Racial/Ethnic Disparities in Diabetes Care and Outcomes: A Mixed Methods Study

Limited research has examined racial/ethnic differences in diabetes care and outcomes among primary care patients. This study examined racial/ethnic differences in diabetes care and outcomes among an ambulatory patient population and explored patient perceptions of the patient-provider relationship to inform strategies to improve care delivery. Using data from 62,149 adults with diabetes who received care within Atrium Health in 2013, regression models assessed associations between race/ethnicity and the following outcomes: glycated hemoglobin (HbA1c) tests, low density lipoprotein (LDL) and blood pressure (BP) screening, foot and eye exams, and HbA1c, LDL, and BP control. Eleven patients with diabetes and uncontrolled hypertension participated in three focus groups about their perceptions of the patient-provider relationship. Compared to non-Hispanic Whites, non-Hispanic Blacks had 22% to 73% higher odds of receiving screenings (HbA1c, LDL, BP, foot and eye exams;

Assessing the feasibility of fly based surveillance of wildlife infectious diseases

Monitoring wildlife infectious agents requires acquiring samples suitable for analyses, which is often logistically demanding. A possible alternative to invasive or non-invasive sampling of wild-living vertebrates is the use of vertebrate material contained in invertebrates feeding on them, their feces, or their remains. Carrion flies have been shown to contain vertebrate DNA; here we investigate whether they might also be suitable for wildlife pathogen detection. We collected 498 flies in Taï National Park, Côte d’Ivoire, a tropical rainforest and examined them for adenoviruses (family Adenoviridae), whose DNA is frequently shed in feces of local mammals. Adenoviral DNA was detected in 6/142 mammal-positive flies. Phylogenetic analyses revealed that five of these sequences were closely related to sequences obtained from local non-human primates, while the sixth sequence was closely related to a murine adenovirus. Next-generation sequencing-based DNA-profiling of the meals of the respective flies identified putative hosts that were a good fit to those suggested by adenoviral sequence affinities. We conclude that, while characterizing the genetic diversity of wildlife infectious agents through fly-based monitoring may not be cost-efficient, this method could probably be used to detect the genetic material of wildlife infectious agents causing wildlife mass mortality in pristine areas

Is the blood an alternative for programmed cell death ligand 1 assessment in non-small cell lung cancer?

Anti-programmed cell death (PD)-1/PD-ligand 1 (L1) therapies have significantly improved the outcomes for non-small cell lung cancer (NSCLC) patients in recent years. These therapies work by reactivating the immune system and enabling it to target cancer cells once more. There is a general agreement that expression of PD-L1 on tumour cells predicts the therapeutic response to PD-1/PD-L1 inhibitors in NSCLC. Hence, immunohistochemical staining of tumour tissue biopsies from NSCLC patients with PD-L1 antibodies is the current standard used to aid selection of patients for treatment with anti-PD-1 as first line therapy. However, issues of small tissue samples, tissue heterogeneity, the emergence of new metastatic sites, and dynamic changes in the expression of PD-L1 may influence PD-L1 status during disease evolution. Re-biopsy would expose patients to the risk of complications and tardy results. Analysis of PD-L1 expression on circulating tumour cells (CTCs) may provide an accessible and non-invasive means to select patients for anti-PD-1 therapies. Additionally, CTCs could potentially provide a useful biomarker in their own right. Several published studies have assessed PD-L1 expression on CTCs from NSCLC patients. Overall, analysis of PD-L1 on CTCs is feasible and could be detected prior to and after frontline therapy. However, there is no evidence on whether PD-L1 expression on CTCs could predict the response to anti-PD-1/PD-L1 treatment. This review examines the challenges that need to be addressed to demonstrate the clinical validity of PD-L1 analysis in CTCs as a biomarker capable of predicting the response to immune checkpoint blockade

Stability, resistance and change in mammalian microbiota and their associations with host health

What is the nature of a complex organism? Metagenomic research and its insights into biosystem function have fundamentally altered the answer to this question. High- throughput sequencing technology has revealed the multitude of microbes that live in and on human beings and other mammals. Metagenomics is beginning to uncover the relationships between microbiome and host that contribute to a complex organism’s biological processes. The vast quantities of data generated by sequencing have also created analytical challenges that require new methods to identify biologically meaningful results. The research described in this dissertation applies many of these techniques to elucidate the role of microbiota in human health. Chapter 1 presents results from our study of human choline metabolism that identified a relationship between the human gut microbiome and health. Primer design and qPCR experiments that confirm Chapter 1 results are explained in Chapter 2. Chapter 3 characterizes the microbial community from cystic fibrosis lung infection exposed to repeated courses of antibiotic therapy. An experiment designed to improve the resolution of ARISA, a metagenomic profiling technique, is described in Chapter 4. In Chapter 5, the relationship between gut microbial community composition and exercise in mice is investigated. In total, the work in this dissertation identifies several novel relationships between microbiota, host and environmental factors that may prove important in identifying underlying biological mechanisms that will improve human health

Experiencing Cancer in Appalachian Kentucky

Nothing tells the story of people working together better than a community quilt. A diversity of talents, colors, and materials brought together through skill and shared purpose. Perhaps never before have we as Americans needed a stronger reminder that many hands make short work of big problems. The work presented here by the L.A.U.N.C.H. Collaborative offers a new framework for health care that could be compared to a digital quilt, powered by community-based participatory design, with lived expertise and the newest advances in broadband-enabled connected health solutions. This work demonstrates the value and need to engage local communities and what can be learned when beneficiaries and traditional caregivers work together to develop healthcare solutions