Patient access to complex chronic disease records on the internet

Background: Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Methods: Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results: By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions: Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available

Quercetin elevates p27Kip1 and arrests both primary and HPV16 E6/E7 transformed human keratinocytes in G1

Our previous work with primary bovine fibroblasts demonstrated that quercetin, a potent mutagen found in high levels in bracken fern (Pteridium aquilinum), arrested cells in G1 and G2/M, in correlation with p53 activation. The expression of bovine papillomavirus type 4 (BPV-4) E7 overcame this arrest and lead to the development of tumorigenic cells lines (Beniston et al., 2001). Given the possible link between papillomavirus infection, bracken fern in the diet and cancer of the upper gastrointestinal (GI) tract in humans, we investigated whether a similar situation would occur in human cells transformed by human papillomavirus type 16 (HPV-16) oncoproteins. Quercetin arrested primary human foreskin keratinocytes in G1. Arrest was linked to an elevation of the cyclin-dependent kinase inhibitor (cdki) p27Kip1. Expression of the HPV16 E6 and E7 oncoproteins in transformed cells failed to abrogate cell cycle arrest. G1 arrest in the transformed cells was also linked to an increase of p27Kip1 with a concomitant reduction of cyclin E-associated kinase activity. This elevation of p27Kip1 was due not only to increased protein half-life, but also to increased mRNA transcription

Don't lose sight of the importance of the individual in effective falls prevention interventions

Falls remain a major public health problem, despite strong growth in the research evidence of effective single and multifactorial interventions, particularly in the community setting. A number of aspects of falls prevention require individual tailoring, despite limitations being reported regarding some of these, including questions being raised regarding the role of falls risk screening and falls risk assessment. Being able to personalise an individual's specific risk and risk factors, increase their understanding of what interventions are likely to be effective, and exploring options of choice and preference, can all impact upon whether or not an individual undertakes and sustains participation in one or more recommendations, which will ultimately influence outcomes. On all of these fronts, the individual patient receiving appropriate and targeted interventions that are meaningful, feasible and that they are motivated to implement, remains central to effective translation of falls prevention research evidence into practice

The effectiveness of constraint-led training on skill development in interceptive sports: a systematic review (Clark, McEwan and Christie) – a commentary

Clark, McEwan and Christie's systematic review1 offers a timely examination of current literature assessing effects of a constraints-led approach (CLA) to training on ‘technical and cognitive skill in sport’, in comparison to traditional training methods. They concluded that, currently, there is strong evidence to advocate for the effects of training interventions that espouse benefits of constraints-led training on acquiring skill in interceptive actions. Clark, McEwan and Christie reported that 18 studies satisfied their proposed inclusion criteria and, of these studies, 77% provided evidence of the effectiveness of the CLA. Consequently, Clark, McEwan and Christie argued that a ‘the implementation of the constraints-led approach within interceptive sport can be advocated’ (p. 17). This is a revealing insight, which supports their claims that this finding ‘provides the opportunity for researchers to collect more compelling evidence to answer the question: “Does constraint-led training assist with the development of technical skills within interceptive sport?”’. While we endorse their call for more empirical evidence on the effectiveness of a CLA to practice and training design, we qualify it by highlighting some limitations of Clark, McEwan and Christie's systematic review

Phenomenology and Cosmology of an Electroweak Pseudo-Dilaton and Electroweak Baryons

In many strongly-interacting models of electroweak symmetry breaking the lowest-lying observable particle is a pseudo-Goldstone boson of approximate scale symmetry, the pseudo-dilaton. Its interactions with Standard Model particles can be described using a low-energy effective nonlinear chiral Lagrangian supplemented by terms that restore approximate scale symmetry, yielding couplings of the pseudo-dilaton that differ from those of a Standard Model Higgs boson by fixed factors. We review the experimental constraints on such a pseudo-dilaton in light of new data from the LHC and elsewhere. The effective nonlinear chiral Lagrangian has Skyrmion solutions that may be identified with the `electroweak baryons' of the underlying strongly-interacting theory, whose nature may be revealed by the properties of the Skyrmions. We discuss the finite-temperature electroweak phase transition in the low-energy effective theory, finding that the possibility of a first-order electroweak phase transition is resurrected. We discuss the evolution of the Universe during this transition and derive an order-of-magnitude lower limit on the abundance of electroweak baryons in the absence of a cosmological asymmetry, which suggests that such an asymmetry would be necessary if the electroweak baryons are to provide the cosmological density of dark matter. We revisit estimates of the corresponding spin-independent dark matter scattering cross section, with a view to direct detection experiments.Comment: 34 pages, 4 figures, additional references adde

Interpretive structural modelling of risk sources in a virtual organisation

International audienceSpeedier network decision making together with shorter time to bring items to market together with lower network operating costs all result from enhanced knowledge sharing. In addition re-use of enterprise and network knowledge resulting from improved capture means that any risk of repeating earlier project work is limited, repetition of past mistakes is reduced. Decisions are made with greater awareness of any risks involved and therefore there is likely to be a reduction in costs arising from faulty decisions and failed collaborations. While there are many advantages attaching to the use of virtual organizations (VOs) there are also challenges, including risks that have become apparent through undertaking a review of the literature. In total 13 sources of risk were found stemming from the network related risks in a VO, where the emphasis of the study was placed,. This paper contains a thorough study that will identify these threats as well as gaining a sound understanding of them by examining them one by one as they have been identified by the literature and previous studies. Subsequently, their relative importance will be analysed through the use of Structural Modeling (ISM) using information gathered in a questionnaire

Advanced optical imaging in living embryos

Developmental biology investigations have evolved from static studies of embryo anatomy and into dynamic studies of the genetic and cellular mechanisms responsible for shaping the embryo anatomy. With the advancement of fluorescent protein fusions, the ability to visualize and comprehend how thousands to millions of cells interact with one another to form tissues and organs in three dimensions (xyz) over time (t) is just beginning to be realized and exploited. In this review, we explore recent advances utilizing confocal and multi-photon time-lapse microscopy to capture gene expression, cell behavior, and embryo development. From choosing the appropriate fluorophore, to labeling strategy, to experimental set-up, and data pipeline handling, this review covers the various aspects related to acquiring and analyzing multi-dimensional data sets. These innovative techniques in multi-dimensional imaging and analysis can be applied across a number of fields in time and space including protein dynamics to cell biology to morphogenesis

Rare Z-decay into light CP-odd Higgs bosons: a comparative study in different new physics models

Various new physics models predict a light CP-odd Higgs boson (labeled as $a$) and open up new decay modes for Z-boson, such as $Z \to \bar{f} f a$, $Z\to a\gamma$ and $Z\to aaa$, which could be explored at the GigaZ option of the ILC. In this work we investigate these rare decays in several new physics models, namely the type-II two Higgs doublet model (type-II 2HDM), the lepton-specific two Higgs doublet model (L2HDM), the nearly minimal supersymetric standard model (nMSSM) and the next-to-minimal supersymmetric standard model (NMSSM). We find that in the parameter space allowed by current experiments, the branching ratios can reach $10^{-4}$ for $Z \to \bar{f} f a$ ($f=b,\tau$), $10^{-9}$ for $Z\to a\gamma$ and $10^{-3}$ for $Z\to aaa$, which implies that the decays $Z \to \bar{f} f a$ and $Z \to a a a$ may be accessible at the GigaZ option. Moreover, since different models predict different patterns of the branching ratios, the measurement of these rare decays at the GigaZ may be utilized to distinguish the models.Comment: Version in JHEP (discussions added, errors corrected

Actinobacillus actinomycetemcomitans Lipopolysaccharide‐Mediated Experimental Bone Loss Model for Aggressive Periodontitis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141900/1/jper0550.pd

Ocular fundus pathology and chronic kidney disease in a Chinese population

<p>Abstract</p> <p>Background</p> <p>Previous study indicated a high prevalence of ocular fundus pathology among patients with chronic kidney disease (CKD), while the relationship between them has never been explored in a Chinese Population.</p> <p>Methods</p> <p>This cross-sectional study included 9 670 participants enrolled in a medical screening program. Ocular fundus examination was performed by ophthalmologists using ophthalmoscopes. The presence of eGFR less than 60 mL/min/1.73 m²and/or proteinuria was defined as CKD.</p> <p>Results</p> <p>Compared to participants without CKD, participants with CKD had higher prevalence of retinopathy (28.5% vs. 16.3%, P < 0.001), glaucoma suspect (3.1% vs. 1.8%, P = 0.004), age-related macular degeneration (1.7% vs. 0.9%, P = 0.01) and overall eye pathology (32.0% vs. 19.4%, P < 0.001). After adjusting for potential confounders, the odds ratio of proteinuria for overall eye pathology and retinopathy was 1.29 (95% confidence interval [CI] 1.07-1.55) and 1.37 (95% CI 1.12-1.67), respectively. The results were robust after excluding participants with hypertension or with diabetes.</p> <p>Conclusions</p> <p>Ocular fundus pathology is common among Chinese patients with CKD. Regular eye exam among persons with proteinuria is warranted.</p