13 research outputs found
Finishing the euchromatic sequence of the human genome
The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead
Demonstration of anticoagulation patient self-testing feasibility at an Indian Health Service facility: a case series analysis
Background: Anticoagulation patient self-testing
(PST) represents an alternative approach to
warfarin monitoring by enabling patients to use
coagulometers to test their international normalized
ratio (INR) values. PST offers several advantages
that potentially improve warfarin management.
Objective: To describe implementation and
associated performance of a PST demonstration
program at an Indian Health Service (IHS) facility.
Methods: A non-consecutive case series analysis
of patients from a pharmacy-managed PST
demonstration program was performed at an IHS
facility in Oklahoma between July 2008 and
February 2009.
Results: Mean time in therapeutic range (TTR) for
the seven patients showed a small, absolute
increase during the twelve weeks of PST compared
to the twelve weeks prior to PST. Four of the seven
patients had an increase in TTR during the twelve
week course of PST compared to their baseline
TTR. Three of four patients with increased TTR in
the final eight week period of PST achieved a TTR
of 100%. Of the three patients who experienced a
decrease in TTR after initiating self-testing, two
initially presented with a TTR of 100% prior to PST
and one patient had a TTR of 100% for the final
eight weeks of PST. The two patients not achieving
a TTR of 100% during the twelve week PST period
demonstrated an increase in TTR following the first
four weeks of PST.
Conclusion: Although anticoagulation guidelines
now emphasize patient self-management (PSM)
only, optimal PST remains an integral process in
PSM delivery. In the patients studied, the results of
this analysis suggest that PST at the IHS facility
provided a convenient, alternative method for
management of chronic warfarin therapy for
qualified patients. More than half of the patients
demonstrated improvement in TTR. Although there
is a learning curve immediately following PST
initiation, the mean TTR for the entire PST period increased modestly when compared to the time
period prior to PST.Antecedentes: La automedición por el paciente
(PST) de la anticoagulación representa un abordaje
alternativo a la monitorización de warfarina al
capacitar a los pacientes a utilizar coagulómetros
para medir los valores de su ratio internacional
normalizado (RIN). La PST ofrece varias ventajas
que mejoran el manejo de warfarina.
Objetivo: describir la implantación y la actuación
asociada a un programa de demostración de PST en
un centro del Servicio Sanitario Indio.
Métodos: Se realizó un análisis de una serie de
casos no consecutivos de un programa de PST
realizado por una farmacia en un Servicio Sanitario
Indio de Oklahoma desde julio 2008 a Febrero
2009.
Resultados: El tiempo medio en rango terapéutico
(TRT) para los siete pacientes mostró un pequeño
incremento absoluto durante los 12 meses de PST
comparado con los 12 meses previos al PST.
Cuatro de los siete pacientes tuvieron un aumento
de TRT durante las 12 semanas de tratamiento
comparado con el TRT al inicio. Tres de los cuatro
con aumento de TRT, alcanzaron un TRT del 100%
al final del periodo de 8 semanas. De los tres
pacientes que tuvieron un descenso de TRT
después de inicial la automedición, dos presentaban
un TRT antes del PST del 100% y un paciente tenÃa
un TRT del 100% al final de las 8 semanas de PST.
Los dos pacientes que no alcanzaron un TRT del
100% durante las 12 semanas de PST demostraron
un aumento de TRT después de las 4 semanas
iniciales.
Conclusión: Aunque las guias de anticoagulación
actualmente solo enfatizan el auto-manejo por el
paciente, el PST optimo es parte integral de ese
auto-manejo En los pacientes estudiados, los
resultados de este análisis sugieren que el PST en
un centro del Servicio Sanitario Indio proporciona
un método conveniente y alternativo para el manejo
crónico del tratamiento con warfarina en pacientes cualificados. Más de la mitad de los pacientes
demostró un aumento del TRT. Aunque existe una
curva de aprendizaje inmediatamente después de la
iniciación del PST, la media de TRT para el
periodo completo de PST aumentó modestamente
comparada con el tiempo anterior al PST
BELIEFS AND ATTITUDES REGARDING SMOKING CESSATION AMONG AMERICAN INDIANS: A PILOT STUDY
Background: American Indians (AI) have some of the highest smoking rates in the United States. The Muscogee Nation of Oklahoma developed a culturally targeted program called ‘‘Second Wind’’ based on the American Cancer Society’s FreshStart smoking cessation program, but it has not been formally tested. Methods: We conducted six focus groups of AI adult smokers at the Haskell Health Center (Lawrence, Kansas). Focus groups assessed beliefs, attitudes, and behaviors related to smoking cessation, as well as participants’ perceptions of the ‘‘Second Wind’’ curriculum’s appropriateness and feasibility for this diverse group. Focus groups were audiotaped, transcribed, coded, and analyzed for content themes. Participants were 41 AI adults (63% female), 21–67 years of age. Participants smoked an average of 13 cigarettes per day, half had made a quit attempt in the past year, and 63% were daily smokers. For pharmacotherapy, most preferred the nicotine patch. Results: Focus group responses were categorized into three major themes: traditional tobacco use, quitting and quit attempts, and the ‘‘Second Wind’’ program. Those who reported that traditional tobacco use is important were less inclined to use tobacco recreationally. Second Wind modifications suggested by participants included increasing use of AI imagery and addressing the meaning of tobacco to AI cultures. Conclusions: American Indian smokers are unique because of their traditional use of tobacco. Our participants felt that smoking cessation can be accomplished without discouraging traditional use of tobacco. We suggest ways to improve the ‘‘Second Wind’’ curriculum so that it is targeted for a heterogeneous group of AI smokers