years ago, I had a student who was in class on Tuesday and missed the test on Thursday. He said he wasn’t feeling well and went home to the doctor. I didn’t think too much of it until he gave me the excuse and the area code in the excuse was in Florida. I’m in Alabama. I did some digging and the clinic didn’t exist nor did a single one of the doctors listed on the excuse. It was paid for on the internet.

Kevin Patton (02:56):
The other story I have was a girl who was in my online class in 2019. We could tell she was cheating in multiple classes, but couldn’t nail down proof. She missed a test in my class and sent me a picture of a funeral program as an excuse. I didn’t think much of it and opened the test again. A month later, her other teacher commented about, ”Hey, is so-and-so at a funeral?’ And I said, ‘That was a month ago.’

Kevin Patton (03:33):
The girl voluntarily sent in the same funeral program with only a day change to that teacher. Same picture, same name, same real church on the front. We called the church. They didn’t have a funeral on either date. I think the thing that upset me the most in these cases is the lying when they wanted to go into medicine. The second one said, pharmacy school. I’ll be lenient and let you have a makeup extension, but don’t lie to me about it.”

Kevin Patton (04:16):
Those stories came from Heather and she then followed up with a second message. “On the second student with the funeral programs, we did take the student up for submitting false documents to the school. She was suspended for a semester. However, she had a bachelor’s degree from another large public university and this was her first semester at our school. She needed A&P for pharmacy school.

Kevin Patton (04:46):
If I were her, I would never mention that semester in future endeavors. She will never have to explain it and except for the loss of tuition, there’s not much punishment for her. I wonder how many times she did this at her large university and did not get caught. Only because of our small size did she get caught.”

Kevin Patton (05:12):
Well, thanks so much, Heather, for sharing your experiences with deadlines. And this is the dilemma for all of us, isn’t it? Striking that balance to between managing the integrity of our course and thereby maintaining its value to students in general against that other thing, which is the kindness of leniency, neither is insignificant.

Kevin Patton (05:39):
Neither is unimportant to student learning. Another factored away on this scale came up in some discussions we’ve been having at The A&P Professor Community, our online virtual community at theAPprofessor.org/community. That factor is what kind of deadline we’re looking at may result in different responses to a student who’s asking for leniency.

Kevin Patton (06:08):
Is it something we can extend for them without pulling a thread that will unravel the whole learning activity or might it unravel the built-in integrity measures we’ve baked into that activity? Is it a paper test? Is it a lab practical, a written assignment, a project, a discussion post? Well, there’s all kinds of things that we might have in our course that have deadlines. Each one may have a different best response and perhaps different students and their diverse situations may have different best responses.

Kevin Patton (06:50):
Maybe it’s not all this way or that way. Maybe it’s a spectrum. Whatever the best response may be, it’s one that we’ve really weighed against our values and goals. Yet another issue that came up in our discussions is whether it’s best to build some flexibility into deadlines so that students don’t have to ask for leniency. That is, the extensions are already built in.

Kevin Patton (07:26):
I do a version of that with many of my A&P tests. In my pre-A&P course, they have until the end of the semester to get it all done. In my regular A&P I and II courses, I always gave them a long window of time to get their online tests done. An issue with this approach is that once we get to the end of the semester, we’re out of time for long windows or extensions. It seems that often, our request for leniency with deadlines come during that end of semester time when we really don’t have much, if any, wiggle room to grant extensions. Another option I guess, is to make an artificial earlier than necessary end of term deadline.

Kevin Patton (08:20):
That is a final, everything has to be done by this date, deadline that is on paper at least the final deadline. Then with the remaining few days in which you really can accept late work, you can post a special grace period in which you will allow late work. Maybe with a penalty of some sort or maybe without a penalty, whatever works best for you and your students.

Kevin Patton (08:52):
The advantage of building in extensions and grace periods and things like that is that it doesn’t require anyone to ask for special treatment. It really does even the playing field a bit and make things feel more equitable than they otherwise might feel. I’d love to hear from you. What are your thoughts on deadlines?

Sponsored by AAA

Kevin Patton (09:21):
A searchable transcript and a captioned audiogram of this episode are funded by AAA, The American Association for Anatomy. One of my favorite things about being a member of AAA is their journal evidence based teaching and learning of anatomy and physiology. It’s called Anatomical Sciences Education. There’s something in every issue that gets me thinking and rethinking the way I teach A&P.

Kevin Patton (09:50):
They have a lot of other resources for teaching A&P, too. Check them all out at anatomy.org. Just click the resources tab, then teaching resources. You’ll find some amazing stuff there.

Shoulders and Birth

Kevin Patton (10:09):
A couple of weeks ago, I ran across an article in the proceedings of the National Academy of Science that I thought you’d find interesting because all of us, at some point in our story of the human body that we tell in our A&P course, we address this issue of human birth and the fact that well, humans kind of have this anatomical issue that needs to be dealt with.

Kevin Patton (10:35):
Sometimes, we have to a medically intervene and that issue is the large size of the head of the human fetus. There’s a very narrow space that it needs to get through in order for birth to be accomplished successfully. Yeah, there are some adaptations that our skull has developmentally. For example, those sutures that don’t really develop as fast as they could otherwise develop, thus leaving fontanels that are pretty flexible and they allow some wiggle room, I guess, or wiggle-ability in the skull of that infant that’s in the process of being born.

Kevin Patton (11:25):
We know that sometimes there’s some medical issues that need to be dealt with. Yeah, we tell that story. But a part of the story that I’ve never really emphasized or looked at is the idea that the wide shoulders of the human fetus are an issue as well and can cause some medical problems in some cases.

Kevin Patton (11:52):
This paper that came out a couple of weeks ago was looking at this from a developmental and evolutionary perspective, comparing the rate of development of different parts of the skeleton in humans with other primates. They found that in humans, our shoulders widen late in development compared to other primates. They proposed that this is an adaptation for human birth, that because we are upright bipedal walkers, we have this arrangement of the adult skeleton that can potentially complicate the birth of our offspring because of that large skull and potentially wide shoulders.

Kevin Patton (12:46):
So what can we do about the shoulders? Well, we can maybe wait a little bit longer before we grow them so wide. There’s a link in the show notes that’ll take you to that paper if you want to learn more about it.

Missing B Vitamins

Kevin Patton (13:01):
Have you ever had a student take a look at that long list of vitamins that’s in the A&P textbook and say, “Wait a minute. We look at all these B vitamins here and are some numbers missing. What’s going on with that?”

Kevin Patton (13:18):
Well, I’ve had that question and if you haven’t run into that yet, or don’t know the answer to it, here’s a quick update, a quick refresher. The missing vitamins are vitamins B4, B8, B10 and B11. And the reason that they’re not listed there is that, well, at one time, there were compounds that were given those designations, those numbers for the B vitamins, but as time went by, we realized they don’t really fit the definition of a vitamin. And of course, the definition of a vitamin has been kind of polished a little bit over time as well.

Kevin Patton (14:04):
Usually, we think of a vitamin as something that is essential in the diet and required for normal human growth. They’re required to be obtained by the diet because they can’t be manufactured in the human body. It turns out that those four, which are B4, B8, B10, B11, well, they just don’t fit that definition.

Kevin Patton (14:31):
Not only that, over time, there’s been more than one thing that has had one or another of those designations. There’s a little historical quirk as well. Vitamin B4, that’s usually had been assigned to the compound adenine, which we know is used throughout the body for a lot of things, but we can make that. It has referred to other compounds like carnatine and choline. Vitamin B8, which is inositol. Well, that’s a sugar and yeah, we need that in our body, but we can make it. No, it’s not a vitamin. Vitamin B10, well, most of the time that was assigned to para-amino-benzoic acid or P-A-B-A, PABA.

Kevin Patton (15:25):
Most people have a microbiome that will synthesize para-amino-benzoic acid. Okay, technically it’s not human tissues that’s making it. But our microbiome, maybe we should consider that a human tissue or a human organ or a human partner at least. For that reason, it’s been dumped out as a vitamin over the official list of vitamins at least. Some people still use these designations, but in terms of mainstream science, that’s no longer used.

Kevin Patton (16:04):
Okay. So the fourth of four vitamins that are not going to appear in the table in your textbook is vitamin B11. B11 has most often referred to pteryl-hepto-glutamic acid. But well, turns out that what that is is folic acid or at least a variation or a derivative of folic acid, which is vitamin B9.

Kevin Patton (16:36):
If it’s already vitamin B9, then maybe we shouldn’t call it B11. That introduces way more confusion than the kind of confusion that we sometimes allow in scientific lingo. There’s that. And another thing is that it’s not always pteryl-hepto-glutamic acid that has been labeled B11, salicylic acid has been called B11 and our body does make that sort of when we take aspirin. The acetosalicylic acid that makes up aspirin, that breaks apart in our body and so we break it apart to make salicylic acid and that salicylic acid can be used therapeutically as we well know. That’s what happened to those missing B vitamins.

Sponsored by HAPI

Kevin Patton (17:32):
The free distribution of this podcast is sponsored by the Master of Science in Human Anatomy & Physiology Instruction, the HAPI degree. In every cohort, we have a diversity of learners from far and wide. They come in with a variety of graduate degrees including doctorates and a range of teaching experience from none to well, a lot.

Kevin Patton (18:01):
What they all have in common is a desire to teach A&P effectively by learning collaboratively about a contemporary teaching practice applied specifically to A&P. There’s a new cohort forming now. No matter how advanced your current credentials are now, don’t you want to hang out with us to deepen your knowledge and skills by joining us at Northeast College of Health Sciences?

Kevin Patton (18:30):
Just go to northeastcollege.edu/hapi. That’s H-A-P-I. Or click the link in the show notes or episode page.

Skin’s Microbiome

New Speaker (18:43):
Ever since I stopped making preview episodes for each regular episode, in response to listener feedback, I’ve been very bad about providing a WORD DISSECTION….

Kevin Patton (18:58):
…that occasional opportunity where we practice what we all do in our teaching and take apart words and translate their parts to deepen our understanding. Sometimes they are old and familiar terms and sometimes they’re terms new to us are maybe so fresh that they’re new to everyone. Well, now’s a good time to go back and review some terms that we dissected in the preview to Episode 47. Because well, we’re going to need them for of this episode.

Kevin Patton (19:33):
The first of two terms that I want to dissect and they’re related terms, by the way, the first one is microbe. M-I-C-R-O-B-E, microbe. And that’s an easy one to dissect because there are two main parts to it. The first one micro is a word part that we see in a lot of scientific terms, even within human anatomy & physiology and micro means small or tiny.

Kevin Patton (20:01):
What about the B-E part at the end? Will that -be, is derived from the word part bio. So it’s a shortened form of bio and we know that bio means life. If we put micro together with bio to form microbe, then what we have is a term that literally means a very tiny organism or putting the micro back into its original form, we can call it a microorganism.

Kevin Patton (20:36):
Usually, we define a microbe is any organism too small to be viewed by the unaided eye. That would include bacteria, protozoa and some fungi and algae. Now, you notice, I didn’t say virus there. But it would include a virus in most cases. That’s usually the way it’s used. Even though we can debate as to whether a virus is an organism or not, we still study it in biology and we treat it as if it is an organism, even if we don’t define it that way.

Kevin Patton (21:13):
That’s a microbe. Okay. A related term, just if related in no other way than linguistically, but of course it’s related in other ways too, is the term microbiome. Again, we have that word part micro, which means small or tiny.

Kevin Patton (21:30):
We have that bio in there and it’s really just the -bi part of bio that we’re using. And so again, we’re shortening it and we know that means life. And then the -ome ending means an entire collection like genomics. When we talk about the genome or the biome, that term that we use in the ecological aspects of biology, literally then microbiome means an entire collection of microorganisms.

Kevin Patton (22:08):
But of course in biology, it refers to more than just a collection of microbes. It’s an interactive system of microorganisms and their activities in nature. It’s a system, it’s an interactive system within itself and with other organisms in nature.

Kevin Patton (22:31):
That term was coined in 1988 when John Whipps and his colleagues, Lewis and Cooke defined it as, “a characteristic microbial community occupying a reasonably well defined habitat which has distinct physico-chemical properties.”

Kevin Patton (22:54):
I do want to mention that Nobel Laureate, Joshua Lederberg is often credited with popularizing the term microbiome. So even though he didn’t invent it, he kind of made it famous, at least in the context that we usually use it in.

Kevin Patton (23:11):
In 2001, he described it as, “The ecological community of commensal, symbiotic and pathogenic microorganisms that literally share our body space and have been all but ignored as determinants of health and disease.” So that was 2001.

Kevin Patton (23:30):
The idea, the concept of this goes way back before 2001 and way back before 1988. A lot of scientists point out that the concept of the microbiome was laid out in the works of Sergei Nikolaievich Winogradsky and his colleagues who worked out the early ideas of microbial ecology way back in the late 19th century and early 20th century.

Kevin Patton (24:03):
They discovered that microbes behave differently in their native habit habitat than they do in the lab. So therefore we can take it that they have different effects when they live in communities on the living human skin, than they would in a lab culture. They had that core idea worked out.

Kevin Patton (24:26):
They just needed a term for this core concept that would sufficiently intimidate our A&P students. That’s what this segment in this episode is about, the human microbiome, which I often call the human microbial system, which kind of helps students understand in that it does act like our regular body systems and that yeah, it’s part of our body, or is it?

Kevin Patton (24:56):
Now, this always sparks a lively discussion or sometimes not so lively depending on the time of day about whether the human microbiome is us or is not us. That is itself or not self. That is the human microbial system really part of the human body or is it just something on our body, meagerly on the external faces of the boundaries between internal and external environment.

Kevin Patton (25:34):
Those debates usually also bring up how we define a body system. Is the microbiome really made up of organs? What might those organs be? The microbes? Okay. If we give on that point, aren’t organ supposed to be made up of several different tissues? Well, how do we fit all that into that classic framework of biological levels of organization?

Kevin Patton (26:04):
Shouldn’t we instead be putting them somewhere at the population in community and ecosystem levels or the biome level? Doesn’t the name imply a tiny biome and not a body system? The great thing is I think the evolving, scientific thinking could land on either side of that debate personally, my view, which is also evolving as I learn more kind of straddles both position. To me, that’s just kind of a fun to look at. I’m more interested in how it works and what it does in the body, but I don’t know that I would put all of my resources defend one side of that debate or another.

Kevin Patton (26:57):
In fact, I’m not so sure we should consider that dusty, old classic plan of biological as an organization to be as rigid and unchangeable as we often do. When thinking about how global warming and pollutants and over consumption have disrupted global ecosystems enough to trigger worldwide pandemics and other biological disasters, aren’t we as biologists better able to see that as author James Hamblin puts it, self and other is less of a dichotomy than a continuum?

Kevin Patton (27:38):
In other words, can any individual organism live in isolation? And because we can’t, are we really a completely distinct organism? Yeah. Maybe we need to reconsider things, but not in this episode. Let’s leave that aside. But if you have some interesting perspectives of your own or some nice resources that can shine a light on it, then please do share it with us at the podcast thought line or be a guest on an upcoming episode.

Kevin Patton (28:11):
Before we get too far, though, I need to scratch that itch that you know that haunts me now in my elder years. That is the urge to tell stories from the olden days.

Kevin Patton (28:30):
Way back when, when I used to care for and train performing wild animals, something I learned was that skin health is surprisingly important to overall health back then, I wasn’t thinking about the microbiome. After all the term wasn’t invented yet back then and the concept hadn’t really been applied much if at all, to the skin and overall health of humans and other animals.

Kevin Patton (29:00):
Even so, I knew that keeping our trained California sea lions in clean fresh water was sufficiently different from the microbe-infested, salty ocean water of their native habitat that we had to be vigilant for skin issues. We had one sea lion, her name was Shorty, who developed serious conjunctivitis that blinded her in one eye. She had to get regular salt water baths every day to help keep it under control and to keep the conjunctivitis from coming back.

Kevin Patton (29:39):
To this day, I want to find out why somebody thought it was a good idea to package salt in 80-pound bags. Man, them saltwater baths, they were a chore for me, although she loved them and I was glad to do it. 80-pound bags of salt. Couldn’t we like divide that in half or something?

Kevin Patton (30:00):
By the way, Shorty always balanced a beach ball on her nose kind of sideways after that, after she became blind in one eye, because she couldn’t see it on her blind side. But we didn’t ask her to stop doing that trick because well, like many performing animals, she got mad if she missed that trick because she loved the fish and she loved the praise, including applause. Mostly the fish, but performing wild animals do love that noise that we humans make when they do a trick well.

Kevin Patton (30:35):
When I took care of lions and tigers and leopards and other big cats, we would hose them off everyone in a while. They either tolerated it or in most cases, thought it was a lot fun. But they kind of lost their big cat smell for a few days and did seem to be a little bit more prone to flaky skin and even occasional rashes when we did it frequently.

Kevin Patton (31:01):
We spaced them out to a point where the skin issues became uncommon. But I was told it was a good idea to do public housing off of the cats to satisfy the activists who didn’t understand that getting a regular shower is not something that’s really in the best interests of the animals. But we as humans just can’t help thinking that animals need to live a pampered life in a penthouse suite carpeted in lush green grass.

Kevin Patton (31:36):
Now, with elephants who I also worked with in the circus, we found that they not only thrived with occasional showers, they also liked a good brushing with a wire brush and maybe some sandpaper for the rougher spots because well, that’s what they do in nature, rub against tree bark and rough boulders to desquamate some of that rapidly growing stratum corneum they have.

Kevin Patton (32:06):
Apparently, their skin microbiome isn’t healthy without that kind of treatment. Now, human skin microbiome, no, we don’t want to do that. That’s going to mess things up. But for elephants, that works well. All this is to say that the skin microbiome is important and it’s different in different mammals who all have very similar hairy skin.

Kevin Patton (32:32):
More recently, we know that there are variations in the microbiome from one part of the skin to another, in the same animal or the same person. We know that disruptions can cause mild health issues like flakiness, which by the way, is a bigger problem than you might think in a lion with a huge mane and in an animal that’s easily annoyed by an itchy scalp.

Kevin Patton (33:02):
But sometimes disruptions can be very severe as they are in some advanced cases of eczema, which we now understand is linked to and perhaps even caused by a disruption of the skin’s microbiome. There are a lot of new treatments for eczema being developed and have already been released that are about managing the skin microbiome, not about controlling the inflammation directly or minimizing the damage directly, but instead it’s about wildlife management, managing the wildlife on our skin in a way that’s going to promote the eventual development of a healthy set of microbial communities on our skin that are going to react with each other and with our own body in a healthy way, rather than in the unhealthy way that is happening during a case of eczema.

Kevin Patton (33:58):
There are other skin conditions that I’m sure also involve the skin’s microbiome. Nowadays, now that we’re connecting more and more of these dots about the microbiome and the skin and the health of the entire body, we’re seeing that maybe we should not be living the overly showered, overly bathed, overly clean pampered life either.

Kevin Patton (34:25):
That question of how much is too much, what’s the best practices as far skincare goes in humans, that question has been explored in a recent book, which I’ll tell you about in just a moment.

Sponsored by HAPS

Kevin Patton (34:44):
Marketing support for this podcast is provided by HAPS, The Human Anatomy & Physiology Society, promoting excellence in the teaching of human anatomy & physiology for over 30 years. Did you know that when you join HAPS, you become eligible to join AAA at a deeply discounted rate and that you’ll get access to AAA’s journal, Anatomical Sciences Education and access to HAPS Educator journal for A&P Teaching?

Kevin Patton (35:17):
That’s two great journals that apply directly to what you and I every day, that is teaching A&P. By joining HAPS, you’ll unlock all kinds of HAPS members, only benefits and resources such as HAPS Institute courses, access to HAPS safety guidelines and sample learning outcomes. And well, the list goes on and on. You can join me as a HAPS member at theAPprofessor.org/HAPS.

Clean: The New Science of Skin

Kevin Patton (35:53):
In a previous segment, I was talking about the microbiome of the skin, which brings me here to my local bookstore to see if they have a copy of the new recommendation in The A&P Professor book club. It’s called Clean: The New Science of Skin and it’s written by James Hamblin, MD.

Kevin Patton (36:19):
This book has been acclaimed by NPR, Vanity Fair, the Smithsonian and well, me. I listened to it not long after it was released in audio in 2020 and I loved it. Even though it was only my wife and youngest son inside my pandemic bubble at the time, I had acclaimed it to them and added it to my podcast idea file. And well, now it’s time to acclaim it or proclaim it or whatever to you too.

Kevin Patton (36:56):
Hamblin gives us a thorough and interesting historical and cultural discussion about skincare. I’m always interested in the stories behind why we do what we do and how things got to be the way they are today.

Kevin Patton (37:14):
That part of the book sucked me right in. In doing that, both he and I, the reader began to realize that the bathing and/or showering and lotions and skincare rituals that humans do have almost nothing to do with health and wellness. That lack of a link between our modern skin care practices and health can lead to unhealthy conditions.

Kevin Patton (37:48):
It can mess up our skin’s microbiome. And by doing that, it can mess up other things in our body, because we know it’s all connected, right? Everything in the body’s interconnected, even the human microbiome or human microbial system. One of the things in this book that is often one of the first things mentioned in the media is that while researching and writing this book, Dr. Hamblin decided to stop showering. Yeah, that’s true. He stopped showering and found out there’s a sort of let’s not shower movement that’s growing in popularity really.

Kevin Patton (38:35):
Okay. Because it’s not really a spoiler I’ll tell you that when he says he stopped showering, it’s not really as drastic as it sounds. He still cleans himself regularly, just not in the harsh let’s utterly destroy our microbiome at least once a day kind of cleaning that has become the norm for a lot of people.

Kevin Patton (39:00):
What exactly does he do? Well, that would be a spoiler. You’re just going to have to listen to or read the book like I did. But his point is a good one. We need to learn to manage the microbial systems that exist in the different parts of our skin if we want to be healthy and well, we need to change those skincare rituals that we do and we do them just because they become a cultural norm for us. But to do that effectively, we need to understand way more about how our skin’s microbiome works.

Kevin Patton (39:39):
The science is advancing rapidly and we need to stay tuned into that. This book is a way to get started. It goes into some of the core ideas about the skin’s microbiome in a clear and understandable way, enough to get us prepped, to keep learning more as the science advances. As I encouraged all of us to do back in Episode 47, I think we need to weave a very basic understanding of the human microbial system, the human microbiome, into the story of the human body that we tell our students in our A&P course.

Kevin Patton (40:22):
Not only does that help them understand current concepts of human biology and help them understand their own health, but it also helps prepare them for the emerging microbiome-informed therapies—or alterations of common therapies—that they’ll be working with in their careers.

Kevin Patton (40:45):
Once again, the book that we’re recommending for the AP Professor Book Club at this time is Clean: The New Science of Skin by James Hamblin, MD.

Staying Connected

Kevin Patton (40:59):
If there’s anything in this episode that struck a chord with you and you want to share it with a colleague, there’s an easy way to do that. Simply go to theAPprofessor.org/refer to get a personalized share link that will get your friend all set up.

Kevin Patton (41:18):
When you share this podcast, that helps all of us by keeping the conversation going. I always provide links if you want to dive deeper into any of the topics in this episode. If you don’t see those links in your podcast player, go to the show notes at the episode page at theAPprofessor.org/114, where you can explore any ideas mentioned in this podcast.

Kevin Patton (41:45):
While you’re there, you can claim your digital credential for listening to this episode. Those credentials or badges help you keep track of your professional development so you can more easily update your CV, apply for promotion or a grant or go after that next teaching position.

Kevin Patton (42:06):
These credentials demonstrate your commitment to continuous growth as an effective A&P educator. You’re always encouraged to call in with your questions, comments, counterpoints, stories and ideas in the podcast thought. That’s 1-833-LION-DEN or 1-833-546-6336. Or send a recording or written message to podcast@theAPprofessor.org. And you’re invited to join my private A&P teaching community way off the social platforms at theAPprofessor.org/community. I’ll see you down the road.

Aileen (43:00):
The A&P Professor is hosted by Dr. Kevin Patton, an award-winning professor and textbook author in human anatomy & physiology.

Kevin Patton (43:14):
Please get medical attention if symptoms persist.

We’re living in strange times, aren’t we? There’s a lot of health misinformation and dis information coming at us from all directions. As science faculty, we have an obligation to promote only evidence-based information and critical analysis. Let’s all help each other keep everyone safe and healthy.