Summer's children: an outdoor educational curriculum to help children discover the beauty of nature

Master's Project (M.Ed.) University of Alaska Fairbanks, 2019Changes in current societies are affecting childhood experiences. In an era where children spend countless hours indoors and on electronic devices the questions must be asked, are children developing valuable connections to the natural world around them? How much quality time are they really spending in the out-of-doors in a natural environment that would induce a connection? Time for outdoor play has diminished as nature has become to be regarded as separate from everyday life. The importance of an outdoor educational curriculum is established that would allow children to have a closer connection to nature by allowing a healthy balance of the time children spend outdoors. This project explores the questions of what an outdoor educational curriculum would look like that is project-based and child-led. A curriculum that would help children develop a sense of place, a sense of identity, and one that would help children develop self-efficacy while building self-esteem. This paper presents the main dimensions that quality outdoor experiences help to establish in the growing child and highlights the role of professionals and families in creating quality outdoor learning experiences

Predictors of syphilis seroreactivity and prevalence of HIV among street recruited injection drug users in Los Angeles County, 1994-6

Objectives: To describe HIV prevalence and the association between syphilis incidence and sexual and drug injection risk behaviours in a cohort of street recruited injecting drug users (IDUs) in Los Angeles County, between 1994 and 1996. Methods: During the study period, 513 street recruited African-American and Latino IDUs were screened for syphilis and antibodies to HIV. Subjects were administered a risk behaviour survey at baseline and followed up at 6 month intervals for 18 months with repeated interviews and serological screening. Rate ratios were used to examine associations between syphilis incidence and demographic characteristics and risk behaviours. A proportional hazard model was used to identify predictors of syphilis incidence independent of demographic characteristics. Results: 74% of the sample were male, 70% African-American, 30% Latino; and the median age was 43 years. Overall baseline serological prevalence of HIV was 2.5% and of syphilis 5.7%. None of the participants were co-infected for HIV and syphilis at baseline or at any of the 6 month follow ups. Among 390 eligible IDUs retained for analysis of incidence data, the overall syphilis incidence was 26.0 per 1000 person years. Higher syphilis incidence was found for women compared with men (RR=2.70; 95% CI 1.60, 4.55), and for those 44 years of age or younger compared with those 45 years of age and older (RR=2.26; 95% CI 1.25, 4.08). African-Americans were more likely to be syphilis incident cases when compared with Latinos, although the difference did not reach statistical significance (RR=1.27; 95% CI 0.72, 2.23). In bivariate analysis, risk behaviours significantly associated with higher syphilis incidence included injection of cocaine, “speedball” and heroin, “crack” smoking, recency of first injection event, backloading of syringes, injecting with others, exchanging drugs or money for sex, multiple sex partners, and non-heterosexual sexual preference. Variables that significantly predicted syphilis infection at follow up in the multivariate analysis included multiple sex partners (RR=7.8; 95% CI 2.4, 25.0), exchanging money for sex (RR=3.0; 95% CI 0.9, 9.6), and recent initiation to injection drug use (RR=4.6; 95% CI 1.1, 18.8). Conclusion: Syphilis transmission among IDUs in Los Angeles County remains a serious public health concern, particularly among IDUs who engage in trading of sex for money or drugs. Although low, the prevalence of HIV observed in this study constitutes a serious concern because of the potential for expanded HIV transmission in this susceptible population of IDUs with high syphilis incidence. Enhanced case finding screening efforts and prevention of transmission of sexually transmitted infections should specifically target hard to reach IDUs and their sexual partners

Mixed Histocytosis Manifesting as Suprasellar Mass with Aortic Involvement

Introduction: Histiocytoses are a group heterogeneous diseases of unknown cause affecting myeloid progenitor cells. Erdheim-Chester disease (ECD) is a subclassification of Non-Langerhan cell Histiocytosis (LCH). ECD has characteristic lesions of the skeletal, cardiac, and vascular systems. There are many instances when LCH and ECD occurs concurrently, called mixed Histiocytosis. Fewer than 500 cases of ECD have been reported and even fewer of mixed histiocytosis. Case: 42 year old caucasian female presented after a syncopal event, status post tenosynovitis release surgery. Patient presented with pallor and hypotension upon arrival, prompting a syncope workup. Patient admitted long standing history of claudication, fever, and weight loss.Labs yielded a WBC of 10.5 ESR of 67, and CRP of 2.3. Initial CTA to rule out PE revealed inflammation of the aorta and left subclavian vessel with mural thickening of descending aortic arc. CTA also showed stenosis of the celiac, superior mesenteric, and renal arteries, suspicious of Takayasu arteritis. Subsequent CT and MRI exhibited a suprasellar mass which was later resected and biopsied diagnosed as BRAF positive Langerhans Cell Histiocytosis, staining positive for CD1a, S-100, Langerin, CD68 and CD168. Discussion: The BRAFv600e gene mutation is implicated in both LCH and ECD, suggesting a common origin. After discovery of the BRAF mutation on both LCH and ECD, a study reported significant co-occurrence between the two, including 19% of the largest ECD cohort. Recognizing LCH, ECD, and mixed histiocytosis is imperative as treatment regiments regimens differ. Thus, actively considering mixed histiocytoses is important in the setting of LCH diagnosis.https://scholarlycommons.henryford.com/merf2019caserpt/1104/thumbnail.jp

Trichomonas vaginalis, HIV, and African-Americans.

Trichomonas vaginalis may be emerging as one of the most important cofactors in amplifying HIV transmission, particularly in African-American communities of the United States. In a person co-infected with HIV, the pathology induced by T. vaginalis infection can increase HIV shedding. Trichomonas infection may also act to expand the portal of entry for HIV in an HIV-negative person. Studies from Africa have suggested that T. vaginalis infection may increase the rate of HIV transmission by approximately twofold. Available data indicate that T. vaginalis is highly prevalent among African-Americans in major urban centers of the United States and is often the most common sexually transmitted infection in black women. Even if T. vaginalis increases the risk of HIV transmission by a small amount, this could translate into an important amplifying effect since Trichomonas is so common. Substantial HIV transmission may be attributable to T. vaginalis in African-American communities of the United States

Factor VIII Eradication in Acquired Hemophilia A

Acquired Hemophilia A manifests as an autoimmune condition characterized by spontaneous synthesis of IgG against Factor VIII (FVIII) occurring in 1 in 1,500,000 cases annually with an approximate 9-22% mortality1,2.A 72-year-old-male with recent hospitalization from ESBL UTI and DVT, returned to the hospital with weakness, fatigue, exertional dyspnea and diffuse ecchymosis while on Xarelto. Admission labs revealed an elevated PTT without prior personal or family history of coagulopathy. Subsequent testing exhibited non-corrective PTT mixing study of 199s, preliminary FVIII activity of 0.26% and FVIII inhibitor level of 112.0 Bestheda units (BU).Patient was treated with prednisone 1mg/kg and Cyclophosphamide 2mg/kg daily. With minimal change of FVIII activity/inhibitor levels after seven days, cyclophosphamide was subsequently increased to 3mg/kg daily; 800mg Rituximab weekly for four weeks and adjuvant IVIG 1g/kg for two days were added. While FVIII inhibitor levels decreased promptly after giving Rituximab, FVIII activity remained relatively stagnant throughout the treatment course until the inhibitor level breached 10BU. The FVIII inhibitor decreased from 112 to 1.6BU, FVIII activity increased from 0.26% to 17%, and PTT decreased from 199s to 38s over 35 days.Cyclophosphamide and steroids were insufficient, and Rituximab and IVIG were supplemented in the treatment regimen. The patient\u27s levels improved only after the initiation of Rituximab and IVIG. Given this, further research should be conducted in the use of Rituximab and IVIG for the treatment of acquired Hemophilia A with Factor VIII inhibitor.https://scholarlycommons.henryford.com/merf2019caserpt/1106/thumbnail.jp

The Adult Film Industry: Time to Regulate?

The industry is putting the health of its employees, adult film perfomers, at risk by insisting that they work without condoms

Healthy Penis: San Francisco's Social Marketing Campaign to Increase Syphilis Testing among Gay and Bisexual Men

The authors describe the development, implementation, and evaluation of their innovative social marketing campaign

Spatial video geonarratives and health: case studies in post-disaster recovery, crime, mosquito control and tuberculosis in the homeless

A call has recently been made by the public health and medical communities to understand the neighborhood context of a patient’s life in order to improve education and treatment. To do this, methods are required that can collect “contextual” characteristics while complementing the spatial analysis of more traditional data. This also needs to happen within a standardized, transferable, easy-to-implement framework. The Spatial Video Geonarrative (SVG) is an environmentally-cued narrative where place is used to stimulate discussion about fine-scale geographic characteristics of an area and the context of their occurrence. It is a simple yet powerful approach to enable collection and spatial analysis of expert and resident health-related perceptions and experiences of places. Participants comment about where they live or work while guiding a driver through the area. Four GPS-enabled cameras are attached to the vehicle to capture the places that are observed and discussed by the participant. Audio recording of this narrative is linked to the video via time stamp. A program (G-Code) is then used to geotag each word as a point in a geographic information system (GIS). Querying and density analysis can then be performed on the narrative text to identify spatial patterns within one narrative or across multiple narratives. This approach is illustrated using case studies on post-disaster psychopathology, crime, mosquito control, and TB in homeless populations. SVG can be used to map individual, group, or contested group context for an environment. The method can also gather data for cohorts where traditional spatial data are absent. In addition, SVG provides a means to spatially capture, map and archive institutional knowledge. SVG GIS output can be used to advance theory by being used as input into qualitative and/or spatial analyses. SVG can also be used to gain near-real time insight therefore supporting applied interventions. Advances over existing geonarrative approaches include the simultaneous collection of video data to visually support any commentary, and the ease-of-application making it a transferable method across different environments and skillsets.https://doi.org/10.1186/s12942-015-0014-