Eileen S. Alexander

The COVID-19 pandemic caused a sudden shift to virtual platforms. Physical distance and limited experience with both synchronous and asynchronous teamwork at work and school hampered problem-solving and the development of critical thinking skills. Under these circumstances, the implementation of team-based and problem-based learning (TBL, PBL, respectively) required a reevaluation of how teams collaborate and engage in problem-solving remotely. The research team conducted a systematic review to identify health services studies, themes, and attributes of learning initiatives associated with the success of TBL and PBL conducted during the COVID-19 pandemic. This systematic review was conducted using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The review results identified three themes associated with TBL and PBL learning initiatives in health services: (1) TBL and PBL have transformed health services education with modified TBL (mTBL) and modified PBL (mPBL) as the new norms; (2) the amplification of age-appropriate principles for professional motivation in healthcare; and (3) active learning impacts practical abilities for professional success and future leadership roles. The pandemic underscored the importance of flexibility, resilience, and innovation in TBL and PBL approaches in health services education. Despite the superiority of mPBL and mTBL, the barriers to implementation and student acceptance of active learning include inadequate resource and space allocation, and student preferences for passive, traditional lecture. Further, online learning required increased facilitator training, administration time, and time to provide feedback.

THANK YOU FOR THE OPPORTUNITY TO REVIEW THE MANUSCRIPT, “PUBLIC HEALTH STUDENT INTERNSHIP: AN OPPORTUNITY TO EXPLORE SYSTEM, SELF, AND SOCIETY.” THIS ESSAY INCLUDES AN ASSESSMENT OF INTERNSHIP EXPERIENCES IN PUBLIC HEALTH AND SEEKS TO INCREASE COMMUN...

Esophageal strictures (ES) in children are not well characterized pathologically. We report unique histopathologic analyses of resected acquired ES and control esophagi (CE). Muscle layer thicknesses were measured in intact well-oriented areas; inflammatory cells were counted in the most inflamed high power field (hpf). Sections were stained with relevant antibodies. Results were expressed as median, lower and upper quartiles. Wilcoxon Rank Sums non-parametric test was used to compare groups; P ≤ 0.05 was considered significant. All ES (N = 10) showed focal replacement of lamina propria, muscularis mucosa and submucosa by actin+ fibers emanating from muscularis propria. Compared to CE (N = 8), ES displayed significantly thickened muscularis mucosa and propria, and increased mast cells (tryptase- and chymase-positive), and eosinophils in muscle layers (all P ≤ 0.01). Matrix proteins periostin and fibronectin were identified in the muscle layers of CE, and in the extracellular matrix in areas of disrupted architecture in ES. Compared to CE, acquired ES in children show significant structural alterations, including obliterative muscularization, inflammatory cell mural infiltrates, and extracellular matrix protein deposits. Therapies targeting connective tissue expansion, mast cells, eosinophils and inflammation may be beneficial to treat ES.