Team-Based Learning for Immunology Courses in Allied Health Programs

Immunology is now a major component of studies in human biology, with many diseases having immune system involvement. Because so many areas of study include aspects of immunological knowledge, how to teach and incorporate immunology must be evaluated and assessed at all levels of education including K-12, undergraduate, graduate, medical, and professional programs. Traditional teaching methods such as lecture have significant shortcomings which make them less appealing to students today who are more digitally inclined and demand more active and engaging learning environments. Herein, we describe and propose the use of the active learning model of Team-Based Learning (TBL) to incorporate immunology into medical and professional programs. TBL is defined as an evidence based collaborative learning strategy taught in a three-step cycle: pre-class preparation, in-class readiness assurance testing (RAT), and application-focused exercises. In TBL, students are assigned to 6-7 member teams. Students complete the in-class RAT individually followed by taking the RAT as a team (T-RAT). Following the RAT and T-RAT, the instructor can then provide immediate feedback on concepts that proved especially difficult. The remainder of class time is then spent with teams working case studies and applications relative to the instructional topic or disease. Teams decide the best outcome or answer for a given application and report their answers simultaneously in class, followed by a discussion facilitated by the instructor. Research indicates that students involved in active learning classes, such as those using TBL have significantly increased levels of student engagement and high performance on examinations. This review will highlight how to implement TBL into a professional program (medical, dental, nursing, or pharmacy), how to assess student performance and provide real world examples of case studies and applications.

Colloidal Drug Aggregate Stability in High Serum Conditions and Pharmacokinetic Consequence

Colloidal drug aggregates have been a nuisance in drug screening, yet, because they inherently comprise drug-rich particles, they may be useful in vivo if issues of stability can be addressed. As the first step toward answering this question, we optimized colloidal drug aggregate formulations using a fluorescence-based assay to study fulvestrant colloidal formation and stability in high (90%) serum conditions in vitro. We show, for the first time, that the critical aggregation concentration of fulvestrant depends on media composition and increases with serum concentration. Excipients, such as polysorbate 80, stabilize fulvestrant colloids in 90% serum in vitro for over 48 h. Using fulvestrant and an investigational pro-drug, pentyloxycarbonyl-( p-aminobenzyl) doxazolidinylcarbamate (PPD), as proof-of-concept colloidal formulations, we demonstrate that the in vivo plasma half-life for stabilized colloids is greater than their respective monomeric forms. These studies demonstrate the potential of turning the nuisance of colloidal drug aggregation into an opportunity for drug-rich formulations.

Ceftolozane/Tazobactam

Objective: To review the chemistry, pharmacology, microbiology, pharmacokinetics, pharmacodynamics, clinical efficacy, tolerability, dosage, and administration of ceftolozane/tazobactam, a new antipseudomonal cephalosporin combined with a well-established β-lactamase inhibitor. Data Sources: A literature search through clinicaltrials.gov and PubMed was conducted (January 2007-May 2015) using the search terms ceftolozane, ceftolozane/tazobactam, FR264205, CXA-101/tazobactam, and CXA-201. References from retrieved articles and abstracts presented at recent meetings were reviewed to identify additional material. The prescribing information was also reviewed. Study Selection and Data Extraction: Preclinical data as well as phase 1, 2, and 3 studies published in English were evaluated. Data Synthesis: Ceftolozane/tazobactam displays enhanced potency against Pseudomonas aeruginosa in vitro. Clinical trials have shown that ceftolozane/tazobactam is noninferior to levofloxacin for the treatment of complicated urinary tract infections (76.9% vs 68.4%, 95% CI = 2.3-14.6) and when used in combination with metronidazole is noninferior to meropenem for the treatment of complicated intra-abdominal infections (83% vs 87.3%, 95% CI = −8.91 to 0.54). An alternate antibiotic should be considered in patients who have a severe β-lactam allergy or an estimated creatinine clearance between 30 and 50 mL/min. Ceftolozane/tazobactam is well tolerated, with few drug interactions and no effects on the cytochrome P450 system. Conclusions: In an era of increasing resistance to antimicrobials, ceftolozane/tazobactam provides clinicians with an additional treatment option for infections caused by multidrug-resistant Gram-negative organisms, including extended-spectrum β-lactamase–producing bacteria and Pseudomonas aeruginosa.

Evaluation of the epidoxorubicin--formaldehyde conjugate, epidoxoform, in a mouse mammary carcinoma model

This study was conducted to evaluate the toxicity and efficacy of Epidoxoform, a prodrug of the active metabolite of epidoxorubicin, in a mouse model of mammary carcinoma. A dose escalation trial established a maximal tolerated dose of 20 mg/kg given intraperitoneally (i.p.) to 6-8 week old female C3 HeJ mice. Two days following injection of 10(6) Gollin-B mouse mammary tumor cells into the mammary fat pad, Epidoxoform was given and tumor growth compared to mice treated similarly with the maximum tolerated dose of epidoxorubicin and untreated controls. In all efficacy trials, a significant difference was found for tumor volume between Epidoxoform and epidoxorubicin treated mice and controls. In mice treated with a two-dose regimen, significantly increased efficacy was also found between Epidoxoform compared to epidoxorubicin. Epidoxoform appears to be efficacious in this model of mammary carcinoma, with improved efficacy over the parent compound epidoxorubicin. Further evaluation of this analogue appears warranted.

Relationship between smoking, dietary intakes and plasma levels of vitamin E and beta-carotene in matched maternal-cord pairs

The concentrations of tocopherols and carotenoids are lowered in umbilical cord blood plasma, which may have a negative effect on antioxidant protection in neonates. Smoking may adversely affect dietary intakes and plasma concentrations of carotenoids. The dietary intakes of vitamin E and beta-carotene were assessed in 66 pregnant women (31 smokers and 35 non-smokers) between 10 and 20 weeks gestation using a food frequency questionnaire. The concentrations of alpha-tocopherol and beta-carotene were measured in maternal plasma at the time of the dietary assessment, and in the matched umbilical cords of their newborn after delivery. In smoking and non-smoking mothers, the mean intakes of vitamin E (9.3 [SD 5] and 8.2 [SD 5] mgd-1) and beta-carotene (3464 [SD 1885] and 2977 [SD 1503] micrograms d-1) were not significantly different. The plasma concentrations of alpha-tocopherol (20.8 [SD 4] and 20.5 [SD 4] mumol L-1), the alpha-tocopherol to lipid ratios (3.2 [SD 0.8] and 3.5 [SD 0.8]) and the plasma concentrations of beta-carotene (0.22 [SD 0.1] and 0.22 [SD 0.1] mumol L-1) were not significantly different in smoking and non-smoking mothers. There were no significant differences in plasma alpha-tocopherol (7.4 [SD 2] and 7.3 [SD 2] mumol L-1), in alpha-tocopherol to lipid ratios (3.2 [SD 0.6] and 2.8 [SD 0.6]) or in beta-carotene concentrations (0.05 [SD 0.04] and 0.03 [SD 0.02] mumol L-1) in cords from newborns of smoking and non-smoking mothers. There was a significant correlation (r = 0.41, P = 0.015) between dietary intakes and plasma concentrations of beta-carotene in non-smoking mothers. However, this relationship was not significant in smoking mothers (r = 0.28, P = 0.12). There were no relationships between dietary intakes and plasma concentrations of tocopherol. These results indicate that smoking during pregnancy does not appear to affect the dietary intakes or plasma concentrations of alpha-tocopherol and beta-carotene in pregnant women or their babies. However, smoking does influence the relationship between dietary intakes and plasma levels of beta-carotene.

Delayed onset of post-rabies vaccination encephalitis

A 31-year-old veterinarian developed seizures, left hemiparesis, loss of memory, and behavioral disorders 5 months after intensive antirabies vaccination, the longest incubation period yet recorded. Computed tomographic scan revealed a right frontal contrastenhanced mass that extended to the left frontal lobe through the corpus callosum. Brain biopsy showed foci of primary demyelination largely confined to the white matter. The lesions were characteristic of the demyelinating encephalomyelitis that follows treatment with certain vaccines against rabies. The hemiplegia improved, but seizures, memory impairment, and abnormal behavior persisted.