Access to care and use of the Internet to search for health information: results from the US National Health Interview Survey
BACKGROUND: The insurance mandate of the Affordable Care Act has increased the number of people with health coverage in the United States. There is speculation that this increase in the number of insured could make accessing health care services more difficult. Those who are unable to access care in a timely manner may use the Internet to search for information needed to answer their health questions.
OBJECTIVE: The aim was to determine whether difficulty accessing health care services for reasons unrelated to insurance coverage is associated with increased use of the Internet to obtain health information.
METHODS: Survey data from 32,139 adults in the 2011 National Health Interview Study (NHIS) were used in this study. The exposure for this analysis was reporting difficulty accessing health care services or delaying getting care for a reason unrelated to insurance status. To define this exposure, we examined 8 questions that asked whether different access problems occurred during the previous 12 months. The outcome for this analysis, health information technology (HIT) use, was captured by examining 2 questions that asked survey respondents if they used an online health chat room or searched the Internet to obtain health information in the previous 12 months. Several multinomial logistic regressions estimating the odds of using HIT for each reported access difficulty were conducted to accomplish the study objective.
RESULTS: Of a survey population of 32,139 adults, more than 15.90% (n=5109) reported experiencing at least one access to care barrier, whereas 3.63% (1168/32,139) reported using online health chat rooms and 43.55% (13,997/32,139) reported searching the Internet for health information. Adults who reported difficulty accessing health care services for reasons unrelated to their health insurance coverage had greater odds of using the Internet to obtain health information. Those who reported delaying getting care because they could not get an appointment soon enough (OR 2.2, 95% CI 1.9-2.5), were told the doctor would not accept them as a new patient or accept their insurance (OR 2.1, 95% CI 1.7-2.5 and OR 2.1, 95% CI 1.7-2.5, respectively), or because the doctor's office was not open when they could go (OR 2.2, 95% CI 1.9-2.7) had more than twice the odds of using the Internet to obtain health information compared to those who did not report such access difficulties.
CONCLUSIONS: People experiencing trouble accessing health care services for reasons unrelated to their insurance status are more likely to report using the Internet to obtain health information. Improving the accuracy and reliability of health information resources that are publicly available online could help those who are searching for information due to trouble accessing health care services.
Caenorhabditis elegans microRNAs of the let-7 family act in innate immune response circuits and confer robust developmental timing against pathogen stress
Animals maintain their developmental robustness against natural stresses through numerous regulatory mechanisms, including the posttranscriptional regulation of gene expression by microRNAs (miRNAs). Caenorhabditis elegans miRNAs of the let-7 family (let-7-Fam) function semiredundantly to confer robust stage specificity of cell fates in the hypodermal seam cell lineages. Here, we show reciprocal regulatory interactions between let-7-Fam miRNAs and the innate immune response pathway in C. elegans. Upon infection of C. elegans larvae with the opportunistic human pathogen Pseudomonas aeruginosa, the developmental timing defects of certain let-7-Fam miRNA mutants are enhanced. This enhancement is mediated by the p38 MAPK innate immune pathway acting in opposition to let-7-Fam miRNA activity, possibly via the downstream Activating Transcription Factor-7 (ATF-7). Furthermore, let-7-Fam miRNAs appear to exert negative regulation on the worm's resistance to P. aeruginosa infection. Our results show that the inhibition of pathogen resistance by let-7 involves downstream heterochronic genes and the p38 MAPK pathway. These findings suggest that let-7-Fam miRNAs are integrated into innate immunity gene regulatory networks, such that this family of miRNAs modulates immune responses while also ensuring robust timing of developmental events under pathogen stress.
Noncoding RNA. piRNA-guided transposon cleavage initiates Zucchini-dependent, phased piRNA production
PIWI-interacting RNAs (piRNAs) protect the animal germ line by silencing transposons. Primary piRNAs, generated from transcripts of genomic transposon "junkyards" (piRNA clusters), are amplified by the "ping-pong" pathway, yielding secondary piRNAs. We report that secondary piRNAs, bound to the PIWI protein Ago3, can initiate primary piRNA production from cleaved transposon RNAs. The first ~26 nucleotides (nt) of each cleaved RNA becomes a secondary piRNA, but the subsequent ~26 nt become the first in a series of phased primary piRNAs that bind Piwi, allowing piRNAs to spread beyond the site of RNA cleavage. The ping-pong pathway increases only the abundance of piRNAs, whereas production of phased primary piRNAs from cleaved transposon RNAs adds sequence diversity to the piRNA pool, allowing adaptation to changes in transposon sequence.
Small silencing RNAs, including microRNAs, endogenous small interfering RNAs (endo-siRNAs) and Piwi-interacting RNAs (piRNAs), have been shown to play important roles in fine-tuning gene expression, defending virus and controlling transposons. Loss of small silencing RNAs or components in their pathways often leads to severe developmental defects, including lethality and sterility. Recently, non-templated addition of nucleotides to the 3' end, namely tailing, was found to associate with the processing and stability of small silencing RNAs. Next Generation Sequencing has made it possible to detect such modifications at nucleotide resolution in an unprecedented throughput. Unfortunately, detecting such events from millions of short reads confounded by sequencing errors and RNA editing is still a tricky problem. Here, we developed a computational framework, Tailor, driven by an efficient and accurate aligner specifically designed for capturing the tailing events directly from the alignments without extensive post-processing. The performance of Tailor was fully tested and compared favorably with other general-purpose aligners using both simulated and real datasets for tailing analysis. Moreover, to show the broad utility of Tailor, we used Tailor to reanalyze published datasets and revealed novel findings worth further experimental validation. The source code and the executable binaries are freely available at https://github.com/jhhung/Tailor.
The DNA damage response to double-strand breaks (DSBs) is critical for cellular viability. Recent work has shown that a host of chromatin regulators are recruited to a DSB, and that they are important for the DNA damage response. However, the functional relationships between different chromatin regulators at DSBs remain unclear. Here we describe a conserved functional interaction among the chromatin remodeling enzyme, SWI/SNF, the NuA4 and Gcn5 histone acetyltransferases, and phosphorylation of histone H2A.X (gammaH2AX). Specifically, we find that the NuA4 and Gcn5 enzymes are both required for the robust recruitment of SWI/SNF to a DSB, which in turn promotes the phosphorylation of H2A.X.
Coronary vessel development is a crucial part of heart development requiring the interplay of the epicardial, myocardial and endocardial layers of the heart for proper formation. Coronary vascularization is regulated by a host of transcription factors further regulated by chromatin remodeling enzymes, including Histone Deacetylases (HDACs). To investigate the functions of HDACs in coronary vascular development, we have deleted Hdac3 in endocardial cells using Cre LoxP technology. Endocardial cell-‐specific deletion of Hdac3 results in aberrant coronary vessel formation and complete postnatal lethality. We have thus shown that Hdac3 is a critical regulator of the coronary vascular development pathway.
Teletoxicology offers the potential for toxicologists to assist in providing medical care at remote locations, via remote, interactive augmented audiovisual technology. This study examined the feasibility of using Google Glass, a head-mounted device that incorporates a webcam, viewing prism, and wireless connectivity, to assess the poisoned patient by a medical toxicology consult staff. Emergency medicine residents (resident toxicology consultants) rotating on the toxicology service wore Glass during bedside evaluation of poisoned patients; Glass transmitted real-time video of patients' physical examination findings to toxicology fellows and attendings (supervisory consultants), who reviewed these findings. We evaluated the usability (e.g., quality of connectivity and video feeds) of Glass by supervisory consultants, as well as attitudes towards use of Glass. Resident toxicology consultants and supervisory consultants completed 18 consults through Glass. Toxicologists viewing the video stream found the quality of audio and visual transmission usable in 89 % of cases. Toxicologists reported their management of the patient changed after viewing the patient through Glass in 56 % of cases. Based on findings obtained through Glass, toxicologists recommended specific antidotes in six cases. Head-mounted devices like Google Glass may be effective tools for real-time teletoxicology consultation.
Cancers of unknown primary (CUP) are a heterogeneous group of histologically proven metastatic tumors whose primary site can't be determined after a standard diagnostic and pathologic work-up. This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents provides an overview of cancers of unknown primary, including initial evaluation and principles of treatment.
Higher-Order Unfolding of Peri/Centric Satellite Heterochromatin is an Early and Consistent Event in Cell Senescence: A Dissertation
Cellular senescence is thought to play an essential role in many biological functions including tumor suppression and organismal aging. Senescent cells, which are permanently removed from the cell cycle, can be found both in vivo in many different tissue types and in vitro within cultures of non-immortalized cells. Despite their inability to proliferate, these cells persist and remain metabolically active for indefinite periods of time. This physiologic process occurs in response to a variety of cellular insults including oxidative stress, shortened telomeres, constitutive oncogene expression, and DNA damage, and can be initiated by upregulation of one of the two known senescent pathways, involving p16/Rb or p53/p21. The senescent cell phenotype is also characterized by changes to cell and nuclear morphology and to the secretory profile of the cell.
Related to changes in nuclear morphology, epigenetic modifications to the packaging of DNA are thought to be key to the initiation and maintenance of the senescence program. While a large number of earlier studies focused on the findings that senescent cells gain regions of condensed heterochromatin, often in the form of Senescent Associated Heterochromatin Foci (SAHF), this thesis work shows that there is a marked loss of heterochromatin in the peri/centromeric regions of the genome. In fact, both α-satellite and satellite II sequences across the genome distend in a striking and unanticipated fashion; this can be readily visualized by fluorescence in situ hybridization (FISH) as their structure changes from a condensed spot to highly elongated and fine thread-like signals. We have termed this exceptional decondensation of constitutive heterochromatin Senescence Associated Distension of Satellites (SADS). Importantly, a series of experiments shows that SADS is both a consistent and an early event in the cell senescence process, which occurs as a result of every senescence induction method examined. We also observed that this distension was characteristic of both human and murine cells and in vivo in human benign Prostatic Intraepithelial Neoplasia (PIN) tissue. Furthermore, unlike SAHF formation, SADS can occur due to the activation of either of the two senescence pathways, p16/Rb or p53/p21.
Additionally, the cytological dimensions of the thread-like satellite signals indicates that SADS represents “unraveling” of DNA on an unprecedented scale. Thus, it was surprising that this event was not facilitated by changes to several canonical histone modifications associated with condensed heterochromatin, namely H3K9Me3, H3K27Me3, or H3K4Me3, nor is it caused by loss of DNA methylation. Consequently, we believe that this marked distension of satellite DNA is due to changes in higher-order folding of the chromatin fiber. This is important for understanding fundamental events in the cell senescence process, but also provides a unique system for study of chromatin packaging that may provide new insights into the organization of DNA well beyond nucleosome packaging and the ten nanometer fiber. In fact, initial super resolution images of SADS suggest that the satellite sequences may be organized into domains or “globules”. Hence, we suggest that the changes to satellite sequence packaging may be facilitated by changes to higher-order nuclear structural proteins, such as LaminB1, which is reduced in senescent cells.
Finally, this work provides analysis of the literature and preliminary experiments to consider the possibility that there are increased levels of cell senescence in Down syndrome (trisomy 21) cells. As individuals with Down syndrome (DS) experience many manifestations of premature aging (including early-onset Alzheimer’s Disease), have a resistance to solid tumor formation, are more susceptible to oxidative stress, and are trisomic for several genes implicated in causing senescence, our analysis provides plausibility for the hypothesis that accelerated rates of senescence may play a significant role in DS physiology. We also provide results of preliminary studies and outline the next steps for experimentation, using DS fibroblasts and a unique genetically engineered DS iPS cell system. As a final note, the quantification of cell senescence in trisomic versus disomic cells for these experiments relies substantially on the new single-cell marker of senescence discovered and established by this theses work, the Senescence-Associated Distension of Satellites.
This chapter examines how clinical investigators ensure the safety of psychiatric research participants while maintaining the integrity of research protocols. It discusses the ethical issues arising from data monitoring, disclosure of interim data, and termination of clinical trials. It outlines unique features of psychiatric research and related cultural issues that may warrant consideration before and during clinical trials. It focuses on the Data Safety Monitoring Boards (DSMBs) overseeing clinical trials their development of detailed plans for monitoring safety and protocol adherence. It looks at the use of statistical programs by DSMBs to document the progression of research studies and make early termination decisions; whether DSMBs actually improve the safety of participants or the integrity of research; how independent DSMBs are; and the factors that DSMBs consider when terminating a trial. Cultural issues involved in clinical trials and challenges that may compromise the neutrality and function of DSMBs are analyzed.
In Selective Allure of Neuroscience and Its Implications for the Courtroom, Shniderman adds to an already long list of reasons for why attorneys and trial consultants should be cautious in using neuroscientific evidence in legal proceedings. Scurich and Shniderman (2014) found that individuals evaluated the scientific validity of neuroscientific evidence based on preexisting beliefs. At first glance, this study might seem like another example of scientists proving a well-known concept that juries and judges bring their individual experiences into the courtroom. In fact, voir dire is premised on identifying individuals with particular types of beliefs that may produce a particular type of verdict. However, on closer examination, the findings from this study highlight a different point – introduction of neuroscientific research may backfire, or in the very least not produce the intended results. And, not knowing how the jury or a judge will interpret a particular type of evidence should be disconcerting to attorneys, legal consultants and experts.
A response to the article: Neuroimagery and the Jury.
An essay about delivering good expert testimony.
The polygraph, an instrument designed to identify deception, first entered the American courtroom more than 90 years ago. In Frye v. United States (1923), the D.C. Circuit Court excluded expert testimony about the findings from a polygraph. The court noted that the “systolic blood pressure deception test, ” the polygraph, had “not yet gained such standing and scientific recognition among physiological and psychological authorities as would justify the courts in admitting expert testimony.…”
Since then, the polygraph and its modern incarnations have continued to incite legal controversy and debate. The public, press and fact finders are no less fascinated with the polygraph now than they were in the beginning of the twentieth century (Keeler, 1930; Myers, Latter, & Abdolahhi-Arena, 2006). Overwhelmingly, courts have banned results of polygraph testing in criminal proceedings (United States v. Scheffer, 1998). The reasoning for this has largely centered on lack of general acceptance in the scientific community and concerns about prejudicial impact of the findings on the jury (Myers et al., 2006). Nevertheless, the polygraph continues to be widely used by law enforcement, in employment screenings, and for specific types of forensic assessments, such as sexual offender evaluations (Grubin, 2010). Accordingly, litigators, corporate counsel, and trial consultants need to have a current understanding of the scientific underpinnings of the polygraph, the improvements to the instrument throughout the decades, and the ongoing controversies regarding the interpretation of results.
High-profile schemes to defraud the elderly of their lifetime savings have headlined top newspapers and tabloids alike. As crime rates -- and vulnerable populations -- increase, the scientific and legal communities must pool our ever-increasing knowledge and resources to protect elderly family members.
Are Measures of Cognitive Effort and Motivation Useful in Differentiating Feigned from Genuine Psychiatric Symptoms?
This study examined the accuracy of two measures of cognitive effort and motivation, the Test of Memory Malingering (TOMM; Tombaugh, 1996) and the Validity Indicator Profile Verbal subtest (VIP-V; Frederick, 2003) using a simulation study design with psychiatric patients (n = 88) and community participants instructed to feign mental illness (n = 29). Little research has evaluated either the TOMM or the VIP in psychiatric patients, a group that may be at an increased risk of misclassification, despite the common use of these measures by forensic evaluators to assess for malingering. Specificity for the TOMM (94.2%) and the VIP-V (71.6%) were somewhat lower than the original validation samples, but Sensitivity rates were mixed: lower for the TOMM (62.1%) but higher for the VIP-V (73.1%). Additionally, VIP-V indicators were examined using Receiver Operating Curve (ROC) and stepwise discriminant analyses. The implications of these results for forensic assessment are discussed.
In United States v. Beatty, 642 F.3d 514 (6th Cir. 2011), the United States Court of Appeals for the Sixth Circuit upheld a decision by the U.S. District Court for the Eastern District of Tennessee to recognize antisocial personality disorder (ASPD) as a mental disease for the purposes of conditional release under the civil commitment statute according to Title 18 United States Code Service (18 U.S.C.S.) § 4243 (hospitalization of a person found not guilty by reason of insanity; 1984).
Gender Differences in Professional Development Among AP-LS Members: Results of the Professional Development of Women Survey
The current survey was designed to examine gender differences in professional development among American Psychology - Law Society (AP-LS) members. The survey was based on the University of California, Irvine NSF ADVANCE survey, and examines issues related to work climate, workload, productivity, job satisfaction, work/life balance, and leadership among AP-LS members.
A partial preview of this chapter is available in Google Books.
This study describes the potential problems and possible solutions to the integration of multiple malingering measures. Multivariate prediction models, using both discriminant function analyses and regression tree approaches, are compared. Study measures, including an abbreviated version of the SIRS (SIRS-A), the MMPI-2, the TOMM and the VIP Verbal subtest, were administered to 29 community members instructed to malinger and 87 psychiatric patients instructed to respond honestly. Predictive accuracy varied substantially across measures and the correlations between tests ranged from .19 to .79. Further, 48% of the psychiatric sample were misclassified as malingering by at least one test and 46% of the malingering sample were classified as honest by at least one test; “unanimous” findings occurred in only half of the cases. Multivariate models identified the SIRS-A as the strongest predictor of malingering, but the MMPI-2, TOMM, and VIP provided significant contributions to these models. The implications of these findings for the problem of multiple, contradictory indicators in general, and the specific problems associated with clinical assessments of malingering in particular, are discussed.