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The gut microbiota is recognized as a contributor to host metabolic homeostasis, as obesity and diabetes are associated with unique gut microbiome signatures. Further, strategies aimed at beneficially shifting the gut microbiome, such as prebiotic treatment, show promise in ameliorating metabolic disease; however, the mechanisms are not yet understood. A potential contribution of the gut microbiota to host metabolism is via modification of host and diet-derived metabolites. For example, bile acids, crucial to lipid digestion and absorption, are modified by gut microbes in the small intestine. Bile acids have also been identified as signaling molecules in the intestine, liver, adipose, and nervous system, playing a role in metabolic homeostasis. Despite their importance, few studies have examined the impact of bile acid signaling on mediating the metabolic benefits of prebiotics. We hypothesized that bile acid homeostasis is altered with dietary factors that shift the gut microbiome, including high fat diet (HFD) feeding and supplementation with the prebiotic fiber oligofructose (OFS), and that taurocholic acid (TCA) and glycodeoxycholic acid (GDCA) that are increased with HFD feeding and OFS supplementation, respectively, would recapitulate the metabolic effects of these diets. Therefore, we conducted an untargeted metabolomics analysis on small intestinal contents of rats fed chow, HFD, or HFD supplemented with OFS, identifying bile acid metabolism as a primary contributor to the observed between-group differences. We then quantified bile acid levels in the small intestine, portal vein, and liver of rats fed chow, HFD, or HFD supplemented with OFS, and identified several bile acids of interest that are altered with HFD or OFS supplementation, including TCA and GDCA. Because these bile acids activate the bile acid receptors, FXR and TGR5, that known to impact metabolic homeostasis, we treated HFD-fed mice with 50 mg/kg GDCA or TCA daily for 12 weeks and measured body weight, adiposity, glucose tolerance, food intake, and indirect calorimetry. We found that GDCA treatment improved glucose tolerance, decreased body weight and adiposity, and increased energy expenditure compared to controls. Further, TCA worsened glucose tolerance independent of body weight. The results of this study implicate GDCA and TCA in the beneficial and detrimental effects of OFS and HFD-feeding, respectively; however, more research is necessary to determine the mechanism underpinning the metabolic effects of GDCA and TCA treatment. This work was supported by the NIH R01DK1804. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The gut microbiota contributes to the development of metabolic disease, and it is well known that diet shapes the gut microbiota, emphasizing the need to better understand how diet impacts metabolic disease via alterations in the gut microbiota. Dietary fiber intake is linked with improvements in metabolic homeostasis in humans, and specific fibers beneficially alter the gut microbiota, promote weight loss, and improve glucose homeostasis. In a previous study, we found that specific plant-based flours, including wheat and barley, supplemented into a high-fat diet (HFD) reduced body weight and adiposity and improved glucose tolerance in rats. However, whether this was due to specific fibers within the flours remains unknown. To test the impact of various dietary fibers on energy and glucose homeostasis, we supplemented HFD-fed mice with 5 different fibers (beta-pectin, beta-glucan, wheat dextrin, resistant starch, or cellulose as a control) at 10% (w/w) for 18 weeks (n=12/group), measuring body weight, adiposity, indirect calorimetry, and glucose tolerance. We found that only beta-glucan supplementation in a HFD decreased adiposity and body weight gain and improved oral glucose tolerance compared to HFD with cellulose, while all other dietary fibers failed to improve metabolic homeostasis. Supplementation with beta-glucan increased energy expenditure and locomotor activity in mice compared to HFD-cellulose. Despite a lack of metabolic effect for most dietary fibers, all fibers supplemented into a HFD shifted the cecal microbiota composition and exhibited increased SCFA levels. However, only beta-glucan supplemented mice specifically exhibited an increase in Ileibacterium relative abundance, as well as higher cecal butyrate levels compared to HFD-cellulose. These findings demonstrate that beta-glucan is a promising therapeutic option for diet-induced obesity and glucose tolerance, possibly via increased energy expenditure. Future studies will investigate the role of the gut microbiota and butyrate in the metabolic improvements observed with beta-glucan supplementation in HFD-feeding. USDA National Institute of Food and Agriculture This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Hyperglycemia is a hallmark characteristic of type II diabetes, due in part to increased hepatic glucose production (HGP). The gut microbiota is now recognized as an important contributor to host energy and glucose homeostasis, and our lab has demonstrated that the gut microbiota can impact HGP. One mechanism that the gut microbiome may be impact HGP is through alterations in gut-derived metabolites from breakdown of ingested foodstuff. Specifically, short chain fatty acids (SCFAs) are bacterial metabolites produced primarily in the distal intestine from dietary fibers, and when administered exogenously, SCFAs improve glucose tolerance. However, the mechanisms underlying the effects of SCFAs on glucose tolerance are not fully understood. Given that SCFAs bind to free fatty acid receptors (FFARs) 2 and 3 localized on enteroendocrine cells to induce gut peptide release, and gut peptides regulate HGP via a gut-brain-liver neuronal axis, we propose colonic SCFAs activate a neuronal signaling mechanism to lower HGP mediated via gut peptide signaling. We infused SCFAs into the colon (50min at 0.01mL/min) during a basal insulin euglycemic clamp in rats. Compared with saline infusion, colonic administration of 10mM butyrate increased the glucose infusion rate needed to maintain glycemia due to a reduction in HGP. This was associated with increased portal concentrations of GLP-1 following butyrate infusion compared to saline. We investigated the role of colonic FFAR2 signaling, which is known to induce release of GLP-1, through either co-administration of a FFAR2 antagonist with butyrate or by colon-specific FFAR2 lentiviral knockdown; both abolished the HGP-lowering effect. Next, co-administering a GLP-1 receptor antagonist with 10mM butyrate during a clamp abolished the butyrate-induced reduction of HGP. Additionally, hepatic or celiac branch vagotomy abolished the HGP-lowering effect of colonic butyrate, suggesting a celiac afferent and hepatic efferent neuronal signaling pathway. Together, these studies uncover a FFAR2, GLP-1 receptor, vagal-dependent signaling mechanism by which colonic butyrate lowers HGP. Research presented was supported under NIH award R01DK121804. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

BACKGROUND High-risk therapies (HRTs), including medications and medical devices, are an important driver of preventable harm in children’s hospitals. To facilitate shared situation awareness (SA) and thus targeted harm prevention, we aimed to increase the percentage of electronic health record (EHR) alerts with the correct descriptor of an HRT from 11% to 100% on a high-acuity hospital unit over a 6-month period. METHODS The interdisciplinary team defined an HRT as a medication or device with a significant risk for harm that required heightened awareness. Our aim for interventions was to (1) educate staff on a new HRT algorithm; (2) develop a comprehensive table of HRTs, risks, and mitigation plans; (3) develop bedside signs for patients receiving HRTs; and (4) restructure unit huddles. Qualitative interviews with families, nurses, and medical teams were used to assess shared SA and inform the development and adaptation of interventions. The primary outcome metric was the percentage of EHR alerts for an HRT that contained a correct descriptor of the therapy for use by the care team and institutional safety leaders. RESULTS The percentage of EHR alerts with a correct HRT descriptor increased from an average of 11% to 96%, with special cause variation noted on a statistical process control chart. Using qualitative interview data, we identified critical awareness gaps, including establishing a shared mental model between nursing staff and the medical team as well as engagement of families at the bedside to monitor for complications. CONCLUSIONS Explicit, structured processes and huddles can increase HRT SA among the care team, patient, and family.

Head and neck cancers represent a significant portion of cancer diagnoses, with head and neck cancer incidence increasing in some parts of the world. Typical treatment of early-stage head and neck cancers includes either surgery or radiotherapy; however, advanced cases often require surgery followed by radiation and chemotherapy. Salivary gland damage following radiotherapy leads to severe and chronic hypofunction with decreased salivary output, xerostomia, impaired ability to chew and swallow, increased risk of developing oral mucositis, and malnutrition. There is currently no standard of care for radiation-induced salivary gland dysfunction and treatment is often limited to palliative treatment that provides only temporary relief. AMP-activated protein kinase (AMPK) is an enzyme that activates catabolic processes and has been shown to influence the cell cycle, proliferation, and autophagy. In the present study, we found that radiation (IR) treatment decreases tissue levels of phosphorylated AMPK following radiation and decreases intracellular NAD+ and AMP while increasing intracellular ATP. Further, expression of Sirtuin-1 (SIRT1) and nicotinamide phosphoribosyl transferase (NAMPT) were lower five days following IR. Treatment with AMPK activators, AICAR and metformin, attenuated compensatory proliferation (days 6, 7 and 30) following IR, and reversed chronic (day 30) salivary gland dysfunction post-IR. Additionally, treatment with metformin or AICAR increased markers of apical/basolateral polarity (phosphorylated aPKCζT560 positive area) and differentiation (amylase positive area) within irradiated parotid glands to levels similar to untreated controls. Taken together, these data suggest that AMPK may be a novel therapeutic target for treatment of radiation-induced salivary damage.

Background An emerging evidence base has explored the nutritional consequences of gender-based violence (GBV) perpetrated against girls during childhood/adolescence. We conducted a rapid evidence assessment of quantitative studies describing associations between GBV and girls’ nutrition. Methods We adapted systematic review methods and included empirical, peer-reviewed studies, published after 2000 (until November, 2022), that were written in Spanish or English and reported quantitative associations between girls’ exposure to GBV and nutrition outcomes. A variety of GBV forms were considered: childhood sexual abuse (CSA), child marriage, preferential feeding of boys, sexual IPV and dating violence. Nutrition outcomes included anemia, underweight, overweight, stunting, micronutrient deficiencies, meal frequency, and dietary diversity. Results In total, 18 studies were included, 13 of which were conducted in high-income countries. Most sources utilized longitudinal or cross-sectional data to quantify associations between CSA, sexual assault, and intimate partner/dating violence and elevated BMI/overweight/obesity/adiposity. Findings suggest that CSA perpetrated by parents/caregivers is associated with elevated BMI/overweight/obesity/adiposity via cortisol reactivity and depression; this relationship may be compounded by additional intimate partner/dating violence in adolescence. The effects of sexual violence on BMI are likely to emerge during a sensitive period of development between late adolescence and young adulthood. Emerging evidence was found regarding the relationship between child marriage (and the related exposure: age at first pregnancy) and undernutrition. The association between sexual abuse and reduced height and leg length was inconclusive. Conclusion Given that only 18 studies were included, the relationship between girls’ direct exposure to GBV and malnutrition has received little empirical attention, especially with respect to studies conducted in LMIC and fragile settings. Most studies focused on CSA and overweight/obesity, where significant associations were found. Future research should test the moderation and mediation effects of intermediary variables (depression, PTSD, cortisol reactivity, impulsivity, emotional eating) and consider sensitive periods of development. Research should also explore the nutritional consequences of child marriage.

Peripheral lymph nodes (LNs) have been implicated as potential contaminants of ground beef, yet the source and timing of Salmonella LN infection in cattle is still unclear, limiting targeted intervention. The aim of this study was to leverage the vertical integration of special-fed veal production to identify preharvest environmental exposures, specifically in livestock trailers and harvest facility holding pens where calves spend 30 min to 4 h, that result in Salmonella LN infection. Ten cohorts of 80 to 82 veal calves were followed through the harvest process, and environmental samples were collected in barns, trailers, and holding pens. Mesenteric LNs from 35 calves were collected at harvest, and 25 prefemoral LNs per cohort were pooled. Within the same cohort, for 12 samples for which the serovar of the environmental and calf LN Salmonella isolates matched, the isolates were submitted for whole genome sequencing to determine whether environmental exposure resulted in LN infection. Cohort-level Salmonella mesenteric LN prevalence ranged from 0% (0 of 35 samples) to 80% (28 of 35 samples), and pooled prefemoral LNs were positive for Salmonella in 3 of the 10 cohorts. Salmonella prevalence in samples from barns, livestock trailers, and harvest facility holding pens was 22% (13 of 60 samples), 74% (59 of 80 samples), and 93% (74 of 80 samples), respectively. Some environmental and LN isolates were multidrug resistant. Four instances of Salmonella transmission from trailers and/or holding pens to calf LNs were supported by sequence data. Salmonella serovars Agona, Give, and Muenster were identified in transmission events. One instance of transmission from the livestock trailer, two instances from holding pens, and one instance from either trailer or holding pens were observed. Further research is needed to evaluate the extent of environmental Salmonella transmission in cattle and to determine whether targeted interventions in trailers or holding pens could reduce novel Salmonella LN infection in veal calves before harvest.

In intervocalic position, Spanish /b/, /d/, and /g/ are lenited to fricatives or approximants [β], [ð], and [ɣ] (Hualde 2005).The goal of this study is to examine the ability to learn allophones of these Spanish voiced stops among L2 learners. Eighteen native English-speaking Spanish learners were recorded reading word lists at the beginning and end of a semester-long course on Spanish pronunciation, which included explicit instruction on voiced stop allophones. Ennever, Meakins, and Round (2017)’s automatic segmentation method was used to analyze degree of lenition. This method uses the intensity contour to determine the on- and offset of intervocalic consonants. It yields three measurements: difference between maximum and minimum intensity (Δi), maximum change in intensity over time, i.e. velocity, (vpeak) and duration. A smaller absolute value of Δi and vpeak, and a shorter duration correspond with a greater degree of lenition. Between the two recording times, Δi, vpeak, and duration all decreased, demonstrating some learning of Spanish lenition. Results on the impact of preceding and following vowels, and consonant place of articulation were mixed. Syllable stress and age of onset of Spanish instruction had no effect on lenition.

Obesity is due in part to increased consumption of a Western diet that is low in dietary fiber. Conversely, an increase in fiber supplementation to a diet can have various beneficial effects on metabolic homeostasis including weight loss and reduced adiposity. Fibers are extremely diverse in source and composition, such as high-amylose maize, β-glucan, wheat fiber, pectin, inulin-type fructans, and soluble corn fiber. Despite the heterogeneity of dietary fiber, most have been shown to play a role in alleviating obesity-related health issues, mainly by targeting and utilizing the properties of the gut microbiome. Reductions in body weight, adiposity, food intake, and markers of inflammation have all been reported with the consumption of various fibers, making them a promising treatment option for the obesity epidemic. This review will highlight the current findings on different plant-based fibers as a therapeutic dietary supplement to improve energy homeostasis via mechanisms of gut microbiota.

Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. The Sustainable Development Goals (SDGs) call for its elimination in target 5.2. To monitor governments' progress towards SDG target 5.2, this study aimed to provide global, regional, and country baseline estimates of physical or sexual, or both, violence against women by male intimate partners.This study developed global, regional, and country estimates, based on data from the WHO Global Database on Prevalence of Violence Against Women. These data were identified through a systematic literature review searching MEDLINE, Global Health, Embase, Social Policy, and Web of Science, and comprehensive searches of national statistics and other websites. A country consultation process identified additional studies. Included studies were conducted between 2000 and 2018, representative at the national or sub-national level, included women aged 15 years or older, and used act-based measures of physical or sexual, or both, intimate partner violence. Non-population-based data, including administrative data, studies not generalisable to the whole population, studies with outcomes that only provided the combined prevalence of physical or sexual, or both, intimate partner violence with other forms of violence, and studies with insufficient data to allow extrapolation or imputation were excluded. We developed a Bayesian multilevel model to jointly estimate lifetime and past year intimate partner violence by age, year, and country. This framework adjusted for heterogeneous age groups and differences in outcome definition, and weighted surveys depending on whether they were nationally or sub-nationally representative. This study is registered with PROSPERO (number CRD42017054100).The database comprises 366 eligible studies, capturing the responses of 2 million women. Data were obtained from 161 countries and areas, covering 90% of the global population of women and girls (15 years or older). Globally, 27% (uncertainty interval [UI] 23-31%) of ever-partnered women aged 15-49 years are estimated to have experienced physical or sexual, or both, intimate partner violence in their lifetime, with 13% (10-16%) experiencing it in the past year before they were surveyed. This violence starts early, affecting adolescent girls and young women, with 24% (UI 21-28%) of women aged 15-19 years and 26% (23-30%) of women aged 19-24 years having already experienced this violence at least once since the age of 15 years. Regional variations exist, with low-income countries reporting higher lifetime and, even more pronouncedly, higher past year prevalence compared with high-income countries.These findings show that intimate partner violence against women was already highly prevalent across the globe before the COVID-19 pandemic. Governments are not on track to meet the SDG targets on the elimination of violence against women and girls, despite robust evidence that intimate partner violence can be prevented. There is an urgent need to invest in effective multisectoral interventions, strengthen the public health response to intimate partner violence, and ensure it is addressed in post-COVID-19 reconstruction efforts.UK Department for International Development through the UN Women-WHO Joint Programme on Strengthening Violence against Women Data, and UNDP-UN Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, a cosponsored programme executed by WHO.

Obesity continues to be a global health risk affecting over 650 million adults worldwide. Fiber intake is negatively correlated with obesity, and increased fiber intake is associated with weight loss. Fiber is digested by the gut microbiota to produce short chain fatty acids (SCFA), which may have a beneficial effect on metabolic disease. While it is well known that SCFAs are mostly utilized by enterocytes as a fuel source, the timing of postprandial production and absorption of SCFAs from a meal, as well as the effect of high-fat feeding, has yet to be characterized. In the present study, we aimed to determine the levels of acetate, butyrate, and propionate, the major SCFAs, after a meal in rats maintained for 4wks on a chow, high-fat diet (45% kcal from fat; HFD) or HFD with 10% oligofructose (OFS), a well-studied prebiotic known to induce weight loss. SCFA levels were measured in the distal small intestine, cecum, and colon of rats, as well as the portal vein and vena cava at 0, 2, 4, 6, and 8 hours following consumption of an isocaloric meal of the maintenance diet. Chow rats had significantly increased levels of SCFAs as early as 2h postprandially, in the cecum, colon, portal vein, and vena cava compared to baseline levels, whereas HFD-fed rats displayed minimal increases in SCFAs. Addition of OFS rescued SCFA production, peaking at 4h postprandial; however, concentrations were not rescued to chow values at all timepoints. Increased body weight and adiposity was not associated with baseline SCFA levels in any compartment, but was negatively associated with postprandial SCFA levels in the cecum, colon, and portal vein. Overall, this study demonstrates that SCFAs exhibit a post-prandial rise similar to ingested macronutrients, and that baseline fasting levels of SCFAs may be an inaccurate indication of SCFA production in rodents. These data lay the groundwork for future studies to examine how rises in SCFA levels from breakdown of non-digestible carbohydrates can contribute to improve metabolic disease. Disclosure R. Meyer: None. A.I.L. Lane: None. A. Kangath: None. S.N. Weninger: None. T. Martinez: None. F. Duca: None.

Manipulations to the microbiota may serve as a potential treatment for obesity. Oligofructose (OFS), a nondigestible carbohydrate, beneficially alters the distal gut microbiome and results in decreased food intake and bodyweight, although the exact mechanisms remain unknown. Despite the importance of small intestinal (SI) gut-brain nutrient feedback mechanisms in regulating food intake and energy homeostasis, no studies have directly examined whether OFS can improve SI gut-brain signaling, potentially via changes in the SI microbiota. Given recent evidence highlighting the importance of SI microbiota on regulating metabolic homeostasis, we tested the hypothesis that OFS specifically improves SI lipid-sensing mechanisms controlling food intake, via manipulation of SI microbiota. Before any significant changes in body weight are observed, acute (3d) treatment with OFS in high fat (HF)-fed rats results in a significant suppression of 2hr food intake following an intralipid or liquid meal SI infusion (6kcal) compared to HF alone, likely due to a restored gut to brain signal. OFS treatment also increased jejunal CD36 gene and protein expression, which is known to mediate lipid-induced release of GLP-1. As such, OFS-treated rats exhibited significantly increased portal GLP-1 levels and c-fos, a marker neuronal activation, in the NTS of the hindbrain following intralipid SI infusion, compared to HF-fed rats. Importantly, transplant of SI microbiota from 3d OFS HF-fed donors into HF-fed rats recapitulated these results, demonstrating the importance of OFS-induced SI microbiota changes in restoring nutrient-induced gut brain signaling. These results highlight the importance of the small intestinal microbiota in energy regulation and identify a potential role of the small intestine and small intestinal nutrient sensing in the beneficial effects of OFS. Disclosure S.N. Weninger: None. E. Beauchemin: None. A.I.L. Lane: None. R. Meyer: None. F. Duca: None. Funding Arizona Biomedical Research Commission (NIA17-7401)

The relationship between obesity and the gut microbiome has become increasingly recognized, highlighting the need to determine how specific diets can beneficially impact gut microbiota to improve metabolic disease. Many studies have found an increase in dietary fiber not only causes a shift in the microbiome but also results in weight loss and altered feeding behavior. Dietary fibers are diverse both in composition and source, being found in many different plant-based flours. Fiber can also be characterized by solubility, with highly soluble fibers being most easily broken down by gut bacteria to produce short chain fatty acids (SCFAs). However, the efficacy and mechanism of specific plant-based flours on obesity is not well characterized. To better understand which plant-based flours have the greatest impact on energy homeostasis, we treated high-fat diet (HFD; 45% kcal from diet)-fed rats with four different flours for 6wks. The flours, barley flour, oat bran, wheat bran, and amylose maize were incorporated into the HFD at either 5% or 10% fiber content, and were compared to an isocaloric, nutrient-matched chow and HFD controls. We hypothesized that the soluble barley flour at 10% fiber would have the greatest impact on energy homeostasis due to the high levels of beta-glucan, while the amylose maize, oat bran, and wheat bran will have a significant but less pronounced effect. We found that the rats fed high dose barley flour and wheat bran had significantly reduced body weight gain. High and low dose barley flour resulted in significantly reduced food intake compared to HFD, and all high dose flour diet-fed rats exhibited lower adiposity compared to the HFD rats. We found all high dose flour diet-fed rats exhibited changes in feeding behavior and energy expenditure compared to HFD rats measured by metabolic cages. These results demonstrate plant based fibers can have differing effects on food intake and body composition, underscoring the need to determine the most effective dietary manipulations for obesity treatment. Disclosure T. Martinez: None. F. Duca: None. S.N. Weninger: None. R. Meyer: None. A.I.L. Lane: None. Funding National Institute of Food and Agriculture (2019-67017-29252)

The validity of a comprehensive international neuropsychological (NP) test battery for detection of HIV associated neurocognitive disorders (HAND) in a Tamil speaking southern Indian cohort (69 HIV+ and 67 HIV−) was explored. The prevalence of HAND was significantly higher in the HIV+ versus HIV− group (33% vs.13%, p < 0.01). Impairment rates were highest in the motor and speed of information processing domains. An NP battery translated into Tamil appears to be a valid tool for assessing HAND because a prevalence it found of HAND in southern India is similar to that found elsewhere.

Given the finding that the marginalized are less politically engaged, we examine those who are arguably the most marginalized—the undocumented—and ask: what underwrites recent cases where the undocumented have been politically engaged in meaningful and substantive ways? Additionally, how does this compare with the existing literature on the practice of citizenship for those with formal rights? And what are the implications for our understanding of political participation in the contemporary USA? We seek to address these questions by examining cases where undocumented immigrants act like citizens even though they lack formal political rights. Our cases deviate from previous literature which argues that more marginalized people participate less and that those without formal rights engage in contentious politics in lieu of “normal,” institutional politics. Our analysis of the DREAMers and of immigrant worker centers helps us rethink this traditional distinction between “normal” and contentious politics. Moving beyond a focus on the specific actions that fall into each category, we instead emphasize how the context for these actions is crucial to understanding the foundations of political participation. In particular, we argue that the same “normal” political actions taken by citizens versus noncitizens reveals different foundations underneath; for those without formal rights, what underwrites participation in “normal” and contentious politics alike is what we call grassroots citizenship. We examine how the political participation of undocumented workers and DREAMers takes place within immigrant organizations and how it relies on three pillars: solidarity, critical analysis, and collective action. While previous literature has emphasized the urban and local nature of active, alternative citizenships, our cases operate at multiple scales, demonstrating how grassroot citizenship can be leveraged and “scaled up” to state and national levels. Additionally, through an analysis of grassroots citizenship, we get some purchase on the question of why politicians sometimes listen to people who cannot vote.

Introduction Interprofessional Practice Model (IPM) embodies autonomy, accountability, and authority for clinicians to advocate for those they serve. Interprofessional Shared Governance (ISG) is a monthly meeting structure consisting of Point of Care Interprofessional Councils (PoC-IC), Housewide Tenets, and leadership forums. ISG supports interprofessional shared decision-making, facilitation of bi-directional communication, and collaboration between POC-IC and housewide councils. ISG influences each housewide council and PoC-IC to develop patient and family empirical outcomes that align with the strategic plan while developing leaders. Methods The Bone Marrow Transplant (BMT) unit formed an interdisciplinary PoC-IC that includes a Mentor, Operational Excellence Leaders, Chair, 6 core nursing members, and multiple interprofessional team members (Patient Care Assistant, Health Unit Coordinator, PT/OT, Nurse Practitioner, Child Life Specialist, Care Manager, Social Worker, Pharmacist, and Dietician). Members collaborate to form goals that align with the housewide direction. Mentor collaborates with the team to establish a shared decision-making process for elections and member representation. Six PoC-IC core members are responsible for attending assigned housewide tenet council meeting and reporting information back to other PoC-IC members. Results Unit dashboard, which includes defined goals and percentages and harm infection rates, are presented at the monthly BMT PoC-IC meeting. Each goal is reviewed and interventions are discussed in collaboration with the team using a unified approach. PoC-IC members contact stakeholders within each goal to define interventions for improvement. Meeting minutes, updated interventions, and status of goals and infection rates are relayed to the BMT team. Members of the PoC-IC connect with bedside team members for assistance and collaboration. BMT POC-IC has defined the following goals: 1. Sepsis Algorithm compliance (antibiotics ordered and infused within the first hour of documented fever); 2. Patient Family Experience (90% compliance with greeting families as they enter/exit the unit, physician and nursing communication to patients and families, and addressing patient's pain); 3. Safety (documentation of chlorhexidine (CHG) bathing, environmental wipe down compliance, and catheter line associated bloodstream infection (CLABSI) rate reduction). Conclusions Since the Shared Governance restructuring, the BMT PoC-IC has raised and maintained Patient and Family Experience scores greater than 90% and continues to meet the goal of 100% Sepsis Algorithm compliance. PoC-IC members continue to collaborate with bedside team members to incorporate housewide interventions to improve CHG bathing, environmental cleanliness, and CLABSI rate reduction which is currently 1.76 BSI per 1,000 catheter line days.

Topic Significance & Study Purpose/Background/Rationale Central venous catheters (CVC) are frequently used in Bone Marrow Transplant (BMT) patients. BMT RNs are responsible for the care of CVC during a patient's hospitalization. CVC require dressing changes, needless connector changes, and frequent line entries. Patients with a CVC are at risk for acquiring a catheter line associated bloodstream infection (CLABSI). Due to BMT patients having compromised immune systems and altered gut integrity, the risk for acquiring a CLABSI is exponentially higher. Methods, Intervention, & Analysis A nurse led BMT unit based team was formed which became known as BMT CVC Representatives. CVC Representatives function as resources for team members, patients, and families. A CVC Representative rounds weekly on all patients on the BMT unit. Along with assessing the status of CVC dressings, activities include monitoring chlorhexidine (CHG) bathing (including education on CHG bathing to team members, patients, and families), monitoring passive disinfection devices, identifying patients with potential for CLABSI and assisting in crafting interventions for CLABSI prevention, mitigating potential CVC complications, and participating in CLABSI huddles. Findings & Interpretation BMT CVC Representatives are able to foster frontline engagement and identification of interventions that align with the goal to delivering exceptional and safe care. The interventions practiced at the bedside are critical to the patients' overall health and achievement of quality outcomes. The team is able to collaborate in mitigating patient specific solutions when dealing with challenging CVC care situations. BMT CLABSI infection rate continues to be a focus with the CLABSI rate at 2.00 BSI per 1,000 catheter line days at the end of fiscal year 2019 as compared to 2.65 BSI per 1,000 catheter line days at the end of fiscal year 2018. Discussion & Implications There has been an increase in awareness of CVC care which directly effects the BMT patient's health and outcomes. With weekly rounds the BMT CVC Representatives are able to be a resource for the team, patients, and families. They are a constant advocate for CHG bathing and other CLABSI prevention interventions.

BACKGROUND: Leveraging quality metrics can be a powerful approach to identify substantial performance gaps in kidney disease care that affect patient outcomes. However, metrics must be meaningful, evidence-based, attributable, and feasible to improve care delivery. As members of the American Society of Nephrology Quality Committee, we evaluated existing kidney quality metrics and provide a framework for quality measurement to guide clinicians and policy makers. METHODS: We compiled a comprehensive list of national kidney quality metrics from multiple established kidney and quality organizations. To assess the measures’ validity, we conducted two rounds of structured metric evaluation, on the basis of the American College of Physicians criteria: importance, appropriate care, clinical evidence base, clarity of measure specifications, and feasibility and applicability. RESULTS: We included 60 quality metrics, including seven for CKD prevention, two for slowing CKD progression, two for CKD management, one for advanced CKD and kidney replacement planning, 28 for dialysis management, 18 for broad measures, and two patient-reported outcome measures. We determined that on the basis of defined criteria, 29 (49%) of the metrics have high validity, 23 (38%) have medium validity, and eight (13%) have low validity. CONCLUSIONS: We rated less than half of kidney disease quality metrics as highly valid; the others fell short because of unclear attribution, inadequate definitions and risk adjustment, or discordance with recent evidence. Nearly half of the metrics were related to dialysis management, compared with only one metric related to kidney replacement planning and two related to patient-reported outcomes. We advocate refining existing measures and developing new metrics that better reflect the spectrum of kidney care delivery.

Hyposalivation and xerostomia create chronic oral complications that decrease the quality of life in head and neck cancer patients who are treated with radiotherapy. Experimental approaches to understanding mechanisms of salivary gland dysfunction and restoration have focused on in vivo models, which are handicapped by an inability to systematically screen therapeutic candidates and efficiencies in transfection capability to manipulate specific genes. The purpose of this salivary gland organotypic culture protocol is to evaluate maximal time of culture viability and characterize cellular changes following ex vivo radiation treatment. We utilized immunofluorescent staining and confocal microscopy to determine when specific cell populations and markers are present during a 30-day culture period. In addition, cellular markers previously reported in in vivo radiation models are evaluated in cultures that are irradiated ex vivo. Moving forward, this method is an attractive platform for rapid ex vivo assessment of murine and human salivary gland tissue responses to therapeutic agents that improve salivary function.

Scholars of contemporary capitalism have argued that the rise of flexible accumulation and precarious employment has left workers disillusioned and adrift, experiencing an erosion of solidarities and human bonds. In contrast, this study uncovers a sense of collective efficacy where existing scholarship would lead us to least expect it: among workers who are, structurally, among the most marginal and vulnerable. The case examined is a Chicago living wage campaign, which for three long years mobilized workers laboring outside of traditional employment relationships. Why would a sense of collective efficacy emerge when participants’ ability to make change had remained in doubt for years? Why would workers who lack structural power come to feel so efficacious? Drawing on in-depth interviews with campaign participants, I argue that their understandings of power arose from their experience of collective action. The case sheds new light on our understanding of identity and subjectivity under contemporary capitalism.

Innovation in kidney diseases is not commensurate with the effect of these diseases on human health and mortality or innovation in other key therapeutic areas. A primary cause of the dearth in innovation is that kidney diseases disproportionately affect a demographic that is largely disenfranchised, lacking sufficient advocacy, public attention, and funding. A secondary and likely consequent cause is that the existing infrastructure supporting nephrology research pales in comparison with those for other internal medicine specialties, especially cardiology and oncology. Citing such inequities, however, is not enough. Changing the status quo will require a coordinated effort to identify and redress the existing deficits. Specifically, these deficits relate to the need to further develop and improve the following: understanding of the disease mechanisms and pathophysiology, patient engagement and activism, clinical trial infrastructure, and investigational clinical trial designs as well as coordinated efforts among critical stakeholders. This paper identifies potential solutions to these barriers, some of which are already underway through the Kidney Health Initiative. The Kidney Health Initiative is unique and will serve as a current and future platform from which to overcome these barriers to innovation in nephrology.

How can we best conceptualize working-class mobilization in the post-Fordist regime of flexible accumulation? With the increasing precariousness of employment, how do workers press their demands? While the emphasis thus far has been on the melding of workplace and community organizing, which is a hallmark of “social movement unionism,” I argue that there is a countervailing trend afoot that has received far less attention—that is, a bifurcation of strategies. Only those select workers who are in powerful structural locations, such as transportation and distribution workers, are in a position to take the economic route while the swelling ranks of the precariat have turned instead to the political sphere to press their demands. Additionally, I address what this bifurcation means for labor's power and working-class formation. Does the separation of economic and political protest lead to a weakened working class? Such a separation has been thought to undermine class-based solidarities, with community identities undermining workplace-based ones. I argue, however, that the contemporary context is different in that precarious workers’ mobilizations in the community have become explicitly class-based. In contrast to the long-standing notion of the workplace as the hotbed of working-class consciousness, the community has emerged as a locus of class-based perspectives and solidarities. Throughout I emphasize not just strategy and material gain for the working class, but also shifts in civil society, organizations, and subjectivity. My argument is developed through a case study of the Chicago Jobs and Living Wage Campaign, which is then compared to other cases of precarious worker mobilization around the globe. Examining the tensions inherent in precarious workers’ political mobilization in the context of the post-Fordist neoliberal state, the study has implications for labor and social movements, class formation, citizenship, and contemporary capitalism.

There has been a reduction in the most severe cases of HIV-associated neurocognitive disorders (HAND) with advances in antiretroviral treatment (ART). But the prevalence of milder forms of HAND still remains high. Data from systematically conducted studies on the effects of ART on cognition are scanty in India, where HIV-1 clade C is prevalent. The purpose of the present study was to assess the effect of antiretroviral therapy in HIV-seropositive (HIV+) individuals (n = 92) with CD4 cell counts

Background: HIV infected individuals are at increased risk of developing psychiatric co-morbidi- ties, particularly depression. Coping with a disease associated with significant morbidity, mortali- ty and financial stress is likely to result in psychiatric morbidity even among caregivers, especially family members. However, there is scarcity of such data in HIV uninfected caregiver spouses. Ma- terial and Methods: Beck Depression Inventory (BDI-II), a diagnostic tool that measures depres- sive symptoms, was administered to HIV uninfected caregiver spouses of HIV infected individuals (n = 55) and HIV seronegative individuals from general population (n = 63) with similar demo- graphic profile. Chi-square test was used for categorical data. Results: Caregiver spouses exhibited higher depressive symptoms on the BDI-II (mean score 5.25 vs. 3.03; p = 0.029) as compared to others. The scores tended to be higher on the majority of the items, with sadness (p = 0.032), pu- nishment feeling (p = 0.024) and crying (p = 0.037) being statistically significant. Conclusions: Our results indicate that it is important to address the mental health needs of the spouses of HIV in- fected individuals as they may play a major role in their care and support in the Indian context.

Scholarship on events has been devoted primarily to large-scale occurrences that transform macro structures. Here we put forward a perspective that we term eventful subjectivity which moves the analysis of events in two related directions. First, we shift the arena of eventful analysis from rare world historical occurrences to smaller, more frequent events. Second, we direct attention away from macro-structural outcomes to micro-level changes in understanding. We employ the framework of eventful subjectivity to examine a living wage campaign in Chicago, demonstrating how the multi-faceted diversity of the campaign – in the context of collective action – engendered solidarity rather than fragmentation.

The authors discuss the reasons why they believe that increased research investments are an integral step in helping reduce the public health burden of kidney disease as of 2016, and it mentions how chronic kidney disease (CKD) is a growing public health problem in the U.S. According to the article, more than 20 million Americans have CKD which can lead to end-stage renal disease. U.S. federal expenditures for kidney disease treatment are examined, along with CKD treatment costs.

Binge drinking is common among adolescents. Alcohol use, particularly binge drinking, has been associated with neurocognitive deficits and increased risk-taking behaviors, which may contribute to negative driving outcomes among adolescents even while sober.To examine potential differences in self-reported risky driving behaviors between adolescent binge drinkers and a matched sample of controls on measures of (1) compliance with graduated licensing laws, (2) high-risk driving behaviors, and (3) driving outcomes (i.e., crashes, traffic tickets).This study examined driving behaviors and outcomes in adolescent recent binge drinkers (n = 21) and demographically and driving history matched controls (n = 17) between the ages of 16-18 years.Binge drinkers more frequently violated graduated licensing laws (e.g., driving late at night) and engaged in more "high-risk" driving behaviors, such as speeding and using a cell phone while driving. Binge drinkers had more traffic tickets, crashes, and "near crashes" than the control group. Speeding was the behavior most associated with crashes within the binge drinkers.In this study, binge-drinking teens consistently engage in more dangerous driving behaviors and experience more frequent crashes and traffic tickets. They are also less compliant with preventative restrictions placed on youth while they are learning critical safe driving skills.These findings highlight a need to examine the contribution of underlying traits (such as sensation seeking) and binge-related cognitive changes to these high-risk driving behaviors, which may assist researchers in establishing alternative prevention and policy efforts targeting this population.

The present study aimed to examine if bilingualism affects executive functions and verbal fluency in Marathi and Hindi, two major languages in India, with a considerable cognate (e.g., activity is actividad in Spanish) overlap. A total of 174 native Marathi speakers from Pune, India, with varying levels of Hindi proficiency were administered tests of executive functioning and verbal performance in Marathi. A bilingualism index was generated using self-reported Hindi and Marathi proficiency. After controlling for demographic variables, the association between bilingualism and cognitive performance was examined. Degree of bilingualism predicted better performance on the switching (Color Trails-2) and inhibition (Stroop Color-Word) components of executive functioning; but not for the abstraction component (Halstead Category Test). In the verbal domain, bilingualism was more closely associated with noun generation (where the languages share many cognates) than verb generation (which are more disparate across these languages), as predicted. However, contrary to our hypothesis that the bilingualism “disadvantage” would be attenuated on noun generation, bilingualism was associated with an advantage on these measures. These findings suggest distinct patterns of bilingualism effects on cognition for this previously unexamined language pair, and that the rate of cognates may modulate the association between bilingualism and verbal performance on neuropsychological tests. (JINS, 2012, 18, 305–313)

Medical management of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) includes hypertensive, hypervolemic, and hemodilution (“triple-H”) therapy. However, there is little information regarding the indications and guidance used to initiate and adjust triple-H therapy. A 43-item questionnaire was e-mailed to 375 members of the Neurocritical Care Society. Questions were designed to investigate the diagnostic approach to cerebral vasospasm and prophylactic and therapeutic administration of triple-H therapy. Completed surveys were received from 167 respondents (45% response proportion). Eighty-six percent of respondents worked in hospitals with neurointensive care units (NICUs). SAH patients in hospitals with a NICU had longer ICU stay (P = 0.037) and had indwelling central venous catheters for longer (P

The P2X7 nucleotide receptor (P2X7R) is an ATP-gated ion channel expressed in bone cells. Homozygous null P2X7R (P2X7R(-/-)) mice have reduced bone formation, so we hypothesized that P2X7R(-/-) mice have impaired fracture healing compared to P2X7R(+/+) control mice. To test the hypothesis, adult P2X7R(-/-) mice and P2X7R(+/+) mice were studied. Osteotomy of the right femur was performed and a stainless-steel pin was inserted into the medullary cavity to stabilize the fracture site. No differences in callus development were seen in the radiograph, micro computed tomography, or dual-energy x-ray absorptiometry measurements. Mechanical testing showed that the recovery of ultimate force, stiffness, and energy to failure were slightly decreased in P2X7R(-/-) mice compared with the control. Histomorphometric measurements of the callus revealed that mineralizing surface and bone formation were significantly decreased, by 22% (p0.001) and 29% (p0.05), respectively, in P2X7R(-/-) mice in comparison with the wild-type control. These data show that a null mutation of the P2X7R does not affect the amount of callus formed in our osteotomy fracture model. However, callus remodeling was significantly delayed. Our data suggest the different role of the P2X7R in woven bone and lamellar bone formation.

This review provides a critical analysis of the central nervous system effects of acute and chronic methamphetamine (MA) use, which is linked to numerous adverse psychosocial, neuropsychiatric, and medical problems. A meta-analysis of the neuropsychological effects of MA abuse/dependence revealed broadly medium effect sizes, showing deficits in episodic memory, executive functions, information processing speed, motor skills, language, and visuoconstructional abilities. The neuropsychological deficits associated with MA abuse/dependence are interpreted with regard to their possible neural mechanisms, most notably MA-associated frontostriatal neurotoxicity. In addition, potential explanatory factors are considered, including demographics (e.g., gender), MA use characteristics (e.g., duration of abstinence), and the influence of common psychiatric (e.g., other substance-related disorders) and neuromedical (e.g., HIV infection) comorbidities. Finally, these findings are discussed with respect to their potential contribution to the clinical management of persons with MA abuse/dependence.