Weekly Proactive Telephone Breastfeeding Standard Care by Lactation Consultants in the First Month Postpartum Prolongs Breastfeeding for Up to 6 Months.

Many mothers, especially those with co-morbidities, do not achieve exclusive breastfeeding (EBF) for the first 6 months, with the loss of multiple health benefits including enhanced infant nutrition. We wished to evaluate whether proactive lactation consultant telephone advice in the first month postpartum improved breastfeeding rates for up to 6 months. A prospective cohort observational study was performed. Mother groupings included the following: Control (CG, n = 379)-standard postnatal care; Exposure (EG, n = 386)-standard postnatal care delivered by lactation consultant telephone contact for the first 3 weeks postpartum and then follow-up calls at 1, 3 and 6 months postpartum to ascertain breastfeeding status. Sore nipples (24%) and fussy/unsettled behaviour (14-19%) were common EG concerns. EG EBF rates were higher at 1 month (65% vs. 53%; p < 0.001), 3 months (57% vs. 49%; p = 0.041) and 6 months (45 vs. 33%; p < 0.001). EG EBF rates across the 6 months were higher for infants admitted to the NNU (52.9% vs. 37.5%, p = 0.003), obese mothers (58.3% vs. 37.2%, p < 0.001), mothers with depression (60.8% vs. 43.4%, p = 0.036) and all birth modes. Proactive early lactation advice significantly prolongs EBF and consequently enhances infant nutrition overall, including for mothers at risk of early breastfeeding cessation.

Third party product certification for drinking water health effects.

Third-party certification to drinking water product consensus standards is how products for potable water systems are deemed suitable for public health and safety in North America. Drinking water product consensus standards are a type of standard developed through a process that includes participation from expert volunteers and requires general agreement from all stakeholders. Certification to drinking water product consensus standards is required via plumbing codes and state or local regulations in most of the United States and Canada, making third-party certification essential for products intended for sale and installation in North America. Third-party certification bodies (CBs) test and certify products to these drinking water product consensus standards through an evaluation process that includes a thorough review of each product's composition, laboratory testing, and inspection of each facility where the product is manufactured. Products that comply with the consensus standard requirements are entitled to bear a certification mark that demonstrates their suitability for use in potable water systems. Drinking water product standards developed by NSF reference NSF/ANSI/CAN 600: Health Effects Evaluation and Criteria for Chemicals in Drinking Water for the toxicological criteria to evaluate chemical leachates derived from material extraction testing. Here, we review the third-party product certification process for evaluating products used in potable water systems and describe how the certification process relies on the health effects criteria and toxicological evaluation procedures described in NSF/ANSI/CAN 600.

Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma.

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.

Change Engagement, Change Resources, and Change Demands: A Model for Positive Employee Orientations to Organizational Change.

The purpose of this conceptual article is to introduce the construct of change engagement and a model that also consists of change-related organizational resources, change-related job resources and demands, and change-related personal resources. We propose that change engagement is a construct that is theoretically and practically useful for understanding employee reactions to and adoption of organizational change. Drawing from existing models of employee engagement, we add to the change literature by identifying salient change-related organizational resources, job resources, job demands, and personal resources in a previously validated framework that brings together the literature on both engagement and change. By using the proposed change engagement framework, practitioners and researchers will potentially be able to effectively diagnose, manage, and optimize employee change readiness and enthusiasm for ongoing change. Furthermore, the change engagement model (CEM) provides practitioners and researchers with a comprehensive and practically useful model that will be easy to comprehend and communicate. The model can be applied to the planning, implementation, and evaluation of discrete change initiatives, as well as to ongoing change. The model is therefore well-suited to contemporary organizational contexts where change is widely recognized to be a constant.

Synthesis and biological study of the phomopsolide and phomopsolidone natural products.

The complete history of the syntheses and biological activities of the phomopsolide and phomopsolidone classes of natural products is reviewed. These efforts include the successful synthesis of four of the five phomopsolide natural products, two of the four phomopsolidone natural products and two analogues of phomopsolide E, including the 7-oxa and 7-aza analogues. In addition, the utility of these synthetic efforts to enable the initial structure activity relationship studies for these classes of natural products is also covered.

Correction: The asymmetric syntheses of cryptocaryols A and B.

Correction for 'The asymmetric syntheses of cryptocaryols A and B' by Alhanouf Zakaria Aljahdali et al., Chem. Commun., 2018, 54, 3428-3435.

The asymmetric syntheses of cryptocaryols A and B.

The recent total syntheses of cryptocaryols A and B are reviewed. These efforts include the correction of the initially assigned absolute and relative stereochemistry of this class of natural products. In addition to enabling the initial structure activity relationships for this class of natural products, these syntheses demonstrated the practical utility of several novel synthetic approaches.

Poster exhibitions at conferences: are we doing it properly?

OBJECTIVE: Literature exploring the educational value and quality of conference poster presentation is scarce. The aim of this study was to identify and describe the variation in poster exhibitions across a spectrum of conferences attended by trainees. DESIGN: Prospective observational assessment of conference posters was carried out across 7 variables at 4 conferences attended by surgical trainees in 2012. Posters were compared by individual variables and according to overall poster score combining all 7 variables examined. The number of authors listed was also compared. SETTING AND PARTICIPANTS: Random samples of consecutively numbered posters were examined at the exhibitions of 4 conferences, which included a UK national medical education conference (Association for the Study of Medical Education), a UK international surgical conference (Association of Surgeons of Great Britain and Ireland), a European oncology conference (European Society of Surgical Oncology), and a North American joint medical and surgical conference (Digestive Diseases Week). RESULTS: Significant variation existed between conferences in posters and their presentation. The proportion of presenters failing to display their posters ranged from 3% to 26% (p < 0.0001). Adherence to size guidelines varied from 89% to 100% (p = 0.002). The inclusion of references ranged from 19% to 82% (p < 0.0001). The presence of a presenting author during the allocated session varied widely from 21% to 86% (p < 0.0001). No significant variation was observed in the proportion of posters that were formatted using aims, methods, results, and conclusion sections (81%-93%; p = 0.513) or in the proportion of posters that were identified as difficult to read (24%-28%; p = 0.919). Association for the Study of Medical Education outperformed each of the other exhibitions overall (p < 0.0001). Posters with greater than the median of 4 authors performed significantly better across all areas (p < 0.0001-0.042) except presenter attendance (p = 0.480). CONCLUSIONS: Poster exhibitions varied widely, with room for improvement at all 4 conferences. Lessons can be learned by all conferences from each other to improve presenter engagement with and the educational value of poster exhibitions.

Mammalian target of rapamycin (mTOR): conducting the cellular signaling symphony.

The mammalian target of rapamycin (mTOR) protein kinase responds to diverse environmental cues to control a plethora of cellular processes. mTOR forms the catalytic core of at least two distinct signaling complexes known as mTOR complexes 1 and 2. Differing sensitivities to the mTOR inhibitor rapamycin, unique partner proteins, distinct substrates, and unique cellular functions distinguish the complexes. Here, we review recent progress in our understanding of the regulation and function of mTOR signaling networks in cellular physiology.

Regulation of mTOR complex 1 (mTORC1) by raptor Ser863 and multisite phosphorylation.

The rapamycin-sensitive mTOR complex 1 (mTORC1) promotes protein synthesis, cell growth, and cell proliferation in response to growth factors and nutritional cues. To elucidate the poorly defined mechanisms underlying mTORC1 regulation, we have studied the phosphorylation of raptor, an mTOR-interacting partner. We have identified six raptor phosphorylation sites that lie in two centrally localized clusters (cluster 1, Ser(696)/Thr(706) and cluster 2, Ser(855)/Ser(859)/Ser(863)/Ser(877)) using tandem mass spectrometry and generated phosphospecific antibodies for each of these sites. Here we focus primarily although not exclusively on raptor Ser(863) phosphorylation. We report that insulin promotes mTORC1-associated phosphorylation of raptor Ser(863) via the canonical PI3K/TSC/Rheb pathway in a rapamycin-sensitive manner. mTORC1 activation by other stimuli (e.g. amino acids, epidermal growth factor/MAPK signaling, and cellular energy) also promote raptor Ser(863) phosphorylation. Rheb overexpression increases phosphorylation on raptor Ser(863) as well as on the five other identified sites (e.g. Ser(859), Ser(855), Ser(877), Ser(696), and Thr(706)). Strikingly, raptor Ser(863) phosphorylation is absolutely required for raptor Ser(859) and Ser(855) phosphorylation. These data suggest that mTORC1 activation leads to raptor multisite phosphorylation and that raptor Ser(863) phosphorylation functions as a master biochemical switch that modulates hierarchical raptor phosphorylation (e.g. on Ser(859) and Ser(855)). Importantly, mTORC1 containing phosphorylation site-defective raptor exhibits reduced in vitro kinase activity toward the substrate 4EBP1, with a multisite raptor 6A mutant more strongly defective that single-site raptor S863A. Taken together, these data suggest that complex raptor phosphorylation functions as a biochemical rheostat that modulates mTORC1 signaling in accordance with environmental cues.

Site-specific mTOR phosphorylation promotes mTORC1-mediated signaling and cell growth.

The mammalian target of rapamycin (mTOR) complex 1 (mTORC1) functions as a rapamycin-sensitive environmental sensor that promotes cellular biosynthetic processes in response to growth factors and nutrients. While diverse physiological stimuli modulate mTORC1 signaling, the direct biochemical mechanisms underlying mTORC1 regulation remain poorly defined. Indeed, while three mTOR phosphorylation sites have been reported, a functional role for site-specific mTOR phosphorylation has not been demonstrated. Here we identify a new site of mTOR phosphorylation (S1261) by tandem mass spectrometry and demonstrate that insulin-phosphatidylinositol 3-kinase signaling promotes mTOR S1261 phosphorylation in both mTORC1 and mTORC2. Here we focus on mTORC1 and show that TSC/Rheb signaling promotes mTOR S1261 phosphorylation in an amino acid-dependent, rapamycin-insensitive, and autophosphorylation-independent manner. Our data reveal a functional role for mTOR S1261 phosphorylation in mTORC1 action, as S1261 phosphorylation promotes mTORC1-mediated substrate phosphorylation (e.g., p70 ribosomal protein S6 kinase 1 [S6K1] and eukaryotic initiation factor 4E binding protein 1) and cell growth to increased cell size. Moreover, Rheb-driven mTOR S2481 autophosphorylation and S6K1 phosphorylation require S1261 phosphorylation. These data provide the first evidence that site-specific mTOR phosphorylation regulates mTORC1 function and suggest a model whereby insulin-stimulated mTOR S1261 phosphorylation promotes mTORC1 autokinase activity, substrate phosphorylation, and cell growth.

Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care.

Discriminatory treatment of African Americans in healthcare is well recognized, yet the literature is unclear on the specific role that perceived racism and mistrust play in the patient-provider relationship. The purpose of this study was to test a mid-range theoretical model entitled Perceptions of Racism and Mistrust in Health Care (PRMHC). This model hypothesized that perceived racism influences cultural mistrust, which affects trust in providers--and these combined psychosocial aspects of healthcare affect satisfaction with the care received. One-hundred-forty-five African-American subjects participated in structured interviews to collect demographic and psychosocial data. Provider data was obtained through chart audits. In a group of low-income African Americans in two primary care clinics, perceptions of racism and mistrust of whites had a significant negative effect on trust and satisfaction. Perceived racism had both a significant, inverse direct effect on satisfaction as well as a significant indirect effect on satisfaction mediated by cultural mistrust and trust in provider. Structural equation modeling analysis supported the hypothesized theoretical relationships and explained 27% of the variance in satisfaction with care. The findings add to the existing literature by enhancing our understanding of the complex perspectives on trust and overall satisfaction with care among African-American patients. Results suggest that improving health outcomes for African Americans requires a broader understanding of cultural competence, one that addresses societal racism and its impact on provider-patient relationships.