Painful, swollen, oozing right great toe.

We initially suspected septic arthritis or osteomyelitis in this patient. Further investigation proved it was neither.

Differences in physician communication when patients ask versus tell about religion/spirituality: a pilot study.

BACKGROUND AND OBJECTIVES: Research suggests that physicians should pursue spiritual issues and that patients desire to discuss religion/spirituality (R/S) in medical encounters. This study explored the differences in physician communication in response to patient inquiry or disclosure of R/S and hypothesizes that physician communication will differ when patients disclose R/S as contrasted to inquire about R/S. METHODS: Family physicians and family medicine resident physicians were recruited from a family medicine department at a community hospital (n=27). An objective structured clinical examination, with a standardized patient encounter, was used to expose the participants to a conversation regarding R/S. Participants were assigned, by alternating clustered assignment, to two conditions: patient disclosure of R/S or patient inquiry about physician R/S. The primary outcome measure was physician response, specifically physician-control, partnership-building, and supportive-talk messages. RESULTS: When the patient asks questions about R/S, physicians communicate more control messages and less supportive talk messages than when the patient discloses information about R/S. CONCLUSIONS: Training physicians to anticipate and respond to patient disclosure and inquiry will increase the likelihood they can enact patient-centered strategies. These methods should focus on teaching residents how to be sensitive to the R/S context of their patients and to recognize their own intuitive reactions to patient communication in that context.

The internalization of yeast Ste6p follows an ordered series of events involving phosphorylation, ubiquitination, recognition and endocytosis.

A general pathway for the internalization of plasma membrane proteins that involves phosphorylation, ubiquitination, recognition and endocytosis has recently emerged from multiple studies in yeast. We refer to this series of events as the PURE pathway. Here we investigate whether the yeast a-factor transporter Ste6p, an ATP-binding cassette protein, utilizes the PURE pathway. Deletion of a 52-amino acid sequence (the 'A box') within the linker region of Ste6p has previously been shown to block ubiquitination and endocytosis (Kolling R, Losko S. EMBO J 1997; 16:2251-2261). Using wild-type and mutant forms of GFP-tagged Ste6p, we identified two residues (T(613) and S(623)) within the A box as likely sites of Ste6p phosphorylation important for internalization. Mutation of these residues to alanine blocked ubiquitination and endocytosis of Ste6p, similar to the effect of deleting the entire A box, while substitution with glutamic acid (to mimic phosphorylation) suppressed the ubiquitination and endocytic defects. Importantly, a translational fusion of monoubiquitin to the C-terminus of Ste6p-T(613)A, S(623)A or Ste6p-DeltaA restored endocytosis, providing strong evidence that the role of phosphorylation is to direct ubiquitination, which in turn is a critical signal for Ste6p internalization. We also identified multiple (five) lysine residues in the linker that are important for Ste6p ubiquitination. Our results demonstrate that Ste6p follows the PURE pathway and that GFP-tagged Ste6p provides a powerful model protein for studies of endocytosis and post-endocytic events in yeast.