431 research outputs found
Dissemination of evidence-based standards of care.
Standards of care pertain to crafting and implementing patient-centered treatment interventions. Standards of care must take into consideration the patient's gender, ethnicity, medical and dental history, insurance coverage (or socioeconomic level, if a private patient), and the timeliness of the targeted scientific evidence. This resolves into a process by which clinical decision-making about the optimal patient-centered treatment relies on the best available research evidence, and all other necessary inputs and factors to provide the best possible treatment. Standards of care must be evidence-based, and not merely based on the evidence - the dichotomy being critical in contemporary health services research and practice. Evidence-based standards of care must rest on the best available evidence that emerges from a concerted hypothesis-driven process of research synthesis and meta-analysis. Health information technology needs to become an every-day reality in health services research and practice to ensure evidence-based standards of care. Current trends indicate that user-friendly methodologies, for the dissemination of evidence-based standards of care, must be developed, tested and distributed. They should include approaches for the quantification and analysis of the textual content of systematic reviews and of their summaries in the form of critical reviews and lay-language summaries
Epigenetic regulation of osteogenesis: human embryonic palatal mesenchymal cells.
Mesenchymal stem cells (MSCs) provide an appropriate model to study epigenetic changes during osteogenesis and bone regeneration due to their differentiation potential. Since there are no unique markers for MSCs, methods of identification are limited. The complex morphology of human embryonic palatal mesenchyme stem cell (HEPM) requires analysis of fractal dimensions to provide an objective quantification of self-similarity, a statistical transformation of cellular shape and border complexity. We propose the hypothesis of a study to compare and contrast sequential steps of osteogenic differentiation in HEPMs both phenotypically using immunocytochemistry, and morphometrically using fractal analysis from undifferentiated passage 1 (P1) to passage 7 (P7) cells. The proof-of-concept is provided by results we present here that identify and compare the modulation of expression of certain epigenetic biomarkers (alkaline phosphatase, ALP; stromal interaction molecule-1, STRO-1; runt-related transcription factor-2, RUNX2), which are established markers of osteogenesis in bone marrow studies, of osteoblastic/skeletal morphogenesis, and of osteoblast maturation. We show that Osteoinductive medium (OIM) modulates the rate of differentiation of HEPM into Run-2+ cells, the most differentiated subpopulation, followed by ALP+ and STRO-1+ cells. Taken together, our phenotypical and morphometric data demonstrate the feasibility of using HEPM to assess osteogenic differentiation from an early undifferentiated to a differentiated stage. This research model may lay the foundation for future studies aimed at characterizing the epigenetic characteristics of osteoimmunological disorders and dysfunctions (e.g., osteoarthritis, temporomandibular joint disorders), so that proteomic profiling can aid the diagnosis and monitor the prognosis of these and other osteoimmunopathologies
Anthropogenic forcing is a plausible explanation for the observed surface specific humidity trends over the Mediterranean area
Reliability of Quality Assessments in Research Synthesis: Securing the Highest Quality Bioinformation for HIT.
Current trends in bio-medicine include research synthesis and dissemination of bioinformation by means of health (bio) information technology (H[b] IT). Research must secure the validity and reliability of assessment tools to quantify research quality in the pursuit of the best available evidence. Our concerted work in this domain led to the revision of three instruments for that purpose, including the stringent characterization of inter-rater reliability and coefficient of agreement. It is timely and critical to advance the methodological development of the science of research synthesis by strengthening the reliability of existing measure of research quality in order to ensure H[b] IT efficacy and effectiveness
Immune surveillance of nasopharyngeal carcinoma (NpC)
In the U.S., nasopharyngeal carcinoma (NpC) kills >7,600 each year. Deaths are predominantly among adult men, and in most
cases, early detection and treatment can save lives. Despite the annual spending of approximately 3.2 billion dollars on head and
neck cancer research, NpC remains a neglected disease since its fatality rates are among the lowest nation wide. The relative
survival rates from NpC have not improved in the U.S. in the last 20 years. Infection with Epstein Barr Virus (EBV) is an important
co-factor in the etiology of NpC. In other regions of the word (e.g., South-East Asia, Latin America), EBV infection and NpCrelated
prevalence and mortality are substantially higher and more alarming. Epidemiological data indicate high prevalence of
EBV infection and increased risk for NpC among Central and South American and Asian immigrants in the U.S., and also predict a
sharp increase in NpC incidence in the next decade. To face this emerging threat, it is important to develop and validate novel
modes of detection and intervention for NpC. To this end, we characterized the proteomic signature of NpC, and of the tumor
infiltrating lymphocytes of the CD8+, activated (CD38+, mTOR+) and regulatory immune cell (FoxP3+) phenotype. Paraffinized
biopsies were processed, and tissue microarrays constructed and tested by immunohistochemistry and triimmunohistofluorescence
for a battery of signaling markers, including AKT and PI3K, in conjunction with EBV status and
ANKRD11, an NpC susceptibility biomarker. Microphotographs, analyzed and quantified by confocal microscopy and fractal
analysis, suggest new avenues for immunotherapies of NpC
Disseminating the best available evidence: New challenges in public reporting of health care
As a direct benefit of the Health Care Reform Act (2010), concerted effort has been deployed to define and characterize the process
by which the best available evidence for diagnosis or treatment intervention prognosis can be obtained. The science of research
synthesis in health care has established the systematic research protocol by which randomized clinical trials and other clinical
studies must be reviewed and compared for the level and quality of the evidence presented, as well as the consensus of the best
available evidence synthesized and shared. This process of systematic review yields a reliable and valid approach in comparing
different interventions and strategies to prevent, diagnose, treat and monitor health conditions in terms of efficacy, and or of
effectiveness. The resulting bioinformation outcome of comparative effectiveness and efficacy research review of the available
clinical data is expressed as a consensus of the best available evidence, which finds its way in evidence-based clinical practice
guidelines, standards of care and eventually, in policies: hence, the acronym CEERAP (comparative effectiveness and efficacy
review and policy). The methodological and the procedural criteria that determine and regulate the public reporting dissemination
of this sort of bioinformation, and the extent of benefit to the patient's health literacy, which have remained a bit more elusive to
this date, are investigated and discussed in this paper
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