Making Americans: Administrative Discretion and Americanization

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Irritable Bowel Syndrome: Clinical Manifestations, Dietary Influences, and Management.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause. It is the most commonly diagnosed functional gastrointestinal disorder, accounting for about one third of gastroenterology visits. It generally presents as a complex of symptoms, including psychological dysfunction. Hypersensitivity to certain foods, especially foods that contain high amounts of fructose, plays a role in the pathophysiology of IBS. Elevated consumption of high-fructose corn syrup (HFCS) has been discussed in this aspect. The treatment options for IBS are challenging and varied. In addition to dietary restrictions for HFCS-induced IBS, such as low-FODMAP (Fermentable Oligosaccharides, Disaccharide, Monosaccharides, and Polyols) diets, existing drug therapies are administered based on the predominant symptoms and IBS-subtype. Patients with IBS are likely to suffer from issues, such as anxiety, depression, and post-traumatic-stress disorder. Biopsychosocial factors particularly socioeconomic status, sex, and race should, thus, be considered for diagnostic evaluation of patients with IBS

Clinical Factors Implicated in Antibiotic Resistance in Helicobacter pylori Patients

Helicobacter pylori is a common gastric pathogen associated with multiple clinical syndromes, including cancer. Eradication rates of H. pylori remain suboptimal despite the progress made in the past few decades in improving treatment strategies. The low eradication rates are mainly driven by antibiotic resistance of H. pylori. Non-invasive molecular testing to identify patients with antibiotic-resistant H. py-lori represents a promising therapeutic avenue, however this technology currently remains limited by availability, costs, and lack of robust validation. Moreover, there is insufficient evidence to demonstrate that resistance-testing-based treatment approaches are superior to appropriately designed empiric strat-egies. Consensus guidelines recommend use of proven locally effective regimens; however, eradication data are inconsistently generated in several regions of the world. In this review, we describe several clinical factors associated with increased rates of antibiotic resistant H. pylori, including history of previous antibiotic exposure, increasing age, female gender, ethnicity/race, extent of alcohol use, and non-ulcer dyspepsia. Assessment of these factors may aid the clinician in choosing the most appropriate empiric treatment strategy for each patient. Future study should aim to identify locally effective therapies and further explore the clinical factors associated with antibiotic resistance

Creation and Implementation of a Flipped Jigsaw Activity to Stimulate Interest in Biochemistry Among Medical Students

Learner-centered pedagogical methods that are based on clinical application of basic science concepts through active learning and problem solving are shown to be effective for improving knowledge retention. As the clinical relevance of biochemistry is not always apparent to health-profession students, effective teaching of medical biochemistry should highlight the implications of biochemical concepts in pathology, minimize memorization, and make the concepts memorable for long-term retention.Here, we report the creation and successful implementation of a flipped jigsaw activity that was developed to stimulate interest in learning biochemistry among medical students. The activity combined the elements of a flipped classroom for learning concepts followed by a jigsaw activity to retrieve these concepts by solving clinical cases, answering case-based questions, and creating concept maps. The students’ reception of the activity was very positive. They commented that the activity provided them an opportunity to review and synthesize information, helped to gauge their learning by applying this information and work with peers. Students’ improved performance especially for answering the comprehension-based questions correctly in the post-quiz as well as the depth of information included in the post-quiz concept maps suggested that the activity helped them to understand how different clinical scenarios develop owing to deviations in basic biochemical pathways

Motility of the antroduodenum in healthy and gastroparetics characterized by wireless motility capsule

The wireless motility capsule (WMC) measures intraluminal pH and pressure, and records transit time and contractile activity throughout the gastrointestinal tract. Our hypothesis is that WMC can differentiate antroduodenal pressure profiles between healthy people and patients with upper gut motility dysfunctions.This study aims to analyze differences in the phasic pressure profiles of the stomach and small intestine in healthy and gastroparetic subjects.Data from 71 healthy and 42 gastroparetic subjects were analyzed. The number of contractions (Ct), area under the pressure curve and motility index (MI = Ln (Ct *sum amplitudes +1)) were analyzed for 60 min before gastric emptying of the capsule (GET), (gastric window) and after GET (small bowel window) and results between groups were compared with the Wilcoxon rank sum test.Significant differences were observed between healthy and gastroparetic subjects for Ct and MI ( P  < 0.05). Median values of the motility parameters in gastric window were Ct = 72, MI = 11.83 for healthy and Ct = 47, MI = 11.12 for gastroparetics. In the small bowel, median values were Ct = 144.5, MI = 12.78 for healthy and Ct = 93, MI = 12.12 for gastroparetics. Diabetic subjects with gastroparesis showed significantly lower Ct and MI compared with healthy subjects in both gastric and small bowel windows while idiopathic gastroparetic subjects did not show significant differences.The WMC is able to differentiate between healthy and gastroparetic subjects based on gastric and small bowel motility profiles.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78624/1/j.1365-2982.2010.01468.x.pd

American Neurogastroenterology and Motility Society consensus statement on intraluminal measurement of gastrointestinal and colonic motility in clinical practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73395/1/j.1365-2982.2008.01230.x.pd

New Voices in U.S. Immigration Debates: Latino and Asian American Attitudes Toward the Building Blocks of Comprehensive Immigration Reform

That U.S. immigration policy has shaped the demography, size, and potential for routine political influence of Latino and Asian American populations is a truism.  What is perhaps less acknowledged, but also increasingly clear is that debates over U.S. immigration policy (and Congressional and Executive inaction and posturing) are shaping the politics of Latino and Asian American communities for the next generation.  In this paper, I examine the factors that shape Latino and Asian American attitudes toward U.S. immigration policy with a particular eye to whether generational differences in Latino and Asian American communities predict different preferred outcomes of the national debate on immigration policy.  This generational question is one that will take on increasing influence in coming years as the children and grandchildren of today’s immigrants make up a larger and larger share of these panethnic populations.            This paper speaks to three sets of scholarly questions.  First, I analyze the predictors of attitudes toward immigration policies in the contemporary debate among Latinos and Asian Americans.  Second, I assess whether there are predictable differences in these attitudes across immigrant generations.  Finally, I compare Latino and Asian American attitudes.             I find that Latinos and Asian Americans do not speak with one voice on immigration reform.  Interestingly, the starkest differences are seen across immigrant generations in these communities.  Latino immigrants are more likely than other Latinos to prefer legalization as the core policy outcome.  Asian immigrants are more likely than other Asian Americans to prefer a policy outcome that creates opportunities for migrants with skills to migrate.  Needless to say, these are not mutually exclusive as bills being debated in Congress today include both elements, but they certainly offer a different staring point for shaping policy