Immediate Versus Delayed Insertion of the Levonorgestrel Intrauterine Device in Postpartum Adolescents: A Randomized Pilot Study.

This pilot study assessed the feasibility of conducting a larger randomized controlled trial comparing the proportion of adolescents using a levonorgestrel intrauterine device (LNG IUD) at six months postpartum when it is inserted immediately after vaginal delivery (within 10 minutes after placental expulsion) compared to insertion four to six weeks postpartum. Pregnant adolescents (14 to 19 years) who desired a LNG IUD for postpartum contraception were randomized to insertion of the LNG IUD either within 10 minutes of delivery of the placenta or at 4-6 weeks postpartum. Study follow-up visits were conducted at 4-6 weeks postpartum, 10 weeks postpartum, and 6 months postpartum. From November 2013 to June 2015, eleven adolescents were randomized - six participants to the immediate postpartum LNG IUD insertion group, and five to the delayed insertion group. All six women in the immediate insertion group had successful immediate postpartum insertion; two of five women in the delayed insertion group had an IUD inserted. At six months postpartum, four of six women in the immediate insertion group had a LNG IUD in place; of the five women in the delayed group, three did not have a LNG IUD in place and two were pregnant. The study was discontinued after 19 months because of suboptimal enrollment. Though insertion of a LNG IUD immediately after delivery is an appropriate option for some adolescents, a larger prospective study comparing immediate to delayed LNG IUD insertion is unlikely to be feasible at our institution

Accessibility Online: All Students means all students.

Much of the technology around us has been designed for persons with different needs. We can now set an alarm just by asking a device to do so. We can enter stores without touching doors, and read captions for the news on television while listening to music on earbuds. Online curriculum needs to mirror this type of access to give all students the ability to engage with content. Can the visually impaired student in a biology classroom use a microscope? Where are videos with captions for hearing impaired students? Can a student with limited dexterity independently access interactive slides? Deliberate planning of online lessons and selective use of virtual resources can help foster your students’ independence and alleviate barriers. Come learn from the experts

Joint Annual Wellness Visit Scheduling

Problem/Impact Statement: The pharmacists in Scarborough & Westbrook Primary Care conduct Medicare Annual Wellness Visits (AWVs) with a physician. The pharmacist and physician see the patient individually. The practices achieved and sustained FY18 Joint AWV volume goals through a new process to reschedule physician-only AWVs to Joints AWVs with a pharmacist. This leads to reschedule rework and reduced time practice staff have for patient care

A 2022 Assessment of Food Security and Health Outcomes during the COVID-19 Pandemic

We conducted a Northern New England survey to understand the impacts of the COVID-19 pandemic on food security, food access, home food production, health behaviors, and health outcomes. The surveys were conducted in the spring of 2022 (April-May) with a total of 1,013 adults (598 in Maine and 415 in Vermont) responding to the survey. Key findings include:1. The prevalence of food insecurity remains similarly high to early points in the pandemic, likely driven by inflation and food prices, and long-term impacts from the pandemic. 2. The majority (62%) indicated the recent rise in food prices affected their food purchasing, this was significantly higher (90%) for food insecure respondents. 3. 1/3 of respondents utilized food assistance programs in the last 12 months. They reported difficulty traveling to food program offices to apply or recertify as a key challenge. 4. 2/3 of respondents engaged in some kind of home food production (HFP) and half of those did HFP activities for the first time or did existing HFP activities more in the last 12 months. 5. Nearly 1/3 reported weight gain during the COVID-19 pandemic. Food insecure respondents were significantly more likely to report weight gain. 6. Nearly 40% of food insecure respondents ate fewer fruits and vegetables and certain animal products in the last 12 months. These changes are significantly higher than for food secure respondents. 7. Half of the respondents faced a health care challenge in the last 12 months, with canceled appointments and trouble finding a timely appointment being the most commonly reported challenges. 8. More than 50% of respondents indicated anxiety and/or depression, with 17% of those with a diagnosis newly diagnosed in the last 12 months. 9. Compared to food secure respondents, food insecure respondents were significantly more likely to face a variety of health challenges in the last 12 months, including difficulty accessing healthcare, being diagnosed with anxiety and depression, stopping and skipping medications due to cost, and using habit-forming substances

Targeting Antigen to the Surface of EVs Improves the In Vivo Immunogenicity of Human and Non-human Adenoviral Vaccines in Mice

Adenoviral (Ad) vectors represent promising vaccine platforms for infectious disease. To overcome pre-existing immunity to commonly used human adenovirus serotype 5 (Ad5), vectors based on rare species or non-human Ads are being developed. However, these vectors often exhibit reduced potency compared with Ad5, necessitating the use of innovative approaches to augment the immunogenicity of the encoded antigen (Ag). To achieve this, we engineered model Ag, enhanced green fluorescent protein (EGFP), for targeting to the surface of host-derived extracellular vesicles (EVs), namely exosomes. Exosomes are nano-sized EVs that play important roles in cell-to-cell communication and in regulating immune responses. Directed targeting of Ag to the surface of EVs/exosomes is achieved by “exosome display,” through fusion of Ag to the C1C2 domain of lactadherin, a protein highly enriched in exosomes. Herein, we engineered chimpanzee adenovirus ChAdOx1 and Ad5-based vaccines encoding EGFP, or EGFP targeted to EVs (EGFP_C1C2), and compared vaccine immunogenicity in mice. We determined that exosome display substantially increases Ag-specific humoral immunity following intramuscular and intranasal vaccination, improving the immunological potency of both ChAdOx1 and Ad5. We propose that this Ag-engineering approach could increase the immunogenicity of diverse Ad vectors that exhibit desirable manufacturing characteristics, but currently lack the potency of Ad5

Home Food Production and Food Security Since the COVID-19 Pandemic

We conducted a Northern New England survey to understand the initial and continued impacts of the COVID-19 pandemic on food security, food access, and home food production (HFP) (i.e. gardening, fishing, harvesting shellfish, foraging, hunting, trapping, raising animals for meat, dairy, or eggs, and food preservation such as canning, drying or freezing). The surveys were conducted in the Spring and Summer of 2021 (March – June). The survey was conducted in Maine (n = 562) and Vermont (n = 426). The cohort of respondents was representative of racial and ethnic identities of Vermont and Maine state populations. The data presented in this research brief were weighted to be representative of income in both states. Here, we summarize our findings related to changes in food security, food sourcing, and HFP before and since the COVID-19 pandemic. When data are referred to as “significant” it indicates a statistical significance at p\u3c 0.05

Change in Food Security and Health Outcomes Since the COVID-19 Pandemic in Northern New England

We conducted a Northern New England survey in March-June of 2021 to understand the initial and continued impacts of the COVID-19 pandemic on food security, health behaviors, and health outcomes. A total of 988 adults (562 in Maine and 426 in Vermont) responded regarding food access and availability, health behaviors such as diet composition and exercise, and use of habit-forming substances (e.g. alcohol, tobacco, etc.) before and in the year following the onset of the COVID-19 pandemic. Key findings include: 1. 39.1% of Maine and 43.2% of Vermont respondents indicated weight gain since the start of the COVID-19 pandemic. 2. Individuals with food insecurity were significantly less likely to consume fruits and vegetables and engage in physical activity than those who report being food secure. 3. Nearly half of respondents indicated anxiety or depression during the COVID-19 pandemic. 4. Those with persistent food insecurity (i.e. food insecure before and during the COVID-19 pandemic) were 8.8 times more likely to experience higher levels of stress, 2.6 times more likely to experience anxiety and be diagnosed with diabetes type 2 and hypertension during the COVID-19 pandemic. 5. Individuals who identify as LGBTQ+ were more likely to be food insecure, 4 times more likely to report anxiety or depression, and also experienced higher levels of stress than individuals who did not identify as LGBTQ+ during the COVID-19 pandemic. 6. Individuals with food insecurity were up to 7 times more likely to skip or stop their medication for anxiety, depression, and/or hypertension, as compared to food secure respondents. 7. Individuals reporting the use of substances prior to the onset of the pandemic (e.g., tobacco, alcohol, and drugs) were more likely to have increased their use of additional habit-forming substances during the COVID-19 pandemic. Substance use was also associated with a higher prevalence of stress

Clinicians Reflect on COVID-19: Lessons Learned and Looking Beyond

As a result of the unprecedented COVID-19 pandemic, clinical faculty had to abruptly adapt their clinical teaching and case supervision practices to adjust to the myriad restrictions brought on by the pandemic. This brought specialized challenges for clinicians who uniquely serve as both legal practitioners and law teachers in the law school setting. With little support and guidance, clinicians tackled never before seen difficulties in the uncharted waters of running a clinical law practice during a pandemic. In this report, we review the responses of 220 clinicians to survey questions relating to how law clinics and clinicians were treated by their institutions as they navigated these changes. Were clinical courses treated differently than other courses? Were clinical faculty treated differently than other faculty? Were some clinical courses treated differently than others? Did clinical faculty and staff experience pressure by their institutions to teach in-person or hybrid courses? In addition to summarizing the findings to these questions, this report examines the disparate impact of the COVID-19 pandemic on clinicians and sheds light on some of the distinct challenges they faced. The report concludes with a list of recommended actions that law schools may take to equip themselves to provide appropriate support for clinical faculty during inevitable future emergencies, emphasizing the importance of autonomy and discretion for clinicians; specialized attention for diverse and vulnerable clinicians; and the very serious ethical and legal obligations of clinical law practices

Clinicians Reflect on COVID-19: Lessons Learned and Looking Beyond

As a result of the unprecedented COVID-19 pandemic, clinical faculty had to abruptly adapt their clinical teaching and case supervision practices to adjust to the myriad restrictions brought on by the pandemic. This brought specialized challenges for clinicians who uniquely serve as both legal practitioners and law teachers in the law school setting. With little support and guidance, clinicians tackled never before seen difficulties in the uncharted waters of running a clinical law practice during a pandemic. In this report, we review the responses of 220 clinicians to survey questions relating to how law clinics and clinicians were treated by their institutions as they navigated these changes. Were clinical courses treated differently than other courses? Were clinical faculty treated differently than other faculty? Were some clinical courses treated differently than others? Did clinical faculty and staff experience pressure by their institutions to teach in-person or hybrid courses? In addition to summarizing the findings to these questions, this report examines the disparate impact of the COVID-19 pandemic on clinicians and sheds light on some of the distinct challenges they faced. The report concludes with a list of recommended actions that law schools may take to equip themselves to provide appropriate support for clinical faculty during inevitable future emergencies, emphasizing the importance of autonomy and discretion for clinicians; specialized attention for diverse and vulnerable clinicians; and the very serious ethical and legal obligations of clinical law practices