University Of Colorado-Denver Research Articles

Tracking of single microvilli to study regulation of the intestinal phosphate transporters

Intestinal phosphate (Pi) uptake is a key mechanism in systemic Pi homeostasis. Modulation of intestinal Pi transport has been recently recognized as an important target in prevention of hyperphosphatemia and the associated cardiovascular complications in Chronic Kidney Disease. Intestinal Pi absorption is mainly mediated by the sodium‐phosphate co‐transporter NaPi2b expressed in the intestinal apical microvilli. Recent evidences show that agonists of the LXR nuclear hormone receptor inhibit intestinal NaPi transport activity, however, the detailed mechanisms of how LXR decreases intestinal NaPi transport activity, including the role of changes in membrane cholesterol or PDZ interacting proteins, remain to be determined.We study these processes at the molecular level applying the Modulation Tracking nanoimaging method to microvilli of live cells expressing fluorescently tagged NaPi2b. Tracking single microvilli we measure their motion, image NaPi2b distribution on the membrane and perform Fluorescence Correlation Spectroscopy techniques (RICS, N&B) in steady state, even if the microvilli are moving. Motility of the microvilli, protein diffusion and clustering, are monitored under stimulation to get insights into the process of intestinal transporters regulation.Work supported in part by NIH R01 DK066029‐01A2 (ML, EG and LL), NIH‐P41‐RR03155 (EG and LL) and P50‐GM076516 (EG, MD and LL).

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Asthma Control And Disordered Microbial Communities In The Lower Airways Of Patients With Poorly Controlled Asthma

S U N D A Y 486 Asthma Control And Disordered Microbial Communities In The Lower Airways Of Patients With Poorly Controlled Asthma E. Goleva, J. K. Harris, R. J. Martin, A. Dakhama, R. Alam, E. W. Gelfand, D. Y. M. Leung; National Jewish Health, Denver, CO, University of Colorado Denver, Denver, CO. RATIONALE: the role of lower airway bacterial communities in asthma is poorly understood. METHODS: BAL samples were obtained from 23 adults with chronic asthma (FEV1 73.6613.1%, PC20 1.462.3 mg/ml) and 20 normal control subjects. Bacterial DNA was extracted using Qiagen EZ1 system and sequenced using 454 FLX chemistry. Taxonomic identification was performed with RDP classifier and BLAST. Asthma control was measured by asthma control questionnaires (ACQ). RESULTS: Based on microbiome data, asthmatics were subdivided into three groups: group A with commensal flora only (n56); group B with expansions (>10% of 16s RNA sequences) in organisms also seen in normal controls (n59); group C with expansions (>10%) of unique organisms not seen in the normal microbiome (n58) (Comamonas testosteroni (n51), Simonsiella muelleri (n51), Asticcacaulis (n54), Streptococcus pseudopneumoniae (n52)). A progressive reduction in the number of sequences for Genera Prevotella (Rsq50.65, p<0.0001) and Veillonella (Rsq50.53, p50.0006), considered to be major airway commensal flora, was observed in groups B and C. The lowest number of commensal sequences was observed in group C. There was progressively lower asthma control from groups A to C (ACQ test score 0.8660.28, 1.6360.23, 2.0260.24, for groups A-C, respectively, p50.0175, ANOVA). Alpha diversity metrics significantly increased for bacterial diversity/richness from groups A to C (Sequences(observed) p50.0011, ANOVA; richness(Ho) p50.0017, ANOVA). CONCLUSIONS: Expansion of selected groups of bacteria in the lower airways of asthmatics was associated with reduced numbers of commensal flora organisms and increased richness/bacterial diversity. The loss of asthma control was the greatest with expansion of unique organisms.

Review of American Indian Veteran Telemental Health

Rural American Indian veterans have unique healthcare needs and face numerous barriers to accessing healthcare services. Over the past decade, the Department of Veterans Affairs in conjunction with the University of Colorado Denver has turned to the promising field of telemental health to develop a series of videoconferencing-based clinics to reach this vulnerable population and improve mental healthcare services. The ongoing development, implementation, and expansion of these clinics have been assessed as part of a program improvement. The outcomes of these assessments have been documented in a series of published articles, controlled studies, program and case reports, and model descriptions. This article summarizes a decade of experience with the American Indian Telemental Health Clinics, the clinic model, and the literature arising from these clinics and presents lessons learned while establishing, maintaining, and evaluating these clinics. The ability to tailor the clinics to individual sites and cultures and to provide various services has been critical to the operation of the clinics. Culturally specific care through culturally knowledgeable providers, onsite tribal outreach workers, and collaboration with community services has proven essential in operating the clinics, as well as building rapport, trust, and engagement with the target patient population. It is hoped that the lessons learned and practices presented here can not only assist others working to improve the care for rural Native veterans but also serve as a model in the use of telemental health services for improving care and access to rural veteran and non-veteran populations.

Yo Soy Colorado: Three Collaborative Hispanic Cultural Heritage Initiatives

Collaborative activities that reflect ‘ethnicity as provenance’ benefit from collaborative, interdependent relationships among archives, classroom, and community. Examples from Center for Colorado &amp; the West at Auraria Library (University of Colorado Denver) and the Southern Colorado Ethnic Heritage and Diversity Archives and the Voices of Protest Oral History Project (Colorado State University-Pueblo) illustrate collection development practices that advance joint ownership of archival materials by the archives and the originating cultural population. Concluding reflections offer transferable principles for working collaboratively with cultural communities on creation, identification, interpretation, and preservation of photographs, videos, documents, oral histories and ephemeral material reflective of culture, achievements, conflict, and legacy.

The associations among coping, nadir CD4+ T-cell count, and non-HIV-related variables with health-related quality of life among an ambulatory HIV-positive patient population

We investigated HRQoL among HIV-positive outpatients from October, 2006-December, 2007, incorporating medical chart review, and a survey of coping styles. Consented HIV-positive patients receiving medical care at University of Colorado Denver, with HAART as first antiretroviral regimen, completed the MOS-HIV and Brief COPE survey instruments. Linear regression identified a priori factors hypothesized to be associated with the MOS-HIV composite mental and physical health scores (MHS, PHS). Brief COPE survey maladaptive and adaptive coping components were added to the models and retained if significant. Among the 157 patient cohort, parsimonious multivariable linear regression models (P < 0.05) indicated higher nadir CD4+ T-cell counts and adaptive coping were associated with a higher MHS; public/no insurance, mental illness, current number of non-HIV medications, and maladaptive coping were inversely associated with MHS. Nadir CD4+ T-cell count and efavirenz use were associated with a higher PHS; mental illness, current number of non-HIV mediations, and maladaptive coping were inversely associated with PHS. Factors independently associated with lower MHS and lower PHS include lower nadir CD4+ T-cell counts, and use of maladaptive coping. Efforts to reduce use of maladaptive coping strategies and earlier identification and treatment of HIV may improve HRQoL in HIV-positive patients.

Prevention of Overweight/Obesity as a Strategy to Optimize Cardiovascular Health

The prevalence of obesity in the United States and the world has risen to epidemic/pandemic proportions. This increase has occurred despite efforts by healthcare providers and consumers alike to improve the health-related behaviors of the population and a tremendous push from the scientific community to better understand the pathophysiology of obesity. This epidemic is all the more concerning given the clear association between excess adiposity and adverse health consequences such as cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). These risks associated with overweight/obesity are primarily related to the deposition of excess adiposity or body fatness. Weight loss, specifically loss of body fat, is associated with benefits in all of the obesity-related comorbidities, but, unfortunately, most weight loss interventions are associated with weight regain and are therefore not successful in the long term. It is for these reasons that efforts to prevent weight gain and overweight/obesity are necessary. This is especially important when one considers younger individuals, who have even more to lose as a consequence of a longer duration of excess adiposity. After a brief review of the epidemiology of obesity, this statement will make the case for the importance of weight gain prevention. This argument will first include a review of the complications of overweight and obesity in both adults and children, including the future CVD risks of obesity in early life. Energy balance dysregulation and adaptations to the weight-reduced state, favoring weight regain, will then be reviewed as further argument for the need for obesity prevention. This will be followed by a discussion on the goals and strategies for accomplishing the difficult task of the prevention of weight gain and obesity. ### Classification of Overweight and Obesity The body mass index (BMI) is the most widely used and accepted method for the assessment and classification of excess adiposity or body fatness. Overweight …

A Quarter Century of the Advocacy Coalition Framework: An Introduction to the Special Issue

A Quarter Century of the Advocacy Coalition Framework : An Introduction to the Special Issue

Weaving the native web: using social network analysis to demonstrate the value of a minority career development program.

American Indian and Alaska Native scientists are consistently among the most underrepresented minority groups in health research. The authors used social network analysis (SNA) to evaluate the Native Investigator Development Program (NIDP), a career development program for junior Native researchers established as a collaboration between the University of Washington and the University of Colorado Denver. The study focused on 29 trainees and mentors who participated in the NIDP. Data were collected on manuscripts and grant proposals produced by participants from 1998 to 2007. Information on authorship of manuscripts and collaborations on grant applications was used to conduct social network analyses with three measures of centrality and one measure of network reach. Both visual and quantitative analyses were performed. Participants in the NIDP collaborated on 106 manuscripts and 83 grant applications. Although three highly connected individuals, with critical and central roles in the program, accounted for much of the richness of the network, both current core faculty and "graduates" of the program were heavily involved in collaborations on manuscripts and grants. This study's innovative application of SNA demonstrates that collaborative relationships can be an important outcome of career development programs for minority investigators and that an analysis of these relationships can provide a more complete assessment of the value of such programs.

Non‐palpable splenic enlargement as the Etiology of abdominal pain in an adolescent with Hemoglobin SC Disease

To the Editor: Hemoglobin SC disease (HbSC) has an incidence of approximately 1:833 live births in African-Americans 1. HbSC patients retain splenic function longer than HbSS patients resulting in an increased risk of splenic sequestration crisis and infarctions in older patients 2, 3. Herein, we report a unique presentation of remarkable splenomegaly in which the spleen enlarged in an anterior to posterior plane without evidence of splenic sequestration in an adolescent female with HbSC disease. An 11-year-old female was diagnosed with HbSC disease at birth via newborn screening. The past medical history was pertinent for a single episode of acute chest syndrome at 5 years of age and an episode of splenic sequestration 5 years later after returning from 3 months at sea level to an elevation of approximately 5,280 feet (1,609 m). Laboratory values of note included: a hemoglobin of 9.7 g/dl (baseline ≥10.9 g/dl), platelet count of 116,000/µl (baseline ≥166,000), and WBC 8.4 × 103/µl. Her spleen became non-palpable, and her laboratories returned to baseline in 2–3 months. Over the next 10 months, she complained of intermittent left upper quadrant abdominal pain necessitating admissions for acute pain control three times. However, there were not significant laboratory changes: her hemoglobin remained at 10.9–12.8 g/dl with a normal absolute neutrophil counts (2,340–5,378/µl) and platelet counts 166,000–594,000/µl. No palpable splenomegaly was noted on numerous abdominal examinations. On the fourth admission for abdominal pain with concomitant mild dyspnea, an abdominal CT scan was performed. An enlarged spleen was detected measuring 13 cm × 15 cm with mass effect on the stomach and left kidney, which did not extend below the left costal margin without evidence of splenic infarction (Fig. 1). CT imaging of the abdomen. A: Contrast-enhanced axial abdominal CT images show enlargement of the spleen more in the anterior–posterior relative to the cranial–caudal dimension and significant mass the effect on the left kidney by the enlarged spleen (arrow). B: Contrast-enhanced coronal reformatted abdominal CT images show enlargement of the spleen more in the anterior–posterior relative to the cranial–caudal dimension with a significant mass effect on the left kidney (arrow). The patient underwent a laparoscopic splenectomy without complications. The spleen weighed 537 g (expected weight for sex and age is 87 g) without evidence of infarction on histological review. She was discharged in good clinical condition without recurrence of abdominal pain in the past 12 months. Splenomegaly in adolescence and into adulthood is seen in more than 50% of individuals with HbSC disease; however, only 6% of HbSC patients develop splenic complications, including sequestration 2, 3. Of note, splenomegaly often portends this complication in patients with HbSC, for 46% of HbSC patients with splenic sequestration crisis had splenomegaly noted prior to the onset of symptoms with an average interval from detection of splenomegaly to sequestration of 3.6 years 3. This unique presentation of moderate abdominal pain, requiring hospital admission times four and complicated by mild dyspnea on the last admission, warranted imaging which demonstrated significant, non-palpable splenomegaly. Her abdominal pain resolved with splenectomy which revealed substantial splenic enlargement at five times the normal splenic weight for age. This case serves as a reminder that persistent abdominal pain in patient with HbSC should be evaluated thoroughly, as this unrecognized splenomegaly could have led to further complications. Lindsey Micel MD*, Rachelle Nuss MD* , Laura Fenton MD , Mark Lovell MD§, Christopher C Silliman MD, PhD christoper.silliman@ucdenver.edu* ¶, * The Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, Sickle Cell Treatment and Research Center, School of Medicine, University of Colorado Denver, Aurora, Colorado, The Departments of Radiology, The Children's Hospital Aurora, Colorado, § The Departments of Pathology, The Children's Hospital Aurora, Colorado, ¶ Research Department, Bonfils Blood Center, Denver, Colorado

Erratum to: Genetic analysis of Down syndrome-associated heart defects in mice

The online version of the original article can be found underdoi:10.1007/s00439-011-0980-2.C. Liu T. Yu S.-I. Matsui L. Zhang D. Fu A. Pao J. K. Cowell N. J. Nowak Y. E. Yu (&)Children’s Guild Foundation Down Syndrome ResearchProgram, Department of Cancer Genetics, Roswell ParkCancer Institute, Elm & Carlton Streets, Buffalo,NY 14263, USAe-mail: yuejin.yu@roswellpark.orgM. MorishimaDepartment of Anatomy and Developmental Biology,Department of Pediatric Cardiology,Tokyo Women’s Medical University, Tokyo, JapanA. C. CostaDivision of Clinical Pharmacology and Toxicology,Department of Medicine, University of ColoradoSchool of Medicine, Aurora, CO 80045, USAK. J. GardinerDepartment of Pediatrics, Intellectual and DevelopmentalDisability Research Center, Human Medical Geneticsand Neuroscience Programs, University of Colorado Denver,Aurora, CO 80045, USAJ. K. CowellMCG Cancer Center, School of Medicine,Medical College of Georgia, Augusta, GA 30912, USAN. J. Nowak Y. E. YuNew York State Center of Excellence in Bioinformaticsand Life Sciences, Buffalo, NY 14263, USAN. J. Nowak Y. E. YuDepartment of Cellular and Molecular Biology,Roswell Park Division of Graduate School, State Universityof New York at Buffalo, Buffalo, NY 14263, USAM. S. ParmacekUniversity of Pennsylvania Cardiovascular Institute,Philadelphia, PA 19104, USAP. LiangDepartment of Biological Sciences,Brock University, St. Catharines, ON L2S 3A1, CanadaA. BaldiniInstitute of Biosciences and Technologies,Texas A&M University, Houston, TX 77843, USAA. BaldiniInstitute of Genetics and Biophysics,National Research Council, 80131 Naples, Italy

1909 URINE PCA3 TESTING FOR THE EARLY DETECTION OF PROSTATE CANCER. FEASIBILITY, TEST PERFORMANCE, AND AGE AND RACE ASSOCIATIONS COMPARED TO SERUM PSA IN A MULTI-ETHNIC POPULATION OVER FOUR YEARS

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 20111909 URINE PCA3 TESTING FOR THE EARLY DETECTION OF PROSTATE CANCER. FEASIBILITY, TEST PERFORMANCE, AND AGE AND RACE ASSOCIATIONS COMPARED TO SERUM PSA IN A MULTI-ETHNIC POPULATION OVER FOUR YEARS Kathleen Torkko, Adrie van Bokhoven, Paul Maroni, Scott Lucia, Suzanne McCartney, Holly Sullivan, John Fulmer, Scott Shappell, and David Crawford Kathleen TorkkoKathleen Torkko Aurora, CO More articles by this author , Adrie van BokhovenAdrie van Bokhoven Aurora, CO More articles by this author , Paul MaroniPaul Maroni Aurora, CO More articles by this author , Scott LuciaScott Lucia Aurora, CO More articles by this author , Suzanne McCartneySuzanne McCartney Aurora, CO More articles by this author , Holly SullivanHolly Sullivan Aurora, CO More articles by this author , John FulmerJohn Fulmer Dallas, TX More articles by this author , Scott ShappellScott Shappell Dallas, TX More articles by this author , and David CrawfordDavid Crawford Aurora, CO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2047AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Serum PSA has inadequate sensitivity and specificity for prostate carcinoma(CaP) detected on biopsy. PCA3 is a prostate specific gene that is up-regulated in CaP. PCA3 urine mRNA test is a new diagnostic tool with much higher specificity for CaP than PSA that is increasingly used to determine the need for repeat biopsy. Its feasibility and performance have not been evaluated in a true screening setting. METHODS We evaluated PCA3 testing using the community-based Prostate Cancer Awareness Week screening population at the University of Colorado Denver over a four year period (2006–09). PCA3 Scores (PCA3/PSA mRNA x103) were determined from first catch urine collected after DRE by a varied group of clinicians. RESULTS Of 971 participants over 4 years, 72.9% were Caucasian (C), 16.3% African American (AA), and 8.3% Hispanic (H). C men tended to be older (mean 63.5 years) than AA (58.8) or H (58.4) men. PCA3 test informative rates were >96% in each year. In this screening population, PSA values ranged from <0.01–203.8 and PCA3 ranged from 0.3–316.2. Using the most recent test results, median PSA was 0.9, 0.9, and 0.6 ng/ml and median PCA3 score was 9.7, 14.6, 7.8 for C, AA, and H men, respectively. With test cutoffs of ≥2.5 ng/ml for PSA and ≥35 for PCA3, percent PSA+ men was 23.4% for C vs. 19.1% for AA, and 18.5% for H men. In contrast, despite younger age for AA vs. C men, the percent PCA3+ men was 35.7% in AA vs. 21.8% C men. Only 10% of H men were PCA3+. The proportions of PSA-/PCA3+ men was higher in AA (24.4%) compared to C (12.5%) and H (6.3%). PCA3 values in these men ranged from 35.3 to 316.2 (median 59.9). CONCLUSIONS The PCA3 assay can be successfully performed in a busy screening setting. The excellent informative rate for the test on the currently available transcription mediated amplification platform (Gen-Probe, Inc., San Diego, CA) shows the robustness of this test after screening DRE. The predictive performance for CaP on bx, including of PSA and PCA3 as continuous variables, remains to be further established. Given the high proportion of men in the Prostate Cancer Prevention Trial who had normal PSA values but had cancer on the end-of-study bx, positive PCA3 tests in men with normal PSAs may be useful to increase specificity of PSA testing, and to detect clinically significant CaP in these patients. As AA men are at highest risk for CaP and have more aggressive CaP, the consistent observation of a higher proportion of AA men with normal serum PSA and positive PCA3 score may help improve early detection in AA men. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e763 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kathleen Torkko Aurora, CO More articles by this author Adrie van Bokhoven Aurora, CO More articles by this author Paul Maroni Aurora, CO More articles by this author Scott Lucia Aurora, CO More articles by this author Suzanne McCartney Aurora, CO More articles by this author Holly Sullivan Aurora, CO More articles by this author John Fulmer Dallas, TX More articles by this author Scott Shappell Dallas, TX More articles by this author David Crawford Aurora, CO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Toll-like Receptor Signaling during Myocardial Ischemia

Acute myocardial infarction and myocardial ischemia are leading causes of short- and long-term morbidity and mortality in the perioperative period. In part, this relates to the fact that treatment options for a myocardial infarction in surgical patients are extremely limited. For example, anti-coagulation or treatment with highly effective inhibitors of platelet aggregation may not be an option due to the risk for bleeding from the operative site. Therefore, it is not surprising that the search for new pharmacologic approaches to treat myocardial ischemia or to render the myocardium more resistant to limited oxygen availability is an area of intense investigation for perioperative scientists.1-4 In fact, the introduction of intraoperative beta-blockers for cardio-protection from ischemia was one of the most significant alterations in anesthesia practice during the past fifteen years. In line with the search for novel therapeutic approaches to render the myocardium more resistant to ischemia, a very exciting research study by Wang et al. from the research laboratory of Dr. Wei Chao from the Anesthesia Center for Critical Care Research of the Massachusetts General Hospital in Boston provides new insight into signaling pathways involving toll-like receptor (TLR)-elicited cardio-protection from ischemia.1

Reverse Remodeling With Left Ventricular Assist Devices

Over the last 2 decades, numerous advancements in medical therapies have improved patient outcomes in heart failure (HF). However, a significant number of patients still progress to end-stage HF, in which treatment options are largely limited to cardiac transplantation. As patient demands for transplant continue to exceed the supply of available organs, mechanical assist devices—specifically, the left ventricular assist device (LVAD)—were initially introduced as a bridge to cardiac transplantation. LVADs have 2 important beneficial effects. First, LVADs are placed in parallel to the native left ventricle (LV), causing pressure and volume unloading of the LV. Second, LVADs restore cardiac output and subsequent perfusion to the organs. As a result of these 2 effects, it became evident that some patients had actual improvement in LV function after LVAD placement. The term reverse remodeling was used to describe the improvement in myocardial function that was observed in patients with a seemingly end-stage disease. With reverse remodeling, a new hope for the treatment of HF was born—using LVADs as a bridge to recovery; however, to date, this promise has largely been unrealized. This probably is reflective of the fact that the sequela of mechanical ventricular unloading are quite complex and appear to involve the engagement of competing biological pathways including regression of cardiomyocyte hypertrophy as well as progressive cell atrophy. Although the promise of ventricular recovery still persists, its actualization will await a more comprehensive dissection of these competing biological processes. This review will discuss the beneficial clinical effects of LVAD support as well as review what is known about the cellular and molecular response to mechanical unloading and mechanisms of reverse remodeling. Key research findings have been summarized in the Table. View this table: Table. Summary of Research of LVAD Support on Clinical Effects and the Cellular and Molecular Changes That May Contribute to Reverse …

Data-Driven Management Strategies in Public Health Collaboratives

School of Public Affairs, University of Colorado, Denver,. Correspondence: Danielle M. Varda, PhD, School of Public Affairs, University of Colorado Denver, 1380 Lawrence Street, Suite 500, Denver, CO 80204 ([email protected]). This research was supported by a mini grant from Assuring the Future of Public Health Systems & Services Research, a program of the University of Kentucky Center for Public Health Systems and Services Research, funded by the Robert Wood Johnson Foundation.

Targeting Hypoxia-induced Inflammation

In the current issue of Anesthesiology, a paper by Kim et al. from the research laboratory of Dr. H. Thomas Lee investigates strategies to dampen ischemia-driven inflammation of the kidneys and subsequent multi-organ failure utilizing experimental models of acute kidney injury (AKI).1 In fact, one of the leading causes of morbidity and mortality in surgical patients is perioperative organ failure, such as occurs in the context of acute kidney injury, liver failure, intestinal or myocardial ischemia, stroke or acute lung injury. A common feature of these perioperative diseases is the presence of hypoxia-induced inflammation.2,3 The relationship between hypoxia and inflammation under these conditions is inter-dependent. For example, exposure to ambient hypoxia - as seen during high-altitude mountaineering - is associated with edema of the lungs or the brain, and systemic inflammatory responses in humans.4,5 Similarly, acute exposure of mice to ambient hypoxia (e.g. 8% of oxygen over 4–8h) leads to increased inflammatory cytokine levels and pulmonary edema.6 Moreover, prolonged donor organ exposure to ischemia during organ transplantation is known to enhance graft inflammation and early graft failure.7,8 For example, the endotoxin-receptor TLR4 is expressed in the donor kidney during kidney transplantation, and TLR4 expression levels increase with prolonged ischemia time. Donor kidneys with a loss-of-function mutation of the TLR4 receptor show attenuated kidney inflammation, and an increased rate of immediate graft function.7 Together, these studies indicate that hypoxia represents an inflammatory stimulus (Figure 1) and suggest that targeting hypoxia-elicited inflammation could represent an important therapeutic approach in perioperative medicine.

Researchers discover a way to simultaneously desalinate water, produce hydrogen and treat wastewater

Humans are constantly hunting for a sustainable supply of both fresh water and reusable energy. Water purification requires a lot of energy, while utility companies need large amounts of water for energy production. Their goal is to find a low-energy-required treatment technology. Researchers at the University of Colorado Denver, College of Engineering and Applied Science, say that they may have discovered the answer.

Evaluating the incorporation of technology and application projects in the higher education mathematics classroom

We report the qualitative and quantitative results of incorporating interdisciplinary application projects and increasing the use of teaching with technology into Calculus I, II and III at the University of Colorado Denver. Minimal changes were made to the curriculum and minimal time was required of instructors to make the changes. Instructors were given one 3-hour introduction to teaching with technology, a 3-hour introduction to one or two interdisciplinary problems to be used in the class, and course instructors met with each other no more than 1 hour per week. To evaluate the effectiveness of these modifications, 24 students were interviewed four times during a 2 year time span, student comments from student evaluations regarding the application projects were recorded, and the grade-point averages (GPAs) of four groups of 40 students for the year following their completion of Calculus III were analysed. The results show that students' enthusiasm and interest in interdisciplinary application projects were greater when the projects were enthusiastically endorsed by the instructor, but even with mixed instructor enthusiasm, incorporating application projects and increasing the use of technology in the classroom increase the well-roundedness of students' education and increase their performance in more advanced courses as measured by their overall GPA for the year following their Calculus III math class.

Asphalt to Ecosystems: Design Ideas for Schoolyard Transformation

437 Children, Youth and Environments Vol. 21 No. 2 (Winter 2011) ISSN: 1546-2250 Asphalt to Ecosystems: Design Ideas for Schoolyard Transformation Danks, Sharon (2010). Oakland, CA: New Village Press; 288 pages. $39.95. ISBN 0976605481. “At the heart of the ecological schooyard philosophy is the concept of raising children to become land stewards” (243). Sharon Danks has given us brilliantly illustrated examples of this philosophy in action in schoolyards around the world in her stunning book, Asphalt to Ecosystems. I cannot remember any book that has made me long so much to return to age seven, to magically enter a book’s photographs and to try out the many natural, creative play and learning spaces that Danks documents. Her professional knowledge as an environmental planner working with school communities to design and build naturalized play and educational spaces makes this work a true tool for anyone wishing to inspire local schools to become places where school grounds reflect a living sustainability ethic. Danks opens with the reasons that schoolyards need to be places for creative engagement with the natural world for children and youth of all ages. Whether they are toddlers smelling the lavender, elementary aged children growing a vegetable garden to enhance their snack and lunch time, or teens creating a natural woodlands and wetlands for their high school science and art classes, these activities educate and engage children in caring for nature while they play and learn. We did not evolve with asphalt but with biological diversity, and nature is our natural habitat. The many colorful photos on every page reflect the ways various countries embody their own perceptions of nature and how children can interact with it. The Scandinavian countries do not have the litigious society of North America, and therefore their schoolyards include small forests, streams, and waterfalls where children can climb trees and make little dams. Child-made public art glows with life in many North American and British school yards where children 438 collaborate with local artists to tile benches, paint murals and weave willows into fences and arches for their school gardens. In Japan, mini rice paddies with traditional bridges grace elementary schoolyards. Cultural identity finds expression in art and garden traditions in each country represented. Danks not only addresses schoolyards, but also energy and design issues in school buildings: adequate natural light, renewable energy, water conservation and even design for water purification and reuse . Children in such environments learn a whole-system understanding of healthy ecosystems. This book will inspire children, teachers, parents, architects and landscape architects to brainstorm what they want for their schools. Danks emphasizes the importance of participatory planning processes to support long-term stewardship—and wisely uses the word stewardship, rather than maintenance, for the approach to caring for these beautiful sites once they exist. The only piece missing from this useful book is how to create school policy supporting sustainability education in states or provinces that lack a philosophy integrating outdoor learning, buildings and landscape design with curricular and health goals. Perhaps Delaine Eastin, California’s Director of Education, in successfully passing legislation requiring and funding school gardens, would write a “How to Create Sustainability Policies for Schools” guide. Asphalt to Ecosystems belongs on every school superintendent’s and every state board of education director’s desk so that all children can have the chance to experience learning and playing in dynamic, living environments that inspire them to life-long stewardship. Reviewer Information Pevec Illène Illène Pevec has been working with all ages of young people in Canada, the U.S. and Brazil to develop gardens since 1998. Her research into how gardening impacts young people has been concurrent. She recently completed her doctoral degree at the University of Colorado Denver with research into adolescent' gardeners' experiences. ...

Medical Student Education: Time for a Radical Change

Dr Lindeque is from the Department of Orthopedics, University of Colorado-Denver, Aurora, Colorado. Dr Lindeque has no relevant fi nancial relationships to disclose. Correspondence should be addressed to: Bennie G.P. Lindeque, MD, Department of Orthopedics, Mail Stop F722, University of Colorado-Denver, 1635 N Aurora Ct, Aurora, CO 80045 (bennie.lindeque@ucdenver.edu). doi: 10.3928/01477447-20100924-01 I have had the opportunity to train medical students, fellows, residents, and attending physicians for 25 years. I have been exposed to and have worked with these groups on more than one continent, experiencing fi rsthand the good, the bad, and the ugly regarding medical student education. In the United States, we believe it is better to have medical students obtain a college degree fi rst so they mature and grow up in an academic world, gaining cognitive, academic, and emotional skills. We believe it will provide those who plan to attend medical school with the necessary skills to become a wellrounded physician. Let us look at the fi nancial cost of such a venture. Whether a student is privileged to receive bursaries or scholarships or whether their parents or some fi nancial institution pays for it, it does not really matter: the cost to society remains the same. What are the costs? In interviews with numerous medical students and residents over a long period, medical school costs are approximately $35,000 per year for a college degree, and by the end of medical school they are $250,000. No one, during residency, is able to signifi cantly reduce the capital debt that normally allows for living expenses. This signifi cant amount only accrues terrifying amounts of interest with big loans and the hefty task of paying back their loans at age 30 years or older (remember a fellowship also needs to be completed). Let us look at the merit of this unbelievably expensive education. Is there unequivocal proof that a medical student is too immature to start medical school directly after graduation from high school? The answer is no. Many European countries start medical students directly after high school. Most students complete a 5to 6-year medical school education and then enter a residency program. Asking medical students and residents their opinion, I have yet to meet one who thinks a 4-year college degree is essential. When asked about 4 years in medical school, they all agree that they waste time on a curriculum