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Organizing community research partnerships in the struggle against AIDS.

Despite pharmaceutical advances, AIDS remains a health problem difficult to treat, leaving preventive interventions as the primary means of promoting risk avoidance. Increasing the capacity of university-based researchers to develop culturally, developmentally, and contextually appropriate AIDS prevention strategies requires the collaboration of community service and advocacy partners. To date, neither university researchers nor community providers have a great deal of partnership experience. Thus, a common language and set of experiences are yet to be developed. This article reviews the history of university-community and researcher-community collaboration for AIDS research and intervention, placing the innovative work of the University of California, San Francisco (UCSF) Center for AIDS Prevention Studies and its community and foundation partnerships among those efforts at the forefront of the community-university dialogue. It concludes with suggestions derived from the collaborative work of UCSF researchers and community service partners to strengthen efforts to develop theory, research methods, and results that are immediately useful and productive of long-term prevention research efforts.

California↗

Telemedicine and developing countries.

A committee was established by the International Telecommunication Union in 1994 to study telemedicine, with particular reference to developing countries. A questionnaire was used to gather data. Fifty-eight responses were received, two-thirds from developing countries. In most developing countries the user did not pay for the telemedicine service, at least not directly. There were few instances of a commercial telemedicine service, and in most countries the telemedicine service was subsidized by the government or another party. The telemedicine 'value chain' describes how equipment suppliers, telecommunications operators and health-care professionals deliver their products or services to the client, who is eventually the ultimate user. Quite different configurations are conceivable, and an analysis of what could be a sustainable, cost-effective value chain in developing countries is required. It is clear that the rapidly growing interest in telemedicine challenges the leaders of the medical establishment to rethink the ways they provide their services and to address the medical needs of areas where such services are absent or in short supply.

Cost-Benefit Analysis↗

Mercury reduction in Munhena, Mozambique: homemade solutions and the social context for change.

The health and environmental impacts of artisanal gold mining are of growing concern in Munhena, Mozambique, where more than 12,000 people are involved in such activities. Gold is extracted using mercury amalgamation, posing a considerable threat to human and environmental health. A pilot project ascertained the feasibility of reducing mercury use and emissions by promoting control measures utilizing local resources. Retorts were fabricated with local materials. Training workshops introduced the homemade retorts, and a portable mercury monitor revealed effective mercury reduction. Barriers to widespread technology adoption include poverty, lack of knowledge and trust, and the free supply of mercury from private gold buyers. Homemade retorts are inexpensive and effective, and miners could benefit by building community amalgamation centers. The government could play a greater role in gold purchasing to reduce mercury pollution.

Environmental Pollution↗

Training in environmental health research for action: the Shanghai-California Environmental Health Training Program.

The Shanghai Center for Disease Control and Prevention (SCDC) was created in 1998; in 2001, with support from Fogarty International Center, the intergovernmental Shanghai-California Environmental Health Training Program was formed. Providing U.S.-based training to SCDC managers allows them to return to Shanghai and share their knowledge. Indexing Chinese journals will enable more exchange of information and will support improvements in Chinese scholarship. Increased international contact will result in greater trust and more rapid warnings to international colleagues, with resultant faster responses to emerging public health threats. Building research capacity in SCDC will allow for more rapid translation of results to policy. The progress of the Program toward establishing a regional (Shanghai) biological specimen bank is an example of building institutional capacity to enhance research that can serve as a lasting foundation for public health research and policy decisions in both Shanghai and China.

California↗

Screening.

Screening for cancer is currently entering a very promising period as new technologies become available for assessment. However, this great opportunity also presents significant problems, starting with how do you select the likeliest method for evaluation? How do you do trials where the technology will be out-moded by the time the result is known? Indeed, how can all promising technologies be evaluated? There is a need for a renewal of methodological thinking on this topic at present. Randomised trials, which currently rely on death as the primary outcome, are very long and very complicated to undertake and run. There is an urgent need for biological markers, which are true surrogate end-points, to help reduce sample size and make trials more feasible, so that more trials can be done. For those screening modalities of demonstrated effectiveness, the key issue at present is how to maximise the outcome in population screening when the technology is transferred from the research setting to the public health setting. It is essential to remember that screening, per se, has never prevented a cancer nor prevented a cancer death. It is impossible to separate the issues of screening with those of adequate treatment: the best results in a screening programme will come when treatment is excellent. Screening is the first, and sometimes key, stage in a global management programme for the cancer in question. As the aim at present is to strive to maximise the effectiveness of population-based programmes, this aspect should be foremost in all thought processes.

Biomarkers, Tumor↗

Ethnomedicine and dominant medicine in multicultural Australia: a critical realist reflection on the case of Korean-Australian immigrants in Sydney.

BACKGROUND: Viewed through the micro focus of an interpretive lens, medical anthropology remains mystified because interpretivist explanations seriously downplay the given context in which individual health seeking-behaviours occur. This paper draws upon both the interpretivist and political economy perspectives to reflect on the ethno medical practices within the Korean-Australian community in Sydney. METHODS: We draw on research data collected between 1995 and 1997 for an earlier study of the use of biomedical and traditional medicine by Korean-Australians in Sydney. A total of 120 interviews were conducted with a range of participants, including biomedical doctors, traditional health professionals, Korean community leaders and Korean migrants representing a range of socio-economic backgrounds and migration patterns. RESULTS AND DISCUSSION: First, the paper highlights the extent to which the social location of migrants in a host society alters or restructures their initial cultural practices they bring with them. Second, taking hanbang medicine in the Korean-Australian community as an illustrative case, the paper explores the transformation of the dominant biomedicine in Australia as a result of the influx of ethnomedicine in the era of global capitalism and global movement. CONCLUSION: In seeking to explain the popularity and supply of alternative health care, it is important to go beyond the culture of each kind of health care itself and to take into consideration the changes occurring at societal, national and global levels as well as consequential individual response to the changes. New social conditions influence the choice of health care methods, including herbal/alternative medicine, health foods and what are often called New Age therapies.

Acculturation↗

High-throughput genomic technology in research and clinical management of breast cancer. Exploiting the potential of gene expression profiling: is it ready for the clinic?

Gene expression profiling is a relatively new technology for the study of breast cancers, but within the past few years there has been a rapid rise in interest in its potential to improve the clinical management of breast cancer. This technology has contributed to our knowledge of the molecular pathology of breast tumours and shows promise as a tool to predict response to therapy and outcome, such as risk of metastasis. Microarray technology is continually developing and it is becoming apparent that, despite the various platforms available, robust conclusions can still be drawn that apply across the different array types. Gene expression profiling is beginning to appear in the breast cancer clinic but it is not yet fully evaluated. This review explores the questions that must be addressed before this technology can become an everyday clinical tool.

Breast Neoplasms↗

Science and technology integration for increased human potential and societal outcomes.

Unifying science based on the material unity of nature at the nanoscale provides a new foundation for knowledge, innovation, and integration of technology. Revolutionary and synergistic advances at the interfaces between previously separated fields of science, engineering and areas of relevance are ready to create nano-bio-info-cogno (NBIC) transforming tools. Developments in systems approach, mathematics, and computation in conjunction with NBIC allow us to understand the natural world and scientific research as closely coupled, complex, hierarchical entities. At this unique moment of scientific and technical achievement, improvement of human performance at individual and group levels, as well as development of suitable revolutionary products, becomes possible and these are primary goals for converging new technologies. NBIC addresses long-term advances in key areas of human activity, including working, learning, aging, group interaction, organizations, and human evolution ((Roco and Bainbridge, 2003)). Fundamentally new tools, technologies, and products will be integrated into individual and social human architecture. This introductory chapter of the Annals outlines research and education trends, funding activities, and the potential of development of revolutionary products and services.

Biological Evolution↗

Collaborating on convergent technologies: education and practice.

Converging technologies will require collaboration across disciplines. A good metaphor for such collaborations is the kind of trading zone that emerges whenever human beings from different cultures interact. NBIC must avoid trading zones that are dominated by one discipline or set of interests and instead encourage multiple stakeholders to form a shared mental model of what needs to be accomplished. An example is drawn from current work on societal dimensions of nanotechnology. Students need to gain experience working in such trading zones, in addition to acquiring disciplinary depth.

Cooperative Behavior↗

Will the wave finally break? A brief view of the adoption of electronic medical records in the United States.

For over thirty years, there have been predictions that the widespread clinical use of computers was imminent. Yet the "wave" has never broken. In this article, two broad time periods are examined: the 1960's to the 1980's and the 1980's to the present. Technology immaturity, health administrator focus on financial systems, application "unfriendliness," and physician resistance were all barriers to acceptance during the early time period. Although these factors persist, changes in clinicians' economics, more computer literacy in the general population, and, most importantly, changes in government policies and increased support for clinical computing suggest that the wave may break in the next decade.

Computers↗

Roadmap for developing and validating therapeutically relevant genomic classifiers.

Oncologists need improved tools for selecting treatments for individual patients. The development of therapeutically relevant prognostic markers has traditionally been slowed by poor study design, inconsistent findings, and lack of proper validation studies. Microarray expression profiling provides an exciting new technology for relating tumor gene expression to patient outcome, but it also provides increased challenges for translating initial research findings into robust diagnostics that benefit patients and physicians in therapeutic decision making. This article attempts to clarify some of the misconceptions about the development and validation of multigene expression signature classifiers and highlights the steps needed to move genomic signatures into clinical application as therapeutically relevant and robust diagnostics.

Biomarkers, Tumor↗

Telemedicine delivery to developing countries.

This paper highlights current activities with regard to telemedicine activities in and for developing countries. The paper reviews: the preparation of a telemedicine report by a study group of the International Telecommunication Union (ITU), the aim of which is to provide recommendations and guidelines for developing countries; the formation of the European Telemedicine Collaboration Group (ETCG), which is undertaking telemedicine pilot projects in developing countries; and telemedicine delivery via inmarsat, which is coordinating production of the ITU report and is a participant in the ETCG.

Developing Countries↗