Selenium is an essential micronutrient that suppresses the redox-sensitive transcription factor NF-B-dependent proinflammatory gene expression. To understand the molecular mechanisms underlying the anti-inflammatory property of selenium, we examined the activity of a key kinase of the NF-B cascade, IB-kinase ␤ (IKK␤) subunit, as a function of cellular selenium status in murine primary bone marrow-derived macrophages and RAW264.7 macrophage-like cell line. In vitro kinase assays revealed that selenium supplementation decreased the activity of IKK␤ in lipopolysaccharide (LPS)-treated macrophages. Stimulation by LPS of seleniumsupplemented macrophages resulted in a time-dependent increase in 15-deoxy-⌬ 12,14 -prostaglandin J 2 (15d-PGJ 2 ) formation, an endogenous inhibitor of IKK␤ activity. Further analysis revealed that inhibition of IKK␤ activity in seleniumsupplemented cells correlated with the Michael addition product of 15d-PGJ 2 with Cys-179 of IKK␤, while the formation of such an adduct was significantly decreased in the selenium-deficient macrophages. In addition, anti-inflammatory activities of selenium were also mediated by the 15d-PGJ 2 -dependent activation of the peroxisome proliferator-activated nuclear receptor-␥ in macrophages. Experiments using specific cyclooxygenase (COX) inhibitors and genetic knockdown approaches indicated that COX-1, and not the COX-2 pathway, was responsible for the increased synthesis of 15d-PGJ 2 in selenium-supplemented macrophages. Taken together, our results suggest that selenium supplementation increases the production of 15d-PGJ 2 as an adaptive response to protect cells against oxidative stress-induced pro-inflammatory gene expression. More specifically, modification of protein thiols by 15d-PGJ 2 represents a previously undescribed code for redox regulation of gene expression by selenium.

Context Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain. Objective To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers will motivate male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control. Design, Setting, and Participants Cluster randomized trial (Barber-Assisted Reduction in Blood Pressure in Ethnic Residents [BARBER-1]) of HTN control among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Intervention Black male patrons of participating barbershops underwent 10-week baseline BP screening. Study sites were then randomized to a comparison group (8 shops, 77 hypertensives/shop) that received standard BP pamphlets or an intervention group (9 shops, 75 hypertensives/shop) in which barbers continually offered BP checks with haircuts and promoted physician follow-up with gender-specific peer-based health messaging. After 10 months, follow-up data were obtained. Primary Outcome Measure Change in HTN control rate for each barbershop. Results The HTN control rate increased more in intervention-arm barbershops than in comparison-arm barbershops (absolute group difference, 8.8%; 95% confidence interval [CI], 0.8 to 16.9%; P=0.036); the intervention effect persisted after adjustment for covariates (P=0.031). A marginal intervention effect was found for systolic BP change (absolute group difference: −2.5 mmHg; 95% CI, −5.3 to 0.3 mmHg; P=0.08). Conclusion The effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician referral. Further research is warranted. Trial registration clinicalTrials.gov Identifier NCT00325533

BackgroundThere is increasing interest in using prediction models to identify patients at risk of readmission or death after hospital discharge, but existing models have significant limitations. Electronic medical record (EMR) based models that can be used to predict risk on multiple disease conditions among a wide range of patient demographics early in the hospitalization are needed. The objective of this study was to evaluate the degree to which EMR-based risk models for 30-day readmission or mortality accurately identify high risk patients and to compare these models with published claims-based models.MethodsData were analyzed from all consecutive adult patients admitted to internal medicine services at 7 large hospitals belonging to 3 health systems in Dallas/Fort Worth between November 2009 and October 2010 and split randomly into derivation and validation cohorts. Performance of the model was evaluated against the Canadian LACE mortality or readmission model and the Centers for Medicare and Medicaid Services (CMS) Hospital Wide Readmission model.ResultsAmong the 39,604 adults hospitalized for a broad range of medical reasons, 2.8 % of patients died, 12.7 % were readmitted, and 14.7 % were readmitted or died within 30 days after discharge. The electronic multicondition models for the composite outcome of 30-day mortality or readmission had good discrimination using data available within 24 h of admission (C statistic 0.69; 95 % CI, 0.68-0.70), or at discharge (0.71; 95 % CI, 0.70-0.72), and were significantly better than the LACE model (0.65; 95 % CI, 0.64-0.66; P =0.02) with significant NRI (0.16) and IDI (0.039, 95 % CI, 0.035-0.044). The electronic multicondition model for 30-day readmission alone had good discrimination using data available within 24 h of admission (C statistic 0.66; 95 % CI, 0.65-0.67) or at discharge (0.68; 95 % CI, 0.67-0.69), and performed significantly better than the CMS model (0.61; 95 % CI, 0.59-0.62; P < 0.01) with significant NRI (0.20) and IDI (0.037, 95 % CI, 0.033-0.041).ConclusionsA new electronic multicondition model based on information derived from the EMR predicted mortality and readmission at 30 days, and was superior to previously published claims-based models.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-015-0162-6) contains supplementary material, which is available to authorized users.

The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.

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