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This article explores how a group of paramedics were cross-trained as community health workers (CHWs) in Indiana. Cross-training paramedics as CHWs provided a foundation to better understand the social issues that occur outside of the hospital and clinic, thereby enabling further empathy among paramedics and seeking means to connect patients to other health and social services agencies. I detail how earning a certification as a CHW shifted the mindset of the paramedics and their approach toward caregiving. Ultimately, I argue how cross-training healthcare professionals can further expand the general awareness of CHWs and possible opportunities for employment. However, steps must be taken to ensure that reducing the CHW model to a cross-training opportunity will not minimise the impacts of hiring a full-time CHW.

Dopaminergic agonism effectively treats dysglycemia, with dopaminergic agonist bromocriptine approved as a type 2 diabetes therapy. Though bromocriptine’s actions have been mainly attributed to stimulation of dopamine D2 receptors (D2R) in the brain, we previously showed that bromocriptine also targets metabolically-relevant peripheral tissues including the endocrine pancreas. Here, we employ bromocriptine as a tool to elucidate roles of dopaminergic and adrenergic signaling in regulation of pancreatic hormone secretion. Using bromocriptine, we demonstrate a new mechanism for metabolic actions in pancreatic α-cells and β-cells via D2R and adrenergic α2A receptor (α2A-AR) signaling. In β-cells, bromocriptine acts jointly on D2R and α2A-AR to reduce glucose-stimulated insulin secretion (GSIS) , while in α-cells, bromocriptine acts via D2R to reduce glucagon secretion. Bromocriptine reduces cAMP in β-cells via concurrent actions on D2R and α2A-AR, further emphasizing shared roles of adrenergic and dopaminergic receptor agonism in GSIS regulation. At the receptor level, α2A-AR activation by bromocriptine leads to receptor recruitment of an ensemble of G proteins driven mainly via G protein signaling with no β-arrestin2 recruitment. In contrast, D2R recruits both G proteins and β-arrestin2 upon bromocriptine stimulation, demonstrating signaling unique to each receptor. Docking studies also reveal that bromocriptine binding to α2A-AR is distinct from bromocriptine-bound D2R, providing a structural basis for bromocriptine’s dual actions on β-cell α2A-AR and D2R. Together, joint dopaminergic and adrenergic receptor actions on α-cell and β-cell hormone release provide a new therapeutic mechanism to improve dysglycemia in diabetes. Disclosure S. Bertera: None. L. Friggeri: None. R. Logan: None. R. Free: None. R. Bottino: Employee; Imagine Pharma. Funding Department of Defense (PR141292) , National Institutes of Health (R01DK124219, R01DK097160, RDA046138) , the John F. and Nancy A. Emmerling Fund of The Pittsburgh Foundation, Intramural Research Program of the National Institute of Neurological Disorders and Stroke (ZIA-NS002263) , Veterans Affairs VA-ORD-BLR&D (I01BX002678) , the Deutsche Forschungsgemeinschaft (SFB1423, project number 421152132) .

Supplemental Material, sj-pdf-1-cat-10.1177_1076029621991185 for A Machine Learning Approach to Predict Deep Venous Thrombosis Among Hospitalized Patients by Logan Ryan, Samson Mataraso, Anna Siefkas, Emily Pellegrini, Gina Barnes, Abigail Green-Saxena, Jana Hoffman, Jacob Calvert and Ritankar Das in Clinical and Applied Thrombosis/Hemostasis

As the U.S. health care system continues to face a myriad of challenges due to political uncertainty, cost, lack of reform, and financial insecurity, many individuals and communities throughout the U.S. will continue to encounter barriers to accessing care. Among the most vulnerable groups include black, immigrant, refugee, and low-income communities. These groups encounter significant barriers in the form of social determinants of health – such as lack of financial security, education level, and transportation. One type of non-clinical worker, commonly known as a community health worker (CHW), provides one means of addressing these issues. However, in many states, CHWs are not well integrated within the workforce and/or are treated with ambivalence. Their strengths include belonging to the community they work within, emphasizing community outreach, health education, and advocacy. Their strengths address vital gaps in care for marginalized communities. This paper explores key findings from a dissertation project that documented the lived experiences of CHWs. The aim of this paper is to present the practical and theoretical findings regarding these workers as they are integrated into the workforce in the state of Indiana. The theoretical framing of this project includes moral economy and anthropological framings of health care. The project utilized a collaborative approach with a local CHW organization and drew on participant observation (>300 hours), semi-structured interview (n=50 interviews), focus groups, and photovoice. The results demonstrate similar yet diverse experiences among these workers, disparities in the vision of the CHW model between stakeholders and CHWs, and the vital role of advocacy in promoting health and wellbeing. Overall, this project demonstrates that social scientists can play a crucial role in infusing social theory in conceptions of health and wellbeing in addition to fostering collaborative research relationships with community partners.

Chopper presence and then chopper speed was varied during wet high shear granulation of a placebo formulation using a PMA-1 granulator while also varying the impeller speed. The granules were extensively analyzed for differences due to the chopper. The effect of the chopper on the granules varied with impeller speed from no effect at a low impeller speed of 300 rpm to flow interruptions at an impeller speed of 700 rpm to minimal impact at very high impeller speeds as caking at the bowl perimeter obscured the effect of the chopper on the flow pattern. Differences in the granule flowability were minimal. However, it was concluded that the largest fraction of optimal granules would be obtained at an impeller speed of 700 rpm with the chopper at 1,000 rpm allowing balances between flow establishment, segregation, and centrifugal forces.