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Creating the environment for a successful community partnership.

This paper describes the development of the American Indian Oncology Program (AIOP) and presents the accomplishments of a participatory research approach that involved an integrated network for cancer care and research. AIOP used a participatory process to develop infrastructure, identify research questions, develop methodologies, write supplemental grants, and evaluate accomplishments based on community defined measures of success. Partnerships between University and Indian Health Service, private, and state institutions led to improved collaboration. Health services delivery improved by increasing provider involvement at multiple institutions via a Tumor Board. Community awareness improved through workshops addressing community-specific cancer concerns. Collectively, these resulted in an environment receptive to the development of research activities. The AIOP team, through a participatory process, developed infrastructure at each institution that facilitated interaction, community-based education, and improved patient care; identified new partners; raised community-level knowledge and awareness about cancer; encouraged a research-friendly environment and building research capacity; and increased the cultural competency of researchers wishing to work in American Indian communities and created a cadre of future American Indian cancer researchers. As evidenced by successful pilot project development and formation of ongoing research and funding applications, the authors created a research-receptive environment and promoted potentially sustainable research capacity in the community. Much of their success is the result of utilizing a participatory model for capacity building that included not only communities but institutions. Cancer 2006. Published 2006 by the American Cancer Society.

Arizona↗

Genetic and genomic tools for Xenopus research: The NIH Xenopus initiative.

The NIH Xenopus Initiative is establishing many of the genetic and genomic resources that have been recommended by the Xenopus research community. These resources include cDNA libraries, expressed sequence tags, full-length cDNA sequences, genomic libraries, pilot projects to mutagenize and phenotype X. tropicalis, and sequencing the X. tropicalis genome. This review describes the status of these projects and explains how to access their data and resources. Current information about these activities is available on the NIH Xenopus Web site (http://www.nih.gov/science/models/xenopus/).

Animals↗

Variation in postoperative analgesic requirements in the morbidly obese following gastric bypass surgery.

Patient-controlled analgesia is a relatively new method of administering intravenous narcotics for postoperative pain relief. The technique involves the self-administration of a given analgesic in a bolus dose with the aid of a timed infusion and sequencing device. Ten morbidity obese patients undergoing elective gastric bypass surgery were treated in a prospective, unblinded, pilot project to evaluate the efficacy of patient-controlled analgesia. Analgesic therapy was satisfactory in all patients. The mean total dose of morphine sulfate administered during the first 36 hours postoperatively was 66 mg, an average of 1.7 mg/hr. There was a tenfold variation (17.5-175 mg) in the 36 hr total dose. The total dose was not related to body surface area, age, sex, dose per injection, or anesthetic agent. The large variation in individual narcotic analgesic requirements could be a major factor in the suboptimal management of postoperative pain with conventional dosing. Patient-controlled analgesia may circumvent these problems.

Adult↗

I am not alone: spirituality of chronically ill rural dwellers.

Spirituality plays a vital role in adjusting to chronic illness and rehabilitation nurses strive to gain understanding of their patients' spirituality in order to improve patient care and outcomes. The purpose of this qualitative study was to explore the nature of spirituality in chronically ill rural dwellers and how it relates to their illness. As a part of this pilot project, 10 women with chronic illness volunteered to participate in a phone interview to discuss their spirituality. Content analysis was used to analyze the data. The theme Means the World to Me described what spirituality meant to participants. The following themes described how spirituality related to chronic illness: I Am Not Alone, Putting on a Happy Face, Others Are Worse Off, Transcending Despair and Letting Go. Participants were able to use spiritual coping measures to transcend despair. Results from this study provide rehabilitation nurses with insight into the spirituality needs of chronically ill rural-dwelling women.

Adult↗

Peptidomic analysis of human blood specimens: comparison between plasma specimens and serum by differential peptide display.

The human Plasma Proteome Project pilot phase aims to analyze serum and plasma specimens to elucidate specimen characteristics by various proteomic techniques to ensure sufficient sample quality for the HUPO main phase. We used our proprietary peptidomics technologies to analyze the samples distributed by HUPO. Peptidomics summarizes technologies for visualization, quantitation, and identification of the low-molecular-weight proteome (<15 kDa), the "peptidome." We analyzed all four HUPO specimens (EDTA plasma, citrate plasma, heparin plasma, and serum) from African- and Asian-American donors and compared them to in-house collected Caucasian specimens. One main finding focuses on the most suitable method of plasma specimen collection. Gentle platelet removal from plasma samples is beneficial for improved specificity. Platelet contamination or activation of platelets by low temperature prior to their removal leads to distinct and multiple peptide signals in plasma samples. Two different specimen collection protocols for platelet-poor plasma are recommended. Further emphasis is placed on the differences between plasma and serum on a peptidomic level. A large number of peptides, many of them in rather high abundance, are only present in serum and not detectable in plasma. This ex vivo generation of multiple peptides hampers discovery efforts and is caused by a variety of factors: the release of platelet-derived peptides, other peptides derived from cellular components or the clot, enzymatic activities of coagulation cascades, and other proteases. We conclude that specimen collection is a crucial step for successful peptide biomarker discovery in human blood samples. For analysis of the low-molecular-weight proteome, we recommend the use of platelet-depleted EDTA or citrate plasma.

Anticoagulants↗

A functional annotation of subproteomes in human plasma.

The data collected by Human Proteome Organization's Plasma Proteome Pilot project phase was analyzed by members of our working group. Accordingly, a functional annotation of the human plasma proteome was carried out. Here, we report the findings of our analyses. First, bioinformatic analyses were undertaken to determine the likely sources of plasma proteins and to develop a protein interaction network of proteins identified in this project. Second, annotation of these proteins was performed in the context of functional subproteomes involved in the coagulation pathway, the mononuclear phagocytic system, the inflammation pathway, the cardiovascular system, and the liver; as well as the subset of proteins associated with DNA binding activities. Our analyses contributed to the Plasma Proteome Database (http://www.plasmaproteomedatabase.org), an annotated database of plasma proteins identified by HPPP as well as from other published studies. In addition, we address several methodological considerations including the selective enrichment of post-translationally modified proteins by the use of multi-lectin chromatography as well as the use of peptidomic techniques to characterize the low molecular weight proteins in plasma. Furthermore, we have performed additional analyses of peptide identification data to annotate cleavage of signal peptides, sites of intra-membrane proteolysis and post-translational modifications. The HPPP-organized, multi-laboratory effort, as described herein, resulted in much synergy and was essential to the success of this project.

Blood Coagulation↗

Analysis of the HUPO Brain Proteome reference samples using 2-D DIGE and 2-D LC-MS/MS.

Within the Human Proteome Organization (HUPO) Brain Proteome Project, a pilot study was launched with reference samples shipped to nine international laboratories (see Hamacher et al., this Special Issue) to evaluate different proteome approaches in neuroscience and to build up a first version of a brain protein database. One part of the study addresses quantitative proteome alterations between three developmental stages (embryonic day 16; postnatal day 7; 8 weeks) of mouse brains. Five brains per stage were differentially analyzed by 2-D DIGE using internal standardization and overlapping pH gradients (pH 4-7 and 6-9). In total, 214 protein spots showing stage-dependent intensity alterations (> two-fold) were detected, 56 of which were identified. Several of them, e.g. members of the dihydropyrimidinase family, are known to be associated with brain development. To feed the HUPO BPP brain protein database, a robust 2-D LC-MS/MS method was applied to murine postnatal day 7 and human post-mortem brain samples. Using MASCOT and the IPI database, 350 human and 481 mouse proteins could be identified by at least two different peptides. The data are accessible through the PRIDE database (http://www.ebi.ac.uk/pride/).

Aging↗

2-D DIGE as a quantitative tool for investigating the HUPO Brain Proteome Project mouse series.

Brain development and aging is a complex process involving proliferation, differentiation and apoptosis. Elucidating proteome changes in these processes can help to understand the mechanisms of brain development and maintenance as well as neurodegenerative diseases. The research reported here is a contribution to the HUPO Brain Proteome Project mouse pilot study. Whole, frozen C57BL/6J mouse brain comprising three different developmental stages (embryonic day 16, postnatal day 7, and postnatal days 54-58) were processed by using 2-D DIGE. A total of 1999 spots were matched between all gels. Of these, 206 spots were differentially expressed between the different stages: 122 spots were highest in intensity in embryonic stage E16, 26 highest in the juvenile group P7 and 58 spots highest in P56, the adult stage. The results show a pattern of temporal expression. Based on the expression patterns we tentatively suggest that proteins involved in the establishment of primary structures in the brain are expressed highest in the embryonic mouse. Proteins involved in the development of the brain are expressed highest in the juvenile phase and proteins that make utilization of the brain possible by delivering energy are expressed highest in the adult mice.

Aging↗

Assessment and comparison of human exposure to lead between Belgium, Malta, Mexico and Sweden.

This is a follow-up study of UNEP/WHO Pilot Project on Assessment of Human Exposure to Lead and Cadmium through Biological Monitoring, carried out in 1983/1984. The main objectives of the follow-up study were: to study whether differences in blood-lead levels found between countries in the Biological Monitoring Project were confirmed and were primarily due to exposure via ingested lead (oral intake) or via inhaled lead; to make a preliminary survey, in selected areas, of the possible sources of high exposure (Malta, Belgium). Four countries participated: Belgium, Malta, Mexico, Sweden. To insure comparability between the populations, certain categories were monitored: teachers for socio-economic status, non smoking males, aged between 25 and 50 years old. The blood-lead concentration (PbB) was measured to determine the current exposure and the feces-lead excretion (PbF) was determined to find out the part of the exposure due to ingestion. Blood-lead levels and feces-lead excretion were very different between the four countries. Median values for PbB, in micrograms Pb/1, were, in decreasing values 247 in Malta, 188 in Mexico, 135 in Belgium and 53 in Sweden. Median values for PbF, in micrograms Pb/day, were 361 in Malta, 159 in Mexico, 82 in Belgium and 22 in Sweden. Oral intake seems to be the major exposure route in the four countries. The relationship between PbB and PbF is curvilinear. To investigate the possible source of high exposure, a preliminary survey was made in Malta and Belgium; lead in air suspended and sedimenting particles was monitored as well as the lead concentration in some food and street dust samples. Concerning the comparison of lead concentrations in these environmental samples between Belgium and Malta, no major differences were detected. The high internal exposure to lead in Maltese people, as measured by PbB, is probably due to a combination of several factors.

Adult↗

Issues in the development of a clinical database on Alzheimer's disease.

The diagnosis and assessment of Alzheimer's disease is rapidly becoming a major focus of study within the aging population. The increasing proportion of older adults in the United States and the lack of knowledge concerning the causes of Alzheimer's disease have contributed to this increased need for further study. This paper describes a pilot project aimed at regional databases on Alzheimer's disease. The project description also is intended to illustrate the use of a structured systems approach to the system development process.

Aged↗

[Work absenteeism data--a source of information for epidemiological research in occupational risks?].

The usefulness of data on absence from work due to sickness (absenteeism) as an indicator of specific and detailed information of diagnoses is widely discussed in the international literature. In occupational health indicators for health risks (e g sickness absence of more than 14 days), details on diagnosis and workplace are very useful, if analysed by epidemiological means. A pilot project, initiated by a high sickness absence in the automobile industry, led to a test of an industrial health information system, which was abruptly stopped by data protection arguments. The epidemiologic approach of an age-adjusted comparison of incidences relies on the access to morbidity data of the health insurance system. With the diagnostic information at hand differences of incidences in one production branch (as recognized by the incidence ratio SIR) are to be discovered if related to certain specific diagnoses. Thus, a direct comparison of comparable rates helps to identify specific reasons for increased absence from work. Practical solutions were found if the owner of the data, the National Federation of Enterprise Sickness Funds, conducted the analyses. First results showed as yet unknown associations of myocardial infarction and obstructive lung diseases in the metallurgical industry. In such cases not only the validity of such results has to be verified, but also other epidemiological tools, such as a case-referent approach to determine risk ratios, are required for the identification of any causally important relationship.

Absenteeism↗

[Preschool screening examinations in medical practice].

In most European countries systematic screening programs for infants and preschool children are being introduced or are already established as a routine procedure. The contents and the possible effects of such programs are discussed critically in this paper, which also describes the present state in Switzerland as well as a pilot project initiated by the Bernese Pediatric Association.

Child, Preschool↗

[Morbidity detection in general practice].

A system of morbidity registration in the domain of primary health care is presented on the basis of experiences made abroad. A pilot project (Sentinella) functions in the environments of Berne since November 1984. Its extension to the whole of Switzerland is scheduled for the middle of 1986.

Air Pollution↗

Short-term chronic fluoride administration and trabecular bone remodeling in beagles: a pilot study.

We carried out a pilot project to examine the alterations in trabecular bone remodeling activity of spayed Beagle dams exposed to 0.7 mg/kg body wt/day of sodium fluoride (NaF) for a 6 month period. The results indicated that short-term NaF administration does activate trabecular bone remodeling activity by stimulating the formation of new Basic Multicellular Units (BMUs) of bone remodeling activity. However, interference with bone cell differentiation, with the functional efficiency and/or life-span of individual osteoclasts and osteoblasts followed. Cellular toxic effects appear early with NaF administration, and as such, suggest that the increases in bone mass seen early in the course of NaF treatment may be negated by prolonged administration of this substance. However, preservation of bone mass will probably result with long-term therapy, due to decreases in numbers of bone cells, in their functional efficiencies, and in their individual life-spans.

Animals↗

User acceptability--a critical success factor for picture archiving and communication system implementation.

The Department of Diagnostic Imaging at the Hospital for Sick Children (HSC), Toronto, implemented a picture archiving and communication system (PACS) during the last year. This report describes our experience from the point of view of user acceptability. Based on objective data, the following key success factors were identified: user involvement in PACS planning, training, technical support, and rollout of pilot projects. Although technical factors are critical and must be addressed, the main conclusion of our study is that other nontechnical factors need to be recognized and resolved. Recognition of the importance of these factors to user acceptance and clear communication and consultation will help reduce negative user attitudes and increase the chance of a successful PACS implementation.

Academic Medical Centers↗

[Features of frontotemporal dementia from the perspective of a special family support group].

Eight spouses of patients diagnosed with frontotemporal dementia (FTD) participated in a special support group. Seven weekly sessions of 90-min duration were held. This pilot project provided the opportunity to learn more about FTD and the specific problems and needs of caregivers. Their problems are predominantly due to changes in the patients' personalities and behaviour, not to the cognitive impairment. Furthermore, in contrast to Alzheimer's disease, patients are relatively young, the current state of scientific knowledge about FTD is unsatisfactory, and the disease is almost unknown among physicians. As part of the group activity, caregivers received information on the typical symptoms of FTD. This enhanced their understanding of the alterations in the patients' personalities and behaviour and facilitated acceptance of the disease. During group meetings, participants were encouraged to express their own needs and to deal with painful emotions including aggression, anger, mourning, and guilt. The caregivers felt relieved by sharing their problems with others. They were able to learn from each other and to exchange suggestions and solutions. The group also helped to establish new contacts and friendships. Participants' evaluations of the novel intervention were very positive. We conclude from these initial observations that support groups are needed for caregivers of patients with FTD which are tailored to their specific needs.

Adaptation, Psychological↗

[Chronic pain. Epidemiology and management in Germany].

At least 5 million patients with chronic and severely debilitating pain exist among the adult population in Germany, i.e. 8% of this population. Various biological and psychosocial risk factors contribute to the continuing chronicity of pain, resulting in enormous direct and indirect costs totalling an estimated 38 billion euro annually. The introduction of a medical specialty for pain treatment in 1998 has not appreciably affected the quality of outpatient pain management. In contrast, more recent approaches of multimodal treatment, including medical, psychological and behavioral components, have shown a significant and lasting effect in patients with a high incidence of workplace incapacitation and sick leave. In particular, the GRIP pilot project (Göttingen Intensive Back Project) has resulted in an increased rate (to 200%) of return to the workplace and in a decrease in health system expenses to 50% of the pretreatment level.

Back Pain↗

Environmental justice, local knowledge, and risk: the discourse of a community-based cumulative exposure assessment.

While risk assessment continues to drive most environmental management decision-making, its methods and assumptions have been criticized for, among other things, perpetuating environmental injustice. The justice challenges to risk assessment claim that the process ignores the unique and multiple hazards facing low-income and people of color communities and simultaneously excludes the local, non-expert knowledge which could help capture these unique hazards from the assessment discourse. This paper highlights some of these challenges to conventional risk assessment and suggests that traditional models of risk characterization will continue to ignore the environmental justice challenges until cumulative hazards and local knowledge are meaningfully brought into the assessment process. We ask whether a shift from risk to exposure assessment might enable environmental managers to respond to the environmental justice critiques. We review the US EPA's first community-based Cumulative Exposure Project, piloted in Brooklyn, NY, and highlight to what extent this process addressed the risk assessment critiques raised by environmental justice advocates. We suggest that a shift from risk to exposure assessment can provide an opportunity for local knowledge to both improve the technical assessment and its democratic nature and may ultimately allow environmental managers to better address environmental justice concerns in decision-making.

Environment↗