Veterans' voices: use of the American Customer Satisfaction Index (ACSI) Survey to identify My HealtheVet personal health record users' characteristics,needs, and preferences

Background

Consumer research reveals considerable interest in the use of Personal Health Records (PHRs), yet adoption remains relatively low. Both adopters and nonadopters represent important perspectives from which to understand this paradox.

Objective

This study focuses on direct feedback from adopters obtained using the American Customer Satisfaction Index (ACSI) survey on the My HealtheVet PHR portal (http://www.myhealth.va.gov) of the Veterans Health Administration (VHA). The results represent a source of direct feedback with which to better understand veterans'' needs and preferences.

Methods

The ACSI Survey was implemented in October 2007 to measure satisfaction and elicit information about characteristics and preferences of My HealtheVet PHR adopters. The data represent a continuous random sample of site visitors who have navigated at least four pages on the site. A total of 100 617 surveys were completed (17.2%).

Results

Satisfaction with My HealtheVet is high (8.3/10.0), and users are highly likely to return to the site (8.6/10.0) and recommend the site to other veterans (9.1/10.0). The majority of system adopters are male (91%), between the ages of 51 and 70 (68%), and served in the Vietnam War (60%). Most veterans currently visit the site to utilize pharmacy-related features.

Conclusion

VHA has used the ACSI to monitor satisfaction, and to better understand the characteristics, needs, and preferences of early adopters. The data provide an important source of direct feedback to inform program development. Future research will include monitoring the impact of enhancements and new features on satisfaction, and conducting additional research with nonadopters to identify barriers to adoption and use.     

构建NCBI镜像FTP数据库及其应用

目的建立一个FTP服务器为院内生物医学研究人员提供快速下载NCBI常用生物数据库的FTP服务。方法采用Linux系统和perl、shell程序设计,构建FTP服务系统。结果与结论系统实现了数据下载、更新、系统管理等功能,并进行了测试,目前系统已经上线服务。     

伏立康唑治疗血液病合并侵袭性真菌感染38例

目的:评价伏立康唑治疗血液病合并侵袭性真菌感染(invasive fungal infection,IFI)的有效性与安全性.方法:收集我院2006年1月至2009年2月住我院血液科诊断为血液病合并IFI的患者,分析患者在发生真菌感染时伴随的高危因素、临床症状、影像学检查以及病原菌分布,并对经伏立康唑治疗的患者进行疗效评价,观察药物的不良反应.结果:伏立康唑治疗IFI总有效率为52.77%.单变量分析显示延长伏立康唑治疗疗程(P<0.05)和患者基础病稳定(P<0.001)能显著提高疗效.伏立康唑主要不良事件有胆红素升高、低钾、转氨酶升高和视觉障碍.结论:伏立康唑在治疗血液病患者IFI上具有广谱抗真菌功效,同时它所引发的不良事件较少且多能耐受.     

PAirwise Sequence Comparison (PASC) and Its Application in the Classification of Filoviruses

PAirwise Sequence Comparison (PASC) is a tool that uses genome sequence similarity to help with virus classification. The PASC tool at NCBI uses two methods: local alignment based on BLAST and global alignment based on Needleman-Wunsch algorithm. It works for complete genomes of viruses of several families/groups, and for the family of Filoviridae, it currently includes 52 complete genomes available in GenBank. It has been shown that BLAST-based alignment approach works better for filoviruses, and therefore is recommended for establishing taxon demarcation criteria. When more genome sequences with high divergence become available, these demarcations will most likely become more precise. The tool can compare new genome sequences of filoviruses with the ones already in the database, and propose their taxonomic classification.     

Association of alpha2A-adrenergic receptor gene polymorphism with susceptibility to suicide in Japanese females

OBJECTIVES: It has been suggested that noradrenergic system abnormalities are involved in suicide. Postmortem brain studies have shown that molecular and functional alterations in alpha2A-adrenergic receptor-induced signal transduction are associated with suicide and depression. Recently, a single nucleotide polymorphism (SNP) within a coding region of the alpha2A-adrenergic receptor gene (ADRA2A), which results in an Asn-to-Lys change at amino acid 251 (N251K), has been implicated in susceptibility to suicide in Caucasians. The aim of our study is to determine whether genetic variants of the ADRA2A gene are also associated with suicide in a Japanese population. METHODS: Three SNPs, C-1291G, N251K and rs3750625C/A, and one insertion/deletion polymorphism in the ADRA2A gene were genotyped in 184 completed suicides and 221 control subjects with the polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: Neither variation of the N251K SNP nor the insertion/deletion polymorphism was found in our Japanese samples. The C-1291G SNP in the promoter region was found to be significantly associated with suicide in females (P=0.043 and 0.013 for genotypic and allelic comparisons, respectively). One of the common haplotypes, CC of C-1291G and rs3750625C/A, was also associated with suicide in females (P=0.015). These associations were also significant in the female violent suicide victims (P=0.009 and 0.009 for allelic and CC haplotypic comparisons, respectively). Although the significance was nominal, it was maintained even after correction for multiple comparisons. By contrast, neither of these two SNPs showed any association with violent and/or non-violent suicide in males. CONCLUSION: Our results raise the possibility that promoter genetic variation in the ADRA2A gene is associated with either suicide or violent suicide in females.     

From candidate gene to genome-wide association studies in cardiovascular disease

Continuous updating of the genotyping technology has led to improvement of genetic study design. The recent advances in technology coupled with the advances in our understanding of the molecular mechanisms have allowed a more comprehensive examination of the role of genetics, environment and their interaction in determining the individual risk of cardiovascular disease (CVD).Initial candidate gene studies identified a limited number of polymorphisms associated with disease, explaining only a minor part of trait variance. Furthermore, results were not often concordant, with meta-analyses not reaching the statistical power to confirm an association in many cases. The advent of the genome-wide design furnished an enormous quantity of information and decreased time of genotyping, while increased complexity of analyses and costs. Their results were more concordant, even when they suggested associations between CVD and polymorphisms distant from codifying regions or in genes involved in previously unsuspected pathways. Future results from genome-wide studies coupled with results from functional studies and investigation on gene-environment interactions will allow improvement of cardiovascular risk assessment and discovery of new targets for therapy and prevention.In this review, a brief history of cardiovascular genetics is reported, from candidate gene to genome wide association studies, that led to the identification of association between CVD and SNPs in the 9p21 region, firstly thought a gene desert without importance.     

基于NCBI核酸数据库的紫荆皮混淆品种华中五味子的DNA鉴定研究

目的:探讨利用NCBI核酸数据库中ITS序列鉴定紫荆皮商品药材,为保证紫荆皮药材质量提供依据.方法:从紫荆皮药材中提取DNA,以ITS序列通用引物进行PCR扩增,扩增产物经纯化后直接双向测序,利用ITS序列相似度和系统发育树进行鉴定.结果:获得了紫荆皮商品药材的ITS序列信息.结论:经DNA鉴定,发现市场上流通的紫荆皮主流商品来源于木兰科五味子属植物华中五味子,药用部位为茎皮.     

Synapsin knockdown is associated with decreased neurite outgrowth,functional synaptogenesis impairment,and fast high‐frequency neurotransmitter release

Synapsins (Syns) are an evolutionarily conserved family of synaptic vesicle‐associated proteins related to fine tuning of synaptic transmission. Studies with mammals have partially clarified the different roles of Syns; however, the presence of different genes and isoforms and the development of compensatory mechanisms hinder accurate data interpretation. Here, we use a simple in vitro monosynaptic Helix neuron connection, reproducing an in vivo physiological connection as a reliable experimental model to investigate the effects of Syn knockdown. Cells overexpressing an antisense construct against Helix Syn showed a time‐dependent decrease of Syn immunostaining, confirming protein loss. At the morphological level, Syn‐silenced cells showed a reduction in neurite linear outgrowth and branching and in the size and number of synaptic varicosities. Functionally, Syn‐silenced cells presented a reduced ability to form synaptic connections; however, functional chemical synapses showed similar basal excitatory postsynaptic potentials and similar short‐term plasticity paradigms. In addition, Syn‐silenced cells presented faster neurotransmitter release and decreased postsynaptic response toward the end of long tetanic presynaptic stimulations, probably related to an impairment of the synaptic vesicle trafficking resulting from a different vesicle handling, with an increased readily releasable pool and a compromised reserve pool. © 2015 Wiley Periodicals, Inc.     

Effect of mechanical instrumentation with adjunct photodynamic therapy on salivary TNFα levels and clinical periodontal and peri‑implant status in patients with depression: A randomized controlled trial

IntroductionThe aim of the present randomized controlled trial was to assess the effect of mechanical instrumentation (MI) with adjunct photodynamic therapy (PDT) on salivary tumor necrosis factor-alpha (TNFα) levels and clinical periodontal and peri‑implant status in patients with depression.Materials and methodsIn groups 1 and 2, individuals with periodontal and peri‑implant diseases with and without depression, respectively were included. Group-3 comprised of systemically healthy individuals with a healthy periodontal and peri‑implant status. In groups 1 and 2, patients in the test- and control groups received MI with and without PDT respectively. Periodontal and peri‑implant probing depth and plaque and gingival indices were measured. Radiographic evaluation was done at baseline. Whole salivary tumor necrosis factor alpha (TNFα) in peri‑implant sulcular fluid were measured at baseline. The clinical and immunological parameters were reassessed at 120 days’ follow-up. Level of significance was set at P<0.05.ResultsThirty-four, 36 and 37 implants were in function in groups 1, 2 and 3, respectively. At baseline, periodontal and peri‑implant clinical parameters and TNFα levels were significantly higher in groups 1 (P<0.05) and 2 (P<0.05) than Group-3. At 4-months follow-up, there was no difference in periodontal and peri‑implant clinical parameters in the test- and control groups among individuals in groups 1 and 3. In Group-2, there was a significant reduction in periodontal (P<0.05) and peri‑implant (P<0.05) clinical parameters at 4-months follow-up than baseline. In Group-2, there was no significant difference in these parameters among patients in the test- and control-groups.ConclusionIn patients with depression clinical periodontal and peri‑implant status is poorer and salivary TNFα levels are higher after MI with or without PDT. In healthy patients, PDT offers no additional benefits in the treatment of periodontal inflammation.