as solitary lesions, located in the head and neck area (64%), while PCMZL occurred mostly in the upper extremity (47%) and trunk (34%). Lesions were sometimes multiple (40%) and recurrences (67%) were more common. Cases of PCMZL had an increase in reactive CD3 + T cells, with frequent programmed cell death protein 1 expression, whereas cases of CD4 + TLPD often contained abundant reactive B cells. Twenty-five cases were identified as having overlapping features: 6 cases of PCMZL were clonal for both IG and TRG; 11 cases of CD4 + TLPD were clonal for IG and TRG and 6 cases of CD4 + TLPD had light chain–restricted plasma cells. By next-generation sequencing, 23 variants were detected in 15 genes, with PCMZL more likely to show alterations, most commonly affecting TNFAIP3 and FAS, altered in 5 cases. Both entities have an indolent clinical course with response to conservative therapy and management, and warrant interpretation as a lymphoproliferative disorder rather than overt lymphoma.

The revised fourth edition of the World Health Organization (WHO) Classification of Tumours of Haematopoietic and Lymphoid Tissues (2017) reflects significant advances in understanding the biology, genetic basis and behaviour of haematopoietic neoplasms. This review focuses on some of the major changes in B-cell and T-cell non-Hodgkin lymphomas in the 2017 WHO and includes more recent updates. The 2017 WHO saw a shift towards conservatism in the classification of precursor lesions of small B-cell lymphomas such as monoclonal B-cell lymphocytosis, in situ follicular and in situ mantle cell neoplasms. With more widespread use of next generation sequencing (NGS), special entities within follicular lymphoma and mantle cell lymphoma were recognised with recurrent genetic aberrations and unique clinicopathological features. The diagnostic workup of lymphoplasmacytic lymphoma and hairy cell leukaemia has been refined with the discovery of MYD88 L265P and BRAF V600E mutations, respectively, in these entities. Recommendations in the immunohistochemical evaluation of diffuse large B-cell lymphoma include determining cell of origin and expression of MYC and BCL2, so called 'double-expressor' phenotype. EBV-positive large B-cell lymphoma of the elderly has been renamed to recognise its occurrence amongst a wider age group. EBV-positive mucocutaneous ulcer is a newly recognised entity with indolent clinical behaviour that occurs in the setting of immunosuppression. Two lymphomas with recurrent genetic aberrations are newly included provisional entities: Burkitt-like lymphoma with 11q aberration and large B-cell lymphoma with IRF4 rearrangement. Aggressive B-cell lymphomas with MYC, BCL2 and/or BCL6 rearrangements, so called 'double-hit/triple-hit' lymphomas are now a distinct entity. Much progress has been made in understanding intestinal T-cell lymphomas. Enteropathy-associated T-cell lymphoma, type II, is now known to not be associated with coeliac disease and is hence renamed monomorphic epitheliotropic T-cell lymphoma. An indolent clonal T-cell lymphoproliferative disorder of the GI tract is a newly included provisional entity. Angioimmunoblastic T-cell lymphoma and nodal T-cell lymphomas with T-follicular helper phenotype are included in a single broad category, emphasising their shared genetic and phenotypic features. Anaplastic large cell lymphoma, ALK- is upgraded to a definitive entity with subsets carrying recurrent rearrangements in DUSP22 or TP63. Breast implant-associated anaplastic large cell lymphoma is a new provisional entity with indolent behaviour. Finally, cutaneous T-cell proliferations include a new provisional entity, primary cutaneous acral CD8-positive T-cell lymphoma, and reclassification of primary small/medium CD4-positive T-cell lymphoma as lymphoproliferative disorder.

AIMS:Historically, there has been no consensus on the diagnostic classification of high-grade B-cell lymphoma (HGBCL) with morphological features of Burkitt lymphoma (BL) but no MYC gene rearrangement (MYC-negative). The 2016 WHO classification of tumours of haematopoietic and lymphoid tissues has shed some light on this field with the modification of the grey-zone lymphoma with features intermediate between BL and diffuse large B-cell lymphoma, and the creation of several new entities. The aim of this study was to investigate how the revised WHO classification affects our practice in diagnosing these lymphomas in children.METHODS:We retrospectively reviewed cases of mature HGBCL diagnosed at our hospital between 2015 and 2018.RESULTS:Among 14 mature HGBCL cases with BL morphological features, 11 showed MYC rearrangement consistent with BL and 3 were MYC-negative. Two MYC-negative cases showed regions of 11q gain and loss by microarray consistent with Burkitt-like lymphoma with 11q aberration (BLL-11q). The third MYC-negative case showed diffuse and strong MUM1 expression, translocation involving 6p25 by chromosome analysis and IRF4 rearrangement by fluorescence in situ hybridisation analysis consistent with large B-cell lymphoma with IRF4 rearrangement (LBL-IRF4). All patients were treated according to applicable chemotherapeutic protocols and achieved remission.CONCLUSIONS:BLL-11q and LBL-IRF4, two newly defined entities, should be considered in paediatric MYC-negative mature HGBCL cases. Accurate diagnosis needs careful histopathological examination and proper cytogenetic testing. Since they have unique cytogenetic features, specific treatments for them may emerge in the future. Therefore, accurate diagnosis based on the 2016 WHO classification is clinically significant.

The First Impressions program was designed to help communities learn about their strengths and shortcomings through the "fresh eyes" of first-time visitors. This Extension-led community assessment program has been implemented in over 500 communities since the 1990s, yet scant literature exists regarding the program's theoretical foundations or best practices for implementation or evaluation. To address increasing interest in the program among Extension professionals nationwide, we aim to encourage new scholarship regarding the program's use and impacts by providing an overview of how the program works; a discussion of theoretical foundations of the program from geography, urban planning, and psychology literature; and suggestions for improving program efficacy.

AIMS THE OBJECTIVE WAS TO INVESTIGATE IF GENDER DIFFERENCES EXIST IN THE ASSOCIATIONS BETWEEN PERIODONTITIS AND TYPE 2 DIABETES. DISPROPORTIONATE DISPARITIES BY GENDER WERE FOUND TO EXIST IN RATES OF BOTH PERIODONTITIS AND DIABETES WITH RESPECT TO DEMOGRAPHICS AND BEHAVIOURAL PREDICTORS THAT CANNOT BE EXPLAINED SOLELY BY THE WELL-ESTABLISHED ASSOCIATION BETWEEN THESE TWO DISEASES. MATERIALS AND METHODS MULTIPLE DATASETS WERE EXTRACTED FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY (NHANES) 2009-2014, WHICH USED A STRATIFIED MULTISTAGE PROBABILITY SAMPLING TO OBTAIN SAMPLES FROM ALL CIVILIAN NON-INSTITUTIONALISED PEOPLE IN THE USA. BIVARIATE RELATIONSHIPS BETWEEN EACH EXPLANATORY VARIABLE AND PERIODONTITIS LEVEL WERE ASSESSED WITH ODDS RATIOS (OR) AND THEIR 95% CONFIDENCE INTERVALS (CI). A SET OF WEIGHTED LOGISTIC REGRESSION MODELS WAS USED TO INVESTIGATE THE ASSOCIATION DIFFERENTIATIONS BETWEEN PERIODONTITIS AND DIABETES BY GENDER. C-STATISTICS MEASURED THE GOODNESS-OF-FIT OF WEIGHTED LOGISTIC REGRESSION MODELS. RESULTS THE PREVALENCE OF MODERATE-SEVERE PERIODONTITIS WAS 36.39% AND 22.71% AMONG PARTICIPANTS WITH TYPE 2 DIABETES AND WITHOUT DIABETES, RESPECTIVELY. TYPE 2 DIABETES WAS SIGNIFICANTLY ASSOCIATED WITH MODERATE-SEVERE PERIODONTITIS OR (OR = 1.47, 95% CI: 1.18-1.82) AMONG MALES EVEN AFTER ADJUSTING FOR DEMOGRAPHICS, SOCIOECONOMIC STATUS AND ORAL HEALTH BEHAVIOURS. THE AFOREMENTIONED RELATIONSHIP WAS NOT FOUND IN FEMALES. FURTHERMORE, DIFFERENT RELATIONSHIPS OF MODERATE-SEVERE PERIODONTITIS WITH BODY MASS INDEX AND THE USE OF MOUTHWASH WERE FOUND BETWEEN THE MALES AND FEMALES. CONCLUSIONS THE CURRENT FINDINGS SUGGEST THAT IMPORTANT IMPROVEMENTS IN THE DEVELOPMENT OF GENDER-SPECIFIC STRATEGIES IN PREVENTION, SUCH AS ORAL HOME-CARE, TO REDUCE THE HIGH PREVALENCE OF PERIODONTAL DISEASE AND MAINTAIN GOOD ORAL HEALTH ARE VITAL, AND ARE ESPECIALLY IMPORTANT FOR MALE DIABETIC PATIENTS AND THOSE WHO ARE AT HIGH RISK OF DEVELOPING DIABETES, SUCH AS THOSE WHO ARE OBESE.

Dental fear in the paediatric population can be a significant barrier to providing optimal dental care. Pharmacological management techniques utilized to manage anxiety, such as conscious sedation and general anaesthesia, are expensive and require specialized equipment with additional staff training. With recent advances in technology, video glasses are an economic and novel distraction technique that may aid in improving behaviour management and facilitate dental treatment. Clinical relevance: Nervous children may find difficulty in accessing care owing to their inability to co-operate and accept dental treatment. This paper describes an innovative technique that may aid the clinician in overcoming this barrier.

Determining the Relationship between Self-Efficacy and Exercise Frequency among University Students Laura Brown, Todd Sherman Abstract The purpose of this study was to determine what effect, if any, frequency of exercise had on self-efficacy and fitness levels over a fifteen-week period. Participants included 75 female students enrolled in aerobics classes at a rural university. The study consisted of pre- and post-testing of a self-efficacy instrument, cardiovascular fitness, flexibility, muscular strength, muscular endurance, and body fat. Between groups repeated measure analysis of variance indicated a nonsignificant difference between pre- and post-test exercise self-efficacy between classes that met two days per week and classes that met three days per week. Results also indicated a nonsignificant difference between pre- and post-test fitness tests for 1.5-mile run, push-ups, curl-up, and body fat. However, there was a statistically significant difference in pre- and post-test stretch between the two groups. Overall results indicated that there was no statistically significant difference in fitness levels and frequency of exercise between the two groups in four out of five tests. Although differences were not seen in fitness between two days and three days a week, the study does support that exercise alone can help with self-efficacy and overall well-being of college students. The results of this study may be beneficial to college campus efforts in supporting and maintaining a healthy campus and well-being of their students. Full Text: PDF DOI: 10.15640/ijhs.v5n1a3

The USDA Thrifty Food Plan (TFP) specifies types and amounts of foods for a minimal cost, nutritionally adequate diet and provides the basis for maximum Supplemental Nutrition Assistance Program benefits. The TFP meets several constraints, including: cost, energy, nutrient and MyPlate recommendations. The objective was to assess cost impact on the TFP of a sustainability constraint. Using existing sustainable dietary guidelines and organic certification and seasonality as proxies, we developed food lists reflecting the TFP. Food stores representing a range of retail for formats were selected: supercenters, full-service supermarkets, independent grocers, and discount grocery stores. Food price data were collected and recorded at three time points in five different retail food stores in one metropolitan low-income area of Central New York State (CNY). Food price differences were determined between standard TFP and sustainability adjusted TFP. Additional price comparisons were made with local, seasonal produce options available at a regional market. Organic options generated an average price premium of 47% and availability of 33%. Local, seasonal produce options had an average adjusted price discount of 7% based on average yearly availability. The premium/discount will be applied to the TFP. Effects these adjustments have on price and composition in relation to the TFP and reported consumption will be described. Initial adjustments of consumption resulted in 10% TFP monthly cost increase. These preliminary results suggest that the net effect of sustainable constraints is a premium TFP monthly cost, and organic option availability and variety may be limited in stores.

In this analysis, we look for patterns in the relationship between food access, local foods, and community health at the US county level. We take an ecological approach using 2012 Census of Agriculture and County Health Rankings & Roadmaps data collected by the University of Wisconsin Population Health Institute. We address a simple question: is access to local foods activity associated with public health? Results generally support the central premise, but the results are weak depending on the metrics of health and local foods activity chosen. In the end, we concluded that local foods are likely demand driven, and the mere presence of local foods activity is not sufficient to result in healthier community outcomes.

We used the Plan-Do-Study-Act quality improvement methodology to reduce the length of stay (LOS) for autologous stem cell transplant (ASCT) patients. Baseline data were collected from the electronic medical records of patients admitted for ASCT from January – April 2014 to serve as the control population. Changes in care were implemented during April 2014. The post implementation comparison intervals were phase I from May – October 2014 and phase II from November 2014 – April 2015 after re-education of staff. Changes in workflow included changing filgrastim administration post-stem cell infusion from day +6 to day +9. The utilization of TPN was changed from individual provider preferences to protocol based with a nutritional team member rounding with the inpatient hematology team. Criteria for starting TPN included patients with less than 50% required calories for >7 days, severe mucositis, or weight loss (>10%) from the time of hospital admission. TPN was not used within the first week of hospital admission unless clinically required. Time to neutrophil engraftment and LOS were monitored continuously during the study period. The pre-implementation median LOS was 17 days (n=16, range: 14-22 days) with a median neutrophil engraftment day of +12 (n=22, range: 10-13). Post-implementation with 3 days less of filgrastim, the median neutrophil engraftment day remained +12 (n=45, range: 10-14). Overall there was a decrease in the median LOS to 16 days (n=46, range: 14-29 days). The cost savings was approximately $1500 per patient due to the reduced filgrastim use and administration and approximately $8500 per patient for the decreased LOS. TPN use was 10% (n=20) at baseline. Post-implementation TPN use decreased to 8.33% (n=24) during phase I and 0% (n=23) during phase II. For the patients receiving TPN during phase I the start day went from +7.5 (pre-implementation) to day +11 and the average number of days on TPN decreased from 4.5 to 3 days. The cost savings was approximately $1000 per patient not requiring TPN. The implementation of protocol driven quality improvement parameters decreased our ASCT patients LOS by one day, decreased TPN use to 0% and decreased the need and cost associated with 3 days of filgrastim use. Re-education of providers at the beginning of phase II contributed to this continued improvement. These practice improvements have important clinical implications. Reduced LOS decreases infection risks and improves the quality of life (QOL) for patients and caregivers. Limiting TPN use also reduces the risks of infection and hepatic dysfunction. Decreased use of filgrastim decreases the risk of side effects including injection site reactions and bone pain, further improving patient QOL. Decreased LOS, TPN and filgrastim use, are all economically preferred and beneficial. An ongoing study is evaluating the same parameters in allogenic BMT patients.

Lung cancer screening (LCS) with low-dose radiation computed tomography (LDCT) reduces mortality and is recommended for high-risk current and former smokers. Several potential harms associated with LCS have been identified, including the potential for psychological burden. To summarize the current state of the scientific knowledge on psychological burden associated with LCS, we performed a systematic search of the contemporary quantitative and qualitative research literature. We included randomized controlled trials and cohort studies that evaluated the effect of LCS with LDCT on psychological burden and health-related quality of life assessed using validated and nonvalidated measures. PubMed, CINAHL, PsychINFO, and Scopus were searched for English language articles published between 2004 and January 2015. Data abstraction and quality assessment were conducted by 2 independent reviewers. Thirteen studies were included that met our inclusion criteria. Overall, results were variable with some studies reporting worse psychological burden for patients with indeterminate results at prescreening, after screening, and at short-term follow-up (<6 months after screen). These adverse effects diminished or resolved at long-term follow-up (> 6 months after screen). LCS might be associated with short-term adverse psychological burden, particularly after a false positive result. However, these adverse effects diminished over time. The amount of current evidence is small, with limitations in study design and use of outcome measures. More high-quality research is needed to determine the frequency, duration, and overall magnitude of LCS-related psychological burden in nonclinical trial settings.

Remote sensing, climate, and ground data were used within a geographic information system (GIS) to map desertification risk in the north-west of Jordan. The approach was based on modelling wind and water erosion and incorporating the results with a map representing the severity of drought. Water erosion was modelled by the universal soil loss equation, while wind erosion was modelled by a dust emission model. The extent of drought was mapped using the evapotranspiration water stress index (EWSI) which incorporated actual and potential evapotranspiration. Output maps were assessed within GIS in terms of spatial patterns and the degree of correlation with soil surficial properties. Results showed that both topography and soil explained 75% of the variation in water erosion, while soil explained 25% of the variation in wind erosion, which was mainly controlled by natural factors of topography and wind. Analysis of the EWSI map showed that drought risk was dominating most of the rainfed areas. The combined effects of soil erosion and drought were reflected on the desertification risk map. The adoption of these geospatial and remote sensing techniques is, therefore, recommended to map desertification risk in Jordan and in similar arid environments.