An Exploratory Study of the Likelihood of Adopting Genetic Counseling and Testing for Lynch Syndrome-related Colorectal Cancer Among Primary Care Physicians in Florida

Genetic counseling and testing for inherited cancer syndromes have the potential to save lives and may be an avenue for addressing health care disparities among African Americans newly diagnosed with colorectal cancer (CRC); and their close relatives. African Americans are more likely to be diagnosed with CRC at younger ages (under age 50 years), and diagnosed at later stages when cancer is more aggressive and difficult to treat, which are factors associated with hereditary cancers such as Lynch syndrome-related CRC. Considering the benefits of genetic testing for hereditary cancer syndromes - risk stratification, preventive surveillance, targeted treatment, and subsequent reduction in morbidity and mortality among patients by up to 60% - it appears that genetic testing may have a role in prevention, early intervention and reduction of CRC disparities in African Americans. Primary care physicians (PCPs), often the access point to the healthcare system, were anticipated to be at the forefront of genetic counseling and testing. However, a growing body of literature indicates that PCPs see genetic testing as the role of a specialist. This quantitative survey research study, based on the constructs of the Diffusion of Innovation Theory (Rogers, 2003), explored the factors which influence the likelihood of adoption of genetic counseling and testing for Lynch syndrome-related colorectal cancer among PCPs in Florida

Total and high molecular weight adiponectin have similar utility for the identification of insulin resistance

<p>Abstract</p> <p>Background</p> <p>Insulin resistance (IR) and related metabolic disturbances are characterized by low levels of adiponectin. High molecular weight adiponectin (HMWA) is considered the active form of adiponectin and a better marker of IR than total adiponectin. The objective of this study is to compare the utility of total adiponectin, HMWA and the HMWA/total adiponectin index (S_Aindex) for the identification of IR and related metabolic conditions.</p> <p>Methods</p> <p>A cross-sectional analysis was performed in a group of ambulatory subjects, aged 20 to 70 years, in Mexico City. Areas under the receiver operator characteristic (ROC) curve for total, HMWA and the S_Aindex were plotted for the identification of metabolic disturbances. Sensitivity and specificity, positive and negative predictive values, and accuracy for the identification of IR were calculated.</p> <p>Results</p> <p>The study included 101 men and 168 women. The areas under the ROC curve for total and HMWA for the identification of IR (0.664 <it>vs</it>. 0.669, <it>P </it>= 0.74), obesity (0.592 <it>vs</it>. 0.610, <it>P </it>= 0.32), hypertriglyceridemia (0.661 <it>vs</it>. 0.671, <it>P </it>= 0.50) and hypoalphalipoproteinemia (0.624 <it>vs</it>. 0.633, <it>P </it>= 0.58) were similar. A total adiponectin level of 8.03 μg/ml was associated with a sensitivity of 57.6%, a specificity of 65.9%, a positive predictive value of 50.0%, a negative predictive value of 72.4%, and an accuracy of 62.7% for the diagnosis of IR. The corresponding figures for a HMWA value of 4.25 μg/dl were 59.6%, 67.1%, 51.8%, 73.7% and 64.2%.</p> <p>The area under the ROC curve of the S_Aindex for the identification of IR was 0.622 [95% CI 0.554-0.691], obesity 0.613 [95% CI 0.536-0.689], hypertriglyceridemia 0.616 [95% CI 0.549-0.683], and hypoalphalipoproteinemia 0.606 [95% CI 0.535-0.677].</p> <p>Conclusions</p> <p>Total adiponectin, HMWA and the S_Aindex had similar utility for the identification of IR and metabolic disturbances.</p

The Community Ecology of Herbivore Regulation in an Agroecosystem: Lessons from Complex Systems

AbstractWhether an ecological community is controlled from above or below remains a popular framework that continues generating interesting research questions and takes on especially important meaning in agroecosystems. We describe the regulation from above of three coffee herbivores, a leaf herbivore (the green coffee scale, Coccus viridis), a seed predator (the coffee berry borer, Hypothenemus hampei), and a plant pathogen (the coffee rust disease, caused by Hemelia vastatrix) by various natural enemies, emphasizing the remarkable complexity involved. We emphasize the intersection of this classical question of ecology with the burgeoning field of complex systems, including references to chaos, critical transitions, hysteresis, basin or boundary collision, and spatial self-organization, all aimed at the applied question of pest control in the coffee agroecosystem