Evaluation of a Novel Electronic Genetic Screening and Clinical Decision Support Tool in Prenatal Clinical Settings

“The Pregnancy and Health Profile” (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher’s exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83 % (513/618) of patients that provided feedback, 97 % felt PHP was easy to use and 98 % easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.     

In vitro investigation of the bioaccessibility of carotenoids from raw,frozen and boiled red chili peppers (Capsicum annuum)

Background

Carotenoid-rich foods are associated with antioxidant activity and the ability to alleviate chronic diseases.

Purpose

The present study investigated the effect of processing on the content and bioaccessibility of carotenoids from 13 cultivars of red chili pepper (Capsicum annuum).

Methods

Carotenoids in chili peppers were analyzed before an in vitro digestion process. The portion of carotenoid transferred to the micelle fraction (bioaccessibility) was also quantified.

Results

β-Carotene, β-cryptoxanthin, capsanthin and antheraxanthin were the most abundant carotenoids. Zeaxanthin, violaxanthin, neoxanthin and lutein were detected at lower concentrations. In general, freezing and boiling reduced carotenoid contents. Capsanthin and zeaxanthin had the highest bioaccessibility at an average value from 36 to 40 %, followed by antheraxanthin (26 %). Bioaccessibility of β-cryptoxanthin, violaxanthin and β-carotene was lower, averaging 6.1, 4.8 and 4.0 %, respectively. Neoxanthin and lutein were not detected in micelles. Freezing increased the bioaccessibility of capsanthin, zeaxanthin, antheraxanthin, β-cryptoxanthin and violaxanthin; β-cryptoxanthin bioaccessibility increased and capsanthin and zeaxanthin bioaccessibility decreased following boiling.

Conclusions

Differences in the contents and bioaccessibility of carotenoids in 13 C. annuum cultivars and between the processed methods were herein evidenced.     

The evaluation of three diagnostic tests for the detection of equine influenza nucleoprotein in nasal swabs

Background

Equine influenza (EI) is a highly contagious respiratory disease of horses.

Objectives

The aim of this study was to evaluate two rapid antigen detection kits (Directigen or DFA, and Espline) and a commercial ELISA for the detection of EI nucleoprotein in nasal swabs.

Method

Nasal swab samples from naturally and experimentally infected horses were used to compare the sensitivity and specificity of these assays to virus isolation (VI) and real-time RT-PCR.

Results

If real-time RT-PCR was considered as the gold standard, the sensitivity of the other tests in field samples was 68% (DFA), 35% (ELISA), 29% (Espline), and 9% (VI). These tests had 100% specificity when compared to real-time RT-PCR. A receiver operating characteristic (ROC) curve indicated that decreasing the cutoff of the ELISA would increase sensitivity with some loss of specificity. In samples from experimentally infected horses, the sensitivity of the tests compared with real-time RT-PCR was 69% (VI), 27% (DFA), 6% (Espline), and 2% (ELISA). The specificity was 100% for Espline and ELISA and 95% for VI and DFA.

Conclusions

This study illustrated that DFA is the most sensitive antigen detection test evaluated for the diagnosis of EI and that it can detect virus in some subclinical infected and vaccinated horses. The results suggest that DFA is a useful adjunct to laboratory tests and may be effective as a screening test in a quarantine station or similar facility where horses are monitored daily.     

Follow-up of participants in the Canadian Association of Gastroenterology Scholars’ Program, 2006 to 2012

The Canadian Association of Gastroenterology (CAG) Scholars’ Program (previously known as the Bright Lights Course) is designed to encourage trainees to consider a subspecialty career in gastroenterology. A formal analysis of the Scholars’ Program performed in 2007 revealed that 82% of participants invited to the program pursued or were planning to pursue a career in gastroenterology. The positive results are consistent with the CAG’s strategic plan of developing “the next generation of gastroenterology clinical practitioners, researchers, educators, and leaders” and to “attract, train, and retain the best and the brightest to gastroenterology”. The present study was a follow-up analysis of participants in the Scholars’ Program between 2006 and 2012. Although 93.1% of participants had an interest in gastroenterology before attending the Scholars’ Program, the majority (68.7%) reported a greater interest in gastroenterology after the program. Similar to the study from 2007, the present study again illustrates the importance and success of the Scholars’ Program in generating interest and retaining candidates in gastroenterology.     

Diagnostic accuracy of a clinical prediction rule (CPR) for identifying patients with recent-onset undifferentiated arthritis who are at a high risk of developing rheumatoid arthritis: A systematic review and meta-analysis

Objectives

The Leiden clinical prediction rule (CPR) was developed in 2007 to predict disease progression in patients with recent-onset undifferentiated arthritis (UA). This systematic review and meta-analysis investigates the predictive ability of the rule at identifying patients who are at a high risk of developing rheumatoid arthritis (RA).

Methods

A systematic review of the literature search was conducted from 2007 to May 2013 to identify studies that validated the rule. This study adhered to the PRISMA guidelines. The methodological quality of studies was assessed using the QUADAS-2 tool. Pooled sensitivity and specificity values for each of the cut points were generated using a bivariate random-effects model. Heterogeneity was assessed using the variance of logit-transformed sensitivity and specificity. Bayes' theorem was used to calculate post-test probability of progression from UA to RA.

Results

The search identified four relevant studies, resulting in six data sets (n = 1084). A cut point of ≥9 was identified as the optimal cut point for determining progression to RA. It is associated with a greater pooled specificity (0.99, 95% CI 0.95–1.00) than sensitivity (0.31, 95% CI 0.24–0.37). Using Bayes' theorem, a score of ≥9 points increased the pre-test probability from 40.04% to 93.63%. A less stringent cut-off of ≥8 also identified a significant proportion of patients at risk of RA who have a high likelihood of progressing to RA (LR + 9.5, 95% CI 6.21–14.54).

Conclusion

A cut point of ≥9 offers an optimal estimate for identifying patients with UA who are at a high risk of developing RA and warrant intervention. However, a number of methodological limitations identified across studies suggest that the results should be interpreted cautiously and that further validation of the Leiden CPR is necessary.     

Quality of life in individuals with chronic foot conditions: A cross sectional observational study

BackgroundChronic foot conditions have been reported to be a significant cause of impairment and disability to individuals affected. However, studies to date have particularly focussed on patient satisfaction with outcomes following surgery.ObjectivesThe aim of this study is to examine the impact of three common foot conditions on the levels of impairment and quality of life prior to surgery. Three conditions include Hallux Valgus (HV), Hallux Rigidus (HR) and Hammer Toe (HT).MethodsThis was a pilot cross-sectional observational study of people who were radiologically and clinically diagnosed with one of the three common foot pathologies: HV, HR and HT. Age and gender matched controls were also recruited. Self-reported quality of life was measured.ResultsThe SF-36 scores did not differ significantly between the groups. There was a significant difference in self reported impairment between the groups on the Global Foot and Ankle Scale indicating that the ‘bilateral foot group’ perceived themselves to be significantly more impaired than their counterparts in the control group.ConclusionPatient quality of life is now recognised as one of the most important outcomes of surgery. These findings serve to highlight the level of impairment and quality of life of individuals prior to surgery.     

Regulation of the Mouse Medial Prefrontal Cortical Synapses by Endogenous Estradiol

Recent studies suggest that low endogenous estradiol might be a susceptibility factor for anxiety and trauma-related disorders in women. Consistently, fear extinction, a form of inhibitory learning critical for the management of anxiety symptoms, is positively correlated with endogenous estradiol levels. To understand the synaptic basis of the effect of endogenous estradiol on fear extinction, we studied glutamatergic transmission and plasticity in the infralimbic medial prefrontal cortex (IL-mPFC), a brain region crucial for the regulation of fear extinction. Diestrus mice (low estradiol) exhibited a higher basal glutamatergic transmission compared with proestrus mice (high estradiol). Synaptic plasticity was also regulated by endogenous estradiol, which favored synaptic potentiation in a GluN2B-dependent manner. Activation of estrogen receptor β (ERβ) but not ERα rescued synaptic potentiation in diestrus mice by enhancing GluN2B-mediated NMDA receptor transmission. Our results suggest that both endogenous estradiol and ERβ activation facilitate the ability of the IL-mPFC synapses to undergo potentiation, a mechanism necessary for the regulation of fear extinction.     

普通高校健美操教学培养学生体育兴趣的实验研究

目的:比较学生在上健美操专项课前、后体育兴趣变化情况。方法:①于2004-09/2005-05(为期两学期)以河北北方学院东校区的2004级学生160人为纳入对象。所有学生为自愿选修健美操专项课,并自愿接受调查;以前没有进行过健美操专项训练或选修过健美操专项课。将纳入对象随机分成2组:实验组和对照组,每组80人。实验组进行教学实验,相对于对照组,其教学内容以发展学生个体和调动学生学习积极性为主,从培养学生体育兴趣出发,更系统全面的教授健美操。②对学生进行问卷调查,问卷主要内容:是否喜欢看体育节目、喜欢体育运动本身、经常参加体育活动、经常阅读体育报刊、有适合自己的锻炼方法、喜欢参加学校组织的体育比赛、喜欢上体育课、工作后有继续进行锻炼的必要性、花钱买门票看体育比赛等方面的情况调查。并对学生对健美操理论课的认同感作调查,此调查共分非常满意、满意、较满意、一般、不满意5个层次项目。③上课1年前后两组体育兴趣变化差异比较采用u检验。结果:回收填写完整、准确问卷160份(100.0%)。①体育兴趣:实验组上课1年后,经常参加体育活动、有适合自己锻炼方法、喜欢上体育课的分别占40%(32/80),39%(31/80),72%(58/80),高于上课前[15%(12/80),15%(12/80),22%(18/80),u=3.54,3.39,6.33,P<0.01]。对照组上课前后体育兴趣无变化(P>0.05)。②满意度:实验组非常满意占50%(40/80),一般和不满意都是0。对照组50%(40/80)为一般满意。③实验组和对照组对每周上健美操实践课表示无所谓的学生分别占10%(8/80)和70%(56/80),上课前后的精神状态兴奋的学生分别占86%(69/80)和19%(15/80),没感觉的分别占14%(11/80)和69%(55/80),产生疲劳的分别占0和12%(10/80)。结论:健美操教学实验后学生体育兴趣提高。健美操理论教学内容有利于培养学生体育兴趣,而实践课则不然。