Sickle Cell Trait and Genetic Counseling

Sickle cell trait (SCT) is a very prevalent disorder in the United States, especially among African Americans or people of African descent. However, even with the prevalence of the disorder, there are no standardized guidelines for providing patients with information about SCT and the implications of the disorder at physicals and well-check visits. The purpose of this evidence-based project was to increase awareness for African American patients 18-44 years old in the practice setting about SCT and to provide options for testing and genetic counseling. Kotter\u27s contemporary change theory was used as a guide to implement the new practice approach. A quasi-experimental, single-group, pretest-posttest-only design was used to explore the relationship between providing consistent SCT education and the impact on the rate of SCT screening and genetic counseling. A total of 71 patients participated in the program. The analysis showed a significant (p \u3c 0.001) mean difference of 18.16 points from the preintervention SCT and genetics test mean, which indicated that the intervention was successful in raising SCT and genetics knowledge scores among the target population. The results demonstrated that the implementation of SCT education in the practice setting can enhance social implications related to SCT awareness and opportunities for SCT testing and genetic counseling. The implementation of SCT clinical guidelines can help to increase awareness about SCT and improve the overall population health and reduce the financial burden affiliated with care of those with sickle cell disease and SCT complications

Estimating the cost impact of dressing choice in the context of a mass burns casualty event

SUMMARY. Mass casualty burn events (MCBs) require intense and complex management. Silver-infused longer use dressingsmight help optimise management of burns in an MCB setting. We developed a model estimating the impact of dressing choice inthe context of an MCB. The model was developed in Excel in collaboration with experienced emergency response clinicians. Themodel compares use of silver-infused dressings with use of traditional dressings in patients with partial thickness burns covering30% of their body. Costs were estimated from a UK perspective as a proxy for a funded emergency response team and limitedto cost of dressings, bandages, padding, analgesia and staff time. Expected patient costs and resource use were summarised overan acute 2-week intervention period and extrapolated to estimate possible time savings in a hypothetical MCB. Per patient costswere estimated at £2,002 (silver) and £1,124 (traditional) (a daily additional spend of £63). Per patient staff time was estimatedat 864 minutes (silver) and 1,200 minutes (traditional) (a daily time saving of 24 minutes). Multiplying up to a possible MCBpopulation of 20 could result in a saving equivalent to 9 staff shifts over the 2-week intervention period. The model was sensitiveto type of silver dressing, frequency of dressing change and staff costs. We found increased costs through use of silver dressingsbut time savings that might help optimise burns management in an MCB. Exploring the balance between costs and staff timemight help future MCB response preparation.Keywords: mass casualty incident, burns, silver dressing, SSD, cost mode

Exercise-based cardiac rehabilitation in heart transplant recipients

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine the effectiveness and safety of exercise‐based rehabilitation on the mortality, hospital admissions, morbidity, exercise capacity, health‐related quality of life, and return to work of people after heart transplantation

Health behavior and accident risk: Obesity is associated with the future risk of heavy truck crashes among newly recruited commercial drivers

This study estimates the dose-response relationship between Body Mass Index (BMI) and crash risk in commercial motor vehicle operators. Intake data was collected on 744 new truck drivers who were training for their commercial driver's licenses at a school operated by the cooperating trucking firm during the first two-week phase of instruction. Drivers were then followed prospectively on the job using the firm's operational data for two years, or until employment separation, whichever came first. Multivariate Poisson regression and Cox proportional hazards models were used to estimate the relationship between crash risk and BMI, controlling for exposure using miles driven, trip segments, and job type. Results from the Poisson regression indicated that the risk ratio (RR) for all crashes was significantly higher for drivers in the obesity Class II and Class III categories: RR= 1.6, confidence interval 1.2-2.1 and RR= 1.49, confidence interval 1.12-1.99, respectively. Similarly, the multivariate Cox Proportional Hazard model results showed that crash risk was significantly higher for obesity class II (BMI 35 to 40; RR = 1.35, P =0.06) when compared to normal BMI (BMI 18.5 to <25). The results of this prospective study establish an association between obesity and crash risk show that driver health behavior has important spillovers for public safety

Benzyl 5-hy­droxy-4-oxapenta­cyclo­[5.4.1.02,6.03,10.08,11]dodecane-3-carboxyl­ate

The title compound, C19H18O4, exhibits a long C—C bond [1.575 (2) Å] in the cage structure. In the crystal, pairs of O—H⋯O hydrogen bonds link the mol­ecules into centrosymmetric dimers. C—H⋯O inter­actions also occur

The Heritage Landscape of Plymouth, MA Greenway Planning and Cultural Design

In anticipation of the 400th anniversary of the Pilgrim’s landing in 1620, this studio combined greenway planning and cultural landscape design and interpretation to revitalize the public landscape of Plymouth, Massachusetts and convey the significance of these historic places to visitors and residents. Through the use of landscape research combining GIS data and analysis with historical narratives and maps, this fourteen-week senior BSLA capstone studio developed a regional and town-scale greenway plan along with detailed designs of individual public landscapes in historic downtown Plymouth

Study protocol: national research partnership to improve primary health care performance and outcomes for Indigenous peoples

Background Strengthening primary health care is critical to reducing health inequity between Indigenous and non-Indigenous Australians. The Audit and Best practice for Chronic Disease Extension (ABCDE) project has facilitated the implementation of modern Continuous Quality Improvement (CQI) approaches in Indigenous community health care centres across Australia. The project demonstrated improvements in health centre systems, delivery of primary care services and in patient intermediate outcomes. It has also highlighted substantial variation in quality of care. Through a partnership between academic researchers, service providers and policy makers, we are now implementing a study which aims to 1) explore the factors associated with variation in clinical performance; 2) examine specific strategies that have been effective in improving primary care clinical performance; and 3) work with health service staff, management and policy makers to enhance the effective implementation of successful strategies. Methods/Design The study will be conducted in Indigenous community health centres from at least six States/Territories (Northern Territory, Western Australia, New South Wales, South Australia, Queensland and Victoria) over a five year period. A research hub will be established in each region to support collection and reporting of quantitative and qualitative clinical and health centre system performance data, to investigate factors affecting variation in quality of care and to facilitate effective translation of research evidence into policy and practice. The project is supported by a web-based information system, providing automated analysis and reporting of clinical care performance to health centre staff and management. Discussion By linking researchers directly to users of research (service providers, managers and policy makers), the partnership is well placed to generate new knowledge on effective strategies for improving the quality of primary health care and fostering effective and efficient exchange and use of data and information among service providers and policy makers to achieve evidence-based resource allocation, service planning, system development, and improvements of service delivery and Indigenous health outcomes.Ross Bailie, Damin Si, Cindy Shannon, James Semmens, Kevin Rowley, David J Scrimgeour, Tricia Nage, Ian Anderson, Christine Connors, Tarun Weeramanthri, Sandra Thompson, Robyn McDermott, Hugh Burke, Elizabeth Moore, Dallas Leon, Richard Weston, Haylene Grogan, Andrew Stanley and Karen Gardne

Comparative Linkage Meta-Analysis Reveals Regionally-Distinct, Disparate Genetic Architectures: Application to Bipolar Disorder and Schizophrenia

New high-throughput, population-based methods and next-generation sequencing capabilities hold great promise in the quest for common and rare variant discovery and in the search for ”missing heritability.” However, the optimal analytic strategies for approaching such data are still actively debated, representing the latest rate-limiting step in genetic progress. Since it is likely a majority of common variants of modest effect have been identified through the application of tagSNP-based microarray platforms (i.e., GWAS), alternative approaches robust to detection of low-frequency (1–5% MAF) and rare (<1%) variants are of great importance. Of direct relevance, we have available an accumulated wealth of linkage data collected through traditional genetic methods over several decades, the full value of which has not been exhausted. To that end, we compare results from two different linkage meta-analysis methods—GSMA and MSP—applied to the same set of 13 bipolar disorder and 16 schizophrenia GWLS datasets. Interestingly, we find that the two methods implicate distinct, largely non-overlapping, genomic regions. Furthermore, based on the statistical methods themselves and our contextualization of these results within the larger genetic literatures, our findings suggest, for each disorder, distinct genetic architectures may reside within disparate genomic regions. Thus, comparative linkage meta-analysis (CLMA) may be used to optimize low-frequency and rare variant discovery in the modern genomic era