Physician Perspectives on Malnutrition Screening, Diagnosis, and Management: A Qualitative Analysis.

Malnutrition is an important clinical entity that is frequently underdiagnosed and undertreated, in part due to a lack of education and different perceptions by healthcare providers on its value in medical practice. Given this void, the purpose of this qualitative study was to explore physicians' clinical perspectives on malnutrition care, including its prevalence in their practice, and potential barriers that might preclude the delivery of malnutrition care. Using a directed content qualitative analysis approach, a total of 22 general and subspecialist physicians across three Canadian provinces were interviewed using a series of standardized questions developed by a multidisciplinary research team. Responses were transcribed and then analyzed using NVivo Version 14 software. While physicians recognized the importance of malnutrition screening and treatment, they did not view themselves as the primary drivers and often deferred this responsibility to dietitians. Lack of standard malnutrition screening, education amongst allied healthcare providers, time, personnel, and referral processes to have patients assessed and managed for malnutrition were also identified as contributing factors. For physicians, malnutrition education, standard malnutrition screening during patient encounters, and access to the necessary tools to manage malnutrition using a more centralized approach and standard referral process were viewed as strategies with the potential to improve the ability of the physician to identify and manage disease-related malnutrition and its negative consequences.

Oxidative stress and metabolic perturbations in Escherichia coli exposed to sublethal levels of 2,4-dichlorophenoxyacetic acid.

The chlorophenoxy herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) is used extensively worldwide despite its known toxicity and our limited understanding of how it affects non-target organisms. Escherichia coli is a suitable model organism to investigate toxicity and adaptation mechanisms in bacteria exposed to xenobiotic chemicals. We developed a methodical platform that uses atomic force microscopy, metabolomics and biochemical assays to quantify the response of E. coli exposed to sublethal levels of 2,4-D. This herbicide induced a filamentous phenotype in E. coli BL21 and a similar phenotype was observed in a selection of genotypically diverse E. coli strains (A0, A1, B1, and D) isolated from the environment. The filamentous phenotype was observed at concentrations 1000 times below field levels and was reversible upon supplementation with polyamines. Cells treated with 2,4-D had more compliant envelopes, significantly remodeled surfaces that were rougher and altered vital metabolic pathways including oxidative phosphorylation, the ABC transport system, peptidoglycan biosynthesis, amino acid, nucleotide and sugar metabolism. Most of the observed effects could be attributed to oxidative stress, consistent with increases in reactive oxygen species as a function of 2,4-D exposure. This study provides direct evidence that 2,4-D at sublethal levels induces oxidative stress and identifies the associated metabolic changes in E. coli.