Physiological concentrations of bile acids down-regulate agonist induced secretion in colonic epithelial cells

In patients with bile acid malabsorption, high concentrations of bile acids enter the colon and stimulate Cl− and fluid secretion, thereby causing diarrhoea. However, deoxycholic acid (DCA), the predominant colonic bile acid, is normally present at lower concentrations where its role in regulating transport is unclear. Thus, the current study set out to investigate the effects of physiologically relevant DCA concentrations on colonic epithelial secretory function. Cl− secretion was measured as changes in short-circuit current across voltage-clamped T84 cell monolayers. At high concentrations (0.5–1 mM), DCA acutely stimulated Cl− secretion but this effect was associated with cell injury, as evidenced by decreased transepithelial resistance (TER) and increased lactate dehydrogenase (LDH) release. In contrast, chronic (24 hrs) exposure to lower DCA concentrations (10–200 μM) inhibited responses to Ca2+ and cAMP-dependent secretagogues without altering TER, LDH release, or secretagogue-induced increases in intracellular second messengers. Other bile acids – taurodeoxycholic acid, chenodeoxycholic acid and cholic acid – had similar antisecretory effects. DCA (50 μM) rapidly stimulated phosphorylation of the epidermal growth factor receptor (EGFr) and both ERK and p38 MAPKs (mitogen-activated protein kinases). The EGFr inhibitor, AG1478, and the protein synthesis inhibitor, cycloheximide, reversed the antisecretory effects of DCA, while the MAPK inhibitors, PD98059 and SB203580, did not. In summary, our studies suggest that, in contrast to its acute prosecretory effects at pathophysiological concentrations, lower, physiologically relevant, levels of DCA chronically down-regulate colonic epithelial secretory function. On the basis of these data, we propose a novel role for bile acids as physiological regulators of colonic secretory capacity

Ounce of Prevention: Internship Planning and Implementation for Students, University Advisors, and Site Supervisors

Internships in the health profession, specifically in public and community health education and promotion, are a valuable opportunity for students to acquire new skills, as well as implement their recently acquired academic knowledge. There are generally three key players in the internship process: the faculty advisor or coordinator, the site supervisor, and the student intern. There are processes and procedures that can greatly help facilitate a positive experience for all three parties. Essential to this internship process are good organization skills, meticulous planning abilities, and clear communication channels. This article provides easy steps that all three individuals can benefit from during the planning and implementation phases of the internship experiences

Lean Restaurants: Improving the Dining Experience

Myriad examples exist to describe how lean concepts are applied in the manufacturing and healthcare industries; however, research regarding how lean is applied in the food service industry is sparse. The purpose of this case study is to discover how lean applications are currently being applied in three different full-service dining establishments located in Knoxville, Tennesse

Peer assessment of outpatient consultation letters – feasibility and satisfaction

<p>Abstract</p> <p>Background</p> <p>Written correspondence is one of the most important forms of communication between health care providers, yet there is little feedback provided to specialists. The objective of this study was to determine the feasibility and satisfaction of a peer assessment program on consultation letters and to determine inter-rater reliability between family physicians and specialists.</p> <p>Methods</p> <p>A rating scale of nine 5-point Likert scale items including specific content, style items, education value of the letter and an overall rating was developed from a previous validated tool.</p> <p>Nine Internal Medicine specialists/subspecialists from two tertiary care centres submitted 10 letters with patient and physician identifiers removed. Two Internal Medicine specialists, and 2 family physicians from the other centre rated each letter (to protect writer anonymity). A satisfaction survey was sent to each writer and rater after collation of the results. A follow-up survey was sent 6–8 months later.</p> <p>Results</p> <p>There was a high degree of satisfaction with the process and feedback. The rating scale information was felt to be useful and appropriate for evaluating the quality of consultation letters by 6/7 writers. 5/7 seven writers felt that the feedback they received resulted in immediate changes to their letters. Six months later, 6/9 writers indicated they had maintained changes in their letters.</p> <p>Raters rank ordered letters similarly (Cronbach's alpha 0.57–0.84) but mean scores were highly variant. At site 1 there were significant differences in scoring brevity (p < 0.01) between family physician and specialist raters; whereas, at site 2 there were differences in scoring of history (p < 0.01), physical examination (p < 0.01) and educational value (p < 0.01) of the letter.</p> <p>Conclusion</p> <p>Most participants found peer assessment of letters feasible and beneficial and longstanding changes occurred in some individuals. Family physicians and specialists appear to have different expectations on some items. Further studies on reliability and validity, with a larger sample, are required before high stakes professional assessments include consultation letters.</p

Perceived Barriers to Participation in a Supplemental Nutrition Program Among Low-Income Women on the US/Mexico Border

The benefits of supplemental nutrition programs have been well established. In order to gain an insight into perceived barriers to participation in such programs on the US/Mexico border, unstructured qualitative interviews were conducted with former participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The main barrier to program participation was a lack of time. Other barriers to participation included confusion about program eligibility and the perceived stigma associated with receiving assistance from WIC. Generally, participants felt that WIC was a beneficial program and would recommend it to others. Expanded hours of operation that address the needs of working mothers were recommended in order to increase the recruitment and retention of program participants

Unexpected Findings in an Alternative High School: New Implications for Values Education

It has been well documented that today’s adolescents are at great risk for health-compromising behaviors. Researchers have identified values orientation and values education as important change agents in reducing these “risky” behaviors. It has also been suggested that an individual’s values orientation that is focused on the future and in a societal view of life is associated with protective and resilience factors with fewer health-compromising behaviors. This study examined adolescents’ values orientation and the occurrence of health-compromising behaviors. Health-compromising behaviors for this study included substance abuse, unsafe sexual practices, violence, and sensation-seeking activities. Results indicated that participants were not at risk for health-compromising behaviors related to a present, self-interest value orientation. Contrary to conventional wisdom about the health-compromising behaviors of students determined to be at “higher risk,” the students in this sample did not exhibit the traditional high-risk behaviors or the value orientations. Health-compromising behaviors of adolescents continue to be a priority for health educators, school administrators, as well as parents and other community members. It is imperative that further research explore the relationship between adolescent participation in “risky” behavior as well as the protective factors related to healthier choices

Can Sibling Sex Ratios Be Used as a Valid Test for the Prenatal Androgen Hypothesis of Autism Spectrum Disorders?

Sibling sex ratios have been applied as an indirect test of a hypothesized association between prenatal testosterone levels and risk for autism, a developmental disorder disproportionately affecting males. Differences in sibling sex ratios between those with and without autism would provide evidence of a shared risk factor for autism and offspring sex. Conclusions related to prenatal testosterone, however, require additional assumptions. Here, we used directed acyclic graphs (DAGs) to clarify the elements required for a valid test of the hypothesis that sibling sex ratios differ between children with and without autism. We then conducted such a test using a large, population-based sample of children

Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs

Gender Differences in Incremental Force Production Accuracy Following a 3-, 6-, or 12-Week Strength Training Course

Subjective muscular force production is a commonly used psychophysiological method in resistance training and physical rehabilitation. However, limited research is available regarding whether differences exist in match-force production accuracy between male and female adults. PURPOSE: The purpose of this study was to examine the gender differences in perceived force production accuracy following participation in a strength training course. METHODS: Participants (20 males, 26 females) were sampled from an undergraduate strength training course. Using a hand-grip dynamometer, maximal and incremental force production measurements were collected with the participants in a seated position with their dominant forearm resting on a table. Participants were asked to produce a maximal force on the hand-grip dynamometer followed by two sets of incremental force measures at 25%, 50%, 75%, and 100% of maximal effort with adequate rest in between bouts. Incremental hand-grip measurements were repeated following a 3-, 6-, or 12-week strength training course. A linear regression analysis was used to examine the relationship between gender and hand-grip force error for the increments of force. RESULTS: Results indicated that the most variance in error was at the submaximal muscular force production of 25%, whereas the most accurate increment was at 100%, regardless of duration (3-, 6-, or 12-weeks) of participation in the strength training course (r2 = 0.046, p \u3c 0.001). For increments of lower exertion (i.e., 25% and 50%), there was no significant differences between male and female participants. However, for higher incremental force exertion (i.e., 75% and 100%), approximately 23% of variance (r2 = 0.230, p \u3c 0.001) and 32% of variance (r2 = 0.322, p \u3c 0.001) in force production accuracy, respectively, can be accounted for by gender. CONCLUSION: Following exposure to strength training instruction, physically active female adults are more accurate in force production at incremental exertion levels (i.e., 25%, 50%, 75% of maximal force), whereas males have greater match-force accuracy at 100% of maximal force production

Reaction Channel contributions to the proton + <b>²⁰⁸Pb</b> optical potential at 40 MeV

Background: Reaction channel coupling substantially modifies the real and imaginary nucleon-nucleus interactions for nuclei of Z = 20 or less in ways that cannot be represented as uniform renormalizations of folding model potentials. For such nuclei coupling to inelastic channels also contributes. This raises the question of the effect of these couplings for heavier target nuclei. Purpose: To establish and characterize the contribution to the proton-nucleus interaction generated by coupling to neutron pickup (outgoing deuteron) channels for 40 MeV protons on the heavy closed shell nucleus 208Pb. To identify and evaluate the consequent dynamical non-locality. Methods: Coupled reaction channel (CRC) calculations provide the elastic channel S-matrix Slj due to the included processes. Inversion of Slj will produce the local potential that would yield, in a single channel calculation, the elastic scattering observables from the CRC calculation. Subtracting the bare potential of the CRC calculations gives a local and l-independent representation of the dynamical polarization potential (DPP). From the DPPs due to various combinations of channel couplings, the influence of dynamically generated nonlocality can be identified. Results: Coupling to deuteron channels generates a repulsive component for the real potential and an absorptive component for the imaginary term. The radial shapes of both terms were modified in ways that could not be represented by uniform renormalization; the rms radius of the real part was substantially altered. Evidence of the dynamical nonlocality of the DPP due to pickup is provided by the nonadditivity of contributions of different couplings and other effects. For the doubly closed shell 208Pb coupling to low-lying (nongiant) collective states has a very small effect on elastic scattering, making a negligible contribution compared with pickup, and was not included. Conclusions: The DPPs established here strongly challenge the notion that folding models, in particular local density models, provide a satisfactory description of elastic scattering of protons from heavy nuclei. Coupling to neutron pickup channels induces dynamical nonlocality in the proton optical model potential with implications for direct reactions