Search

Background: Untreated alcohol use disorder (AUD) is associated with poor cirrhosis outcomes. We evaluated factors associated with AUD treatment discussions and initiation in the Veterans Health Administration. Methods: Chart reviews were conducted for veterans with International Classification of Diseases codes for both cirrhosis and AUD who were receiving care at one of three large medical centers in 2020. Factors associated with a 1‐year offer of AUD treatment and its acceptance were assessed using regression models, which included as covariates demographic characteristics, comorbidities, and depression, as measured by the patient health questionnaire (PHQ‐2) from the electronic health record. Results: The cohort included 654 veterans, 68 of whom were engaged in AUD treatment at baseline and 174 who were documented as being in AUD remission. Treatment was offered to 264 (64%) of the 412 veterans with opportunities to initiate it. AUD treatment discussions were most often documented by practitioners in primary care (n = 162), hepatology (n = 45), or both (n = 41). Multivariable logistic regression modeling revealed that treatment was significantly more likely to be offered to patients with co‐occurring bipolar disorder (OR 2.94, p = 0.03) or depression (1.50, p = 0.05) or who were younger (0.97, p = 0.01). Of the 264 patients offered AUD treatment, 107 (40%) agreed to initiate it. Acceptance of an offer of treatment was significantly associated with hospitalization in the prior year (OR 1.74, p = 0.05), prior AUD treatment (9.92, p < 0.0001), and a higher PHQ‐2 depression score (2.85, p = 0.004). Conclusions: We identified factors associated with an offer of AUD treatment and its initiation among veterans with cirrhosis. Application of these findings could increase the likelihood that veterans with alcoholic cirrhosis initiate AUD treatment. [ABSTRACT FROM AUTHOR]

Alcohol use disorder (AUD) screening is important but focused training with using AUDIT‐10 with counselling/mental health (MH) referral may be needed. We aimed to compare the effect of training on AUD screening/intervention in hepatology clinics in pre vs post‐training phases of a quality‐improvement initiative. Pre‐training encounters were evaluated for inquiry into AUD, AUDIT‐10 and MH referrals. Dedicated AUD‐related training was provided to hepatology providers and analyses repeated post‐training. Pre‐training (n = 378) and post‐training patients(n = 318) had similar demographics and disease characteristics. Post‐training there was higher inquiry about alcohol(92% vs 80%, P <.0001), counselling (82% vs 68%, P <.0001). This led to higher diagnosis of drinkers (49% vs 31%, P <.0001) of whom higher proportion had AUDIT‐10 administered(91% vs 34%, P <.0001) and referred to MH(29% vs 8%, P <.0001). On regression presumed alcohol‐related aetiology, younger age and post‐training period were associated with AUDIT‐10 administration. AUD‐focused training significantly improves rates of screening and MH referral for problem drinking in a hepatology clinic population. [ABSTRACT FROM AUTHOR]

The American black bear undergoes a 3-5 month winter hibernation during which time bears do not eat, drink, defecate, or urinate. During hibernation renal function ( GFR) is 16-50% of normal but urine is reabsorbed across the urinary bladder ( UB) urothelium thus enabling metabolic recycling of all urinary constituents. To elucidate the mechanism(s) whereby urine is reabsorbed, we examined the UBs of five nonhibernating wild bears using light, electron ( EM), and confocal immunofluorescent ( IF) microscopy-concentrating on two components of the urothelial permeability barrier - the umbrella cell apical membranes and tight junctions ( TJ). Bear UB has the same tissue layers (serosa, muscularis, lamina propria, urothelia) and its urothelia has the same cell layers (basal, intermediate, umbrella cells) as other mammalians. By EM, the bear apical membrane demonstrated a typical mammalian scalloped appearance with hinge and plaque regions - the latter containing an asymmetric trilaminar membrane and, on IF, uroplakins Ia, IIIa, and IIIb. The umbrella cell TJs appeared similar to those in other mammals and also contained TJ proteins occludin and claudin - 4, and not claudin -2. Thus, we were unable to demonstrate urothelial apical membrane or TJ differences between active black bears and other mammals. Expression and localization of UT-B, AQP-1 and -3, and Na+, K+- ATPase on bear urothelial membranes was similar to that of other mammals. Similar studies of urothelia of hibernating bears, including evaluation of the apical membrane lipid bilayer and GAGs layer are warranted to elucidate the mechanism(s) whereby hibernating bears reabsorb their daily urine output and thus ensure successful hibernation. [ABSTRACT FROM AUTHOR]

Adaptor proteins containing PDZ interactive domains have been recently identified to regulate the trafficking and activity of ion transporters and channels in epithelial tissue. In the renal proximal tubule, three PDZ adaptor proteins, namely NHERF-1, NHERF-2 and PDZK1, are expressed in the apical membrane, heterodimerize with one another, and, at least in vitro, are capable of binding to NHE3 and Npt2a, two major regulated renal proximal tubule apical membrane transporters. Studies using NHERF-1 null mice have begun to provide insights into the organization of these adaptor proteins and their specific interactions with NHE3 and Npt2a. Experiments using brush border membranes and cultured renal proximal tubule cells indicate a specific requirement for NHERF-1 for cAMP-mediated phosphorylation and inhibition of NHE3. NHERF-1 null mice demonstrate increased urinary excretion of phosphate associated with mistargeting of Npt2a to the apical membrane of renal proximal tubule cells. NHERF-1 null animals challenged with a low phosphate diet and proximal tubule cells from these animals cultured in a low phosphate media fail to adapt as well as wild-type mice. These studies indicate a unique requirement for NHERF-1 in cAMP regulation of NHE3 and in the trafficking of Npt2a. [ABSTRACT FROM AUTHOR]

This study examines how the compensation committees of a sample of U.S. corporations from the S & P 500 justify their compensation practices to shareholders. Drawing from research on organizational legitimacy as a theoretical base, we examine the effects of ownership structure, CEO pay, and organizational performance on the frequencies of three types of compensation justifications: external validations, shareholder alignment statements, and discussions of company performance. We find that when companies have more concentrated and active outside owners, they are much more likely to justify their compensation practices by citing the role of compensation consultants as advisors in the compensation-setting process. They are also more likely to discuss the alignment of managerial and shareholder interests, and to downplay a company's accounting returns. Companies that pay their CEOs large base salaries are also more likely to cite the role of consultants, and, for those with dispersed ownership, to discuss shareholder alignment. High accounting returns lead companies to emphasize accounting performance in their compensation justifications, and to downplay market returns. High stock price volatility leads companies to de-emphasize market returns. We discuss the implications of these findings for research and theory on the symbolic aspects of company–shareholder relationships. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We present descriptive data for alternate forms of clustered and unclustered word list recall in 102 healthy elderly adults and test results for 11 patients with Parkinson's disease. The word list test provide a relatively stable measure of verbal memory. Alternate forms were equivalent except for a tendency of the unclustered list of Form 1 to be easier than those of the other three forms. Verbal intelligence, total word recall, and the ability to cluster related words at recall were related significantly. There were modest effects of education on word recall; female subjects tended to recall more words than males. [ABSTRACT FROM AUTHOR]

WNK4 kinase has been proposed to act as a switch that coordinates NaCI and K+ handling in the distal nephron. This hypothesis is based on observations that the kinase inhibits the cell surface expression of the thiazide-sensitive cotransporter (NCC) and the potassium channel Kir 1.1 (ROMK). While WNK4 reduces ROMK surface density by enhancing channel internalization, details regarding the other component of the switch, NCC, remain unresolved. Here, we used 22Na+ transport measurements in X. laevis oocytes and surface luminescence assays in mammalian cells to study WNK4 effects on NCC trafficking. An analysis of the cell surface lifetime of NCC in the presence of brefeldin A (BFA), a reversible inhibitor of exocytosis, showed that WNK4 did not accelerate the rate of NCC internalization. In contrast, forward trafficking time courses revealed that the recovery of cotransporter activity following release from BFA-induced intracellular retention was completely blunted in the presence of the kinase (2 x 30 oocytes/time point, p=0.0028). Mutagenesis studies indicated that a C-terminal coiled-coil domain-containing region mediates the suppressive effect. Taken together, these data suggest that the WNK4 C-terminus suppresses NCC surface expression by reducing its cell surface delivery. Thus, WNK4 may control renal NaCl reabsorption and K+ secretion by coordinating NCC forward trafficking and ROMK endocytosis. [ABSTRACT FROM AUTHOR]