Community Education on MTM Services

Background: Medication nonadherence, defined as “the number of doses not taken or taken incorrectly that jeopardizes the patient’s therapeutic outcome,” is a major health problem with about 43% of the general population nonadherent to their medications. Medication nonadherence accounts for an estimated 125,000 deaths per year in the US, 33-69% of medication-related hospital readmissions, and an estimated $100 to$300 billion in direct and indirect medical costs. Medication therapy management (MTM), defined as “a distinct service or group of services that optimize therapeutic outcomes for individual patients,” has been found to reduce medication nonadherence. However, many individuals eligible for MTM services are not aware of the resource available to them and do not believe the service will be beneficial to them. Objectives: A pre post observational study design will be used to determine the effects of two types of educational interventions on MTM of patient’s perceptions of MTM and enrollment in MTM services. Methodology: Participants will be divided into two intervention groups. All participants will complete a pre survey to assess current perceptions of MTM services. One group will attend a community educational event on MTM, and the second group will receive an educational brochure in the mail. All participants will complete a post survey to reassess perceptions of MTM after the educational intervention. In addition, all participants will be tracked to determine future enrollment in an MTM service. Analysis: Descriptive tests and paired t-tests/Wilcoxon Signed Rank tests will be run on data acquired from pre and post surveys. Unpaired t-tests/Mann Whitney and chi-square tests will be run to compare data between intervention groups. Descriptive tests will be run on data acquired from tracking enrollment

Au-Ag template stripped pattern for scanning probe investigations of DNA arrays produced by Dip Pen Nanolithography

We report on DNA arrays produced by Dip Pen Nanolithography (DPN) on a novel Au-Ag micro patterned template stripped surface. DNA arrays have been investigated by atomic force microscopy (AFM) and scanning tunnelling microscopy (STM) showing that the patterned template stripped substrate enables easy retrieval of the DPN-functionalized zone with a standard optical microscope permitting a multi-instrument and multi-technique local detection and analysis. Moreover the smooth surface of the Au squares (abput 5-10 angstrom roughness) allows to be sensitive to the hybridization of the oligonucleotide array with label-free target DNA. Our Au-Ag substrates, combining the retrieving capabilities of the patterned surface with the smoothness of the template stripped technique, are candidates for the investigation of DPN nanostructures and for the development of label free detection methods for DNA nanoarrays based on the use of scanning probes.Comment: Langmuir (accepted

Recommendations for Effective Integration of Ethics and Responsible Conduct of Research (E/RCR) Education into Course-Based Undergraduate Research Experiences: A Meeting Report.

Advancement of the scientific enterprise relies on individuals conducting research in an ethical and responsible manner. Educating emergent scholars in the principles of ethics/responsible conduct of research (E/RCR) is therefore critical to ensuring such advancement. The recent impetus to include authentic research opportunities as part of the undergraduate curriculum, via course-based undergraduate research experiences (CUREs), has been shown to increase cognitive and noncognitive student outcomes. Because of these important benefits, CUREs are becoming more common and often constitute the first research experience for many students. However, despite the importance of E/RCR in the research process, we know of few efforts to incorporate E/RCR education into CUREs. The Ethics Network for Course-based Opportunities in Undergraduate Research (ENCOUR) was created to address this concern and promote the integration of E/RCR within CUREs in the biological sciences and related disciplines. During the inaugural ENCOUR meeting, a four-pronged approach was used to develop guidelines for the effective integration of E/RCR in CUREs. This approach included: 1) defining appropriate student learning objectives; 2) identifying relevant curriculum; 3) identifying relevant assessments; and 4) defining key aspects of professional development for CURE facilitators. Meeting outcomes, including the aforementioned E/RCR guidelines, are described herein

Giardia Flagellar Motility Is Not Directly Required to Maintain Attachment to Surfaces

Giardia trophozoites attach to the intestinal microvilli (or inert surfaces) using an undefined “suction-based” mechanism, and remain attached during cell division to avoid peristalsis. Flagellar motility is a key factor in Giardia's pathogenesis and colonization of the host small intestine. Specifically, the beating of the ventral flagella, one of four pairs of motile flagella, has been proposed to generate a hydrodynamic force that results in suction-based attachment via the adjacent ventral disc. We aimed to test this prevailing “hydrodynamic model” of attachment mediated by flagellar motility. We defined four distinct stages of attachment by assessing surface contacts of the trophozoite with the substrate during attachment using TIRF microscopy (TIRFM). The lateral crest of the ventral disc forms a continuous perimeter seal with the substrate, a cytological indication that trophozoites are fully attached. Using trophozoites with two types of molecularly engineered defects in flagellar beating, we determined that neither ventral flagellar beating, nor any flagellar beating, is necessary for the maintenance of attachment. Following a morpholino-based knockdown of PF16, a central pair protein, both the beating and morphology of flagella were defective, but trophozoites could still initiate proper surface contacts as seen using TIRFM and could maintain attachment in several biophysical assays. Trophozoites with impaired motility were able to attach as well as motile cells. We also generated a strain with defects in the ventral flagellar waveform by overexpressing a dominant negative form of alpha2-annexin::GFP (D122A, D275A). This dominant negative alpha2-annexin strain could initiate attachment and had only a slight decrease in the ability to withstand normal and shear forces. The time needed for attachment did increase in trophozoites with overall defective flagellar beating, however. Thus while not directly required for attachment, flagellar motility is important for positioning and orienting trophozoites prior to attachment. Drugs affecting flagellar motility may result in lower levels of attachment by indirectly limiting the number of parasites that can position the ventral disc properly against a surface and against peristaltic flow

The Genetic Signatures of Noncoding RNAs

The majority of the genome in animals and plants is transcribed in a developmentally regulated manner to produce large numbers of non–protein-coding RNAs (ncRNAs), whose incidence increases with developmental complexity. There is growing evidence that these transcripts are functional, particularly in the regulation of epigenetic processes, leading to the suggestion that they compose a hitherto hidden layer of genomic programming in humans and other complex organisms. However, to date, very few have been identified in genetic screens. Here I show that this is explicable by an historic emphasis, both phenotypically and technically, on mutations in protein-coding sequences, and by presumptions about the nature of regulatory mutations. Most variations in regulatory sequences produce relatively subtle phenotypic changes, in contrast to mutations in protein-coding sequences that frequently cause catastrophic component failure. Until recently, most mapping projects have focused on protein-coding sequences, and the limited number of identified regulatory mutations have been interpreted as affecting conventional cis-acting promoter and enhancer elements, although these regions are often themselves transcribed. Moreover, ncRNA-directed regulatory circuits underpin most, if not all, complex genetic phenomena in eukaryotes, including RNA interference-related processes such as transcriptional and post-transcriptional gene silencing, position effect variegation, hybrid dysgenesis, chromosome dosage compensation, parental imprinting and allelic exclusion, paramutation, and possibly transvection and transinduction. The next frontier is the identification and functional characterization of the myriad sequence variations that influence quantitative traits, disease susceptibility, and other complex characteristics, which are being shown by genome-wide association studies to lie mostly in noncoding, presumably regulatory, regions. There is every possibility that many of these variations will alter the interactions between regulatory RNAs and their targets, a prospect that should be borne in mind in future functional analyses

Changing Patient Perceptions of Medication Therapy Management: What Method of Education Is Most Effective?

Objective: Medication therapy management (MTM) has been found to reduce medication nonadherence, which is a signifi- cant contributor to negative health outcomes. However, many individuals eligible for MTM are not aware of it and do not believe the service to be beneficial. Thus, the objective of this study was to compare changes in patients\u27 perceptions of and enrollment in MTM between two different educational interventions (mailed brochure vs. live event education)

Necessity of the glossopharyngeal nerve in the maintenance of normal intake and ingestive bout size of corn oil by rats

Recent evidence in the literature suggests that signals carried by the glossopharyngeal nerve (GL), which supplies sensory and parasympathetic innervation of the posterior tongue, might be essential in the maintenance of normal gustatory responses to fat stimuli. Here, we report that GL transection (GLX) significantly decreased corn oil intake and preference in 23-h two-bottle tests relative to sham-operated controls (Sham). Drinking-pattern analysis of corn oil licking revealed that bout size, rather than the number of bouts initiated, was smaller in GLX than Sham rats. We also tested a range of glucose concentrations and found that total licks over daily 23-h sessions significantly decreased in GLX compared with Sham rats, but this difference failed to reach significance when intake or any bout parameter was measured. These results show that the signals in the GL normally contribute to processes involved with corn oil bout termination as opposed to bout initiation. GL-derived signals could potentially provide input to “reward” circuits in the ventral forebrain that could serve to maintain ingestion during a meal or, alternatively, could act at the level of the brain stem to attenuate the inhibitory potency of vagal signals, thus delaying the onset of satiation, or perhaps contribute to a cephalic phase reflex modulation of the gut. Parasympathetic efferents in the GL innervating the von Ebner's glands, which secrete lingual lipase, which is thought to break down corn oil into detectable ligands, could also be playing a role in driving corn oil intake. Whatever the mechanism, an intact GL is clearly necessary in maintaining normal intake of corn oil

Early Identification of Autism Spectrum Disorders Using Patterns of Service Use Prior to Diagnosis

Background/Aims: Early intervention services in the first few years of life significantly improve outcomes for children with autism spectrum disorders (ASD). Yet there are often delays in the identification and diagnosis of ASD. If health systems were better able to identify children at high risk for ASD and bring them in for comprehensive evaluation earlier, more children could be able benefit from early intervention. Methods: This study used data from three Kaiser Permanente sites (Northern California, Georgia, Northwest). All children born between Jan. 1, 2000, and Dec. 31, 2009, were included in the study population. All data stored in the electronic medical records up to June 2012 were collected. Children with an ASD diagnosis from an ASD specialist or two or more ASD diagnoses from nonspecialists were considered to have a valid ASD diagnosis. Controls were matched to cases at a 10:1 ratio and were matched on age, birth month and membership in the 12 months prior to the case’s first ASD diagnosis. We used two-part regression models and cluster analysis to examine whether children diagnosed with ASD have different patterns of service use prior to their first ASD diagnosis than children who do not go on to receive an ASD diagnosis. Results: Standard two-part regression models and cluster analyses identified differential patterns of service use prior to diagnosis for children with ASD compared to children without ASD. Regression models indicated that children with ASD have much greater use of specialty care (e.g. mental health services, neurology) prior to first ASD diagnosis. Cluster analyses provided a more nuanced picture. For example, early-onset ASD cases had a distinctive pattern separate from those who received a diagnosis at an older age. Conclusion: Using data on patterns of service use prior to the initial ASD diagnosis, it may be possible to identify children who are likely on a trajectory to get an ASD diagnosis. By developing and applying algorithms that can identify children most at risk in the first few years of life, comprehensive evaluation could be done at an earlier age, improving the outcomes for these children