The impact of artificial intelligence on the current and future practice of clinical cancer genomics.

Artificial intelligence (AI) is one of the most significant fields of development in the current digital age. Rapid advancements have raised speculation as to its potential benefits in a wide range of fields, with healthcare often at the forefront. However, amidst this optimism, apprehension and opposition continue to strongly persist. Oft-cited concerns include the threat of unemployment, harm to the doctor-patient relationship and questions of safety and accuracy. In this article, we review both the current and future medical applications of AI within the sub-speciality of cancer genomics

The Assessment of Technology Adoption Interventions and Outcome Achievement Related to the Use of a Clinical Research Data Warehouse

Introduction: While funding for research has declined since 2004, the need for rapid, innovative, and lifesaving clinical and translational research has never been greater due to the rise in chronic health conditions, which have resulted in lower life expectancy and higher rates of mortality and adverse outcomes. Finding effective diagnostic and treatment methods to address the complex challenges in individual and population health will require a team science approach, creating the need for multidisciplinary collaboration among practitioners and researchers. To address this need, the National Institutes of Health (NIH) created the Clinical and Translational Science Awards (CTSA) program. The CTSA program distributes funds to a national network of medical research institutions, known as “hubs,” that work together to improve the translational research process. With this funding, each hub is required to achieve specific goals to support clinical and translational research teams by providing a variety of services, including cutting edge use of informatics technologies. As a result, the majority of CTSA recipients have implemented and maintain data warehouses, which combine disparate data types from a range of clinical and administrative sources, include data from multiple institutions, and support a variety of workflows. These data warehouses provide comprehensive sets of data that extend beyond the contents of a single EHR system and provide more valuable information for translational research. Although significant research has been conducted related to this technology, gaps exist regarding research team adoption of data warehouses. As a result, more information is needed to understand how data warehouses are adopted and what outcomes are achieved when using them. Specifically, this study focuses on three gaps: research team awareness of data warehouses, the outcomes of data warehouse training for research teams, and how to measure objectively outcomes achieved after training. By assessing and measuring data warehouse use, this study aims to provide a greater understanding of data warehouse adoption and the outcomes achieved. With this understanding, the most effective and efficient development, implementation, and maintenance strategies can be used to increase the return on investment for these resource-intensive technologies. In addition, technologies can be better designed to ensure they are meeting the needs of clinical and translational science in the 21st century and beyond. Methods: During the study period, presentations were held to raise awareness of data warehouse technology. In addition, training sessions were provided that focused on the use of data warehouses for research projects. To assess the impact of the presentations and training sessions, pre- and post-assessments gauged knowledge and likelihood to use the technology. As objective measurements, the number of data warehouse access and training requests were obtained, and audit trails were reviewed to assess trainee activities within the data warehouse. Finally, trainees completed a 30-day post-training assessment to provide information about barriers and benefits of the technology. Results: Key study findings suggest that the awareness presentations and training were successful in increasing research team knowledge of data warehouses and likelihood to use this technology, but did not result in a subsequent increase in access or training requests within the study period. In addition, 24% of trainees completed the associated data warehouse activities to achieve their intended outcomes within 30 days of training. The time needed for adopting the technology, the ease of use of data warehouses, the types of support available, and the data available within the data warehouse may all be factors influencing this completion rate. Conclusion: The key finding of this study is that data warehouse awareness presentations and training sessions are insufficient to result in research team adoption of the technology within a three-month study period. Several important implications can be drawn from this finding. First, the timeline for technology adoption requires further investigation, although it is likely longer than 90 days. Future assessments of technology adoption should include an individual’s timeline for pursuing the use of that technology. Second, this study provided a definition for outcome achievement, which was completion o

Exploring a Model-Driven Approach to Social Work Theory Education

Accredited social work programs must use practice experience and theory to inform research and practice, policy, engagement, assessment, intervention, and evaluation with varied constituents. Models to teach theory have been all but non-existent. This manuscript presents the S.A.L.T. model for theory assessment and shares findings when the model is applied to assess students’ knowledge

An exploratory research on blockchain in aviation: the case of maintenance, repair and overhaul (MRO) organizations

The aircraft maintenance sector has high complexity with many intermediaries, multiple actors sharing data and needs to ensure high data security. The implementation of Blockchain technology can significantly contribute to the aforementioned characteristics. This research explores the implementation of Blockchain technology in Maintenance, Repair and Overhaul (MRO). For this research, a mixed-method approach was followed to obtain a holistic view of the adoption of Blockchain technology in an aircraft maintenance facility. Semi-structured interviews and a case study were used. The interview findings related to the current status of maintenance records management. The findings also highlighted the value of data storage within MRO’s and the benefits of Blockchain. The paper also discusses the readiness/willingness of aircraft maintenance facilities to implement Blockchain and the barriers to implementation. Recommendations and areas for further research are identifie

What kind of trouble? Meeting the health needs of ‘troubled families’ through intensive family support

The policy rhetoric of the UK Coalition government's ‘Troubled Families’ initiative, and that of New Labour's earlier Respect Agenda, share an emphasis on families’ responsibilities, or rather their irresponsibility, and their financial costs to society. Giving children a chance of a better life coincides, in this framing, with reducing costs for the taxpayer. The research reported here was based on a national study of Family Intervention Projects (FIPs), funded by the UK government between 2009 and 2012, beginning under New Labour, continuing over a period when the FIP programme was discontinued, and ending after the Troubled Families programme had begun. The research involved over 100 in-depth interviews with stakeholders, including service managers, family key workers, and caregivers and children in twenty families, to consider critical questions about the kinds of trouble that families experience in their lives, and how they are recognised in the policy and practice of intensive family intervention

In vitro dissolution models for the prediction of in vivo performance of an oral mesoporous silica formulation

Drug release from mesoporous silica systems has been widely investigated in vitro using USP Type II (paddle) dissolution apparatus. However, it is not clear if the observed enhanced in vitro dissolution can forecast drug bioavailability in vivo. In this study, the ability of different in vitro dissolution models to predict in vivo oral bioavailability in a pig model was examined. The fenofibrate-loaded mesoporous silica formulation was compared directly to a commercial reference product, Lipantil Supra®. Three in vitro dissolution methods were considered; USP Type II (paddle) apparatus, USP Type IV (flow-through cell) apparatus and a USP IV Transfer model (incorporating a SGF to FaSSIF-V2 media transfer). In silico modelling, using a physiologically based pharmacokinetic modelling and simulation software package (Gastroplus™), to generate in vitro/in vivo relationships was also investigated. The study demonstrates that the in vitro dissolution performance of a mesoporous silica formulation varies depending on the dissolution apparatus utilised and experimental design. The findings show that the USP IV transfer model was the best predictor of in vivo bioavailability. The USP Type II (paddle) apparatus was not effective at forecasting in vivo behaviour. This observation is likely due to hydrodynamic differences between the two apparatus and the ability of the transfer model to better simulate gastrointestinal transit. The transfer model is advantageous in forecasting in vivo behaviour for formulations which promote drug supersaturation and as a result are prone to precipitation to a more energetically favourable, less soluble form. The USP IV transfer model could prove useful in future mesoporous silica formulation development. In silico modelling has the potential to assist in this process. However, further investigation is required to overcome the limitations of the model for solubility enhancing formulations

Incorporating sex, gender and vulnerable populations in a large multisite health research programme: The Ontario Pharmacy Evidence Network as a case study

Background: Funders now frequently require that sex and gender be considered in research programmes, but provide little guidance about how this can be accomplished, especially in large research programmes. The purpose of this study is to present and evaluate a model for promoting sex-and gender-based analysis (SGBA) in a large health service research programme, the Ontario Pharmacy Evidence Network (OPEN). Methods: A mixed method study incorporating (1) team members' critical reflection, (2) surveys (n = 37) and interviews (n = 23) at programme midpoint, and (3) an end-of-study survey in 2016 with OPEN research project teams (n = 6). Results: Incorporating gender and vulnerable populations (GVP) as a cross-cutting theme, with a dedicated team and resources to promote GVP research across the programme, was effective and well received. Team members felt their knowledge was improved, and the programme produced several sex-and gender-related research outputs. Not all resources were well used, however, and better communication of the purposes and roles of the team could increase effectiveness. Conclusions: The experience of OPEN suggests that dedicating resources for sex and gender research can be effective in promoting SGBA research, but that research programmes should also focus on communicating the importance of SGBA to their members.Ontario Pharmacy Evidence Network (OPEN)Government of Ontario (Ministry of Health and Long-Term Care Health Systems Research Fund Grant) [06674

A Bout of High Intensity Interval Training Lengthened Nerve Conduction Latency to the Non-exercised Affected Limb in Chronic Stroke

Objective: Evaluate intensity-dependent effects of a single bout of high intensity interval training (HIIT) compared to moderate intensity constant-load exercise (MICE) on corticospinal excitability (CSE) and effects on upper limb performance in chronic stroke.Design: Randomized cross-over trial.Setting: Research laboratory in a tertiary rehabilitation hospital.Participants: Convenience sample of 12 chronic stroke survivors.Outcome measures: Bilateral CSE measures of intracortical inhibition and facilitation, motor thresholds, and motor evoked potential (MEP) latency using transcranial magnetic stimulation. Upper limb functional measures of dexterity (Box and Blocks Test) and strength (pinch and grip strength).Results: Twelve (10 males; 62.50 ± 9.0 years old) chronic stroke (26.70 ± 23.0 months) survivors with moderate level of residual impairment participated. MEP latency from the ipsilesional hemisphere was lengthened after HIIT (pre: 24.27 ± 1.8 ms, and post: 25.04 ± 1.8 ms, p = 0.01) but not MICE (pre: 25.49 ± 1.10 ms, and post: 25.28 ± 1.0 ms, p = 0.44). There were no significant changes in motor thresholds, intracortical inhibition or facilitation. Pinch strength of the affected hand decreased after MICE (pre: 8.96 ± 1.9 kg vs. post: 8.40 ± 2.0 kg, p = 0.02) but not after HIIT (pre: 8.83 ± 2.0 kg vs. post: 8.65 ± 2.2 kg, p = 0.29). Regardless of type of aerobic exercise, higher total energy expenditure was associated with greater increases in pinch strength in the affected hand after exercise (R2 = 0.31, p = 0.04) and decreases in pinch strength of the less affected hand (R2 = 0.26 p = 0.02).Conclusion: A single bout of HIIT resulted in lengthened nerve conduction latency in the affected hand that was not engaged in the exercise. Longer latency could be related to the cross-over effects of fatiguing exercise or to reduced hand spasticity. Somewhat counterintuitively, pinch strength of the affected hand decreased after MICE but not HIIT. Regardless of the structure of exercise, higher energy expended was associated with pinch strength gains in the affected hand and strength losses in the less affected hand. Since aerobic exercise has acute effects on MEP latency and hand strength, it could be paired with upper limb training to potentiate beneficial effects

A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months

Introduction: “Partners in Dementia Care” (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer’s Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia. Methods and Findings: Five matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate. Results: Of 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = −0.09; p = 0.05), depression (B = −0.10; p = 0.03), and unmet need (B = −0.28; p = 0.02; and B = −0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = −0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = −0.96; p < 0.01) and embarrassment (B = −0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided. Conclusions: Partnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia. Trial Registry NCT0029116

Evidence for involvement of non‐classical pathways in the protection from UV‐induced DNA damage by vitamin D‐related compounds

The vitamin D hormone, 1,25dihydroxyvitamin D3 (1,25(OH)2D3), and related compounds derived from vitamin D3 or lumisterol as a result of metabolism via the enzyme CYP11A1, have been shown, when applied 24 hours before or immediately after UV irradiation, to protect human skin cells and skin from DNA damage due to UV exposure, by reducing both cyclobutane pyrimidine dimers (CPD) and oxidative damage in the form of 8‐oxo‐7,8‐dihydro‐2’‐ deoxyguanosine (8‐OHdG). We now report that knockdown of either the vitamin D receptor or the endoplasmic reticulum protein ERp57 by siRNA abolished the reductions in UV‐induced DNA damage with 20‐hydroxyvitamin D3 or 24‐hydroxylumisterol3, as previously shown for 1,25(OH)2D3. Treatment with 1,25(OH)2D3 reduced oxygen consumption rates in UV‐exposed and sham‐exposed human keratinocytes and reduced phosphorylation of CREB (cyclic AMP response binding element protein). Both these actions have been shown to inhibit skin carcinogenesis after chronic UV exposure, consistent with the anticarcinogenic activity of 1,25(OH)2D3. The requirement for a vitamin D receptor for the photoprotective actions of 1,25(OH)2D3 and of naturally occurring CYP11A1‐derived vitamin D related compounds may explain why mice lacking the vitamin D receptor in skin are more susceptible to UV‐induced skin cancers, whereas mice lacking the 1α‐hydroxylase and thus unable to make 1,25(OH)2D3 are not more susceptible. This article is protected by copyright. All rights reserved