Improving Community Advisory Board Engagement In Precision Medicine Research To Reduce Health Disparities

Community Advisory Boards (CABs) are used in efforts to reduce health disparities; however, there is little documentation in the literature regarding their use in precision medicine research. In this case study, an academic-CAB partnership developed a questionnaire and patient educational materials for two precision smoking cessation interventions that involved use of genetic information. The community-engaged research (CEnR) literature provided a framework for enhancing benefits to CAB members involved in developing research documents for use with a low-income, ethnically diverse population of smokers. The academic partners integrated three CEnR strategies: 1) in-meeting statements acknowledging their desire to learn from community partners, 2) in-meeting written feedback to and from community partners, and 3) a survey to obtain CAB member feedback post-meetings. Strategies 1 and 2 yielded modifications to pertinent study materials, as well as suggestions for improving meeting operations that were then adopted, as appropriate, by the academic partners. The survey indicated that CAB members valued the meeting procedure changes which appeared to have contributed to improvements in attendance and satisfaction with the meetings. Further operationalization of relevant partnership constructs and development of tools for measuring these aspects of community-academic partnerships is warranted to support community engagement in precision medicine research studies

Incorporation of cobaltocene as an n-dopant in organic molecular films

© 2007 American Institute of Physics. The electronic version of this article is the complete one and can be found at: http://dx.doi.org/10.1063/1.2752145DOI: 10.1063/1.2752145Electrical or chemical doping of molecular films is an efficient means of improving and controlling charge injection and carrier transport in organic devices. Recent work demonstrated that bis(cyclopentadienyl)cobalt(II) (cobaltocene, CoCp₂) efficiently dopes a tris(thieno)hexaazatriphenylene (THAP) derivative, as shown by a 0.56 eV shift of the Fermi level toward the empty states and an increase of current density by a factor of 10³ over undoped THAP devices. In this work, a combination of x-ray photoemission spectroscopy and Rutherford backscattering is used to elucidate the details of dopant incorporation into bulk films. Cobaltocene is observed to codeposit into the THAP matrix in a controllable manner, with preferential adsorption of the dopant onto the surface of the host film. In the case of CoCp₂-doped tris(8-hydroxy-quinolinato) aluminum (Alq₃) films, negligible amounts of the dopant are found in the bulk matrix and on the film surface, resulting in minimal improvements in the electrical characteristics of doped Alq₃ films. The process of CoCp₂ adsorption onto a film surface or the evolving surface of a growing film which leads to dopant incorporation is likely assisted by charge transfer from cobaltocene to the host material, resulting in ion pairing between the dopant and host

Relationship between human tumour angiogenic profile and combretastatin-induced vascular shutdown: an exploratory study

Combretastatin-A4-phosphate (CA4P) acts most effectively against immature tumour vasculature. We investigated whether histological angiogenic profile can explain the differential sensitivity of human tumours to CA4P, by correlating the kinetic changes demonstrated by dynamic MRI (DCE-MRI) in response to CA4P, with tumour immunohistochemical angiogenic markers. Tissue was received from 24 patients (mean age 59, range 32–73, 18 women, 6 men). An angiogenic profile was performed using standard immunohistochemical techniques. Dynamic MRI data were obtained for the same patients before and 4 h after CA4P. Three patients showed a statistically significant fall in Ktrans following CA4P, and one a statistically significant fall in IAUGC60. No statistically significant correlations were seen between the continuous or categorical variables and the DCE-MRI kinetic parameters other than between ang-2 and Ktrans (P=0.044). In conclusion, we found no strong relationships between changes in DCE-MRI kinetic variables following CA4P and the immunohistochemical angiogenic profile

Effect of a web-based chronic disease management system on asthma control and health-related quality of life: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Asthma is a prevalent and costly disease resulting in reduced quality of life for a large proportion of individuals. Effective patient self-management is critical for improving health outcomes. However, key aspects of self-management such as self-monitoring of behaviours and symptoms, coupled with regular feedback from the health care team, are rarely addressed or integrated into ongoing care. Health information technology (HIT) provides unique opportunities to facilitate this by providing a means for two way communication and exchange of information between the patient and care team, and access to their health information, presented in personalized ways that can alert them when there is a need for action. The objective of this study is to evaluate the acceptability and efficacy of using a web-based self-management system, My Asthma Portal (MAP), linked to a case-management system on asthma control, and asthma health-related quality of life.</p> <p>Methods</p> <p>The trial is a parallel multi-centered 2-arm pilot randomized controlled trial. Participants are randomly assigned to one of two conditions: a) MAP and usual care; or b) usual care alone. Individuals will be included if they are between 18 and 70, have a confirmed asthma diagnosis, and their asthma is classified as not well controlled by their physician. Asthma control will be evaluated by calculating the amount of fast acting beta agonists recorded as dispensed in the provincial drug database, and asthma quality of life using the Mini Asthma Related Quality of Life Questionnaire. Power calculations indicated a needed total sample size of 80 subjects. Data are collected at baseline, 3, 6, and 9 months post randomization. Recruitment started in March 2010 and the inclusion of patients in the trial in June 2010.</p> <p>Discussion</p> <p>Self-management support from the care team is critical for improving chronic disease outcomes. Given the high volume of patients and time constraints during clinical visits, primary care physicians have limited time to teach and reinforce use of proven self-management strategies. HIT has the potential to provide clinicians and a large number of patients with tools to support health behaviour change.</p> <p>Trial Registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN34326236">ISRCTN34326236</a>.</p

Waves, Pulses, and the Theory of Neural Masses

 It is a truism that systems as complex as vertebrate nervous systems are more than the sum of their parts. What is meant is that the interconnection of numbers of neurons gives rise to collective properties belonging to the neural populations and not to the neurons taken one at a time. The purpose of this essay is to explore some facets of the nature of neural collective properties.   Conventional wisdom holds that such properties emerge from the interconnection of finite numbers of neurons in discrete chains and networks, which are logical and anatomical counterparts of the Jacksonian-Sherringtonian heirarchy of reflex arcs. According to a popular analogy, neurons are like the electronic components of a television receiver which can be connected in a certain way or set of ways to give the properties of the receiver. The central thesis of this essay is the idea that, when neurons strongly interact in sufficiently large numbers (on the order of 10' or more), new collective properties emerge that demand a different kind or level of conceptualization.   An analogy equivalent to that given above is the notion that temperature and pressure exist only for a mass, in contrast to the thermal kinetic energy of molecules in the mass. The suggestion is that certain interactive phenomena in vertebrate brains occur only as broadly distributed and continuous events or waves across masses of neurons, and that in some instances these cooperative phenomena may be essential aspects of normal brain function. The task is to describe some of these wave phenomena in terms of underlying collective properties, and to do so in such a way as to minimize confusion between observables and principles. Again by analogy, brain potentials (EEG waves) appear to have somewhat the relation to wave activity of neural masses that flow patterns have to temperature and pressure waves in atmospheric storms. They are observable side effects that are of interest mainly because they give access to the internal dynamics.   The approach used is to review the historical interplay between ideas concerning neural networks and masses, to develop a set of rules for describing neural masses as dynamic entities, and then to discuss some of the implications of those rules for neurophysiology.   Throughout the development the emphasis is placed on the idea of graded neural synaptic interaction, because it is interaction of neurons that gives rise to something more than the sum of parts. Neurons are connected to each other by structural synaptic linkages. For each neuron there is a certain density of these anatomical connections, referring to the number and size of contacts of each neuron with its neighbors within each unit volume of neural mass. But the significant quantity is the momentary functional or effective connection density, which denotes the level of transfer of influence across a given set of connections at a given time and place. If, for example, a volley arrives on an afferent path to a neuron that is in an absolute refractory state, the functional connection density is zero, even though the anatomical connection density is nonzero.   Two kinds of massive connections are distinguished. The first is a one-way or forward connection from one neuron to neurons in another mass; the second is feedback connection of one neuron with many others in the same mass. Both types give rise to mass actions of many neurons, but only the second gives rise to the collective properties of interest in the present context. That is, neural interactions based on functional interconnection densities give rise to wave phenomena, and, as is shown for some of the neural masses in the mammalian olfactory system, the observable effects of wave patterns in turn provide the means for measuring the intensities of interactions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The antipsychotic medication, risperidone, causes global immunosuppression in healthy mice.

Atypical antipsychotic medications such as risperidone are widely prescribed for diverse psychiatric indications including schizophrenia, bipolar disorder and depression. These medications have complex pharmacology and are associated with significant endocrine and metabolic side effects. This class of medications also carries FDA black box warnings due to increased risk of death in elderly patients. Clinical reports indicate that patients treated with these medications are more susceptible to infections; however, the underlying mechanisms/pharmacology are unclear. We have previously reported that risperidone and it\u27s active metabolite distributes to the bone marrow in clinically relevant concentrations in preclinical species, leading us to hypothesize that the hematopoietic system may be impacted by these medications. To test this hypothesis, using proteomic and cytokine array technology, we evaluated the expression of genes involved in inflammatory and immune function following short term (5 days) and longer term (4 weeks) treatment in healthy animals. We report that low-dose risperidone treatment results in global immunosuppression in mice, observed following 5 days of dosing and exacerbated with longer term drug treatment (4 weeks). These data are consistent with increased susceptibility to infection in patients administered these medications and have profound implications for the increasing off-label prescribing to vulnerable patient populations including children and the elderly