Exploring the Role of Genetic Counselors in Tumor Genomic Sequencing : A Survey of Genetic Counselors

In the emerging era of genomics-driven medicine, tumor genomic profiling in particular has begun to revolutionize the field of oncology. As the integration of such technologies evolves and affects the management and treatment of cancer, questions arise with regards to the changing roles of healthcare professionals involved in cancer care. One hundred and twenty-eight members of the National Society of Genetic Counselors (NSGC) responded to a survey to assess the current roles of genetic counselors in oncology and the perceived roles that genetic counselors will have in the clinical use of tumor genomic profiling. With regards to current roles in cancer care, the majority reported that they provide genetics cancer-related expertise to other medical professionals (85.0%, n=85). With respect to perceived roles in the clinical use of tumor genomic sequencing, most responders (80.0%, n=80) indicated that they feel there is a role for genetic counselors. The majority of responders identified 5 roles that genetic counselors would be equipped to play in regard to tumor genomic analysis. The largest number, 91 (97.9%) report identifying and discussing incidental germline findings uncovered by testing, followed by serving as a resources for physicians who may not be comfortable with genomic testing 76.3% (n=71), educating medical students, residents and fellows about tumor genomic sequencing 69.9% (n=65), educating medical professionals on issues around informed consent 67.7% (n=63), and post-test counseling of patients to help interpret tumor sequencing results 65.6% (n=61). The duty of pre-test counseling for patients to help explain tumor sequence testing and informed consent is reported as a significant role by smaller numbers of responders 44.1% (n=41). When prompted to choose the most significant, the majority (56.7%, n=51) report identifying and discussing 3 incidental germline findings as the primary role. Responses show that participants foresee multiple duties that genetic counselors are adept to handle in the context of tumor genomic analysis, with information involving germline findings specified as the most important and relevant to the training of genetic counselors

DNA Data Banking: The Dangerous Erosion of Privacy

This article begins by describing the increasing prominence of DNA evidence in legal matters, before explaining how investigatory agencies wish to use DNA in their criminal investigations: primarily DNA banks and DNA testing large portions of the population in the wake of a crime. The article goes on to discuss privacy concerns about DNA profiling and DNA databanks. It discusses the differences between traditional fingerprint banks, and the greater privacy threats posed by the DNA banks. It moves on to point out the various public and private sector abuses possible with wide-spread DNA profiling. Finally, the authors suggest that legislation should be passed at the state level until Congress can pass a more comprehensive federal statute governing the use of DNA information and collection

DNA Data Banking: The Dangerous Erosion of Privacy

This article begins by describing the increasing prominence of DNA evidence in legal matters, before explaining how investigatory agencies wish to use DNA in their criminal investigations: primarily DNA banks and DNA testing large portions of the population in the wake of a crime. The article goes on to discuss privacy concerns about DNA profiling and DNA databanks. It discusses the differences between traditional fingerprint banks, and the greater privacy threats posed by the DNA banks. It moves on to point out the various public and private sector abuses possible with wide-spread DNA profiling. Finally, the authors suggest that legislation should be passed at the state level until Congress can pass a more comprehensive federal statute governing the use of DNA information and collection

Keep it simple: Accelerating the verb learning process

For early word learners, verbs are more difficult to learn than nouns. Previous research suggests that a simple agent of an action facilitates verb learning. The present investigation was designed to replicate this finding with real-world stimuli. Twenty-four 18-month-old English-learning children participated in one of two conditions. Children either saw a block (simple agent) or a woman (complex agent) perform a novel action named simultaneously as the action occurred. All children were tested in the Intermodal Preferential Looking Paradigm to determine whether they learned the verb. Verb learning was not achieved in either condition; the results indicate that the block did not provide a verb learning advantage at this age. Limitations of the present study and suggestions for future research have been highlighted

Identification of candidate structured RNAs in the marine organism 'Candidatus Pelagibacter ubique'

<p>Abstract</p> <p>Background</p> <p>Metagenomic sequence data are proving to be a vast resource for the discovery of biological components. Yet analysis of this data to identify functional RNAs lags behind efforts to characterize protein diversity. The genome of '<it>Candidatus </it>Pelagibacter ubique' HTCC 1062 is the closest match for approximately 20% of marine metagenomic sequence reads. It is also small, contains little non-coding DNA, and has strikingly low GC content.</p> <p>Results</p> <p>To aid the discovery of RNA motifs within the marine metagenome we exploited the genomic properties of '<it>Cand</it>. P. ubique' by targeting our search to long intergenic regions (IGRs) with relatively high GC content. Analysis of known RNAs (rRNA, tRNA, riboswitches etc.) shows that structured RNAs are significantly enriched in such IGRs. To identify additional candidate structured RNAs, we examined other IGRs with similar characteristics from '<it>Cand</it>. P. ubique' using comparative genomics approaches in conjunction with marine metagenomic data. Employing this strategy, we discovered four candidate structured RNAs including a new riboswitch class as well as three additional likely <it>cis</it>-regulatory elements that precede genes encoding ribosomal proteins S2 and S12, and the cytoplasmic protein component of the signal recognition particle. We also describe four additional potential RNA motifs with few or no examples occurring outside the metagenomic data.</p> <p>Conclusion</p> <p>This work begins the process of identifying functional RNA motifs present in the metagenomic data and illustrates how existing completed genomes may be used to aid in this task.</p

Ancylostoma ceylanicum Hookworm in Myanmar Refugees, Thailand, 2012–2015

During 2012–2015, US-bound refugees living in Myanmar– Thailand border camps (n = 1,839) were surveyed for hookworm infection and treatment response by using quantitative PCR. Samples were collected at 3 time points: after each of 2 treatments with albendazole and after resettlement in the United States. Baseline prevalence of Necator americanus hookworm was 25.4%, Ancylostoma duodenale 0%, and Ancylostoma ceylanicum (a zoonosis) 5.4%. Compared with N. americanus prevalence, A. ceylanicum hookworm prevalence peaked in younger age groups, and blood eosinophil concentrations during A. ceylanicum infection were higher than those for N. americanus infection. Female sex was associated with a lower risk for either hookworm infection. Cure rates after 1 dose of albendazole were greater for A. ceylanicum (93.3%) than N. americanus (65.9%) hookworm (p\u3c0.001). Lower N. americanus hookworm cure rates were unrelated to β-tubulin single-nucleotide polymorphisms at codons 200 or 167. A. ceylanicum hookworm infection might be more common in humans than previously recognized

Implementation of a Curriculum to Optimize Hygiene Behaviors Among Refugees and Migrants Being Resettled

Health knowledge and behaviors can impact well-being and promote community integration post-arrival for refugees and migrants being resettled. Health and hygiene curricula are efficient and accessible mechanisms to mitigate the risk of chronic and infectious diseases in populations being resettled. This report summarizes a successful interagency/interdisciplinary Uganda-based collaboration between the International Organization for Migration, U.S. Centers for Disease Control and Prevention, and the University of Minnesota. The project's objective was to co-create and align a health curriculum and education messages across the resettlement continuum. Due to timing, the curriculum expanded to include COVID-19 prevention education, thus broadening the initiative's impact. Since the initial implementation, thousands of US-bound applicants have had exposure to the curriculum modules. The curriculum is now the primary tool for health education during pre-departure procedures in Kampala, Uganda, with implementations planned in other countries. The modular format and standardized non-technical language facilitated uptake by medical and non-medical personnel. Incorporating end users in curriculum development supports the early adoption and sustainability of the project. The interagency/interdisciplinary partnership strengthens systems and supports resource sharing to optimize the health and well-being of persons resettling in the United States

Through Teaching Are We Learning? Learning Through Teaching: Facilitating Interprofessional Education Experiences

Background: Despite a growing recognition of the value of collaborative patientcentred practice (CPCP) there is a lack of evidence identifying key elements and approaches to an effective interprofessional (IP) education intervention for clinical team members. The present study was conducted to address the paucity of rigorous mixed methods research to address the question: Does clinician team facilitation and mentorship of senior pre-licensure learners participating in IP clinical placements improve team members' attitudes, knowledge, skills, and perceived behaviours in CPCP?Methods: Based on the assumption that Geriatric Day Hospital clinical teams were already highly collaborative, educational experiences for clinical team members were not designed a priori. Rather, the educational experience was grounded in Mezirow's transformative learning theory, proposing that learning is a process of becoming aware of one's assumptions and revising these assumptions based on critical self-reflection. The option to participate in structured observation and feedback by an external observer using the Team Observation Scale provided important and unique opportunities for team reflection. Using the Controlled Before and After (CBA) design, the Attitudes Toward Health Care Teams Scale (ATHCTS), Team Skills Scale (TSS), and Knowledge Questionnaire were administered pre- and post-clinical placements to intervention and control groups. Data were analyzed by descriptive, bivariate, and repeated measures ANOVA. Qualitative data (evaluation and self-reflective forms) were analyzed using content analysis techniques.Results: Eleven IP clinical placements at 3 sites occurred between January 2007 and March 2008 (intervention N = 48; control N = 7). There was no significant change over time between intervention and control groups for the ATHCTS Quality of Care or Physician Centrality subscale scores, the TSS scores, or the Knowledge scores. Qualitative results suggested that participants were more aware of IP teaming, reflective of their own practice, and reported making changes in their own practice and mentorship of students as a result of their engagement in the study.Conclusions: This study demonstrated the viability of using structured observation and feedback processes as a reflective learning exercise. Further research is required to help identify key approaches and elements to an effective IPE intervention in clinical practice

Neutrophils Suppress Intraluminal NK Cell-Mediated Tumor Cell Clearance and Enhance Extravasation of Disseminated Carcinoma Cells

Immune cells promote the initial metastatic dissemination of carcinoma cells from primary tumors. In contrast to their well-studied functions in the initial stages of metastasis, the specific roles of immunocytes in facilitating progression through the critical later steps of the invasion–metastasis cascade remain poorly understood. Here, we define novel functions of neutrophils in promoting intraluminal survival and extravasation at sites of metastatic dissemination. We show that CD11b+/Ly6G+neutrophils enhance metastasis formation via two distinct mechanisms. First, neutrophils inhibit natural killer cell function, which leads to a significant increase in the intraluminal survival time of tumor cells. Thereafter, neutrophils operate to facilitate extravasation of tumor cells through the secretion of IL1β and matrix metalloproteinases. These results identify neutrophils as key regulators of intraluminal survival and extravasation through their cross-talk with host cells and disseminating carcinoma cells. SIGNIFICANCE: This study provides important insights into the systemic contributions of neutrophils to cancer metastasis by identifying how neutrophils facilitate intermediate steps of the invasion–metastasis cascade. We demonstrate that neutrophils suppress natural killer cell activity and increase extravasation of tumor cells.Human Frontier Science Program (Strasbourg, France) (fellowship LT00728/2008-L)Charles King Trust FoundationMassachusetts Institute of Technology. Ludwig Center for Cancer ResearchCancer Research Institute (New York, N.Y.) (Irvington Fellowship)National Institutes of Health (U.S.) (grant P01 CA080111)National Institutes of Health (U.S.) (grant CA163109

See It – Do It – Learn It: Learning Interprofessional Collaboration in the Clinical Context

Background: The primary goal of the Interprofessional Education in Geriatric Care (IEGC) project was to design, deliver, and evaluate interprofessional (IP) clinical placements for pre-licensure learners in geriatric day hospitals.Methods: Project evaluation was guided by the modified Kirkpatrick's Model of Educational Outcomes. Using a controlled before-after design, the Attitudes Toward Health Care Teams Scale (ATHCTS), Team Skills Scale (TSS), and Knowledge Questionnaire were administered to intervention and control learners pre-, post-, and 6 months post clinical placements. Quantitative data were analyzed using descriptive and multivariate statistics. Qualitative data collected through journals and questionnaires were analyzed using content analysis.Findings: Eleven IP clinical placements occurred at 3 test sites involving 32 intervention and 11 control learner participants. There was no significant change, over time, in the ATHCTS quality of care and physician centrality scores for the combined group (i.e., intervention and control) and between intervention and control groups. Time effects were noted in the quality of care scores for the intervention group after controlling for prior IPE (p = .031). The Knowledge scores were higher for the intervention group compared with controls over time (p = .004). Both intervention and control groups demonstrated significant improvements in their TSS scores over time (p = .000), although there was no significant difference in the magnitude of the change between groups (p = .112). Themes observed through qualitative analysis of learners' journals and post-program reflective questionnaires supported the quantitative findings.Conclusions: The IEGC experience was valuable to senior pre-licensure learners in helping them understand collaborative patient-centred practice and team skills. Future research should strive for larger sample sizes through multi-site projects to allow for comparisons within and between clinical sites