Search

Objective: Familial hypercholesterolaemia (FH), an autosomal dominant disorder causing elevated low-density lipoprotein (LDL) cholesterol from birth resulting in premature cardiovascular disease, is only diagnosed in 10% of affected patients. This study involved partnering with patients with FH and with primary care providers (PCPs) to understand health priorities and translate them into hypotheses for future research and enhancement of health practices via electronic health records (EHRs). The goal was to strengthen genetic health education for clinicians and for patients and their families, including improved diagnosis, knowledge and treatment. Perceptions regarding genetic health education and healthcare related to FH facilitated by the use of an EHR for diagnosis and treatment have not been studied. Design: Mixed-methods exploratory qualitative research and surveys. Setting: Qualitative research included five focus groups, 34 semi-structured key informant interviews and open-ended survey items with patients and PCPs at a large medical centre in Western New York. Method: Data were thematically coded to identify themes as formative work for the improvement of relevant EHR features, diagnosis, treatment and genetic health education via information sharing between clinicians and patients. Results: Themes included genetic health knowledge; the importance of being diagnosed; communication between patients, family members and medical professionals; outreach via patients' own advocacy; and treatment, technology, motivation, trust, outside resources (for further genetic health education and support) and awareness of effective treatments. Conclusion: Patients and clinicians can contribute to the development of EHR support for the genetic health education of patients and their families, and for improved diagnosis and treatment of FH. Using their ideas in the development of effective strategies could improve the currently low rate of FH diagnosis and cascade screening (for family members), as well as enhance physician and patient genetic health knowledge and self-empowerment.

Heterozygous familial hypercholesterolemia (HeFH) creates elevated low-density lipoprotein cholesterol (LDL-C), causing premature atherosclerotic cardiovascular disease (ASCVD). Guidelines recommend cascade screening relatives and starting statin therapy at 8-10 years old, but adherence to these recommendations is low. Our purpose was to measure self-reported physician practices for cascade screening and treatment initiation for HeFH using a survey of 500 primary care physicians and 500 cardiologists: 54% "always" cascade screen relatives of an individual with FH, but 68% would screen individuals with "strong family history of high cholesterol or premature ASCVD", and 74% would screen a child of a patient with HeFH. The most likely age respondents would start statins was 18-29 years, with few willing to prescribe to a pediatric male (17%) or female (14%). Physicians who reported previously diagnosing a patient with HeFH were more likely to prescribe to a pediatric patient with HeFH, either male (OR = 1.34, 95% CI = 0.99-1.81) or female (OR = 1.31, 95% CI = 0.99-1.72). Many physicians do not cascade screen and are less likely to screen individuals with family history of known HeFH compared to "high cholesterol or premature ASCVD". Most expressed willingness to screen pediatric patients, but few would start treatment at recommended ages. Further education is needed to improve diagnosis and treatment of HeFH.

Background/synopsisLow-dose aspirin is an effective drug for the prevention of cardiovascular disease (CVD) events but individuals with diabetes mellitus can be subject to 'aspirin resistance'. Thus, aspirin's effect in these individuals is controversial. Higher blood levels of seafood-derived omega-3 polyunsaturated fatty acids (ω3) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) also have beneficial effects in reducing risk of CVD events but few studies have examined the interaction of plasma EPA and DHA with aspirin ingestion.Objective/purposeOur study examined the combinatory effects of EPA, DHA, and aspirin ingestion on HDL-cholesterol (HDL-C) and apoA-I exchange (shown to be associated with CVD event risk).Methods30 adults with Type 2 diabetes mellitus ingested aspirin (81mg/day) for 7 consecutive days, EPA+DHA (2.6g/day) for 28 days, then both for 7 days. Plasma was collected at baseline and at 5 subsequent visits including 4h after each aspirin ingestion. Mixed model methods were used to determine HDL-C-concentrations and apoA-I exchange compared to the baseline visit values. LOWESS curves were used for non-linear analyses of outcomes to help discern change patterns, which was followed by piecewise linear functions for formal testing of curvilinear relationships.ResultsSignificant changes (p < 0.05) compared to baseline in both HDL-C-concentrations and apoA-I exchange were present at different times. After 7 days of aspirin-only ingestion, apoA-I exchange was significantly modified by increasing levels of DHA concentration, with increased apoA-I exchange observed up until log(DHA) of 4.6 and decreased exchange thereafter (p = 0.03). These LOWESS curve effects were not observed for EPA or HDL-C (p > 0.05). Aspirin's effects on apoA-I exchange were the greatest when EPA or DHA concentrations were moderate compared to high or low. Comparison of EPA, DHA, and EPA+DHA LOWESS curves, demonstrated that the majority of the effect is due to DHA.ConclusionOur results strongly suggest that plasma concentrations of EPA and DHA influence aspirin effects on lipid mediators of CVD event risk where their concentrations are most beneficial when moderate, not high or low. These effects on HDL-C cholesterol and apoA-I exchange are novel. Personalized dosing of DHA in those who take aspirin may be a beneficial option for patients with type 2 diabetes mellitus.

This paper provides a template of expected uncertainties and correlations for measurements of total neutron cross-section observables by transmission. Measurements with time-of-flight and mono-energetic neutron sources are covered. The information required for evaluations in the resonance region and high energy region is detailed, along with the template of uncertainties and correlations that can be used in the absence of other information.

This paper provides a template of expected uncertainties and correlations for measurements of neutron-induced capture and charged-particle production cross sections. Measurements performed in-beam include total absorption spectroscopy, total energy detection, γ-ray spectroscopy, and direct charged-particle detection. Offline measurements include activation analysis and accelerator mass spectrometry. The information needed for proper use of the datasets in resonance region and high energy region evaluations is described, and recommended uncertainties are provided when specific values are not available for a dataset.

A novel method was developed to separate the 238U fission contribution measured in quasi-differential time-of-flight scattering experiments in order to isolate the elastic and inelastic events. Pulse height distributions from in-beam measurements were used to generate response functions, which were used to reconstruct the 238U prompt fission neutron spectra. This method was validated by reconstructing the measured 252Cf spontaneous fission pulse height distribution. Monte Carlo calculations were used to model the experiment. Good agreement was observed between the measured and calculated 238U fission contribution.

Objective: To determine individual and group patient ideas and priorities regarding ways to enhance their own health care while providing a supportive environment including a clinical lipidologist and other medical experts. The intent was to transform these ideas and priorities into hypotheses for future research while enhancing current health promotion practice. Design: Communication between patients and medical professionals occurred via individual and group meetings, including group meetings in a non-medical campus location in the community of Rochester, New York. Setting: Familial hypercholesterolaemia (FH) is an autosomal dominant disorder that causes elevated low-density lipoprotein (LDL) cholesterol from birth and premature cardiovascular disease. Unfortunately, <10% of affected patients are diagnosed, which carries implications for knowledge and treatment. Patients' perceptions regarding their own health and others affected by FH have not been described via a direct partnership between patients and medical professionals. Method: Qualitative data were collected and thematic coding methods were used to identify underlying themes. Results: Themes identified from patient-led discussions included knowledge regarding FH; the importance of being diagnosed with FH; communication between patients, their family members and medical professionals; outreach including via their own roles as advocates and using electronic medical records; and awareness of effective treatments. Conclusion: Patients with FH have a great deal to contribute concerning how the medical system approaches them before and after diagnosis as well as research hypotheses that should be of high priority. Taking their ideas into account could improve the very insufficient and life-threatening rate of diagnosis, as well as enhance patient self-empowerment.

Objective: To determine whether integration of the Chronic Care Model into undergraduate medical education is associated with anticipated use of the Model and whether student perceptions match actual integration of the Model into their community projects. Design: This was a cross-sectional study using qualitative and quantitative data. Setting: A novel fourth-year medical student community health improvement course. Method: The study included 45 students who had enrolled in the course before introduction of the Model and 32 formally introduced to the Model through a lecture. Perceptions were measured through a survey and a focus group with data analysed amongst and between cohorts. Projects were reviewed for actual integration of Model elements and these data were compared with reported student perceptions. Results: Although they were in general utilizing most elements of the Model, student perceptions of their use of Model elements significantly differed from actual use of particular elements (p less than 0.001). For instance, whereas the majority believed that their projects focused on the element of Community Resources, most projects actually focused on Self-Management Support. Students formally introduced to the Model trended toward the belief that it would enhance their ability to care for patients more than students without formal exposure to it (p = 0.0516). Conclusions: Although medical students may not recognize it, they may already focus their actions and thinking regarding health improvement toward patient self-management of their chronic disease. Although students require education and training if the Model is to be widely used, they may be naturally attracted to it. (Contains 5 tables.)

Aspirin (acetylsalicylic acid, ASA) is inexpensive and is established in preventing cardiovascular disease (CVD) and colorectal adenomas. Omega-3 (n3) polyunsaturated fatty acids (PUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have also shown benefit in preventing CVD. The combination could be an effective preventative measure in patients with such diseases. ASA and n3 PUFA reduced the risk of CVD in ASA-resistant or diabetic patients. EPA- and DHA-deficient patients also benefited the most from n3 PUFA supplementation. Synergistic effects between ASA and EPA and DHA are 'V-shaped' such that optimal ASA efficacy is dependent on EPA and DHA concentrations in blood. In colorectal adenomas, ASA (300 mg/d) and EPA reduced adenoma burden in a location- and subtype-specific manner. Low doses of ASA (75–100 mg/d) were used in CVD prevention; however, ultra-low doses (30 mg/d) can also reduce thrombosis. EPA-to-DHA ratio is also important with regard to efficacy. DHA is more effective in reducing blood pressure and modulating systemic inflammation; however, high-dose EPA can lower CVD events in high-risk individuals. Although current literature has yet to examine ASA and DHA in preventing CVD, such combination warrants further investigation. To increase adherence to ASA and n3 PUFA supplementation, combination dosage form may be required to improve outcomes. [ABSTRACT FROM AUTHOR]

Neutron capture and transmission measurements have been performed, and resonance parameter analysis has been completed for dysprosium, Dy, and rhenium, Re. The 60 MeV electron accelerator at RPI Gaerttner LINAC Center produced neutrons in the thermal and epithermal energy regions for these measurements. Transmission measurements were made using 6Li glass scintillation detectors. The neutron capture measurements were made with a 16-segment NaI multiplicity detector. The detectors for all experiments were located at ≈25 m except for thermal transmission, which was done at ≈15 m. The dysprosium samples included one highly enriched 164Dy metal, 6 liquid solutions of enriched 164Dy, two natural Dy metals. The Re samples were natural metals. Their capture yield normalizations were corrected for their high gamma attenuation. The multi-level R-matrix Bayesian computer code SAMMY was used to extract the resonance parameters from the data. 164Dy resonance data were analyzed up to 550 eV, other Dy isotopes up to 17 eV, and Re resonance data up to 1 keV. Uncertainties due to resolution function, flight path, burst width, sample thickness, normalization, background, and zero time were estimated and propagated using SAMMY. An additional check of sample-to-sample consistency is presented as an estimate of uncertainty. The thermal total cross sections and neutron capture resonance integrals of 164Dy and Re were determined from the resonance parameters. The NJOY and INTER codes were used to process and integrate the cross sections. Plots of the data, fits, and calculations using ENDF/B-VII.1 resonance parameters are presented.