The MHC, a segment of 4mb, is recognized to be the genomic region in the human genome associated with the highest number of diseases. Its significance calls for its detailed and thorough characterization.Cognitive learning vs behavioral learning our recent attempts to characterize the 4mb of the MHC for heterozygote samples using long sequencing reads (3-10kb) and de novo (not reference-based) assembly is presented.Cognitive learning vs behavioral learning our eventual objective is the generation of MHC haplotypes, if possible for the whole MHC or any other sizeable sub-segment of interest. Most recently, within the MHC we have identified genomic elements, (like mirnas) playing important biological role by controlling the expression of many other genes in the cell.Cognitive learning vs behavioral learning through computational means we have identified a likely large number of mirnas encoded by the MHC. Could the presence of these elements explain the high density of snps, within the MHC, associated with many diseases?Cognitive learning vs behavioral learning alternative approaches combining NGS/genetics and complexity theory/physics provide new insights in the relationships of the different genomic sequences (exons/introns/intergenic sequences) and suggest that these sequences encode for elements forming a continuum of information throughout the MHC.Cognitive learning vs behavioral learning we are in the process of identifying both the information and the interactive relationships of the different subsegments of the MHC.

Clinical laboratories often receive orders for tests that are outside the mainstream of clinical testing.Cognitive learning vs behavioral learning some of these are new/emerging tests for which there simply isn’t a lot of clinical experience. Some are research biomarkers that are primarily of interest to bench scientists.Cognitive learning vs behavioral learning some are panels or algorithms designed largely in response to marketing considerations. What these all have in common is a lack of clinical evidence demonstrating clinical utility, i.E.Cognitive learning vs behavioral learning therapeutic benefit for patients as a consequence of the tests. How should clinical labs evaluate requests for such tests? Historically many laboratories have approached these requests from a financial and/or logistical perspective, approving the tests as long as they don’t overly burden the local laboratory (and provided that they are performed in a CLIA-licensed setting).Cognitive learning vs behavioral learning this presentation will present an additional framework for consideration, namely bioethics. What is the ethical impact of such testing on the individual patient as well as on society as a whole?Cognitive learning vs behavioral learning and how can potentially useful – but still unproven – laboratory tests be introduced into clinical settings in an ethically consistent manner?Cognitive learning vs behavioral learning

Historically, laboratories have operated as revenue centers within hospitals, with providers ordering tests and payers willing to reimburse. Today, labs are trending toward becoming cost centers, with ever-diminishing profit margins.Cognitive learning vs behavioral learning subsequently, some health system administrators are asking ‘why keep the laboratory in-house when we can outsource and cut costs?’ commoditizing laboratory medicine may sound viable at first glance, but on deeper review, is not a sustainable strategy.Cognitive learning vs behavioral learning competitive differentiation comes from demonstrating unique value the laboratory provides that goes well beyond the price of a test or a test result.Cognitive learning vs behavioral learning

Laboratory outreach is emerging as an opportunity for labs to provide value to hospitals and health systems by providing testing services for all patient types, regardless of location.Cognitive learning vs behavioral learning in addition to lowering unit costs, increasing outreach test volumes provide new revenue streams, positions the laboratory to utilize excess capacity and operate more efficiently.Cognitive learning vs behavioral learning

The landmark 1999 report from the institute of medicine "to err is human: building a safer health system" emphasized the importance of clinical practice guidelines to standardize decisions and treatments.Cognitive learning vs behavioral learning A 2015 follow up report "improving diagnosis in health care" again emphasized the importance of guidelines and stressed that cooperation among the health care team including laboratory professionals was essential to reduce diagnostic errors.Cognitive learning vs behavioral learning neither report recognized that diagnostic errors are made when non-harmonized laboratory test results are interpreted using fixed decision values in clinical practice guidelines.Cognitive learning vs behavioral learning harmonization of laboratory test results is one of the most pressing issues in laboratory medicine. The laboratory profession has developed an infrastructure for achieving harmonized (or standardized) results; yet several technical challenges have prevented a large fraction of our measurement procedures from achieving harmonized results.Cognitive learning vs behavioral learning recent initiatives are addressing the challenges to achieve harmonization. It is not widely appreciated that regulations can be an impediment to harmonization.Cognitive learning vs behavioral learning why do IVD manufacturers need to spend millions of dollars for regulatory approval to conform to international recommendations for harmonization that will improve the quality of patient care?Cognitive learning vs behavioral learning current activities to address these issues will be presented.

The direct oral anticoagulants (doacs) currently include one direct thrombin inhibitor (dabigatran) and three direct factor xa inhibitors (rivaroxaban, apixaban, edoxaban) which have various approvals for treatment and prevention of thromboembolic events, as opposed to more traditional anticoagulants, doacs do not require routine laboratory monitoring due to predictable pharmacodynamics, pharmacokinetics, and wide therapeutic windows.Cognitive learning vs behavioral learning doacs have variable effects on routine coagulation tests, such as PT/INR and aptt, depending on the specific drug, drug concentration in the specimen, patient and specific indication and dose, and assay, including the specific reagent used.Cognitive learning vs behavioral learning understanding DOAC effects on locally available routine coagulation tests may allow qualitative use of routine tests in emergent clinical situations but these tests do not reliably determine drug concentration.Cognitive learning vs behavioral learning although quantitative tests for the new drugs exist, they are not widely available, usually do not have turnaround times that would allow use in urgent clinical situations, and none are FDA approved.Cognitive learning vs behavioral learning aside from the issues with monitoring doacs, it is also important for physicians and laboratory professionals to know that doacs can interfere with specialized coagulation testing, such as thrombophilia testing, and that this testing should generally be avoided when doacs are present.Cognitive learning vs behavioral learning

The paris system for reporting urinary cytology (TPS) has been developed by international group of members of the american society of cytopathology and the international academy of cytology to emphasize the goal of detecting high grade urothelial carcinoma (HGUC) while minimizing the emphasis on low grade urothelial neoplasms (LGUN).Cognitive learning vs behavioral learning consequently, definition of the characteristics of the intermediate category of atypia aims at decreasing that category into a clinically meaningful one.Cognitive learning vs behavioral learning criteria for each category have been based on the best available clinical outcomes evidence. The uniqueness of the paris system for reporting urinary cytology lies in the fact that the system is based on understanding of the pathogenesis of urothelial carcinoma and recognizing two separate pathogenetic pathways; one leading to the development of a low grade urothelial neoplasm and the other leading to the formation of a high grade urothelial carcinoma, which is clinically significant and should be detected by cytology.Cognitive learning vs behavioral learning from its inception, the system became enthusiastically accepted by cytology practitioners who recognized the significance of this more simplistic, but clinically significant, approach to urine cytology.Cognitive learning vs behavioral learning it appears that urine cytology is no longer one of the most frustrating and difficult areas of cytology.

Diagnostic error is a major patient safety concern, causing substantial harm and unnecessary medial costs.Cognitive learning vs behavioral learning in every large organization, cases related to diagnostic error make up the largest fraction of filed claims and suits. Although the error rate is not being measured in any setting, it is estimated that 1 in 10 diagnoses is wrong, significantly delayed, or missed altogether.Cognitive learning vs behavioral learning the root causes of diagnostic error include many system-based factors (eg breakdowns in communication, coordinating care, having expertise available when needed, supervision of trainees, etc) as well as cognitive shortcomings.Cognitive learning vs behavioral learning the cognitive errors mostly derive from failures to synthesize the available evidence and inappropriate trust of intuition. Errors related to diagnostic testing are common, and include mistakes by the patient’s doctor (not knowing the best test to order or how to interpret it) as well as problems performing and interpreting the test results by the clinical lab or the radiology department staff.Cognitive learning vs behavioral learning many interventions to reduce diagnostic error have been proposed, although few have been rigorously evaluated in clinical practice.

This shouldn’t be shocking news to most healthcare professionals, but customer service IS a critical function of quality patient care.Cognitive learning vs behavioral learning however, when we as laboratorians think about customer service activities and how that translates into patient care, we tend to think it’s just about what occurs in the literal presence of patients.Cognitive learning vs behavioral learning so, here’s what may be news to some, the patient experience isn’t just about what we do when we’re in their physical presence, but also what we do as we interact with everyone who is in any way associated with their care.Cognitive learning vs behavioral learning therefore, we must make every effort to be engaged in skilled customer service activities with everyone, at all times. Now, the question may arise, what ARE the necessary skills and activities for providing great customer service (i.E., quality patient care) and how well do YOU execute them?Cognitive learning vs behavioral learning this session will provide an opportunity for self-assessment utilizing a customer service skills preferred profile and an interactive discussion regarding the do’s and don’ts for outstanding customer service.Cognitive learning vs behavioral learning