Mercury Transfers in the Aquatic Food Web of a High Alpine Lake Ecosystem, Green Lakes Valley, Colorado

Mercury (Hg) is a global pollutant whose cycling has been dramatically influenced by mobilization of elemental Hg (II) from anthropogenic sources. Mercury mobilization has led to a significant increase in atmospheric deposition of inorganic Hg, which can cycle within terrestrial and aquatic ecosystems. Prior research has documented the long-distance transport of Hg, thus allowing for deposition in remote regions. High elevation areas have been disproportionately affected due to increased deposition and retention of Hg in these areas. There remains, however, a lack of knowledge about the Hg cycle in these areas, particularly as it pertains to the mobilization of Hg into the food chain. Under anoxic conditions, usually in aquatic systems, Hg can be methylated by sulfate and iron-reducing bacteria into methylmercury (MeHg), a neurotoxin that bioaccumulates at each successive trophic level. Prior research at Niwot Ridge in the Colorado Rocky Mountains, U.S., showed elevated concentrations of MeHg in weasels (M. frenata), with low concentrations in its terrestrial food sources, pointing to aquatic systems of the area as a potential source of MeHg. In order to investigate the movement of MeHg into the alpine aquatic food web, I sampled fish, zooplankton, water, and lake sediments in the Green Lakes Valley, Colorado. I present total mercury (THg), methylmercury (MeHg), and stable isotope data for each sample type to determine the flows of MeHg between lakes within the Green Lakes Valley and the factors that affect the bioaccumulation of MeHg in the aquatic food web. The data suggest that MeHg production and bioaccumulation in the Green Lakes Valley increased with elevation, likely due to their proximity to Arikaree rock glacier. Results showed clear rates of MeHg bioaccumulation at each succesive trophic level. Furthermore, fish within the Green Lakes Valley showed no MeHg concentrations over set limits of 200 ng MeHg g-1 ww at which trout show no effect from MeHg concentrations. This project provides the first look into the movement of MeHg and bioaccumulation within an aquatic food web of the Green Lakes Valley. In combination with prior studies on the terrestrial food web in the area, it provides more knowledge of the Hg cycle in high elevation mountain ecosystems.</p

Effectiveness of Clinical Scenarios in Improving Student Interprofessional Skills and Attitudes

Background: “Interprofessional education (IPE) is defined as the process by which individuals from two or more health professions learn with, from, and about each other across the spectrum of their education to improve collaboration, practice, and the quality of health care.” [1] Interprofessional Education has recently gained interest as an important aspect of training in healthcare professions, attracting the attention and support of several key pharmacy organizations. Various models of IPE have been implemented to facilitate collaboration among medical, nursing, pharmacy, and social work students and professionals. One model found to be particularly effective among pharmacy students is a mock clinical scenario, requiring interprofessional collaboration in order to yield the best care for the patient. Objectives: Therefore, the aim of this project is to utilize mock clinical scenarios to improve interprofessional knowledge, collaboration, student attitudes, and behaviors among Cedarville pharmacy, nursing, and social work students and Wright State medical students. The long term goal is to integrate this clinical scenario model, if proven effective, into the interprofessional curriculums of emerging health science centers. Methodology: The study will conduct mock clinical scenarios among pharmacy, nursing, social work, and medical students. The participants will complete a survey prior to the event regarding interprofessional behaviors and attitudes. The volunteers will then complete the scenario in intraprofessional groups. Following the intraprofessional session another survey will be taken to determine any changes in attitudes and behaviors. The subjects will then complete the scenario again in interprofessional groups. Following the interprofessional session a final survey will be administered to further measure change in attitudes and behaviors. Both sessions will be 20 minutes, and participants will be given 5 minutes to complete each survey. Analysis: Analysis will be conducted with the Kruskall-Wallis test to find change in attitudes among the students among the different majors. Also, the Wilcoxon signed-rank test will determine changes within each group since normal distribution will not be assumed

Kinetics of phenol oxidation in supercritical water

Aqueous solutions of phenol were oxidized in a flow reactor at temperatures between 300 and 420°C (0.89 < T r < 1.07) and pressures from 188 to 278 atm (0.86 < P r < 1.27). These conditions included oxidations in both near-critical and supercritical water. Reactor residence times ranged from 1.2 to 111 s. The initial phenol concentrations were between 50 and 330 ppm by mass, and the initial oxygen concentrations ranged from 0 to 1,100% excess. The oxidation experiments covered essentially the entire range of phenol conversions. Analysis of the kinetics data for phenol disappearance using a combination of the integral method and the method of excess revealed that the reaction was first order in phenol and 1/2 order in oxygen, and influenced by pressure. The global reaction order for water was taken to be nonzero, and the global rate constant was assumed to be independent of pressure so that the only effect of pressure was to alter the water concentration and hence the reaction rate. This approach led to a global reaction rate law that was 0.7 order in water and had a rate constant with an activation energy of 12.4 kcal/mol. The implications of these rate laws to the design of a commercial supercritical water oxidation reactor are also explored.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37422/1/690380302_ftp.pd

Evaluating Interprofessional Fast Forward Rounds for Transition of Care Education

Background: Interprofessional Education is gaining recognition by key pharmacy organizations for its value in healthcare education, producing various models for implementation among healthcare students and professionals. Unfolding cases incorporating transitions of care may improve student skills and attitudes toward interprofessional collaboration. Objectives: This project assessed the efficacy of unfolding cases in improving interprofessional skills and attitudes among pharmacy, nursing, and social work students. The ultimate goal is to integrate this model, if proven effective, into the curricula of multiple health science centers. Methodology: First, pharmacy, nursing, and social work students completed a pre-intervention survey regarding interprofessional skills and attitudes before discussing the first “fast-forward rounds” case in professional silos. After a transitions of care lecture, subjects completed the alternative cases in interprofessional groups in a crossover design. The comparable transitions of care cases included common healthcare topics that were challenging but within the scope of regular practice. “Fast forwards” between transitions of care required students to interpret changes in the case throughout the hospital stay. Following the interprofessional session, group debriefing allowed for feedback on cases, transitions, and differences working with and without other professions. Finally, a post-intervention survey was administered to measure changes in interprofessional attitudes and skills. Analysis: Kruskall-Wallis analysis identified differences among the three majors on the pretest and posttest separately. The Wilcoxon sign rank test assessed changes within each group since normal distribution was not assumed. A Chi-squared test analyzed demographic data. Results: Data analysis of results from the conference revealed a significant improvement in 15 of 25 survey questions in the composite group, while 14, 7, and 4 questions showed significant improvement in the pharmacy, nursing, and social work sub-analyses, respectively. Fewer questions showed significant improvement in the social work group, possibly due to the specific medical details of the cases as well as fewer social work participants relative to pharmacy and nursing. Discussion: Results suggest that this intervention can effectively improve student attitudes toward interprofessional collaboration and understanding of transitions of care. Changes can be made to improve the benefit to social work students and to increase the number of majors participating

Factors Influencing Emergency Contraception Use in Indigent Populations

Introduction: Indigent women are disproportionately affected by unwanted, unplanned pregnancies. Studies previously identified lack of knowledge about emergency contraception (EC) as a major deterrent from use. This study was performed to address three potential barriers to the use of EC in indigent populations: culture and religion, patient education, and cost. For the entirety of this study, EC refers to levonorgestrel (LNG). Objectives: To determine the impact of culture and religion, patient education, and cost on EC use in the indigent population. Methods: This study was a cross-sectional observational study to explore and investigate relationships between indigent populations and the use of EC. To be included in the study, participants had to be: at least 14 years old, female, and have an annual household income below the federal poverty line (FPL). Those excluded were less than 14 years old, male, and reported an annual household income above the FPL. A questionnaire consisting of 31 survey questions were utilized to assess the endpoints of the study. The study utilized both paper and electronic forms of the survey. Participants signed informed consent to enable them participate in the study. Out of 319 participants, 59 met all inclusion criteria and were used in statistical analyses. Results:Based on Kruskal-Wallis results, religious groups’ acceptance of EC influenced indigent women’s decision to use it (p=0.016). Level of education also influenced women’s understanding of EC as an abortifacient and knowledge of when LNG is effective. Spearman rho revealed correlations between participants’ willingness to pay for EC or routine birth control and knowing that EC was an option (coefficient 0.391; p-value 0.005). There was also a correlation between the cost of EC and ultimate use (coefficient -0.603; p-value Conclusion: Our research found that religious groups’ acceptance of EC use and knowledge about how LNG works does affect the decision to use EC. Neither cultural identification nor cost of EC appears to have a significant impact on the final decision to use

The oxytocin receptor antagonist, Atosiban, activates pro-inflammatory pathways in human amnion via Gαi signalling

Oxytocin (OT) plays an important role in the onset of human labour by stimulating uterine contractions and promoting prostaglandin/inflammatory cytokine synthesis in amnion via oxytocin receptor (OTR) coupling. The OTR-antagonist, Atosiban, is widely used as a tocolytic for the management of acute preterm labour. We found that in primary human amniocytes, Atosiban (10 μM) signals via PTX-sensitive Gαi to activate transcription factor NF-κB p65, ERK1/2, and p38 which subsequently drives upregulation of the prostaglandin synthesis enzymes, COX-2 and phospho-cPLA2 and excretion of prostaglandins (PGE2) (n = 6; p < 0.05, ANOVA). Moreover, Atosiban treatment increased expression and excretion of the inflammatory cytokines, IL-6 and CCL5. We also showed that OT-simulated activation of NF-κB, ERK1/2, and p38 and subsequent prostaglandin and inflammatory cytokine synthesis is via Gαi−2 and Gαi−3 but not Gαq, and is not inhibited by Atosiban. Activation or exacerbation of inflammation is not a desirable effect of tocolytics. Therefore therapeutic modulation of the OT/OTR system for clinical management of term/preterm labour should consider the effects of differential G-protein coupling of the OTR and the role of OT or selective OTR agonists/antagonists in activating proinflammatory pathways

Trial protocol OPPTIMUM : does progesterone prophylaxis for the prevention of preterm labour improve outcome?

Background Preterm birth is a global problem, with a prevalence of 8 to 12% depending on location. Several large trials and systematic reviews have shown progestogens to be effective in preventing or delaying preterm birth in selected high risk women with a singleton pregnancy (including those with a short cervix or previous preterm birth). Although an improvement in short term neonatal outcomes has been shown in some trials these have not consistently been confirmed in meta-analyses. Additionally data on longer term outcomes is limited to a single trial where no difference in outcomes was demonstrated at four years of age of the child, despite those in the “progesterone” group having a lower incidence of preterm birth. Methods/Design The OPPTIMUM study is a double blind randomized placebo controlled trial to determine whether progesterone prophylaxis to prevent preterm birth has long term neonatal or infant benefit. Specifically it will study whether, in women with singleton pregnancy and at high risk of preterm labour, prophylactic vaginal natural progesterone, 200 mg daily from 22 – 34 weeks gestation, compared to placebo, improves obstetric outcome by lengthening pregnancy thus reducing the incidence of preterm delivery (before 34 weeks), improves neonatal outcome by reducing a composite of death and major morbidity, and leads to improved childhood cognitive and neurosensory outcomes at two years of age. Recruitment began in 2009 and is scheduled to close in Spring 2013. As of May 2012, over 800 women had been randomized in 60 sites. Discussion OPPTIMUM will provide further evidence on the effectiveness of vaginal progesterone for prevention of preterm birth and improvement of neonatal outcomes in selected groups of women with singleton pregnancy at high risk of preterm birth. Additionally it will determine whether any reduction in the incidence of preterm birth is accompanied by improved childhood outcome

Evaluation of the Arabin cervical pessary for prevention of preterm birth in women with a twin pregnancy and short cervix (STOPPIT-2):An open-label randomised trial and updated meta-analysis

BackgroundPreterm-labour-associated preterm birth is a common cause of perinatal mortality and morbidity in twin pregnancy. We aimed to test the hypothesis that the Arabin pessary would reduce preterm-labour-associated preterm birth by 40% or greater in women with a twin pregnancy and a short cervix.Methods and findingsWe conducted an open-label randomised controlled trial in 57 hospital antenatal clinics in the UK and Europe. From 1 April 2015 to 14 February 2019, 2,228 women with a twin pregnancy underwent cervical length screening between 18 weeks 0 days and 20 weeks 6 days of gestation. In total, 503 women with cervical length ≤ 35 mm were randomly assigned to pessary in addition to standard care (n = 250, mean age 32.4 years, mean cervical length 29 mm, with pessary inserted in 230 women [92.0%]) or standard care alone (n = 253, mean age 32.7 years, mean cervical length 30 mm). The pessary was inserted before 21 completed weeks of gestation and removed at between 35 and 36 weeks or before birth if earlier. The primary obstetric outcome, spontaneous onset of labour and birth before 34 weeks 0 days of gestation, was present in 46/250 (18.4%) in the pessary group compared to 52/253 (20.6%) following standard care alone (adjusted odds ratio [aOR] 0.87 [95% CI 0.55-1.38], p = 0.54). The primary neonatal outcome-a composite of any of stillbirth, neonatal death, periventricular leukomalacia, early respiratory morbidity, intraventricular haemorrhage, necrotising enterocolitis, or proven sepsis, from birth to 28 days after the expected date of delivery-was present in 67/500 infants (13.4%) in the pessary group compared to 76/506 (15.0%) following standard care alone (aOR 0.86 [95% CI 0.54-1.36], p = 0.50). The positive and negative likelihood ratios of a short cervix (≤35 mm) to predict preterm birth before 34 weeks were 2.14 and 0.83, respectively. A meta-analysis of data from existing publications (4 studies, 313 women) and from STOPPIT-2 indicated that a cervical pessary does not reduce preterm birth before 34 weeks in women with a short cervix (risk ratio 0.74 [95% CI 0.50-1.11], p = 0.15). No women died in either arm of the study; 4.4% of babies in the Arabin pessary group and 5.5% of babies in the standard treatment group died in utero or in the neonatal period (p = 0.53). Study limitations include lack of power to exclude a smaller than 40% reduction in preterm labour associated preterm birth, and to be conclusive about subgroup analyses.ConclusionsThese results led us to reject our hypothesis that the Arabin pessary would reduce the risk of the primary outcome by 40%. Smaller treatment effects cannot be ruled out.Trial registrationISRCTN Registry ISRCTN 02235181. ClinicalTrials.gov NCT02235181