Launching Integrative Experiences through Linked Courses: The Future Educators Learning Community (FELC)

This article describes the first implementation of the Future Educators Learning Community, and particularly, the impact of three linked courses and instructor collaboration. With supporting literature and the context and background of this learning community as the foundation, our experiences are structured into three distinct categories: preparing, implementing, and reflecting upon our journey. Pertinent logistics are discussed as well as the importance of ongoing communication and collaboration in response to real-time feedback from students. Throughout this initial implementation, recurring themes emerged that extended meaning for both students and instructors. The article concludes with important lessons learned, as well a poetic representation of the initial Future Educator Learning Community

Ruptured heterotopic pregnancy presenting as hemorrhagic shock

Background: Heterotopic pregnancy is a rare event consisting of simultaneous intrauterine and extrauterine pregnancies. If undiagnosed, it is probable the patient will present to an Emergency Department and require emergent care. Case Report: A 25 year-old woman arrived at the Emergency Department at 14 weeks gestation reporting sharp abdominal cramping and pelvic pain with a history of current tobacco use. Trans-abdominal ultrasound revealed a viable intrauterine pregnancy consistent with 14 weeks, closed cervix with free fluid noted in pelvis, and no evidence of ovarian torsion. Over the next three hours, the patient’s condition deteriorated and hemoglobin levels dropped. The surgeon on call was consulted and suspected ruptured hepatic adenoma versus hepatic hemangioma versus visceral aneurysm. A laparotomy was emergently performed with supraceliac control of aorta to permit resuscitation, and the right and left upper quadrants of the abdominal cavity were investigated without discovery of bleeding source. Further investigation revealed ruptured left tubal ectopic pregnancy and a partial salpingectomy was performed. Conclusions: This case serves as a clinical reminder that while heterotopic pregnancy is thought to be rare, when a patient presents with known intrauterine pregnancy and abdominal pain, heterotopic pregnancy should be included in the differential diagnosis. More common use of assisted reproductive technology may increase the incidence of heterotopic pregnancies, making familiarity with the signs, symptoms, and risk factors for this condition important

Effects of resistance training on classic and specific bioelectrical impedance vector analysis in elderly women

Raw bioelectrical impedance analysis (BIA) data [resistance (R); reactance (Xc)] through bioelectrical impedance vector analysis (BIVA) and phase angle (PhA) have been used to evaluate cellular function and hydration status. The purpose of this investigation was to examine the effects of resistance training (RT) on classic and specific BIVA in elderly women. Twenty women (mean ± SD; age: 71.9 ± 6.9 years; BMI: 24.5 ± 3.0 kg m(-2)) completed a 6-month RT program. Whole-body, single-frequency BIA, body geometry, and leg strength (5RM) measures were completed at baseline (t0), 3 months (t3), and 6 months (t6). The mean impedance vector displacements were compared using Hotelling's T(2) test to evaluate changes in R and Xc relative to height (R/ht; Xc/ht) or body volume (Rsp; Xcsp) estimated from the arms, legs, and trunk. 5RM, PhA, and BIVA variables were compared using ANOVA. PhA improved at t6 (p < 0.01), while 5RM improved at t3 and t6 (p < 0.01). Using classic BIVA, 6 months (T(2) = 31.6; p < 0.01), but not 3 months of RT (T(2) = 4.5; p = 0.20), resulted in significant vector migration. Using specific BIVA, 6 months (T(2) = 24.4; p < 0.01), but not 3 months of RT (T(2) = 5.5; p = 0.10), also resulted in significant vector migration. 5RM was correlated to both PhA (r = 0.48-56) and Xcsp (r = 0.45-53) at all time points. Vector displacements were likely the result of improved cellular integrity (Xcsp) and cellular health (PhA)

Polyfluoroalkyl Chemicals and Menopause among Women 20-65 Years of Age (NHANES)

Background: Polyfluoroalkyl chemicals (PFCs) such as perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) have been associated with early menopause. However, previous cross-sectional studies have lacked adequate data to investigate possible reverse causality (i.e., higher serum concentrations due to decreased excretion after menopause)

Elevated HbA1c levels and the accumulation of differentiated T cells in CMV+ individuals

Aims/hypothesis Biological ageing of the immune system, or immunosenescence, predicts poor health and increased mortality. A hallmark of immunosenescence is the accumulation of differentiated cytotoxic T cells (CD27−CD45RA+/−; or dCTLs), partially driven by infection with the cytomegalovirus (CMV). Immune impairments reminiscent of immunosenescence are also observed in hyperglycaemia, and in vitro studies have illustrated mechanisms by which elevated glucose can lead to increased dCTLs. This study explored associations between glucose dysregulation and markers of immunosenescence in CMV+ and CMV− individuals. Methods A cross-sectional sample of participants from an occupational cohort study (n = 1,103, mean age 40 years, 88% male) were assessed for HbA1c and fasting glucose levels, diabetes, cardiovascular risk factors (e.g. lipids), numbers of circulating effector memory (EM; CD27−CD45RA−) and CD45RA re-expressing effector memory (EMRA; CD27−CD45RA+) T cells, and CMV infection status. Self-report and physical examination assessed anthropometric, sociodemographic and lifestyle factors. Results Among CMV+ individuals (n = 400), elevated HbA1c was associated with increased numbers of EM (B = 2.75, p \u3c 0.01) and EMRA (B = 2.90, p \u3c 0.01) T cells, which was robust to adjustment for age, sex, sociodemographic variables and lifestyle factors. Elevated EM T cells were also positively associated with total cholesterol (B = 0.04, p \u3c 0.05) after applying similar adjustments. No associations were observed in CMV− individuals. Conclusions/interpretation The present study identified consistent associations of unfavourable glucose and lipid profiles with accumulation of dCTLs in CMV+ individuals. These results provide evidence that the impact of metabolic risk factors on immunity and health can be co-determined by infectious factors, and provide a novel pathway linking metabolic risk factors with accelerated immunosenescence. Electronic supplementary material The online version of this article (doi:10.1007/s00125-015-3731-4) contains peer-reviewed but unedited supplementary material, which is available to authorised users

A randomized clinical trial on the effects of progestin contraception in the genital tract of HIV-infected and uninfected women in Lilongwe, Malawi: Addressing evolving research priorities

Hormonal contraception is central in the prevention of unintended pregnancy; however there are concerns that certain methods may increase the risk of HIV acquisition and transmission. Hormonal contraceptives may modify the genital mucosa in several ways, however the mechanisms are incompletely understood. Few studies have examined genital HIV shedding prospectively before and after initiation of hormonal contraception. The effects of hormonal contraception on genital HIV shedding in the setting of antiretroviral therapy (ART) are also unknown. We designed a pilot clinical trial in which HIV-infected and uninfected women were randomized to either depot medroxyprogesterone acetate (DMPA) injectable or levonorgestrel (LNG) implant in Lilongwe, Malawi. The objectives were to: 1) assess the effect and compare the impact of type of progestin contraception (injectable versus implant) on HIV genital shedding among HIV-infected women, 2) assess the effect and compare the impact of type of progestin contraception on inflammatory/immune markers in the genital tract of both HIV-infected and uninfected women, and 3) assess the interaction of progestin contraception and ART by examining contraceptive efficacy and ART efficacy. An additional study aim was to determine the feasibility and need for a larger study of determinants of HIV transmissibility and acquisition

‘An elephant cannot fail to carry its own ivory’: Transgenerational ambivalence, infrastructure and sibling support practices in urban Uganda

This article examines how urban Ugandans navigate family support systems through a focus on the under-researched area of sibling care practices. We conceptualise such systems as transgenerational infrastructure to capture the complex flows, negotiations and dilemmas of both inter- and intra-generational relationships, orderings and power, situating family support practices within their spatial, structural and social contexts. Drawing on grounded narratives of lived experience collected in Jinja, Uganda, the article offers an alternative interpretation to what is commonly portrayed as a weakening of family support systems in sub-Saharan Africa. We develop a transgenerational ambivalence perspective which allows for a deeper understanding of the heterogeneity and fluidity of family support as an ethical practice replete with complex emotions and dilemmas shaped in the junctures between social norms, agency, resources and material conditions. Through focusing on working-age Ugandans, we demonstrate the potential for a transgenerational ambivalence approach to make visible contradictions at structural and subjective levels and focus greater attention on the importance of sibling relationships and birth order than is evident in the existing intergenerational literature. This can help researchers in the task of linking family dynamics to the growing precarity and uncertainties of life in the marginal socio-economic contexts of urban sub-Saharan Africa

Wastewater Sequencing Reveals Community and Variant Dynamics of the Collective Human Virome

Wastewater is a discarded human by-product, but its analysis may help us understand the health of populations. Epidemiologists first analyzed wastewater to track outbreaks of poliovirus decades ago, but so-called wastewater-based epidemiology was reinvigorated to monitor SARS-CoV-2 levels while bypassing the difficulties and pit falls of individual testing. Current approaches overlook the activity of most human viruses and preclude a deeper understanding of human virome community dynamics. Here, we conduct a comprehensive sequencing-based analysis of 363 longitudinal wastewater samples from ten distinct sites in two major cities. Critical to detection is the use of a viral probe capture set targeting thousands of viral species or variants. Over 450 distinct pathogenic viruses from 28 viral families are observed, most of which have never been detected in such samples. Sequencing reads of established pathogens and emerging viruses correlate to clinical data sets of SARS-CoV-2, influenza virus, and monkeypox viruses, outlining the public health utility of this approach. Viral communities are tightly organized by space and time. Finally, the most abundant human viruses yield sequence variant information consistent with regional spread and evolution. We reveal the viral landscape of human wastewater and its potential to improve our understanding of outbreaks, transmission, and its effects on overall population health

Factores asociados al consumo de drogas ilícitas en estudiantes de secundaria, universitarios y población general en Colombia

Tesis doctoralSegún los estudios poblacionales que se realizan en Colombia desde 1992, el consumo de drogas ilegales crece en Colombia de manera sostenida. Tales estudios presentan análisis descriptivos, distribuciones porcentuales y prevalencias, sin que se ahonde en el escrutinio de los factores que están incidiendo en las cifras de consumo. Con el interés de ahondar en la comprensión de éste fenómeno, facilitar su predicción y contribuir con su atención integral, en esta investigación se propone identificar factores individuales, familiares y del contexto, asociados al consumo de drogas ilegales en Colombia. Para alcanzar dichos propósitos se realizan dos investigaciones: 1) una revisión sistemática sobre los factores que inciden en el consumo de drogas ilegales y 2) la formulación de tres modelos de factores asociados al consumo de drogas ilegales en Colombia y la clasificación del tipo de consumidores, a partir de los factores identificados previamente. Se analizaron las bases de datos de estudios nacionales realizados con población general, estudiantes de secundaria y estudiantes universitarios, en las cuales se utilizó la metodología del Sistema Interamericano de Datos Uniformes sobre Consumo de Drogas. Inicialmente se establecieron en cada uno de los tres grupos analizados, los factores relacionados con el consumo de sustancias ilícitas y las clases latentes de consumidores, los cuales permitieron plantear tres modelos de factores asociados al consumo, uno para cada población. Se encontró que el consumo de drogas ilícitas en el último año, se asoció en las tres poblaciones, con tener amigos y familiares consumidores de drogas ilícitas; haber iniciado el consumo de tabaco y alcohol, y tener una baja percepción del riesgo con respecto al uso de marihuana. Por su parte, con el análisis de clases latentes se identificaron tres clases entre los consumidores de drogas ilícitas en la población general, seis clases entre escolares y cuatro clases entre universitarios. Los resultados indican factores que pueden ser considerados para orientar la prevención del consumo de drogas ilegales y su atención integral.1. INTRODUCCIÓN 2. JUSTIFICACIÓN Y PLANTEAMIENTO DEL PROBLEMA 3. OBJETIVOS 4. ESTUDIO 1: REVISIÓN SISTEMÁTICA SOBRE LOS FACTORES ASOCIADOS AL RIESGO DEL CONSUMO DE DROGAS ILEGALES 5. ESTUDIO 2: FORMULACIÓN DE MODELOS DE CONSUMO DE DROGAS ILÍCITAS EN COLOMBIA, CON ESTUDIANTES DE SECUNDARIA, UNIVERSITARIOS Y POBLACIÓN GENERAL 6.REFERENCIAS 7. ANEXOSDoctoradoDoctor en Psicologí