Communities & Workplaces as Learning Environments: Reflections on a Life's Theme

In the January/February 1998 issue of the Council for Independent College’s newsletter, Independent, the front page headline announced receipt of a $1.5 million grant to enhance community-campus partnerships. Goals were to review the impact of service-learning, internships, and other forms of experiential education on faculty, staff, students and community members. CIC President Splete shared that “We’re going to look more closely at the ways in which colleges develop interdependent, mutually beneficial partnerships with their communities—and we will develop ideas to enhance those connections. Through these efforts we hope to help colleges better understand how these important links with their communities affect such internal processes as the curriculum and the way faculty work.” Robert L. Sigmon was one of the primary researchers on the project. A few years after participating in the project, Sigmon wrote about the value of communities and workplaces as learning environments. With the creative editing assistance of Dr. Lisa Keyne, his original paper has been slightly revised, but re-emphasizes his lifelong passion for strengthening community voice in experiential education initiatives of higher education. KEYWORDSservice-learning; origin

Working Paper

To educate students for a lifetime of contribution to society, colleges and universities accept an enormous challenge. Toward this end, they help students pursue a broad range of goals-prepare for careers, acquire a sense of civic responsibility; gain self-awareness, and learn how to learn

Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention

AbstractObjectives. We examined the relations of elevated creatine kinase (CK) and its myocardial band isoenzyme (CK-MB) to clinical outcomes after percutaneous coronary intervention (PCI) in patients enrolled in Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II (trial) (IMPACT-II), a trial of the platelet glycoprotein IIb/IIIa inhibitor eptifibatide.Background. Elevation of cardiac enzymes often occurs after PCI, but its clinical implications are uncertain.Methods. Patients undergoing elective, scheduled PCI for any indication were analyzed. Parallel analyses investigated CK (n = 3,535) and CK-MB (n = 2,341) levels after PCI (within 4 to 20 h). Clinical outcomes at 30 days and 6 months were stratified by postprocedure CK and CK-MB (multiple of the site’s upper normal limit).Results. Overall, 1,779 patients (76%) had no CK-MB elevation; CK-MB levels were elevated to 1 to 3 times the upper normal limit in 323 patients (13.8%), to 3 to 5 times normal in 84 (3.6%), to 5 to 10 times normal in 86 (3.7%), and to >10 times normal in 69 patients (2.9%). Elevated CK-MB was associated with an increased risk of death, reinfarction, or emergency revascularization at 30 days, and of death, reinfarction, or surgical revascularization at 6 months. Elevated total CK to above three times normal was less frequent, but its prognostic significance paralleled that seen for CK-MB. The degree of risk correlated with the rise in CK or CK-MB, even for patients with successful procedures not complicated by abrupt closure.Conclusions. Elevations in cardiac enzymes, including small increases (between one and three times normal) often not considered an infarction, are associated with an increased risk for short-term adverse clinical outcomes after successful or unsuccessful PCI

Teaching the Three E’s of Sustainability Through Service‐Learning in a Professional Program

Using seven established course design principles for effective service‐learning, this chapter discusses the lessons learned in teaching the three E’s of sustainability: environmental; economic; and (social) equity, in a professional program at an American Midwestern public university.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154652/1/tl20374_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154652/2/tl20374.pd

Mechanism of benefit of combination thrombolytic therapy for acute myocardial infarction: A quantitative angiographic and hematologic study

AbstractObjectives. The goal of this study was to lend insight into the mechanisms responsible for the beneficial effects of combination thrombolytic therapy.Background. Combination thrombolytic therapy for acute myocardial infarction bas been associated with less reocclusion and fewer in-hospital clinical events than has monotherapy.Methods. Infarct-related quantitative coronary dimensions and hemostatic protein levels were evaluated in 287 patients with acute myocardial infarction during the early (90-min) and convalescent (7-day) phases after administration of recombinant tissue-type plasminogen activator (rt-PA), urokinase or combination rt-PA and urokinase.Results. Minimal lumen diameter was similar in the 90-min and 7-day phases after treatment with rt-PA, urokinase and combination rt-PA and urokinase (0.72 ± 0.45 mm, 0.62 ± 0.53 mm and 0.75 ± 0.58 mm, respectively, at 90 min, p = 0.16; and 1.05 ± 0.56 mm, 1.12 ± 0.72 mm and 0.94 ± 0.54 mm, respectively, at 7 days, p = 0.22). In-hospital clinical event and reocclusion rates were less frequent in patients receiving combination therapy than in those receiving monotherapy (25% vs. 38% and 32% for rt-PA and urokinase, respectively, p = 0.084; and 3% vs. 13% and 9% for rt-PA and urokinase, respectively, p = 0.03), but these events were unrelated to early or late coronary dimensions. Patients receiving combination therapy or urokinase monotherapy had significantly higher peak fibrin degradation products (1,307 ± 860 and 1,285 ± 898 μg/ml vs. 435 ± 717 μg/ml, respectively, p < 0.0001) and lower nadir fibrinogen levels (0.85 ± 1.00 and 0.75 ± 0.53 g/liter vs. 1.90 ± 0.86 g/liter, respectively, p < 0.0001) than did those receiving rt-PA monotherapy. Peak fibrinogen degradation products indirectly correlated (p = 0.004) and baseline (p = 0.026) and nadir (p = 0.089) fibrinogen levels directly correlated with reocclusion.Conclusions. Lower in-hospital clinical event and reocclusion rates observed with combination thrombolytic therapy may relate to systemic hematologic factors rather than to the residual lumen obstruction after thrombolysis

Hemorrhagic complications associated with the use of intravenous tissue plasminogen activator in treatment of acute myocardial infarction

: Little attention has been paid to the importance of clinical factors associated with bleeding complications caused by the use of thrombolytic agents. The goal of our study was to examine clinical and hematologic factors associated with an increased risk of bleeding in a prospectively observed population that received intravenous tissue plasminogen activator for acute myocardial infarction.: Bleeding complications were evaluated in 386 consecutive patients treated with 150 mg of tissue plasminogen activator over six to eight hours for acute myocardial infarction. All patients also underwent immediate cardiac catheterization.: Quantitation of blood loss during the patients' hospital stay included a median drop in hematocrit of 11.4 points, a median nadir hematocrit of 31.2, a 14 percent rate of significant clinically evident bleeding, and a 31 percent rate of transfusion of two or more units of blood. All of these parameters were much more severe in patients treated with coronary artery bypass surgery. Access site hematoma was the most common source of bleeding (45 percent of patients), whereas 8 percent had gastrointestinal bleeding, two patients had retroperitoneal bleeding, and two patients had intracranial bleeding. The median nadir fibrinogen was 1.3 g/liter. Multiple linear regression models were used to investigate the relationship between clinical variables, including multiple hematologic measurements, and measures of the amount of blood loss. The use of coronary artery bypass grafting was the variable most closely associated with hemorrhage. Other invasive procedures (angioplasty and intra-aortic balloon pumping) were also associated with increased bleeding. Among the patient descriptors examined, lighter weight, older age, female sex, and history of hypertension were associated with greater blood loss. Of laboratory coagulation parameters, only nadir fibrinogen levels were significantly associated with more bleeding.: Careful clinical evaluation may improve assessment of the risk/benefit ratio of thrombolytic therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27546/1/0000590.pd

Comparing glacial and Holocene opal fluxes in the Pacific sector of the Southern Ocean

Author Posting. © American Geophysical Union, 2009. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 24 (2009): PA2214, doi:10.1029/2008PA001693.The silicic acid leakage hypothesis (SALH) predicts that during glacial periods excess silicic acid was transported from the Southern Ocean to lower latitudes, which favored diatom production over coccolithophorid production and caused a drawdown of atmospheric CO2. Downcore records of 230Th-normalized opal (biogenic silica) fluxes from 31 cores in the Pacific sector of the Southern Ocean were used to compare diatom productivity during the last glacial period to that of the Holocene and to examine the evidence for increased glacial Si export to the tropics. Average glacial opal fluxes south of the modern Antarctic Polar Front (APF) were less than during the Holocene, while average glacial opal fluxes north of the APF were greater than during the Holocene. However, the magnitude of the increase north of the APF was not enough to offset decreased fluxes to the south, resulting in a decrease in opal burial in the Pacific sector of the Southern Ocean during the last glacial period, equivalent to approximately 15 Gt opal ka−1. This is consistent with the work of Chase et al. (2003a), and satisfies the primary requirement of the SALH, assuming that the upwelled supply of Si was approximately equivalent during the Holocene and the glacial period. However, previous results from the equatorial oceans are inconsistent with the other predictions of the SALH, namely that either the Corg:CaCO3 ratio or the rate of opal burial should have increased during glacial periods. We compare the magnitudes of changes in the Southern Ocean and the tropics and suggest that Si escaping the glacial Southern Ocean must have had an alternate destination, possibly the continental margins. There is currently insufficient data to test this hypothesis, but the existence of this sink and its potential impact on glacial pCO2 remain interesting topics for future study.Funding for this research was provided in part by the U.S. NSF (grant OPP02-30268). We thank the core repository at LDEO and the Antarctic Research Facility at FSU for providing samples

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p&lt;0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (&lt;1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (&lt;1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Re-engaging a Pioneer: Robert L. Sigmon and Service-Learning Roots

Robert L. Sigmon invested a career in building quality experiential education and service-learning. Upon contributing his "library" to Elon University, Partnerships engaged him in conversation about his work, and rich legacy to the field. In this article, we re-introduce this pioneer, review his work, and hear his ongoing challenge to the field. Partnerships encourages researchers today to access the archives at Elon to expand service-learning research.KEYWORDSservice-learning; community partnerships; service-learning pioneers; community engagemen