ATP release from human airway epithelial cells studied using a capillary cell culture system

Epithelial release of adenosine triphosphate (ATP), an important autocrine and paracrine signalling molecule, is acutely mechanosensitive and therefore difficult to study. We describe here a novel preparation that minimizes mechanical and metabolic perturbations, and use it to examine ATP secretion by epithelial cells. The Calu-3 cell line derived from human airway sub-mucosal glands was cultured in a hollow fibre bioreactor on porous capillaries that were perfused by a re-circulating medium pump. Cells became polarized and cultures were stable for > 5 months, as evidenced by microscopy and lactate production (≈250 μg (10⁸ cells)⁻¹ day⁻¹). Elevating apical flow rate 5-fold increased ATP secretion from ≈200 to 6618 fmol min⁻¹. Reducing apical osmolarity by 25–43 % also increased ATP secretion, which then declined spontaneously to a plateau rate that persisted as long as hypotonic perfusion was maintained. Release deactivated rapidly after shear and osmotic stresses were terminated, and was not associated with detectable cell lysis. Lowering apical [Ca²⁺] to increase connexin hemichannel permeability also stimulated ATP release and increased secretion during both hyposmotic and shear stress; however, the connexin 43 blocker flufenamic acid inhibited shear-induced ATP release only in low-Ca²⁺ solution, and therefore another secretory pathway may operate with physiological (i.e. m m ) calcium. Regardless of the mechanism, the present results quantify ATP responses to mechanical and osmotic stimuli and demonstrate the usefulness of capillary cultures for studying epithelial secretion.     

Antibodies against factor VIII in patients with solid tumors: successful treatment of cancer may suppress inhibitor formation.

Between 1995 and 1998, we treated 5 patients with anti-factor VIII antibodies and spontaneous bleeding. All patients had underlying malignant conditions. Initial control of the bleeding episodes and reduction in inhibitor titer was achieved in all patients. Disappearance of factor VIII inhibitor occurred in 3 patients after either resection of the tumor or chemotherapy. Immunosuppression therapy failed to eradicate the antibody in 2 patients with metastatic disease. Antibodies against factor VIII appearing in certain patients may be directly associated with the underlying malignancy, rather than a coincidental finding. Attempts to reduce the titer or eradicate the inhibitor may fail if recognition of the underlying condition is not sought, or an appropriate treatment of cancer is not offered.     

Measuring homelessness and residential stability: The residential time‐line follow‐back inventory

Reliable and valid longitudinal residential histories are needed to assess interventions to reduce homelessness and increase community tenure. This study examined the test‐retest reliability, sensitivity to change, and concurrent validity of the Residential Time‐Line Follow‐Back (TLFB) Inventory, a method used to record residential histories in the Collaborative Program to Prevent Homelessness (n = 1,381). The Residential TLFB Inventory yielded temporally stable aggregate measures of duration in residential categories, and it revealed significant differences in change over time when contrasting study groups. A comparison of agency and participant data at one site.     

Information technology implications of case management

Information technology is a critical component to implementing a comprehensive and effective case management process. The vendor marketplace is aggressively working to address gaps in function and integration. In the meantime, organizations must begin now to plan their case management processes. This is no small task. Most organizations are struggling to develop the necessary manual systems through consensus building on a multidisciplinary basis. Success in developing and implementing a good manual system, although cumbersome, is an essential prerequisite to automation. Major organizational growth and restructuring is already under way in most settings to respond to the pressures of health care reform. Availability of a tight case management process with appropriate information technology support is the key to success.     

Capabilities Approach: Contextualizing Participants’ Perspectives on Systems Barriers to Recovery

Mental health resources are designed to facilitate recovery for adults with psychiatric disabilities. Two participants of an autovideography intervention described systems barriers to recovery. Researchers employed narrative analysis, guided by the capabilities approach, to evaluate how participants storied their experiences. Participants made meaning from encounters with barriers in ways that oppose the spirit and advancement of recovery while engendering adaptive preferences. Findings indicate that inadequate resources attenuate wellbeing by increasing barriers that actively oppose recovery, and positive reframing of unaccommodating environments reinforces adaptive preferences and incapacity. Adequate resources are essential for successful recovery transformation within the mental health system.     

Relationship Between Depression and/or Anxiety and Hospital Readmission Among Women After Childbirth

ObjectiveTo examine the relationship between depression and/or anxiety and any psychiatric diagnosis and readmission after childbirth.DesignCross-sectional analysis of administrative data from patient discharge records.SettingUrban academic medical center in the northeastern United States.ParticipantsWomen admitted for childbirth (N = 17,905).MethodsDifferences among participants with and without depression and/or anxiety present on admission were compared using t tests and chi-square tests. Risk-adjusted logistic regression models were used to examine the effects of depression and/or anxiety and any psychiatric diagnosis on 7-, 30-, 60-, 90-, and 180-day readmissions after childbirth.ResultsSignificant differences were noted between participants with (n = 1,169) and without (n = 16,736) depression and/or anxiety. Participants with these diagnoses had a higher mean age and a longer mean length of stay during hospitalization for childbirth. A greater proportion of these participants were White, were single, had cesarean births, and were discharged with home health services. The presence of depression and/or anxiety was not significantly associated with readmission. The effect of having any psychiatric diagnosis was significantly associated with a greater risk of readmission at 7 (odds ratio [OR] = 1.51, p = .100), 30 (OR = 1.45, p = .030), 60 (OR = 1.45, p = .026), 90 (OR = 1.56, p = .004), and 180 days (OR =1.74, p < .001) following discharge after childbirth.ConclusionIn this sample, women with a psychiatric diagnosis, but not depression and/or anxiety alone, were at increased risk for readmission after childbirth.