Lead toxicity

Numbers in this series are collected in binders and shelved under call number WA30 C337.Includes bibliographic references

Cultivating a Community of STEM Polymaths at UNG

The University of North Georgia (UNG), Dahlonega, suffers from high attrition of STEM majors and low STEM graduation rates. In response to this challenge, a transdisciplinary (TD) team of UNG STEM faculty – from biology, chemistry, mathematics, and physics - has designed and developed hands-on laboratory experiments that employ empirical, interpretive, critical, and transdisciplinary research methodologies. The TD laboratory curriculum exposes undergraduate STEM students to cutting-edge techniques and new scientific frontiers, which will foster creativity and passion about scientific research, help undergraduates develop skills in analytical thinking and experimental design, and improve their technological fluency. In turn, this will improve persistence by stimulating student interest and participation in STEM. We will present examples of the transdisciplinary experiments that our students are engaging in and provide interactive activities to expose an interdisciplinary audience to the substantive scientific questions and real-world observations of the TD lab at UNG

Mathematics Teaching Assistants’ Community-Building Activities During Remote Instruction

The need to build community in mathematics learning spaces was exacerbated by the COVID-19 pandemic. This study examined the community-building efforts of mathematics TAs during a dynamically uncertain period and how they engaged in pandemic-sensemaking to make sense of and adapt their community-building efforts for remote instruction. We found that TAs engaged in various community-building activities through the synchronous and asynchronous interactions afforded by the design of the course (e.g., during sections, in office hours), and pandemic-sensemaking enabled them to better understand students’ challenges and adapt their efforts to attend to the challenges with building community

A Transdisciplinary Laboratory Course Increases STEM Retention

STEM retention is a national challenge. Recent literature suggests that students leave STEM for many reasons including lack of context, lack of academic preparedness for entering college, and challenges with quantitative reasoning. These observations compelled us to design an introductory, transdisciplinary STEM lab course which we describe herein. This course was designed to integrate the disciplines of biology, chemistry, physics, and mathematics with activities that engage students in real-world, inquiry-based exercises and help students develop quantitative reasoning skills. Assessment showed that students in this STEM lab have higher STEM retention rates than those in equivalent disciplinary courses. The largest gains in STEM retention were seen in the 4th semester for students who took the lab as underclassmen. Additionally, student surveys indicated that students found the context of the lab compelling. In contrast, there were no significant differences in gains in quantitative literacy and reasoning or GPA among STEM lab students and students in discipline-specific labs. These results suggest that students’ engagement in applications of STEM with context might be more important for increasing retention than just focusing on academic ability alone

Use of anti-retroviral therapy in tuberculosis patients on second-line anti-TB regimens: a systematic review

Introduction: Use of antiretroviral therapy (ART) during treatment of drug susceptible tuberculosis (TB) improves survival. However, data from HIV infected individuals with drug resistant TB are lacking. Second line TB drugs when combined with ART may increase drug interactions and lead to higher rates of toxicity and greater noncompliance. This systematic review sought to determine the benefit of ART in the setting of second line drug therapy for drug resistant TB. Methods: We included individual patient data from studies that evaluated treatment of drug-resistant tuberculosis in HIV-1 infected individuals published between January 1980 and December of 2009. We evaluated the effect of ART on treatment outcomes, time to smear and culture conversion, and adverse events. Results: Ten observational studies, including data from 217 subjects, were analyzed. Patients using ART during TB treatment had increased likelihood of cure (hazard ratio (HR) 3.4, 95% CI 1.6–7.4) and decreased likelihood of death (HR 0.4, 95% CI 0.3–0.6) during treatment for drug resistant TB. These associations remained significant in patients with a CD4 less than 200 cells/mm3 and less than 50 cells/mm3, and when correcting for drug resistance pattern. Limitations: We identified only observational studies from which individual patient data could be drawn. Limitations in study design, and heterogeneity in a number of the outcomes of interest had the potential to introduce bias. Discussion: While there are insufficient data to determine if ART use increases adverse drug interactions when used with second line TB drugs, ART use during treatment of drug resistant TB appears to improve cure rates and decrease risk of death. All individuals with HIV appear to benefit from ART use during treatment for TB

Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients.

Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB

Standardized Treatment of Active Tuberculosis in Patients with Previous Treatment and/or with Mono-resistance to Isoniazid: A Systematic Review and Meta-analysis

Performing a systematic review of studies evaluating retreatment of tuberculosis or treatment of isoniazid mono-resistant infection, Dick Menzies and colleagues find a paucity of evidence to support the WHO-recommended regimen

Cost-effectiveness of tuberculosis evaluation and treatment of newly-arrived immigrants

BACKGROUND: Immigrants to the U.S. are required to undergo overseas screening for tuberculosis (TB), but the value of evaluation and treatment following entry to the U.S. is not well understood. We determined the cost-effectiveness of domestic follow-up of immigrants identified as tuberculosis suspects through overseas screening. METHODS: Using a stochastic simulation for tuberculosis reactivation, transmission, and follow-up for a hypothetical cohort of 1000 individuals, we calculated the incremental cost-effectiveness of follow-up and evaluation interventions. We utilized published literature, California Reports of Verified Cases of Tuberculosis (RVCTs), demographic estimates from the California Department of Finance, Medicare reimbursement, and Medi-Cal reimbursement rates. Our target population was legal immigrants to the United States, our time horizon is twenty years, and our perspective was that of all domestic health-care payers. We examined the intervention to offer latent tuberculosis therapy to infected individuals, to increase the yield of domestic evaluation, and to increase the starting and completion rates of LTBI therapy with INH (isoniazid). Our outcome measures were the number of cases averted, the number of deaths averted, the incremental dollar cost (year 2004), and the number of quality-adjusted life-years saved. RESULTS: Domestic follow-up of B-notification patients, including LTBI treatment for latently infected individuals, is highly cost-effective, and at times, cost-saving. B-notification follow-up in California would reduce the number of new tuberculosis cases by about 6–26 per year (out of a total of approximately 3000). Sensitivity analysis revealed that domestic follow-up remains cost-effective when the hepatitis rates due to INH therapy are over fifteen times our best estimates, when at least 0.4 percent of patients have active disease and when hospitalization of cases detected through domestic follow-up is no less likely than hospitalization of passively detected cases. CONCLUSION: While the current immigration screening program is unlikely to result in a large change in case rates, domestic follow-up of B-notification patients, including LTBI treatment, is highly cost-effective. If as many as three percent of screened individuals have active TB, and early detection reduces the rate of hospitalization, net savings may be expected

Effect of Duration and Intermittency of Rifampin on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis

In a systematic review of randomized controlled trials on tuberculosis treatment, Dick Menzies and colleagues find shorter courses of rifampin to be associated with poorer treatment outcomes