Intrarenal Mas and AT(1) receptors play a role in mediating the excretory actions of renal interstitial angiotensin-(1-7) infusion in anaesthetized rats

New Findings What is the central question of this study? Dietary sodium manipulation alters the magnitude of angiotensin‐(1–7) [Ang‐(1–7)]‐induced natriuresis. The present study sought to determine whether this was related to relative changes in the activity of intrarenal Mas and/or AT1 receptors. What is the main finding and its importance? Angiotensin‐(1–7)‐induced diuresis and natriuresis is mediated by intrarenal Mas receptors. However, intrarenal AT1 receptor blockade also had an inhibitory effect on Ang‐(1–7)‐induced natriuresis and diuresis. Thus, Ang‐(1–7)‐induced increases in sodium and water excretion are dependent upon functional Mas and AT1 receptors. We investigated whether angiotensin‐(1–7) [Ang‐(1–7)]‐induced renal haemodynamic and excretory actions were solely dependent upon intrarenal Mas receptor activation or required functional angiotensin II type 1 (AT1) receptors. The renin–angiotensin system was enhanced in anaesthetized rats by prior manipulation of dietary sodium intake. Angiotensin‐(1–7) and AT1 and Mas receptor antagonists were infused into the kidney at the corticomedullary border. Mas receptor expression was measured in the kidney. Mean arterial pressure, urine flow and fractional sodium excretion were 93 ± 4 mmHg, 46.1 ± 15.7 μl min−1 kg−1 and 1.4 ± 0.3%, respectively, in the normal‐sodium group and 91 ± 2 mmHg, 19.1 ± 3.3 μl min−1 kg−1 and 0.7 ± 0.2%, respectively, in the low‐sodium group. Angiotensin‐(1–7) infusion had no effect on mean arterial pressure in rats receiving a normal‐sodium diet but decreased it by 4 ± 5% in rats receiving a low‐sodium diet (P < 0.05). Interstitial Ang‐(1–7) infusion increased urine flow twofold and fractional sodium excretion threefold (P < 0.05) in rats receiving a normal‐sodium diet and to a greater extent, approximately three‐ and fourfold, respectively, in rats receiving the low‐sodium diet (both P < 0.05). Angiotensin‐(1–7)‐induced increases in urine flow and fractional sodium excretion were absent in both dietary groups during intrarenal AT1 or Mas receptor inhibition after either losartan or A‐779, respectively. Thus, AT1 receptor activation, as well as Mas receptor activation, plays an essential role in mediating Ang‐(1–7)‐induced natriuresis and diuresis. Whether this is because Ang‐(1–7) partly antagonizes AT1 receptors or whether Ang‐(1–7)‐induced natriuresis is mediated through AT1–Mas receptor dimerization remains unclear

Comprehensive Primary Health Care in Australia

Objectives: To identify the extent to which the Alma Ata defined Comprehensive Primary Health Care (CPHC) approach is practised and evaluated in Australia and to describe the role that GPs and other medical practitioners play in it along with implications of this for future policy in light of the Health and Hospital Reform Commission (HHRC) and Primary Health Care taskforce reports, 2009 recommendations.Methods: We conducted a narrative review of the literature (published and grey) from 1987 to mid 2007 as part of a global review carried out by teams of researchers in six regions in 2007.  Results: In Australia, the CPHC approach occurs chiefly in Aboriginal Controlled Community Health Services, state funded community health and in rural/remote and inner city areas.  Participation by GPs in CPHC is limited by funding structures, workforce shortages and heavy workloads.  Factors that facilitated the CPHC approach include flexibility in funding and service provision, cultural appropriateness of services, participation and ownership by local consumers and communities and willingness to address the social determinants of health.Conclusions: The recent HHRC and Primary Health Care Taskforce reports recommend an expansion of CPHC services as a means of tackling health inequities. The findings of this review suggest that resources will need to be directed beyond individual treatment to population health issues, cross-sectorcollaboration and consumer participation in order to realise the CPHC model. Without attention to these areas PHC will not be comprehensive and its ability to contribute to reducing inequities will be severely hampered. The absence of an evaluation culture supported with resources for CPHC programs and services also hinders the ability of practitioners and policy makers to assess the benefits of these programs and how their implementation can be improved. Funding structures, workforce issues and evaluation of programs will all need to be addressed if the health sector is to contribute to the goal of reducing health inequities

Project #82: HFWH Vertical Treatment Zone

Problem Statement: Limited Emergency Department bed capacity and increased acuity resulted in increased left without completing service (LWCS) resulting in increased patient safety risk. Goal: Design a new patient throughput workflow to provide safe, timely and quality patient-centered care resulting in decreased LWSC, decreased arrival to provider times, decreased LOS of the discharged patient, and increased patient satisfaction.https://scholarlycommons.henryford.com/qualityexpo2023/1007/thumbnail.jp

A growing global network’s role in outbreak response: AFHSC-GEIS 2008-2009

A cornerstone of effective disease surveillance programs comprises the early identification of infectious threats and the subsequent rapid response to prevent further spread. Effectively identifying, tracking and responding to these threats is often difficult and requires international cooperation due to the rapidity with which diseases cross national borders and spread throughout the global community as a result of travel and migration by humans and animals. From Oct.1, 2008 to Sept. 30, 2009, the United States Department of Defense’s (DoD) Armed Forces Health Surveillance Center Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) identified 76 outbreaks in 53 countries. Emerging infectious disease outbreaks were identified by the global network and included a wide spectrum of support activities in collaboration with host country partners, several of which were in direct support of the World Health Organization’s (WHO) International Health Regulations (IHR) (2005). The network also supported military forces around the world affected by the novel influenza A/H1N1 pandemic of 2009. With IHR (2005) as the guiding framework for action, the AFHSC-GEIS network of international partners and overseas research laboratories continues to develop into a far-reaching system for identifying, analyzing and responding to emerging disease threats

Implementation, effectiveness and political context of comprehensive primary health care: preliminary findings of a global literature review

Primary health care (PHC) is again high on the international agenda. It was the theme of The World Health Report in 2008, thirty years after the Alma-Ata Declaration, and has been the topic of a series of significant conferences around the world throughout 2008. What have we learnt about its impact in improving population health and health equity? What more do we still need to know? These two questions framed a four-year international research/capacity-building project, “Revitalizing Health for All” (RHFA), funded by the Canadian Global Health Research Initiative, which began in 2007. The findings of a global literature review conducted by this Initiative, and focusing on comprehensive primary health care - and how it has been implemented since Alma Ata are presented. The way in which the political context has affected the comprehensiveness of PHC is considered - along with a series of proposed future PHC research areas.Web of Scienc

Referral process to further evaluate poor sleep in breast cancer survivors

Objective: Breast cancer survivors (BCS) are twice as likely to report symptoms of poor sleep as those without cancer. However, sleep disorders are under-assessed and under-treated among BCS. The purpose of this study was to determine the portion of BCS who completed referral visits to a sleep specialist and identify the acceptability, facilitators, and barriers to the screening and referral process. Methods: BCS, who reported having sleep problems, completed questionnaires to screen for symptoms suggestive of sleep disorders. Those with symptoms suggestive of sleep apnea, movement disorders, narcolepsy, insomnia syndrome, or circadian disorders, they were referred to a sleep medicine physician or behavioral sleep medicine psychologist. Two months after the referral, participants were interviewed about their perceptions of the acceptability, barriers, and facilitators to sleep screenings and referrals. Results: Of 34 BCS assessed for eligibility, 29 were eligible and had sleep problems. Only eight of 29 participants (27.6%) completed the sleep referral process. Most thought the screening and referral process was acceptable. However, BCS identified barriers to completing the referral visit, including time, not seeing the need for treatment, insurance/sick leave concerns, and distance/transportation. Conclusion: Adequate evaluation and treatment of sleep disorders in BCS are rare. Creative solutions to address barriers to timely sleep referrals are needed to reduce long-term negative consequences of inadequate sleep

Individual differences in subphonemic sensitivity and phonological skills

open access articleMany studies have established a link between phonological abilities (indexed by phonological awareness and phonological memory tasks) and typical and atypical reading development. Individuals who perform poorly on phonological assessments have been mostly assumed to have underspecified (or “fuzzy”) phonological representations, with typical phonemic categories, but with greater category overlap due to imprecise encoding. An alternative posits that poor readers have overspecified phonological representations, with speech sounds perceived allophonically (phonetically distinct variants of a single phonemic category). On both accounts, mismatch between phonological categories and orthography leads to reading difficulty. Here, we consider the implications of these accounts for online speech processing. We used eye tracking and an individual differences approach to assess sensitivity to subphonemic detail in a community sample of young adults with a wide range of reading-related skills. Subphonemic sensitivity inversely correlated with meta-phonological task performance, consistent with overspecification

Catching Element Formation In The Act

Gamma-ray astronomy explores the most energetic photons in nature to address some of the most pressing puzzles in contemporary astrophysics. It encompasses a wide range of objects and phenomena: stars, supernovae, novae, neutron stars, stellar-mass black holes, nucleosynthesis, the interstellar medium, cosmic rays and relativistic-particle acceleration, and the evolution of galaxies. MeV gamma-rays provide a unique probe of nuclear processes in astronomy, directly measuring radioactive decay, nuclear de-excitation, and positron annihilation. The substantial information carried by gamma-ray photons allows us to see deeper into these objects, the bulk of the power is often emitted at gamma-ray energies, and radioactivity provides a natural physical clock that adds unique information. New science will be driven by time-domain population studies at gamma-ray energies. This science is enabled by next-generation gamma-ray instruments with one to two orders of magnitude better sensitivity, larger sky coverage, and faster cadence than all previous gamma-ray instruments. This transformative capability permits: (a) the accurate identification of the gamma-ray emitting objects and correlations with observations taken at other wavelengths and with other messengers; (b) construction of new gamma-ray maps of the Milky Way and other nearby galaxies where extended regions are distinguished from point sources; and (c) considerable serendipitous science of scarce events -- nearby neutron star mergers, for example. Advances in technology push the performance of new gamma-ray instruments to address a wide set of astrophysical questions.Comment: 14 pages including 3 figure

Gender and historiography: Studies in the earlier middle ages in honour of Pauline Stafford

The chapters in this volume celebrate the work of Pauline Stafford, highlighting the ways in which it has advanced research in the fields of both Anglo-Saxon history and the history of medieval women and gender. Ranging across the period, and over much of the old Carolingian world as well as Anglo-Saxon England, they deal with such questions as the nature of kingship and queenship, fatherhood, elite gender relations, the transmission of property, the participation of women in lordship, slavery and warfare, and the nature of assemblies. Gender and historiography presents the fruits of groundbreaking research, inspired by Pauline Stafford's own interests over a long and influential career