Evaluating a childhood obesity program with the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

Primary care providers can use behavioral lifestyle interventions to effectively treat children with overweight and obesity, but implementing these interventions is challenging. Most childhood obesity intervention evaluation studies focus on effectiveness. Few studies describe implementation. Our goal was to evaluate critical components of a childhood obesity intervention in primary care. We conducted a pilot implementation study of an existing structured lifestyle intervention in the Canton of Bern, Switzerland from 2013 to 2015. The intervention consisted of 10 sessions, led by a primary care physician. It included children aged 6-8 years old, with BMI over the 90th age-adjusted percentile. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework to describe the pilot implementation study. We stratified description of RE-AIM components at the patient- and physician-level. For Reach: 864 children were screened; 65 were overweight; 394 physicians were invited to participate in the study. For Effectiveness: BMI z-score significantly decreased (-5.6%, p = 0.01). For Adoption: 14 participating physicians treated 26 patients. Implementation: the mean number of consultations was 8. For Maintenance: 9 (35%) children discontinued the intervention; 7 (50%) of physicians continued to apply at least one component of the intervention. The summarized components of the program within the RE-AIM framework suggest the program was successful. Stakeholders can use our results if they intend to disseminate and evaluate similar interventions in different settings

first experiences at the medical faculty of berne

Aim: Presentation of skills and knowledge of medical students in psychiatry or psychosocial medicine in basic study (year 1 to 3) after the introduction of a problem oriented learning curriculum at the Medical Faculty of Berne. Method: Description of the curriculum with the different teaching units, and the evaluation by means of formative tools used by students and tutors. Results: With reference to qualitative comparison students of the problem based learning track showed a better preparation of the different teaching units than did traditional students. Moreover, compared to classical teaching, students in problem based learning rated the commitment of the teachers higher. The formative results showed a better adherence to the teaching modules, a higher effort in self learning and a higher interest in psychological or psychiatric learning items. Discussion: The higher commitment of teachers and the explicit structuring of the teaching contents in psychiatry and psychosocial medicine showed positive effects in the learning strategy of students. Beside the fact that exams have been adapted to the new curriculum one can assume that the learning style has changed. This might be a result of the better learning environment in the new curriculum. However, there is not clear how and to what extent these changes will remain active until the final exams of the medical curriculum when psychosocial contents will be reexamined. Conclusions: The intense commitment of the teachers and the better structuring of the subject matter may lead to a better integration of psychosocial and psychiatric issues into the medical curriculum.Ziel: Vorstellung der Änderungen studentischer Fähigkeiten und Fertigkeiten durch die Einführung eines praktisch-orientierten, strukturierten patientenorientierten Unterrichts an der Universität Bern im Rahmen des Grundstudiums (1. bis 3. Studienjahr). Methode: Beschreibung des Unterrichts, Evaluation mittels formativer Werkzeuge, Befragung von Tutoren und Studierenden. Ergebnisse: Qualitativ zeigen sich im Vergleich ein verstärktes Engagement und verbesserte Vorbereitungen auf den Unterricht bei den Reformstudierenden. Ebenso lassen sich bessere Beurteilungen des Unterrichts durch die Studierenden und engagierteres Teaching durch die Tutoren nachweisen. Die formativen Ergebnisse zeigen eine höhere Unterrichtspräsenz, ein größeres Engagement im Selbststudium und ein höheres Interesse an psychologisch-psychiatrischen Inhalten, also eine verminderte Marginalisierung der Fächer mit psychosozialen Inhalten. Diskussion: Das höhere Lehrengagement und die klarere Strukturierung des Unterrichts in Psychosozialer Medizin und Psychiatrie zeigen Effekte im Lernverhalten der Studierenden. Obgleich die Prüfungsart entsprechend der Unterrichtsform geändert worden ist, kann davon ausgegangen werden, dass die Tendenzen in der Verbesserung von Präsenz, Engagement und Reproduktion im Wissen einer realen Verbesserung der Fähigkeiten zugeschrieben werden können. Ob diese Effekte in Bezug auf das in drei Jahren zu absolvierende praktische Staatsexamen in Innerer Medizin, bei welchem zugleich psychosoziale Fertigkeiten geprüft werden, bestehen bleiben, muss sich noch zeigen. Schlussfolgerung: Das Unterrichtsengagement und eine bessere Struktur des Unterrichts führen zur Verminderung der formalen Marginalisierung und inhaltlichen Abwertung des Psychosozialen oder Psychiatrischen Unterrichts

Crystal Structure of Bicc1 SAM Polymer and Mapping of Interactions between the Ciliopathy-Associated Proteins Bicc1, ANKS3, and ANKS6

Head-to-tail polymers of sterile alpha motifs (SAM) can scaffold large macromolecular complexes. Several SAM-domain proteins that bind each other are mutated in patients with cystic kidneys or laterality defects, including the Ankyrin (ANK) and SAM domain-containing proteins ANKS6 and ANKS3, and the RNA-binding protein Bicc1. To address how their interactions are regulated, we first determined a high-resolution crystal structure of a Bicc1-SAM polymer, revealing a canonical SAM polymer with a high degree of flexibility in the subunit interface orientations. We further mapped interactions between full-length and distinct domains of Bicc1, ANKS3, and ANKS6. Neither ANKS3 nor ANKS6 alone formed macroscopic homopolymers in vivo. However, ANKS3 recruited ANKS6 to Bicc1, and the three proteins together cooperatively generated giant macromolecular complexes. Thus, the giant assemblies are shaped by SAM domains, their flanking sequences, and SAM-independent protein-protein and protein-mRNA interactions

Role of Bicaudal C1 in renal gluconeogenesis and its novel interaction with the CTLH complex

<div><p>Altered glucose and lipid metabolism fuel cystic growth in polycystic kidneys, but the cause of these perturbations is unclear. Renal cysts also associate with mutations in Bicaudal C1 (Bicc1) or in its self-polymerizing sterile alpha motif (SAM). Here, we found that Bicc1 maintains normoglycemia and the expression of the gluconeogenic enzymes FBP1 and PEPCK in kidneys. A proteomic screen revealed that Bicc1 interacts with the C-Terminal to Lis-Homology domain (CTLH) complex. Since the orthologous Gid complex in <i>S</i>. <i>cerevisae</i> targets FBP1 and PEPCK for degradation, we mapped the topology among CTLH subunits and found that SAM-mediated binding controls Bicc1 protein levels, whereas Bicc1 inhibited the accumulation of several CTLH subunits. Under the conditions analyzed, Bicc1 increased FBP1 protein levels independently of the CTLH complex. Besides linking Bicc1 to cell metabolism, our findings reveal new layers of complexity in the regulation of renal gluconeogenesis compared to lower eukaryotes.</p></div

Protein levels of CTLH subunits in Bicc1^-/- kidneys.

<p>(A-D) Western blot analysis of (A) RanBP9, (B) Twa1, (C) WDR26 and (D) GID4 in newborn WT and Bicc1^-/- kidney extracts. Bars represent mean ± SEM. **p <0.01. (E) RT-qPCR analysis of WDR26 and GID4 mRNAs in WT and Bicc1^-/- kidneys (n = 3 per genotype). GAPDH mRNA was used for normalization.</p

Mass spectrometric identification of CTLH complex subunits co-purified with TAP-tagged Bicc1-SH.

<p>Mass spectrometric identification of CTLH complex subunits co-purified with TAP-tagged Bicc1-SH.</p

Bicc1 is a target of the CTLH complex.

<p>(A) Western blot and RT-qPCR analysis of endogenous Bicc1 in WT mIMCD3 cells treated for 48 hrs with scrambled or WDR26 and Twa1 siRNAs. Quantifications of three experiments show the average fold change in Bicc1 protein (bottom left) and mRNA levels (bottom right) relative to scramble-treated cells in three independent experiments. TATA-box binding protein (TBP) mRNA was used for normalization. (B) Bicc1 protein levels in mIMCD3 cells after treatment with Bafilomycin A1 (BafA1, 100 nM), MG132 [10 μM] or both for 4 hrs. Bars represent mean ± SEM fold changes in Bicc1 protein levels relative to untreated cells in two experiments. *p<0.05. (C) Coimmunostaining of HA-Bicc1 and endogenous RanBP9 in HEK293T imaged at high laser intensities. Bars 20 μm.</p

Mass spectrometric identification of CTLH complex subunits co-purified with TAP-tagged Bicc1 MutD.

<p>Mass spectrometric identification of CTLH complex subunits co-purified with TAP-tagged Bicc1 MutD.</p

Endogenous Bicc1 in mIMCD3 cells increases FBP1 protein levels independently of its interaction with the CTLH complex.

<p>(A) Western blot analysis of FBP1 in HEK293T cells transfected with the indicated dose of HA-Bicc1. Bars represent mean ± SEMs. *p <0.05. (B) Western blot of FBP1 in mIMCD3 48hrs after transfection of scrambled or Bicc1 siRNA. Below: Bars represent mean ± SEMs. ***p <0.001. (C) Western blot and RT-qPCR analysis (right) of FBP1 in mIMCD3 cells (WT) and a representative CRISPR-edited clone (sgBicc1) (n = 3 per genotype). For RT-qPCR GAPDH mRNA was used for normalization. Bars represent mean ± SEMs. **p <0.01 (D) Western blot of FBP1, WDR26 and Twa1 in mIMCD3 transfected with siScr or siWDR26 or siTWA1 siRNAs for 48 hrs. Error bars represent mean ± SEM of two experiments. *p <0.05. (E) Western blots of FBP1, Bicc1 and WDR26 in LLC-PK1 proximal tubule cells transfected with siScr or two different siWDR26 siRNAs (siA, siB) for 48 hrs. Data are representative of two experiments. (F) Western blots of HA-Bicc1 and FBP1 in HEK293T cells transfected with increasing doses of HA-Bicc1 MutD for 24 hrs. Top: Alanine substitutions in Bicc1 MutD (D913;K915;E916/AAA). Charged residues (red and blue) in end helix (EH) and mid loop (ML) surfaces of the dimerization interface in the SAM domain and their conservation determined by ClustalW (grey shading), as well as the positions of 5 α helices are indicated.</p