Intermediary metabolism studies have typically concentrated on four major regulatory mechanisms—substrate availability, allosteric enzyme regulation, post-translational enzyme modification, and regulated enzyme synthesis. Although transcriptional control has been a big focus, it is becoming increasingly evident that many post-transcriptional events are deeply embedded within the core regulatory circuits of enzyme synthesis/breakdown that maintain metabolic homeostasis. The prominent post-transcriptional mechanisms affecting intermediary metabolism include alternative pre-mRNA processing, mRNA stability and translation control, and the more recently discovered regulation by noncoding RNAs. In this review, we discuss the latest advances in our understanding of these diverse mechanisms at the cell-, tissue- and organismal-level. We also highlight the dynamics, complexity and non-linear nature of their regulatory roles in metabolic decision making, and deliberate some of the outstanding questions and challenges in this rapidly expanding field.

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65 Background: The homeless population presents unique challenges for Colorectal Cancer (CRC) screening and follow-up, due to difficulty completing at home procedures such as stool-based screening and prepping for a colonoscopy. Harris Health System’s Healthcare for the Homeless Program (HHS-HHP) screens patients for CRC using strategies such as on-site stool collection to promote completion of fecal immunochemical tests (FIT). According to the HHS screening algorithm, there are currently no targeted interventions at HHS-HHP to address diagnostic follow-up of FIT-positive patients who require colonoscopy Homeless patients face barriers to colonoscopy, notably the structure of shelters, which makes it difficult to prep for a colonoscopy; and the lack of a companion to accompany patients to and from their procedures. Methods: We reviewed data regarding FIT screening and colonoscopy completion from Harris Health for the 2016-2017 fiscal year. We convened meetings with administrators of the Star of Hope Cornerstone Community and HHS-HHP to examine barriers faced by this population and identify potential interventions to address them. Results: For the 2016-17, fiscal year the average FIT completion rate for the entire population was 72% versus the homeless population was 38%. In the colonoscopy database, 173 homeless patients had positive FITs, but only 43 got their colonoscopy (25%). Reasons for not getting the colonoscopy were poor prep, not being able to reach the patient, and no-shows. There is an obvious need for an intervention to assist homeless patients in completing a colonoscopy after a positive FIT. Conclusions: Our project will assist with the care coordination for the homeless patients requiring a colonoscopy. We plan to coordinate care with the homeless shelters to schedule the use of a private, subacute care room (respite unit), if available, to ensure the patients appropriately prep the night before their procedure. In addition, medical student volunteers will be serving as companions for this project; thus, we plan to work with the patient and shelters to provide volunteers accompany patients to and from their procedures.

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