Setting the Agenda for Patient-Centered Research in Infant and Young-Child Feeding: Results from the Academy of Breastfeeding Medicine and Reaching Our Sisters Everywhere.

Background: Breastfeeding is critically important for optimal health of both birthing people and their infants. Shared, patient-centered goals of how health care team members, community groups, and families can help facilitate breastfeeding success are needed, as are ways to define and measure what breastfeeding success looks like from the patient's perspective. Methods: The Academy of Breastfeeding Medicine and Reaching Our Sisters Everywhere's collaborated in a multi-methods approach to identify breastfeeding priorities most important to parents. Results: We identified (1) Key components of a successful breastfeeding journey defined by parents and families, (2) Research priorities that will enable families to achieve breastfeeding. Conclusion: Dissemination of these findings can foster research efforts that are codesigned with birthing parents and families and reflect their priorities.

The Value of Including the Nursing Perspective in the Boardroom.

In response to the Future of Nursing Report, the Nurses on Boards Coalition promotes the health of communities and the nation by engaging nurses in board service. Nurses possess knowledge and skills that when leveraged in boardroom discussions and decisions may impact the health of the populations served by the board. This article highlights the insights of organizational board leaders, as they describe the impact and influence of nurse board members within their organizations.

Pathologic and immunohistochemical findings in an outbreak of systemic toxoplasmosis in a mob of red kangaroos.

Toxoplasma gondii is a zoonotic protozoan pathogen that infects many endothermic vertebrates, including humans; the domestic cat and other felids serve as the definitive host. Macropodids are considered highly susceptible to toxoplasmosis. Here, we describe the clinical, pathologic, and immunohistochemical findings of an outbreak of systemic toxoplasmosis in a mob of 11 red kangaroos (Macropus rufus), with high morbidity (73%) and mortality (100%) rates. Affected animals had either severe and rapidly deteriorating clinical conditions or sudden death, which was correlated with widespread necrotizing lesions in multiple organs and intralesional T. gondii organisms identified via MIC3-specific immunohistochemistry and confirmed by REP529-specific rtPCR. Quantification of parasites demonstrated the highest parasite density in pulmonary parenchyma compared with other tissues. Our study highlights the continued importance of this severe condition in Australian marsupials.

The Future of Nursing Report Set the Stage for Healthier Hoosiers.

Since the introduction of the Future of Nursing report in 2011, Indiana nursing has successfully implemented many of the recommendations. This article describes these accomplishments. Notable examples include increasing the diversity of the workforce, placement of nurses on community boards and governmental appointments, promoting the advancement of nursing education, and increasing the number of nurses with baccalaureate degrees. Furthermore, Indiana supports the proliferation of new doctoral programs with a scholarship fundraising program to assist nurses with the cost of their education.

Detection of SARS-CoV-2 by RNAscope® in situ hybridization and immunohistochemistry techniques.

In situ hybridization (ISH) and immunohistochemistry (IHC) are essential tools to characterize SARS-CoV-2 infection and tropism in naturally and experimentally infected animals and also for diagnostic purposes. Here, we describe three RNAscope®-based ISH assays targeting the ORF1ab, spike, and nucleocapsid genes and IHC assays targeting the spike and nucleocapsid proteins of SARS-CoV-2.

Stage-based implementation of immediate postpartum long-acting reversible contraception using a reproductive justice framework.

The immediate postpartum period is a favorable, safe, and effective time to provide long-acting reversible contraceptives, yet it is not available widely. We describe an innovative hospital-based approach to immediate postpartum long-acting reversible contraceptives that includes (1) an emphasis on multidisciplinary teambuilding and identification of champions, (2) a focus on the use of implementation science at every stage of the process to develop a systematic and replicable strategy, and (3) an imperative to apply a reproductive justice framework to immediate postpartum long-acting reversible contraceptive implementation. Our model was developed with the use of implementation science best practices. Implementation teams comprised of diverse stakeholders were formed and included champions to promote progress. Our team assessed the implementation context for immediate postpartum long-acting reversible contraceptives and used the findings to develop a readiness assessment for hospitals. A stage-based implementation checklist was then developed to outline necessary infrastructure to support an immediate postpartum long-acting reversible contraceptive initiative. A reproductive justice lens guided planning and implementation. The 3 innovative aspects of our implementation process resulted in a systematic, multidisciplinary, and culturally appropriate model for immediate postpartum long-acting reversible contraceptives that can be replicated across hospitals. Implementation teams and champions moved the work forward at each hospital, and 3 of the 5 participating hospitals moved beyond the exploration stage of implementation during the engagement. Patient education materials and provider training incorporated person-centered and reproductive justice frameworks. Our hope is to continue to partner with stakeholders to better understand how our efforts to support hospital provision of immediate postpartum long-acting reversible contraceptives can increase reproductive health equity rather than perpetuate disparity.

Pancreastatin: multiple actions on human intermediary metabolism in vivo, variation in disease, and naturally occurring functional genetic polymorphism.

RATIONALE: The chromogranin A (CHGA) fragment pancreastatin (human CHGA250-301) impairs glucose metabolism, but the role of human pancreastatin in vivo remains unexplored. METHODS: We studied brachial arterial infusion of pancreastatin (CHGA273-301-amide at approximately 200 nm) on forearm metabolism of glucose, free fatty acids, and amino acids. Plasma pancreastatin was measured in obesity or type 2 diabetes. Systematic discovery of amino acid variation was performed, and the potency of one variant in the active carboxyl terminus (Gly297Ser) was tested. RESULTS: Pancreastatin decreased glucose uptake by approximately 48-50%; the lack of change in forearm plasma flow indicated a metabolic, rather than hemodynamic, mechanism. A control CHGA peptide (catestatin, CHGA352-372) did not affect glucose. Insulin increased glucose uptake, but pancreastatin did not antagonize this action. Pancreastatin increased spillover of free fatty acids by about 4.5- to 6.4-fold, but not spillover of amino acids. Insulin diminished spillover of both free fatty acids and amino acids, but these actions were not reversed by pancreastatin. Plasma pancreastatin was elevated approximately 3.7-fold in diabetes, but was unchanged during weight loss. Proteolytic cleavage sites for pancreastatin in vivo were documented by matrix-assisted laser desorption ionization/time of flight mass spectrometry. Three pancreastatin variants were discovered: Arg253Trp, Ala256Gly, and Gly297Ser. The Gly297Ser variant had unexpectedly increased potency to inhibit glucose uptake. CONCLUSIONS: The dysglycemic peptide pancreastatin is specifically and potently active in humans on multiple facets of intermediary metabolism, although it did not antagonize insulin. Pancreastatin is elevated in diabetes, and the variant Gly297Ser had increased potency to inhibit glucose uptake. The importance of human pancreastatin in vivo as well as its natural variants is established.

Role of H+-ATPase-mediated acidification in sorting and release of the regulated secretory protein chromogranin A: evidence for a vesiculogenic function.

The constitutive and regulated secretory pathways represent the classical routes for secretion of proteins from neuroendocrine cells. Selective aggregation of secretory granule constituents in an acidic, bivalent cation-rich environment is considered to be a prerequisite for sorting to the regulated secretory pathway. The effect of selective vacuolar H+-ATPase (V-ATPase) inhibitor bafilomycin A1 on the pH gradient along the secretory pathway was used here to study the role of acidification on the trafficking of the regulated secretory protein chromogranin A (CgA) in PC12 cells. Sorting of CgA was assessed by three-dimensional deconvolution microscopy, subcellular fractionation, and secretagogue-stimulated release, examining a series of full-length or truncated domains of human CgA (CgA-(1-115), CgA-(233-439)) fused to either green fluorescent protein or to a novel form of secreted embryonic alkaline phosphatase (EAP). We show that a full-length CgA/EAP chimera is sorted to chromaffin granules for exocytosis. Inhibition of V-ATPase by bafilomycin A1 markedly reduced the secretagogue-stimulated release of CgA-EAP by perturbing sorting of the chimera (at the trans-Golgi network or immature secretory granule) rather than the late steps of exocytosis. The effect of bafilomycin A1 on CgA secretion depends on a sorting determinant located within the amino terminus (CgA-(1-115)) but not the C-terminal region of the granin. Moreover, examination of chromaffin granule abundance in PC12 cells exposed to bafilomycin A1 reveals a substantial decrease in the number of dense-core vesicles. We propose that a V-ATPase-mediated pH gradient in the secretory pathway is an important factor for the formation of dense-core granules by regulating the ability of CgA to form aggregates, a crucial step that may underlie the granulogenic function of the protein.

Assessment of selected patient educational materials of various chain pharmacies.

Pharmacy literature commonly used to inform patients about medication side-effects and complications was examined for readability. Forty-five (45) informational sheets were obtained from nine national and regional pharmacies. According to the McLaughlin's SMOG (Simple Measure of Gobbledegook) formula, the reading level of the informational sheets ranged from grade 8-14 (8 = 8th grade level and 14 = collegiate level), with a mean reading level of 12. The sampled pharmacy educational materials may be too difficult for most Americans to read and comprehend. The pharmacist may assist in increasing patient compliance by offering education in a form that is understandable, which increases the likelihood of adherence to desired health behaviors.

Identification of a novel sorting determinant for the regulated pathway in the secretory protein chromogranin A.

Chromogranin A (CgA) is the index member of the chromogranin/secretogranin (or 'granin') family of regulated secretory proteins that are ubiquitously distributed in amine- and peptide-containing secretory granules of endocrine, neuroendocrine and neuronal cells. Because of their abundance and such widespread occurrence, granins have often been used as prototype proteins to elucidate mechanisms of protein targeting into dense-core secretory granules. In this study, we used a series of full-length, point mutant or truncated CgA-green fluorescent protein (GFP) chimeras to explore routing of CgA in neuroendocrine PC12 cells. Using sucrose gradient fractionation and 3D deconvolution microscopy to determine the subcellular localization of the GFP chimeras, as well as secretagogue-stimulated release, the present study establishes that a CgA-GFP fusion protein expressed in neuroendocrine PC12 cells is trafficked to the dense core secretory granule and thereby sorted to the regulated pathway for exocytosis. We show that information necessary for such trafficking is contained within the N-terminal but not the C-terminal region of CgA. We find that CgA's conserved N-terminal hydrophobic Cys(17)-Cys(38) loop structure may not be sufficient for sorting of CgA into dense-core secretory granules, nor is its stabilization by a disulfide bond necessary for such sorting. Moreover, our data reveal for the first time that the CgA(77-115) domain of the mature protein may be necessary (though perhaps not sufficient) for trafficking CgA into the regulated pathway of secretion.