Modeling and experimental results suggest a role for Planar Cell Polarity-dependent multi-cellular rosette structures in ensuring correct epithelial cell migration in the mouse visceral endoderm.

The evidence supporting the management of chronic cough in ILD is limited. This guideline presents suggestions for managing and treating cough on the best available evidence, but future research is clearly needed.

A method of perfusing the isolated human colon in vitro was developed to study the effect of the short-chain fatty acid n-butyrate on sodium absorption under controlled conditions. The isolated colon was viable in vitro provided that ischemia to the colon prior to perfusion was less than 40 min. Viability was judged on glucose utilization, mucosal potential difference, an sodium absorption. Sodium absorption from the lumen was observed either with or without 20 mM n-butyrate. In a control group sodium absorption (nmol/min/cm2 /+- SEM) was 320 /+- 10 (four perfusions, nine observation intervals) and potassium secretion 26 /+- 3 (four perfusions, nine observation intervals). With 20 mM n-butyrate sodium absorption was 1960 /+- 480 (four perfusions, ten observation intervals) (P less than 0.0025). Potassium secretion was 72 /+- 2 (four perfusions, ten observation intervals) and (P less than 0.025). Butyrate absorption was 254 /+- 60 (four perfusions, ten observation intervals) and correlated linearly with the unidirectional flux (Jm leads to S) of sodium (linear coefficient of 0.714, P = less than 0.001). These results suggest that the presence of bacterial short-chain fatty acids may determine the efficiency of sodium absorption in the colon and also indicate that an absence of short-chain fatty acids in the colon could be one factor leading to diminished sodium absorption in the colon of man.

Background: Clinical ladder programs (CLPs) are often utilized by healthcare organizations to monitor and incentivize staff nurse development. Few studies exist related to this topic, yet implementation of CLPs can be an important factor in staff nurse retention and satisfaction, and therefore requires better understanding.Aim: To identify and examine the factors that contribute to a successful CLP.Methods: A systematic search of the literature was conducted in PubMed and CINAHL. Studies were not limited by year and were included if the focus was CLP attributes. PRISMA and PICOT were used to guide the process. A matrix of the existing studies was used, and interrater reliability was established at 90% with consensus building for inclusion of studies by the research team.Results: Twenty-nine studies were identified for inclusion. Most were program evaluation. Institution's organizational culture was identified as the overarching attribute contributing to a successful CLP. Common themes identified as important to a supportive organizational culture were (a) education and experience; (b) competence and critical thinking; (c) job satisfaction and retention; and (d) compensation and institutional cost. Each of these components can play a significant role in the overall success of a CLP.Linking Evidence to Action: While further research of a higher caliber is needed, some recommendations for practice can be made: (a) CLP description and terminology needs to be consistent with intent, (b) mandatory CLP engagement has positive implications, and (c) implementation needs to be driven by bedside nurses and includes both continuous education and refinement of program requirements and incentives.

No abstract

SUMMARY Luminal concentrations of short chain fatty acids (SCFA), ammonia, sodium and potassium were measured in colonic dialysate of 16 control subjects and in 65 cases with ulcerative colitis (UC), which were graded according to mucosal changes into mild (1) Material and methodsGelatin capsules containing dialysis tubing were

on behalf of the CHEST Expert Cough Panel* BACKGROUND: Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed.METHODS: A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza.RESULTS: There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized. Both clinical suggestions and research recommendations were made on the evidence available and CHEST Expert Cough Panel advice.CONCLUSIONS: For outpatient adults with acute cough due to suspected pneumonia, we suggest the following clinical symptoms and signs are suggestive of pneumonia: cough; dyspnea; pleural pain; sweating, fevers, or shivers; aches and pains; temperature $ 38 C; tachypnea; and new and localizing chest examination signs. Those suspected of having pneumonia should undergo chest radiography to improve diagnostic accuracy. Although the measurement of C-reactive protein levels strengthens both the diagnosis and exclusion of pneumonia, there was no added benefit of measuring procalcitonin levels in this setting. We suggest that there is no need for routine microbiological testing. We suggest the use of empiric antibiotics according to local and national guidelines when pneumonia is suspected in settings in which imaging cannot be performed. Where there is no clinical or radiographic evidence of pneumonia, we do not suggest the routine use of antibiotics. There is insufficient evidence to make recommendations for or against specific nonantibiotic, symptomatic therapies. Finally, for outpatient adults with acute cough and suspected influenza, we suggest that initiating antiviral treatment (according to Centers for Disease Control and Prevention advice) within 48 hours of symptoms could be associated with decreased antibiotic use and hospitalization and improved outcomes.

ObjectivesBullying of trainee doctors has been shown to be associated with detrimental outcomes for both doctors and patients. However, there is limited evidence regarding the level of bullying of trainees within medical specialties.MethodsAn annual survey of UK cardiology trainees was conducted through the British Junior Cardiologists’ Association between 2017 and 2020 and asked questions about experiencing and witnessing bullying, and exposure to inappropriate language/behaviour in cardiology departments. Fisher’s exact tests and univariable logistic regression models were used to describe associations between trainee characteristics, and reports of bullying and inappropriate language/behaviour.ResultsOf 1358 trainees, bullying was reported by 152 (11%). Women had 55% higher odds of reporting being bullied (OR: 1.55 95% CI (1.08 to 2.21)). Non-UK medical school graduates were substantially more likely to be bullied (European Economic Area (EEA) OR: 2.22 (1.31 to 3.76), non-EEA/UK OR: 3.16 (2.13 to 4.68)) compared with those graduating from UK-based medical schools. Women were more likely than men to report sexist language (14% vs 4%, p<0.001). Non-UK medical school graduates were more likely to experience racist language (UK 1.5%, EEA 6%, other locations 7%, p=0.006). One-third of trainees (33%) reported at least one inappropriate behaviour with 8% reporting being shouted at or targeted with spontaneous anger. Consultants in cardiology (82%) and other specialties (70%) were most commonly implicated by those reporting bullying.DiscussionBullying and inappropriate language are commonly experienced by cardiology trainees and disproportionately affect women and those who attended non-UK medical schools. Consultants both in cardiology and other specialties are the most commonly reported perpetrators.