[The injury hazard of the 1st subsequent generation (Fi-generation) after gonad irradiation].
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The important role of genetics in pediatric illness has been increasingly recognized, but the true impact has not been well delineated. An important study of pediatric inpatient admissions to a children's hospital in 1978 found a genetic basis for disease in just less than half of admitted patients. We sought to update this study in light of current hospitalization practices and new knowledge about genetics. We systematically reviewed the records of 5,747 consecutive admissions (4,224 individuals), representing 98% of patients admitted in 1996 to Rainbow Babies and Children's Hospital (Cleveland, OH). Each patient was assigned to one of five groups on the basis of the presence or absence of an underlying chronic medical condition and whether that condition had a genetic basis or susceptibility. An underlying disorder with a significant genetic component was found in 71% of admitted children. The vast majority (96%) of underlying chronic disorders in children in this study were either clearly genetic or had a genetic susceptibility. Total charges for 1996 were >$62 million, of which $50 million (81%) was accounted for by disorders with a genetic determinant. The 34% of admissions with clearly genetic underlying disorders accounted for 50% (>$31 million) of the total hospital charges. The mean length of stay was 40% longer for individuals with an underlying disease with a genetic basis than for those with no underlying disease. Charges and length of stay were similar for children with underlying chronic disorders, regardless of the cause. This study begins to quantify the enormous impact of genetic disease on inpatient pediatrics and the health care system. Additional study and frank public discourse are needed to understand the implications on the future health care workforce and on the utilization of health care resources.
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BACKGROUND: Previous research with primary health care professionals has demonstrated consistently that education, training and support are necessary before there should be any expansion in primary care genetics. The genetic liaison nurse role has been suggested as one means of providing this education and support. OBJECTIVE: The aim of this study was to evaluate GP responses to the genetics liaison nurse role as a means of supporting community-based genetics services. METHODS: A self-completion postal questionnaire in primary care was sent to GPs working in Nottingham. Main outcome measures were assessment of potential usage of a genetic outreach professional in terms of time, roles and support for a pilot scheme RESULTS: A total of 182 (55.0%) of 331 GPs working in Nottingham returned a questionnaire. Although 54% did not believe that the genetics liaison nurse role would be useful in the present, most believed that such a role would definitely or probably (64%) be useful in the future. The most valued contribution was as a source of advice when genetics problems arise in a consultation. Providing education on specific genetic disorders and on clinical skills relevant to genetics were also seen as important. Many GPs would also use a liaison nurse to see patients prior to their attending an out-patient clinic with a clinical geneticist. Respondents suggested that each nurse should spend approximately 3 hours a month in each practice and be attached to between 10 and 20 practices. CONCLUSIONS: GPs appreciate that there may be limited genetics services provided in primary care at present, but this is likely to change in the near future. The genetics liaison nurse role should be evaluated as a means of providing genetics specialist outreach support for service delivery and to facilitate education.
PURPOSE: To learn the extent to which HMOs and academic genetic centers (1) are involved in predictive genetic tests for common, complex disorders and (2) interact with each other. METHODS: Surveys of HMO medical directors and directors of U.S. academic genetic centers. RESULTS: In 1996, approximately 28% of HMOs were covering predictive tests for breast and colon cancer, but 75% of all medical directors said their HMO would consider policies regarding predictive testing in the next 5 years. Approximately 80% of directors of academic genetic centers said they provided genetic counseling services for common adult-onset disorders for patients covered by managed care organizations (MCOs), but they ranked the volume of services they provide for pediatric and prenatal indications much higher. Most academic genetic centers (72%) have contracts with MCOs. CONCLUSION: Although genetic services are being provided by academic genetic centers to patients who are members of managed care organizations, many patients with whom genetic testing for adult onset disorders is discussed may never see a geneticist. Academic genetic centers should educate nongeneticist professionals about the use of tests for common disorders.
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The workplace can be responsible for approximately one in 10 cases of adult-onset asthma. Two types of occupational asthma (OA) are distinguished by whether they arise after a latency period that is necessary for acquiring sensitization or as a result of acute exposure to irritant materials (irritant-induced asthma). The pathophysiology of OA with a latency period is similar to that of nonoccupational asthma, whereas the mechanism of irritant-induced asthma is still uncertain. HLA haplotypes and other genetic polymorphisms have been found to be associated with OA. According to various sources of data, the overall frequency of OA has remained stable in the last 10 years, although the frequency of causal agents vary. Registers of causal occupations and agents have been issued on Web sites (eg, www.asmanet.com ). Improved sampling methods have shown that the degree of exposure plays a key role in the onset of the disease, whereas prospective data collected in high-risk workplaces have also identified personal risk factors (eg, atopy, smoking, and rhinoconjunctivitis). A diagnosis of OA should no longer be based on a compatible history only but should be confirmed by means of objective testing. Once the diagnosis is confirmed, the worker should be removed from exposure, and satisfactory compensation programs should be offered, the most important being retraining programs with financial compensations because affected workers are generally young. The cost-effectiveness of prevention programs in high-risk workforces should be assessed.
Genetic counseling is undergoing a rapid transformation as genomic medicine becomes embedded within mainstream healthcare systems. At the same time, the profession is being challenged to respond to systemic racism, colonial legacies, technological change, and evolving expectations regarding equity and justice. Historically, genetic counseling emerged within twentieth-century medical genetics and was influenced by political, social, scientific, and medical forces that included eugenic ideology, values, and practices. The profession has since evolved substantially toward psychosocial, patient-centered, and non-directive models of care. Contemporary debates regarding "newgenics" or "neugenics" further demonstrate how concerns regarding equity, reproductive ethics, disability, and genomic stratification continue to shape genomic healthcare discourse. This qualitative reflexive practice paper explores how systemic racism, colonial legacy, cultural safety and structural power shape genetic counseling practice in the United Kingdom (UK), Aotearoa New Zealand and Australia, and how these forces continue to reshape the profession's future identity. A reflexive, narrative, and comparative qualitative approach was employed, grounded in the authors' lived professional experiences across UK and Australasian contexts and informed by purposively selected policy, professional and scholarly literature relating to cultural safety, dignity, anti-racism, and Human Rights-Based Decision-Making. Through iterative reflexive dialogue, comparative analysis, and thematic synthesis, four interrelated themes were developed examining sociopolitical context, systemic racism, cultural safety and technologization within contemporary genetic counseling practice. Comparative analysis identified substantial differences in how culturally responsive practice is conceptualized and operationalized across settings. In Aotearoa, cultural safety is strongly shaped by Te Tiriti o Waitangi, bicultural accountability, and Māori sovereignty frameworks. In Australia, culturally safer genomic care has increasingly developed through Indigenous-led initiatives and workforce reform, including the Australian Alliance for Indigenous Genomics (ALIGN). In contrast, UK practice remains largely situated within equality, diversity, and inclusion (EDI) frameworks that may insufficiently address systemic racism and structural power within increasingly diverse populations. Reflexive clinical examples demonstrated how inequities may emerge through undocumented patient values, standardized pathways, assumptions regarding autonomy, and misinterpretation of culturally specific communication styles. Re-imagining the future of genetic counseling requires more than just technological advancement. It requires reflexive engagement with dignity, inequity, and the sociopolitical realities of the populations served. These insights re-imagine a culturally grounded, socially responsive future for genetic counseling in an era shaped by genomic mainstreaming, digital transformation, artificial intelligence and workforce reform and one in which the profession remains ethically anchored, relationally attuned, and committed to justice-oriented practice.
Changes in the health care delivery system have comparable impacts on both nursing practice and education, such that tomorrow's nursing practice would best emanate from innovative partnerships between leaders in practice and education. For the foreseeable future, an expert nursing workforce is needed in an expanded form, but an array of challenges to maintaining this workforce are evident. Recent and continuing scientific and technologic advances in health care make the matching of practice and education to evolving trends paramount. Regardless of what the future holds, generative leadership in any realm of practice is essential to move our profession into the forefront of health care.
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India has embarked upon a very ambitious program in biotechnology with a view to harnessing its available human and unlimited biodiversity resources. It has mainly been a government sponsored effort with very little private industry participation in investment. The Department of Biotechnology (DBT) established under the Ministry of Science and Technology in 1986 was the major instrument of action to bring together most talents, material resources, and budgetary provisions. It began sponsoring research in molecular biology, agricultural and medical sciences, plant and animal tissue culture, biofertilizers and biopesticides, environment, human genetics, microbial technology, and bioprocess engineering, etc. The establishment of a number of world class bioscience research institutes and provision of large research grants to some existing universities helped in developing specialized centres of biotechnology. Besides DBT, the Department of Science & Technology (DST), also under the Ministry of S&T, sponsors research at universities working in the basic areas of life sciences. Ministry of Education's most pioneering effort was instrumental in the creation of Biochemical Engineering Research Centre at IIT Delhi with substantial assistance from the Swiss Federal Institute of Technology, Zurich, Switzerland to make available state-of-the-art infrastructure for education, training, and research in biochemical engineering and biotechnology in 1974. This initiative catalysed biotechnology training and research at many institutions a few years later. With a brief introduction, the major thrust areas of biotechnology development in India have been reviewed in this India Paper which include education and training, agricultural biotechnology, biofertilizers and biopesticides, tissue culture for tree and woody species, medicinal and aromatic plants, biodiversity conservation and environment, vaccine development, animal, aquaculture, seri and food biotechnology, microbial technology, industrial biotechnology, biochemical engineering and associated activities such as creation of biotechnology information system and national repositories. Current status of intellectual property rights has also been discussed. Contribution to the India's advances in biotechnology by the industry, excepting a limited few, has been far below expectations. The review concludes with some cautious notes.
In 1990 a symposium was held by the American College of Obstetricians and Gynecologists and the National Abortion Federation to address the national shortage of physician abortion providers. One symposium recommendation was that nurse-midwives be trained to perform first-trimester legal abortions under physician supervision. A national mail survey was conducted to determine the attitudes of nurse-midwives toward performing abortion and related procedures. One-half of the nurse-midwives who were members of the American College of Nurse-Midwives as of October 1991 were polled, and 1,208 questionnaires (71.1%) were returned, resulting in a sample representative of the general membership and students. Seventy-nine percent of respondents would not support federal and state efforts to limit access to abortion, 52% would or possibly would vote in a secret ballot to permit the performance of abortion by certified nurse-midwives; 24% would, or possibly would, incorporate abortion procedures into their practice; and 19% would, or possibly would, perform abortions in an abortion clinic. The lowest level of support to permit the certified nurse-midwife practice of abortion came from the midwest (31%) and southeast (41%) and the greatest from the west coast (65%). Supporters for the nurse-midwife performance of abortion were more likely to have practiced well-woman gynecology and provided abortion-related services such as abortion referrals, pre- and postabortion workups and the treatment of abortion-related complications. They were more likely to have inserted intrauterine contraceptive devices and laminaria, and to have performed circumcision. Opinions about the performance of abortion were not related to age, education, or student status. The majority of nurse-midwives (91%) would be willing to refer a woman to another provider for an abortion, prescribe RU 486 (57%), and perform dilation and curettage for spontaneous abortion (56%). The American College of Nurse-Midwives membership reported many different reasons for support of and opposition to professional involvement with abortion. Further research suggestions for institutional policy and individual practice are offered.
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In the past four years, automation for genomics has enabled a 43-fold increase in the total finished human genomic sequence in the world. This two-part noncomprehensive review will provide an overview of different types of automation equipment used in genome sequencing. Part One focuses on equipment involved in DNA preparation, DNA sequencing reactions, and other automated procedures for preparing DNA for running on sequencers or subsequent analysis; it also includes information on the development of these machines at various genome centers. Part Two, to be published in the next issue, will cover sequencing machinery and array technology, and conclude with a look at the future technologies that will revolutionize molecular biology. "Alternate" sequencing technologies (including mass spectrometry, biochips, and single-molecule analysis) will also be examined.
A survey of China's plant biotechnologists shows that China is developing the largest plant biotechnology capacity outside of North America. The list of genetically modified plant technologies in trials, including rice, wheat, potatoes, and peanuts, is impressive and differs from those being worked on in other countries. Poor farmers in China are cultivating more area of genetically modified plants than are small farmers in any other developing country. A survey of agricultural producers in China demonstrates that Bacillus thuringiensis cotton adoption increases production efficiency and improves farmer health.