Pediatric advocacy: Advancement in academic institutions

IMPACT

Children are facing many threats to their health today that require system change at a sweeping level to have real-world impact. Pediatricians are positioned as natural leaders to advocate for these critical community and policy changes. Academic medical center (AMC) leaders recognize the importance of this advocacy and clear steps can be taken to improve the structure to support pediatricians in their advocacy careers through faculty development and promotion, including standardized scholarly measurement of the outcomes.

Community Engagement: How to Form Authentic Partnerships for Lasting Change

Pediatricians play a critical role in promoting child health through community engagement, yet the skills required to be effective leaders and advocates alongside the community are often not the focus of traditional medical training. The American Academy of Pediatrics Community Pediatrics Training Initiative provides faculty and resident training, curricula, and collaboratives to teach the core skills needed for upstream interventions that can affect the entire population of a community. Core skills include community assessment and competence, composed of data, observational, and experiential components. The work of community action begins to effect system-level change for sustainable, impactful improvements in child health.

Academic Careers in Advocacy: Aligning Institutional Values Through Use of an Advocacy Portfolio

Academic children's hospitals must embrace advocacy as a central component of their missions to discover new knowledge and improve the health of the communities and patients they serve. To do so, they must ensure faculty have both the tools and the opportunities to develop and articulate the work of advocacy as an academic endeavor. This can be accomplished by integrating the work of advocacy at the community and policy-change levels into the traditional value systems of academic medicine, especially the promotions process, to establish its legitimacy. Academic pediatric institutions can support this transformation through robust training and professional development programs and establishing opportunities, resources, and leadership positions in advocacy. The adoption of an advocacy portfolio can be used to align these activities and accomplishments to institutional values and promotion. This alignment is crucial to supporting the advocacy work of pediatricians at a time in which community engagement and systems and policy change must be added to professional activities to ensure optimal outcomes for all children.

Chemotactic peptide FMLP contracts human coronary arteries via cyclooxygenase products

The chemotactic peptide N-formyl-L-methionyl-L-leucyl-L-phenylalanine (FMLP) is a constrictor of bronchial smooth muscle. Recently it has also been shown to contract rabbit coronary arteries by an unknown mechanism. This prompted us to investigate whether the chemotactic peptide has an effect on the tone of human coronary arteries obtained during heart transplantation. FMLP was found to be a potent and efficacious myotropic agent on strips of human coronary artery. Contractions were generally transient and subject to tachyphylaxis. The FMLP-induced vasoconstriction was not dependent on the presence of endothelial cells. The response was unaffected by the histamine H1-antagonist diphenhydramine or the antagonist of peptido-leukotrienes FPL 55712. However, the contractions were completely abolished in the presence of the fatty acid cyclooxygenase inhibitors aspirin or indomethacin. Stimulation of rings of human coronary artery with FMLP resulted in a marked production of prostaglandin (PG)F2 alpha, a smaller production of PGD2, and a slight increase in thromboxane B2. All these prostanoids constricted the artery, but the stable thromboxane mimetic U44069 was 100 times more potent than PGF2 alpha or PGD2. These data indicate that FMLP activates cells of unknown identity in the adventitia or media of human coronary arteries to produce a mixture of vasoconstrictor cyclooxygenase products. These compounds are likely to mediate the myotropic effect of FMLP on this artery. The mechanism may participate in the pathogenesis of some forms of coronary vasospasm.

Endothelium-derived relaxing factor (EDRF): a defence mechanism against platelet aggregation and vasospasm in human coronary arteries

The goal of this investigation was to examine the interactions that can occur between platelet and endothelial cells, especially in human coronary arteries. In a first series of experiments, the effect of human endothelial cells (cultured on microcarrier beads) was tested on the aggregation of washed human platelets. Endothelial cells completely inhibited platelet aggregation. The prostacyclin-mediated anti-aggregatory component could be blocked with indomethacin. The remaining anti-aggregatory effect of endothelial cells could be prevented with the EDRF inhibitors, gossypol, haemoglobin and methylene blue. This indicates that the endothelial autoacoids, EDRF and prostacyclin, are both inhibitors of platelet aggregation. In a second approach we investigated the effect of aggregating platelets on the tone of human coronary arteries obtained during heart transplantation. Aggregating platelets produced strictly endothelium-dependent relaxations of coronary arterial strips. These relaxations were mainly mediated by EDRF, because inhibition of vascular prostacyclin synthesis with aspirin did not inhibit the relaxations significantly, but the relaxations were abolished by the aforementioned EDRF inhibitors. Platelet-derived adenosine 5'-diphosphate (ADP) is mainly responsible for the stimulation of EDRF production in coronary endothelial cells. ADP was an endothelium-dependent vasodilator, and apyrase (ADP-ase) completely prevented platelet-induced vasodilation. The other platelet products, serotonin and thromboxane A2, were weak and potent constrictors of coronary arteries, respectively. These data suggest that the ADP released by aggregating platelets stimulates the coronary endothelium to produce EDRF. EDRF overrides the constrictor effects of serotonin and thromboxane A2 and exerts an inhibitory effect against further platelet aggregation or adhesion.

Response of human coronary arteries to aggregating platelets: importance of endothelium-derived relaxing factor and prostanoids

Epicardial human coronary arteries (HCA) were obtained during heart transplantation. Strip preparations were mounted for isometric tension recording. Tension was induced with prostaglandin F2 alpha (0.3-3 microM). Aggregating human platelets (10(7)/ml and 10(8)/ml) caused marked relaxation if the endothelium of the HCA was intact, but produced modest additional constriction if the endothelium was removed. The endothelium-dependent relaxations to platelets were slightly enhanced in the presence of methysergide (1 microM) or after treatment of the platelets with the thromboxane synthase inhibitor dazmegrel (1 mM, 30 minutes). Relaxations to platelets were markedly inhibited or abolished in the presence of apyrase (1 unit/ml), after selective pretreatment of HCA with gossypol or methylene blue (both 30 microM, 30 minutes), or after addition of hemoglobin (20 microM) to the organ bath. Pretreatment of HCA (not the platelets) with aspirin (30 microM, 30 minutes) had no significant effect on platelet-induced relaxations. Adenosine 5'-diphosphate (0.1-100 microM) induced marked relaxations in endothelium-intact and much smaller relaxations in endothelium-denuded HCA. A low concentration (10 nM) of serotonin (5-HT) produced modest endothelium-dependent relaxations, higher concentrations (0.1-1 microM) led to increases in tension (also in the presence of endothelium). The thromboxane A2 mimetic U44069 (1-100 nM) was the most potent constrictor of HCA irrespective of the presence or absence of endothelium. After inhibition of thromboxane synthase, platelets produced large amounts of prostaglandins E2 and F2 alpha. Both prostaglandins constricted HCA, which can explain the limited effects of dazmegrel.(ABSTRACT TRUNCATED AT 250 WORDS)