Hospice Care in Malaysia: Knowledge, Attitude and Time of Discussion

Despite available and adequate hospice care resources, fewer terminally ill patients in Malaysia use hospice care services than one might reasonably expect. It is reported that only around 10% of patients who die of terminal illness in Malaysia, die in hospice care (Devaraj, 2003). The projected number of individuals that should receive palliative care in Malaysia is 17 to 27% (Connor & Sepulveda Bermedo, 2014). In order to study why hospice care is not accessed as expected, nurses and doctors in Penang and Sabah completed a survey measuring knowledge of current hospice practices, attitude toward caring for the dying, personal death anxiety and when they believe is the right time to discuss hospice care. No significant relationships were found between knowledge of hospice care, attitude towards caring for the dying and personal death anxiety and the decision of nurses and doctors to introduce the topic of hospice care with terminally ill or dying patients. There being a lack of consensus on the interpretation of “terminal illness” and “dying patient”, the right time to discuss hospice could not be determined. Along with the identification of the gap in the process of terminally ill patients receiving end-of-life- care, this study has identified how a more relevant method of research for the Malaysian setting may improve the time and quantity of hospice referral

Placental Flattening via Volumetric Parameterization

We present a volumetric mesh-based algorithm for flattening the placenta to a canonical template to enable effective visualization of local anatomy and function. Monitoring placental function in vivo promises to support pregnancy assessment and to improve care outcomes. We aim to alleviate visualization and interpretation challenges presented by the shape of the placenta when it is attached to the curved uterine wall. To do so, we flatten the volumetric mesh that captures placental shape to resemble the well-studied ex vivo shape. We formulate our method as a map from the in vivo shape to a flattened template that minimizes the symmetric Dirichlet energy to control distortion throughout the volume. Local injectivity is enforced via constrained line search during gradient descent. We evaluate the proposed method on 28 placenta shapes extracted from MRI images in a clinical study of placental function. We achieve sub-voxel accuracy in mapping the boundary of the placenta to the template while successfully controlling distortion throughout the volume. We illustrate how the resulting mapping of the placenta enhances visualization of placental anatomy and function. Our code is freely available at https://github.com/mabulnaga/placenta-flattening .Comment: MICCAI 201

MAP1B Interaction with the FW Domain of the Autophagic Receptor Nbr1 Facilitates Its Association to the Microtubule Network

Selective autophagy is a process whereby specific targeted cargo proteins, aggregates, or organelles are sequestered into double-membrane-bound phagophores before fusion with the lysosome for protein degradation. It has been demonstrated that the microtubule network is important for the formation and movement of autophagosomes. Nbr1 is a selective cargo receptor that through its interaction with LC3 recruits ubiquitinated proteins for autophagic degradation. This study demonstrates an interaction between the evolutionarily conserved FW domain of Nbr1 with the microtubule-associated protein MAP1B. Upon autophagy induction, MAP1B localisation is focused into discrete vesicles with Nbr1. This colocalisation is dependent upon an intact microtubule network as depolymerisation by nocodazole treatment abolishes starvation-induced MAP1B recruitment to these vesicles. MAP1B is not recruited to autophagosomes for protein degradation as blockage of lysosomal acidification does not result in significant increased MAP1B protein levels. However, the protein levels of phosphorylated MAP1B are significantly increased upon blockage of autophagic degradation. This is the first evidence that links the ubiquitin receptor Nbr1, which shuttles ubiquitinated proteins to be degraded by autophagy, to the microtubule network

Design thinking for community-provider collaboration: Designing a culture- and user-friendly refugee wellness center

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Design thinking (human-centered design) is a promising strategy to address health and social justice concerns through the development of innovative products and services that prioritize population needs. This project utilized design thinking to inform suggestions to the design of Hansjörg Wyss Wellness Center that promote a culturally sensitive and welcoming environment in order to improve healthcare outcomes for the refugee population in Philadelphia. Methods: Standard qualitative data gathering methods were used to gather insight into the needs of the South Philadelphia refugee population. Seven focus groups were conducted with patient populations (7 ethnic groups) and community partners. Data were coded independently by four members of the research team, organized into themes, and presented to stakeholders. Stakeholders (physicians, architects, designers, and community representatives) participated in a “Design Sprint” which utilized design thinking exercises to ideate and rapidly prototype solutions to common barriers refugees face to health and wellness. Results: Common barriers to access to healthcare reported in the focus groups include: lack of adequate language interpretation (navigating appointments and understanding medical terminology), long wait times, and transportation. Incorporation of health education resources, space for community events, mental health care, and space/activities for children were commonly suggested priorities for services in the wellness center. Design sessions produced prototypes acceptable to community and staff and informed the architects who have iterated and finalized the blueprint for the wellness center. Conclusions: Engaging end-users and stakeholders through design thinking is an effective strategy to gather community insight, achieve cultural sensitivity, and to promote health equity for underserved patient populations. The current project was limited by lack of measurable outcomes of patient satisfaction, as the center is still under development

Applying design thinking for community-provider collaboration: Designing a culture- and user-friendly refugee wellness center

Background: Designing South Philadelphia’s first permanent healthcare facility dedicated to immigrant and refugee health presents a unique opportunity to integrate cultural sensitivity with principles of community health. Philadelphia is a city saturated with many medical institutions and hospitals, yet there are large health disparities within miles of each other. Bringing together healthcare providers with a common goal of improving community health needs from a cultural standpoint can be tasking, even when all are on the same page. Design thinking is an underexplored perspective that has the potential to address these concerns in an efficient way that improves both provider and patient satisfaction. Objective: Using Design thinking to transform the Hansjorg- Wyss wellness center into a culturally diverse and welcoming environment for patients will ultimately improve healthcare outcomes for the immigrant population in Philadelphia. Methods: Seven focus groups were conducted to gather insight and feedback from patient populations, community partners, architects, and healthcare providers. We conducted a healthcare “design sprint,” with the various stakeholders involved to implement design thinking to ideate solutions for the new wellness center Results: Common barriers to access to healthcare reported in the focus groups include: lack of adequate language interpretation, long wait times, and transportation issues. Common findings among the different focus groups were a desire for services such as health education, spaces for community events, mental health services, and activities for children. Design sessions produced prototypes acceptable to community and staff and suitable for use by architects. Conclusions: Design thinking is a useful tool to merge community interests with healthcare delivery when building a culturally sensitive wellness center

Rapid Assessment of Existing HIV Prevention Programming in a Community Mental Health Center

In preparation for implementation of a comprehensive HIV prevention program in a Community Mental Health Center for persons with mental illness who are also abusing substances, a rapid assessment procedure (RAP) of existing prevention services that may have developed in the setting over time was undertaken at baseline. In addition to an ecological assessment of the availability of HIV-related information that was available on-site, in-depth interviews and focus groups were conducted with Center administrators, direct-care staff, and mental health consumers. Results indicated that responses regarding available services differed depending upon type of respondent, with administration reporting greater availability of preventive programs and educational materials than did direct-care staff or mental health consumers themselves. But overall, formalized training on HIV prevention by case managers is extremely rare. Case managers felt that other providers, such as doctors or nurses, were more appropriate to deliver an HIV prevention intervention

A prospective 3-year follow-up trial of implantation of two trabecular microbypass stents in open-angle glaucoma

PURPOSE: To evaluate 3-year safety and intraocular pressure (IOP) following two trabecular microbypass stents in phakic and pseudophakic subjects with open-angle glaucoma (OAG) not controlled on preoperative medication. PATIENTS AND METHODS: In this prospective pilot study, phakic or pseudophakic subjects with OAG and IOP between 18 mmHg and 30 mmHg on one preoperative topical ocular hypotensive medication underwent medication washout. Thirty-nine qualified subjects with preoperative unmedicated IOP ≥22 mmHg and ≤38 mmHg received two stents. Postoperative examinations were scheduled at Day 1, Week 1, Months 1, 3, 6, and 12, and semiannually through Month 60. Ocular hypotensive medication was considered if postoperative IOP exceeded 21 mmHg. IOP, medication use, and safety were assessed at each visit. Subject follow-up through Month 36 was completed. RESULTS: Thirty-six eyes (92.3%; 95% confidence interval [CI] 79.1%, 98.4%) achieved the primary efficacy end point of Month 12 reduction in IOP ≥20% from baseline (unmedicated IOP) without ocular hypotensive medication. Four subjects required medication during the Month 36 follow-up period. Mean IOP at 36 months for subjects not taking medication was 15.2 mmHg. At 36 months, subjects sustained mean IOP decrease of 9.1±2.7 mmHg (95% CI 8.0 mmHg, 10.14 mmHg), or 37% IOP reduction, from unmedicated baseline IOP. Compared to preoperative medicated IOP, subjects had mean reduction at Month 36 of 5.5±2.7 mmHg (95% CI 4.5 mmHg, 6.6 mmHg), or 26% reduction. Both measures of IOP reduction were highly significant (P<0.001). Other than one case of early postoperative hyphema that resolved at 1 week, no postoperative adverse events were attributed to stent implantation. CONCLUSION: In a pilot study, two trabecular microbypass stents to treat OAG subjects on one preoperative medication provided statistically significant, sustained, and safe reduction of IOP to ≤15 mmHg without medication through 36 months

Assessing BRCA1 activity in DNA damage repair using human induced pluripotent stem cells as an approach to assist classification of BRCA1 variants of uncertain significance.

Funder: King’s College LondonFunder: The European Union Scholarship ProgrammeFunder: National Institute for Health Research (NIHR)Establishing a universally applicable protocol to assess the impact of BRCA1 variants of uncertain significance (VUS) expression is a problem which has yet to be resolved despite major progresses have been made. The numerous difficulties which must be overcome include the choices of cellular models and functional assays. We hypothesised that the use of induced pluripotent stem (iPS) cells might facilitate the standardisation of protocols for classification, and could better model the disease process. We generated eight iPS cell lines from patient samples expressing either BRCA1 pathogenic variants, non-pathogenic variants, or BRCA1 VUSs. The impact of these variants on DNA damage repair was examined using a ɣH2AX foci formation assay, a Homologous Repair (HR) reporter assay, and a chromosome abnormality assay. Finally, all lines were tested for their ability to differentiate into mammary lineages in vitro. While the results obtained from the two BRCA1 pathogenic variants were consistent with published data, some other variants exhibited differences. The most striking of these was the BRCA1 variant Y856H (classified as benign), which was unexpectedly found to present a faulty HR repair pathway, a finding linked to the presence of an additional variant in the ATM gene. Finally, all lines were able to differentiate first into mammospheres, and then into more advanced mammary lineages expressing luminal- or basal-specific markers. This study stresses that BRCA1 genetic analysis alone is insufficient to establish a reliable and functional classification for assessment of clinical risk, and that it cannot be performed without considering the other genetic aberrations which may be present in patients. The study also provides promising opportunities for elucidating the physiopathology and clinical evolution of breast cancer, by using iPS cells