Shared Governance in an Adult Education Doctoral Program: “Self-Directed Learning meets Democratic Process” – A Delicate Balance of Intent, Implementation, and Impact

This symposium explores the governance component offered within a doctoral program in which students were given the opportunity to engage in collective decision-making through democratic process. Panelists, most of whom were research participants for the dissertation upon which this exploration is based, represent cohort groups from 1996 through 2007

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Improvement in visualization and isolation of staphylococci from environmental and clinical samples

Includes bibliographical references (pages [75]-79)Within our natural water reserves there exist staphylococci, and more importantly the Staphylococcus aureus species, a known contact pathogen. Staphylococcus aureus, can be found on the surface o f human skin and mucus membranes and is a member o f the normal flora o f these areas. While S. aureus can exist in harmony on or in our bodies as part o f the normal flora, this bacterium is like a double edged sword, always having the potential to become a serious pathogen. Because o f their potential pathogenic nature and ability to use water as a vehicle, it has been suggested that the staphylococci and more specifically, S. aureus, could serve as a better bacteriological indicator o f human contamination and disease potential o f contact water than the currently used fecal and total coliforms. S. aureus is also resistant to chlorine at the concentrations at which the average swimming pool is maintained and humans can tolerate. . The difficulty in implementing this suggestion lies in the development o f a medium that can successfully selectively recover the staphylococci. Much work has been done to develop a membrane filter medium that can accurately select for and enumerate these bacteria. Over the years, there have been various selective/differential media utilized for the isolation o f Staphylococcus including Lipovitellanin Salt Mannitol Agar (LSM). However, such media have been reported to exhibit a lower recovery rate and selectivity for staphylococci than non-selective media such as Tryptic Soy Agar (TSA). In this study, pyruvate was added to less selective media such as Vogel-Johnson and resulted in an increased recovery o f staphylococci, but the recovery rate was still low. Pyruvate was also tested as an additive to the selective medium LSM45. While the optimal colony morphology o f staphylococci occurred on LSM45 medium when 1% pyruvate was added, the recovery rate was statistically the same on TSA. With the TSA recovery set at 100%, LSM45 without pyruvate recovered 85%, and Mannitol Salt Agar (MSA) recovered 60% o f staphylococcal species. Nutritional studies showed that Staphylococcus aureus will utilize pyruvate as a sole carbon source with growth essentially equivalent to that produced with mannitol. However, the presence o f both pyruvate and mannitol together increased the staphylococcal growth on a level equivalent to the combination o f mannitol and pyruvate individual growth rates. The addition o f pyruvate to LSM45, as applied in the membrane filter technique, resulted in enhanced staphylococcal colony morphology and pigmentation for both clinical and laboratory strains exposed to environmental river water. Staphylococcus aureus on LSM45P were differentiated by color as golden colonies and the coagulase negative staphylococci as white colonies. The addition o f pyruvate was shown to lengthen the "shelf life" o f the LSM45 from less than one week to five weeks. Incorporation o f pyruvate into LSM45 medium resulted in an increase in the overall recovery rate o f environmentally stressed S. aureus and improved characteristics o f the medium for staphylococcal differentiation and enumeration.M.S. (Master of Science

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214337 [58%] were transport related) and 31.1 million DALYs (of which 16.2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34.4% (from 17.5 to 11.5 per 100 000) for transport injuries, and by 47.7% (from 15.9 to 8.3 per 100000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80.5% to 42 774 for transport injuries and by 39.4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16.7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48.5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0.2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury