Three-Stage Assessment as Reverse Innovation in Interprofessional Student Clinical Rotations.

Social determinants of health are increasingly recognized as important factors in individual and public health outcomes and are therefore of interest to both health care systems and medical schools. However, teaching holistic assessment strategies during clinical education remains a challenge. This article reports on the experiences of American physician assistant students who completed an elective clinical rotation in South Africa. In particular, the students' training and practice with 3-stage assessment is highlighted as an example of a reverse innovation practice that could be incorporated in interprofessional health care education models in the United States.

Caring for Refugee Patients: An Interprofessional Course in Resettlement, Medical Intake, and Culture.

INTRODUCTION: Refugees access health care at rates similar to US citizens. Many clinicians, however, do not feel prepared to care for them. This study evaluated whether an interprofessional presentation could improve knowledge of refugee health and cross-cultural comfort. METHODS: The session consisted of a lecture and 3 small-group sessions. Students from various health care programs attended via Zoom. Participants completed pre- and postsurveys to assess cross-cultural comfort and knowledge of refugee health. RESULTS: Of 161 attendees, 63 completed the presurvey (39%) and 49 completed the postsurvey (30%). All 9 knowledge questions demonstrated statistically significant improvements, while only 1 cross-cultural question showed significant improvement. DISCUSSION: The session improved knowledge of refugee health but not cross-cultural comfort, indicating the need for further interventions.

Molecular cloning of ovine endothelial nitric oxide synthase and expression in COS-7 cells.

While studies of human and bovine endothelial nitric oxide synthase (eNOS) demonstrate activation by Ca(2+)/calmodulin, recent progress demonstrates that eNOS phosphorylation can alter sensitivity to intracellular free calcium ([Ca(2+)](i)). The sheep, however, is widely used as a model for cardiovascular adaptation to pregnancy and ovine uterine artery endothelial cell (UAEC) eNOS undergoes pregnancy-specific (P) enhancement of activity associated with increased Ca(2+) and protein kinase signaling in response to a number of agonists, including adenosine triphosphate (ATP). The degree of homology between the ovine and human full-length cDNAs was not previously known and yet is necessary to determine the validity in using an ovine model to study human physiology. The objectives of this study were to isolate and validate the clone of ovine eNOS cDNA and investigate ovine eNOS activation when expressed in COS-7 cells. The ovine eNOS cDNA has high homology to published human and bovine sequences and shares identity with the bovine amino acid sequence. When ovine eNOS was transiently expressed in COS-7 cells (COS-7/oeNOS), A23187 increased specific catalytic activity in a dose- and time-dependent manner. A23187-stimulated activation of eNOS was, however, also accompanied by phosphorylation of eNOS S1179 and dephosphorylation of T497, demonstrating that an increase in [Ca(2+)](i) may not be the sole mechanism of activation. The physiologic relevance of this was further underscored by the finding that ATP dose-dependently increased peak [Ca(2+)](i) and eNOS activity in COS-7/oeNOS, but also increased eNOS p-S1179 and decreased p-T497. This finding was similar to those in ovine P-UAEC treated with the Ca(2+)-mobilizing agonist ATP, wherein activation of eNOS was again concomitant with a rise p-S1179 as well as a slight decrease in p-T497. In conclusion, we describe the full-length ovine eNOS cDNA sequence and show that both physiologic and nonphysiologic calcium-mobilizing agents, which activate ovine eNOS in COS-7 and P-UAEC, do so in association with changes in eNOS phosphorylation. Given this information we can now begin to dissect the relationship between Ca(2+) elevation and specific phosphorylation events in eNOS activation in the ovine model, and thereby gain insight into the possible basis for pregnancy-related dysfunction.