Develop the Disease Specific Bioinformatics Platforms with Integrated Bioinformatics Data

Indiana University-Purdue University Indianapolis (IUPUI)With the advance of multiple types of omics technology and corresponding analytical methods, various type of bioinformatic data have become available. Mining and integrating these data for analysis will provide valuable insights for disease mechanism investigation, drug target identification and new drug development. However, most of the omics data are large size, heterogeneous, and complex, it is challenging for biomedical researchers to mine the data for relevant evidence, especially for those with limited computational skills. In this thesis, I aimed to develop disease specific platforms integrated with multimodal bioinformatic data types to provide researchers with strong bioinformatics support. To achieve this goal, I explored advanced transcriptomic data analytical methods and proposed a novel biomarker for the prediction of overall survival of colon cancer patients, then prototyped a user-friendly patient oriented clinical decision support system to provide accurate and intuitive colorectal cancer risk factor assessment. With the experience of the transcriptomic data analytical methods and the web-based application development, I further designed and implemented Cancer Gene and Pathway Explorer which is an integrative bioinformatics webserver that can be used for cancer publication trends investigation, gene set enrichment analysis with integrated data, and optimal cancer cell line identification. Based on the framework of CGPE, I developed another bioinformatics platform focusing on Alzheimer’s disease, called Alzheimer’s Disease Explorer, which is a first-of-its-kind bioinformatics server, providing rich bioinformatic support from literature, omics and chemical data to facilitate researchers in ND drug development field. By accomplishing a series of work in my thesis, I have shown that integrated disease specific bioinformatics platforms can provide great value to the research community by allowing 1.) fast and accurate investigation of currently available literature, 2.) quick hypothesis generation and validation using transcriptomic datasets, 3.) multi-dimension drug target evaluation and 4) fast querying of published bioinformatics outcomes

Healthcare Providers’ Perceptions Of Barriers And Facilitators To Making A Recommendation To Screen For Colorectal Cancer

ABSTRACT Background. Colorectal cancer (CRC) is the third most commonly diagnosed type of cancer in North Dakota. It also ranks second in late-stage diagnosis among all cancers. High quality screening tests such as colonoscopy have shown to reduce CRC incidence significantly, but screening rates in North Dakota remain low. The literature is consistent in that a recommendation by a healthcare provider is the most influential factor in a patient’s decision to screen. Purpose. The purpose of this dissertation was to understand how healthcare providers perceive the barriers and facilitators that affect their decision to make CRC screening recommendations to patients. Identifying educational concepts and strategies that can be used to address needs and gaps uncovered in this study is also a priority. Sample. A total of 43 out of 55 clinics that provide primary care services in North Dakota was invited to participate in the survey. The sample was one of convenience as the survey was distributed to the 201 healthcare providers practicing at these clinics. There was a total of 74 completed responses for a response rate of 37 percent. Method. A survey was used to collect data from participants on their perceptions of patient-, provider-, and systems-level barriers and facilitators. Descriptive statistics were used to analyze perceptions of providers on individual items. Directional t-tests were used to test for an effect between the independent variable of whether the provider had completed a CRC screening test or not and the dependent variables of the six constructs of patient-, provider-, and systems-level barriers and facilitators. Linear regression was used to test for a correlation between providers’ attitudes on the efficacy of CRC screening tests and the six constructs. Results. No statistical significance was found in the analysis using t-tests. Significance was found using linear regression between the independent variable of the provider’s attitude on the efficacy of immunochemical fecal occult blood test/fecal immunochemical test (iFOBT/FIT) and the constructs of systems barriers, provider facilitators, and systems facilitators. The descriptive analysis did reveal practical insight that can be used to address needs and gaps as well as enhance current practice. Keywords: barriers, cancer, colorectal, education, facilitators, healthcare providers, screening, test

Colorectal Cancer Screening in Veterans Affairs

Each year, eligible veterans are referred to the gastroenterology department for colorectal cancer screening, primarily for colonoscopy. Once the colonoscopy is completed and is found to be unremarkable, the patient is asked to return in 10 years for a follow-up colonoscopy. However, if problems are found on the original colonoscopy, such as polyps, the patient enters a surveillance period where more frequent colonoscopy monitoring occurs. While primary care providers are aware of the monitoring guidelines, many providers unnecessarily order fecal immunochemical tests (FITs) during this period of surveillance. Unnecessary costs to the Veterans Affairs Health System (VAHS) include cost of the kit, time for the provider to order the test, technician time to run the test, patient mailing costs to send the kit to the patient, patient time and expense to return the kit, and time interpreting and reporting the results, which ultimately do not change the course of treatment. This project assessed retroactive VAHS data on appropriate utilization of the FIT. Results showed that within the Veteran Affairs Sacramento system, inappropriate FIT utilization existed. Interventions, such as annual colorectal cancer symposiums and ongoing training as part of educational efforts to increase knowledge of guidelines, were implemented. Post-intervention data indicated the effectiveness of interventions through an 8% decrease in the rate of inappropriate FIT ordering. Ensuring appropriate utilization of the FIT improves standardization of care and decreases health care costs

Ethnicity : UK colorectal cancer screening pilot : final report

27. In summary, the overall evaluation of the UK Pilot has demonstrated that key parameters of test and programme performance observed in randomised studies of FOBt screening can be repeated in population-based pilot programmes. However, our study provides strong evidence of very low CRC screening uptake for ethnic groups in the Pilot area. This is coupled with a very low uptake of colonoscopy for individuals from ethnic groups with a positive FOBt result. 28. It has long been acknowledged that a diverse population may require diverse responses. Following the implementation of the Race Relations Amendment Act 2000, there has been a statutory duty laid upon all NHS agencies to ‘have due regard to the need to eliminate unlawful discrimination’, and to make explicit consideration of the implications for racial equality of every action or policy. 29. Because the observed overall outcomes in the UK Pilot generally compare favourably with the results of previous randomised trials of FOBt screening, the main Evaluation Group has concluded that benefits observed in the trials should be repeatable in a national roll-out. 30. However, our study indicates that any national colorectal cancer screening programme would need to very carefully consider the implications of ethnicity for roll-out, and develop a strategic plan on how best to accommodate this at both a national and local level. Based on our findings, consideration will clearly need to be given to improved access and screening service provision for ethnic minorities. 31. In order to ensure adequate CRC screening provision for a diverse UK population, and to address the explicit implications for racial equality highlighted by our findings, interventions now urgently need to be evaluated to improve access for ethnic minorities. This work should be undertaken as part of the second round of CRC screening currently underway in the English Pilot

Provider Prompting to Improve Colorectal Cancer Screening Rates

Colorectal cancer (CRC) screening is recommended for average risk adults aged 50 to 75 years. Healthy People 2020 objectives include reducing new cancer cases and the illness, disability, and deaths secondary to cancer. Effective CRC screening may prevent cancer through detection and removal of precancerous growths, and may detect cancer in early stages where treatment can lead to a cure. CRC screening rates at an Eastern North Carolina Federally Qualified Health Center (FQHC) were unacceptably low. This Doctor of Nursing Practice (DNP) project implements provider prompting, including an electronic medical record (EMR) reminder and the use of a daily patient list, to help improve provider compliance with offering CRC screening and to improve CRC screening rates. An EMR data mining issue was discovered during implementation, raising baseline CRC completed screening rates from 43.6% to 49.3%. After an eight-week project implementation period, completed CRC screenings increased from 49.3% at baseline to 56.8%. Simple, cost-effective interventions led to a significant increase in completed screenings. The organization will need to further evaluate if other documentation errors could be artificially driving down other key performance values.D.N.P

Is This Going to Be the End? Understanding Problematic Integration Among Appalachian Patients in Colorectal Cancer Screening Navigation

Colorectal cancer (CRC) is preventable through regular screening; however, incidence and mortality rates in Appalachia are among the highest in the United States. Public health programs and interventions meant to mitigate the higher CRC burden and increase screening rates are ongoing in the U.S. and Appalachia. In continuing the efforts to reduce the burden of CRC in Appalachian communities, this dissertation uses a two-part study to investigate communication practices relative to problematic integration and health beliefs in CRC screening conversations from the perspective of both patients and patient navigators in the region. As part of efforts directed by the Rural Cancer Prevention Center (RCPC; 2009-2019), patients who received a positive fecal immunochemical test (FIT) and the patient navigators assigned to connect them with direct visualization follow-up testing were interviewed one-on-one to better understand the role of problematic integration in CRC screening communication. Study 1 investigates patient navigators\u27 (n = 9) perspectives of their efforts to connect patients with appropriate CRC screening, while Study 2 analyzes the accounts of patients (n = 10) with positive FIT who refused follow- up colonoscopy testing (at the time of recruitment) after engaging in patient navigation services. With problematic integration theory and the health belief model as a guide, data from these two studies in the Appalachian Kentucky context support an overarching model for how patient navigators and patients address uncertainty in CRC screening. Analyzing these phenomena at the intersection of communication and health behavior theories highlights the utility of health communication research expertise in guiding interventions across the healthcare continuum. In addition, data from the studies may be used to understand the nature of participation in CRC screening conversations and how these dynamics contribute to patient-centered care and shared decision-making, which is especially important with the additional challenges for screening exacerbated by a global COVID-19 pandemic. The findings from these studies are discussed in terms of contributing to more effective clinical and patient navigation communication practices and providing public health practitioners with essential considerations for shaping interventions to support shared decision-making and improve CRC screening rates in similar populations

Screening and prevention for inherited cancer: exploring the experiences of BRCA mutation carriers in Newfoundland Labrador

Background Females with BRCA 1/2 gene mutations have increased lifetime risk of breast and ovarian cancers. BRCA mutation carriers in NL are not engaging in cancer prevention and screening behaviors according to recommended guidelines. Methods Qualitative interviews were combined with a provincial survey to conduct a comprehensive assessment of BRCA mutation carriers’ opinions towards risk management services. Results Female BRCA mutation carriers’ risk management is influenced by numerous and varied factors including clinical and social influences, family and personal history of cancer, life stage, health system access, and family physicians’ BRCA knowledge and expertise. Individuals were overwhelmingly in support of a centralized and coordinated inherited cancer program. Conclusion The current system of patient self-navigation and reliance on family doctors to coordinate screening and prevention services results in some patients struggling to access the ongoing management they require. An inherited cancer risk service must recognize the complexities that influences individuals’ behaviors towards risk reducing services

Does the South African law policy framework facilitate adolescent access to HIV prevention tools?

Master of Laws in Law and Management Studies. University of KwaZulu-Natal, Pietermaritzburg, 2017.No abstract available

Development, Implementation and Evaluation of a Screening Mammography Program

Breast cancer is a major public health concern in the United States and remains a priority for national women’s health centers, primary care practices and cancer control organizations such as the American Cancer Society (ACS). The cancer care continuum includes the spectrum of prevention/risk reduction, early detection, treatment, and living with the diagnosis. Currently there are no proven primary prevention options for women at average risk of developing breast cancer; therefore, secondary prevention interventions such as screening mammography and clinical breast examination (CBE) are required to reduce morbidity and mortality. This manuscript describes a Doctor of Nursing Practice (DNP) led quality improvement project aimed at increasing mammography screening completion rates in one community health center within a reputable safety-net community health network with access to a mobile mammography van. The intent of this project was to discover the barriers that patients view in complying with their breast cancer screening recommendation, the workflow of the health centers with the best practice, and the creation of a mammography toolkit to provide consistency in processes amongst multiple sites. Although there were challenges in reaching a significant amount of patients to unveil all the possible barriers, overall implementation of this quality improvement project resulted in a well appreciated mammography toolkit, which will be available to all primary care health centers and included in the orientation of medical evaluation workers and health workers as it relates to patients obtaining proper breast health. Keywords: screening mammography, telephone reminder calls, toolkit, DN

Alcohol, assault and licensed premises in inner-city areas

This report contains eight linked feasibility studies conducted in Cairns during 2010. These exploratory studies examine the complex challenges of compiling and sharing information about incidents of person-to-person violence in a late night entertainment precinct (LNEP). The challenges were methodological as well as logistical and ethical. The studies look at how information can be usefully shared, while preserving the confidentiality of those involved. They also examine how information can be compiled from routinely collected sources with little or no additional resources, and then shared by the agencies that are providing and using the information.Although the studies are linked, they are also stand-alone and so can be published in peer-reviewed literature. Some have already been published, or are ‘in press’ or have been submitted for review. Others require the NDLERF board’s permission to be published as they include data related more directly to policing, or they include information provided by police.The studies are incorporated into the document under section headings. In each section, they are introduced and then presented in their final draft form. The final published form of each paper, however, is likely to be different from the draft because of journal and reviewer requirements. The content, results and implications of each study are discussed in summaries included in each section.Funded by the National Drug Law Enforcement Research Fund, an initiative of the National Drug StrategyAlan R Clough (PhD) School of Public Health, Tropical Medicine and Rehabilitation Sciences James Cook UniversityCharmaine S Hayes-Jonkers (BPsy, BSocSci (Hon1)) James Cook University, Cairns.Edward S Pointing (BPsych) James Cook University, Cairns