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ObjectiveAcute pancreatitis is caused by toxins that induce acinar cell calcium overload, zymogen activation, cytokine release and cell death, yet is without specific drug therapy. Mitochondrial dysfunction has been implicated but the mechanism not established.DesignWe investigated the mechanism of induction and consequences of the mitochondrial permeability transition pore (MPTP) in the pancreas using cell biological methods including confocal microscopy, patch clamp technology and multiple clinically representative disease models. Effects of genetic and pharmacological inhibition of the MPTP were examined in isolated murine and human pancreatic acinar cells, and in hyperstimulation, bile acid, alcoholic and choline-deficient, ethionine-supplemented acute pancreatitis.ResultsMPTP opening was mediated by toxin-induced inositol trisphosphate and ryanodine receptor calcium channel release, and resulted in diminished ATP production, leading to impaired calcium clearance, defective autophagy, zymogen activation, cytokine production, phosphoglycerate mutase 5 activation and necrosis, which was prevented by intracellular ATP supplementation. When MPTP opening was inhibited genetically or pharmacologically, all biochemical, immunological and histopathological responses of acute pancreatitis in all four models were reduced or abolished.ConclusionsThis work demonstrates the mechanism and consequences of MPTP opening to be fundamental to multiple forms of acute pancreatitis and validates the MPTP as a drug target for this disease.

This article is designed to unite theory and practice. The focus of attention is the impact of narrative medicine on clinical records. Specifically important is that records are created through dialogue, whereby patients are able to grow the record through their ability to offer critiques and alternative explanations. Merely allowing patients to peruse their records, through advances in technology, is not sufficient to facilitate this aim. Various theoretical and practical considerations are discussed that may facilitate patient involvement and the creation of more accurate and relevant patient records.

Responding to a gap in relevant literatures, this study explores cooperating teachers' perceptions of their roles and responsibilities as contributors to the practicum experiences of preservice teachers of English as a second language who were pursuing a master's degree. Research tools featured focus group and individual interviews with 11 cooperating teachers who were working with practicum students. Findings include a perceived lack of communication between cooperating teachers and practicum course instructors, inadequate written descriptions of cooperating teachers' roles and responsibilities, missed opportunities to develop more fully the quality of cooperating teacher-practicum student collaborations, as well as cooperating teachers' recommendations for enhancing the practicum experiences of those involved.

Despite decades of advocacy for greater investigative attention, research into pronunciation instruction in the teaching of English as a second language (ESL) and English as a foreign language (EFL) continues to be limited. This limitation is particularly evident in explorations of teacher cognition (e.g., teachers' knowledge, beliefs, and understandings), an area emerging as a vibrant focus for grounded research on the development, preparation, and instructional behaviors of ESL/EFL teachers. This article provides a comprehensive review of teacher cognition literatures tied to ESL/EFL pronunciation instruction. The review's dual purposes are (a) to document the current knowledge base of pronunciation teaching, and (b) to propose future directions for classroom-based teacher cognition research in this area. (Contains 1 note.)

This article examines the theoretical basis of the community as it is evoked in health evaluation. In particular, we examine how hospitals carrying out Community Health Needs Assessments (CHNAs) define communities as well as the implications for these definitions for how to study and engage community problems. We present qualitative findings from a sample of Appalachian nonprofit hospitals, who we asked to describe their approach to defining the community in their most recent Internal Revenue Service-mandated CHNA. Drawing upon a theoretical debate in the history of evaluation research, the authors argue that the contemporary community cannot be circumscribed merely by geographic boundaries, nor can it be identified easily with a bounded group of clearly demarcated individuals. Instead, following the tenets of community-based health research, the authors argue for a richer, more dynamic conceptualization of the community in evaluation research in which definitions arise from community bodies themselves.