Genomic medicine and developing countries: creating a room of their own

The notion that developing countries must wait for the developed world to make advances in science and technology that they later import at great cost is being challenged. We have previously argued that developing countries can harness human genetic variation to benefit their populations and economies. Based on our empirical studies of large-scale population genotyping projects in Mexico, India and Thailand, we describe how these resources are being adopted to improve public health and create knowledge-based economies. A significant additional benefit is building the capacity for scientific research and internalizing advances in technology, whatever their source.     

Genomics and clinical medicine: rationale for creating and effectively evaluating animal models

Because resolving human complex diseases is difficult, appropriate biomedical models must be developed and validated. In the past, researchers have studied diseases either by characterizing a human clinical disease and choosing the most appropriate animal model, or by characterizing a naturally occurring or induced mutant animal and identifying which human disease it best resembled. Although there has been a great deal of progress through the use of these methods, such models have intrinsic faults that limit their relevance to clinical medicine. The recent advent of techniques in molecular biology, genomics, transgenesis, and cloning furnishes investigators with the ability to study vertebrates (e.g., pigs, cows, chickens, dogs) with greater precision and utilize them as model organisms. Comparative and functional genomics and proteomics provide effective approaches for identifying the genetic and environmental factors responsible for complex diseases and in the development of prevention and treatment strategies and therapeutics. By identifying and studying homologous genes across species, researchers are able to accurately translate and apply experimental data from animal experiments to humans. This review supports the hypothesis that associated enabling technologies can be used to create, de novo, appropriate animal models that recapitulate the human clinical manifestation. Comparative and functional genomic and proteomic techniques can then be used to identify gene and protein functions and the interactions responsible for disease phenotypes, which aids in the development of prevention and treatment strategies.     

Socialized medicine: Individual and communal disease barriers in honey bees

Honey bees are attacked by numerous parasites and pathogens toward which they present a variety of individual and group-level defenses. In this review, we briefly introduce the many pathogens and parasites afflicting honey bees, highlighting the biology of specific taxonomic groups mainly as they relate to virulence and possible defenses. Second, we describe physiological, immunological, and behavioral responses of individual bees toward pathogens and parasites. Third, bees also show behavioral mechanisms for reducing the disease risk of their nestmates. Accordingly, we discuss the dynamics of hygienic behavior and other group-level behaviors that can limit disease. Finally, we conclude with several avenues of research that seem especially promising for understanding host–parasite relationships in bees and for developing breeding or management strategies for enhancing honey bee health. We discuss how human efforts to maintain healthy colonies intersect with similar efforts by the bees, and how bee management and breeding protocols can affect disease traits in the short and long term.     

Overcoming barriers to the broader implementation of life cycle thinking in business and public administration

Preamble. It is the Purpose of this Corner to serve as an information and communication channel as well as a discussion forum between science and policy in general, as well as between research and management, in business and public administration with regard to goods and services (products). It is the aim of this Corner to improve awareness of, and to help more effectively implement, life cycle thinking in all stages of decision making in business and public administration. This Corner ‘EU Life Cycle Policy and Support’ appears regularly. Contributions are invited and uninvited articles, as well as discussion comments from the LCA community. They outline practical experiences, information on new regulations, directives and other policy instruments, as well as important theoretical considerations. This first edition of the Corner provides, for discussion, a broad commentary on our underlying thoughts and ideas. This builds on ideas presented in e.g. the business context in the Life Cycle Management special edition (Int J LCA Special Issue 1, 2007), as well as recent policy developments in the European Union. This editorial is illustrated with example references related to each issue that were recently published in the journal (see [1–11]). Dr. David W. Pennington is responsible for the Environmental Assessment of Waste and the Sustainable Management of Natural Resources (ENSURE) in the European Commission’s Joint Research Centre (JRC), based at the Institute for Environment and Sustainability in Ispra, Italy. ENSURE complements conventional methods for waste and resource management with the development of recommended approaches, indicators, reference data, and case studies that facilitate life cycle thinking in European business and public administrations. The ENSURE team, consisting of about 15 staffs, provides independent support through computer simulations, modelling, expert workshops, and state-of-the-art laboratories. The responsibilities include the implementation of the European Platform on LCA, which is developing the Reference European Life Cycle Data System (ELCD) and associated Technical Guidance Documents. The team has successfully conducted a series of international workshops and carried out pilot studies with Member States in relation to Life Cycle Thinking and Waste Management. Activities now include the development of European Life-Cycle Guidelines for Waste Management, and the broader development of Life Cycle-based Sustainability Indicators.     

Analysing stratified medicine business models and value systems: innovation-regulation interactions

Stratified medicine offers both opportunities and challenges to the conventional business models that drive pharmaceutical R&D. Given the increasingly unsustainable blockbuster model of drug development, due in part to maturing product pipelines, alongside increasing demands from regulators, healthcare providers and patients for higher standards of safety, efficacy and cost-effectiveness of new therapies, stratified medicine promises a range of benefits to pharmaceutical and diagnostic firms as well as healthcare providers and patients. However, the transition from 'blockbusters' to what might now be termed 'niche-busters' will require the adoption of new, innovative business models, the identification of different and perhaps novel types of value along the R&D pathway, and a smarter approach to regulation to facilitate innovation in this area. In this paper we apply the Innogen Centre's interdisciplinary ALSIS methodology, which we have developed for the analysis of life science innovation systems in contexts where the value creation process is lengthy, expensive and highly uncertain, to this emerging field of stratified medicine. In doing so, we consider the complex collaboration, timing, coordination and regulatory interactions that shape business models, value chains and value systems relevant to stratified medicine. More specifically, we explore in some depth two convergence models for co-development of a therapy and diagnostic before market authorisation, highlighting the regulatory requirements and policy initiatives within the broader value system environment that have a key role in determining the probable success and sustainability of these models.     

Web searches for laboratory animal medicine: using the "mouse" for access to online resources

Laboratory animal medicine professionals must be able to integrate information from a variety of sources to make sound decisions. To address concerns from preveterinary and veterinary students that information about the specialty is difficult to locate, the authors examined the utility of electronic search engines to provide links to appropriate websites of significant educational value to the field. They assembled this reference document to assist veterinary students, residents, and postdoctoral fellows in the acquisition of online texts, journals, newsletters, government regulations, and other sources of current information as they relate specifically to laboratory animal medicine.     

Cancer genetics evaluation: barriers to and improvements for referral

Despite the availability of cancer susceptibility testing, little information exists regarding physicians' selection and referral of eligible patients. This study provides insight into whom, why, and when physicians refer for cancer genetics evaluation, as well as their comfort level within this role. Eighty-two physicians (51 primary care, 15 gynecology, 11 surgery and 5 oncology) completed a survey (response rate: 34%) regarding cancer genetics referral practices. Of these, 59% reported an awareness of the hospital's cancer genetics program. Program awareness was greater among oncologists, surgeons, and gynecologists than among primary care physicians (p < 0.0001). Patients were referred for enhanced risk assessment (88%), improved medical management (85%), and concern for family members (83%). Patient eligibility was based on family cancer history (96%), patient cancer history (83%), and patient request (73%). Patients were not referred mainly due to patient disinterest (54%) or physician concern about either insurance coverage (44%) or insurance discrimination (31%). Primary care physicians were less comfortable with identifying patients for referral (p < 0.001) and with discussing genetics (p < 0.002) than specialists. The largest barriers to referral were lack of program awareness and limited knowledge regarding patient eligibility, improved insurance coverage, and antidiscrimination legislation. Physician-targeted marketing and education may improve the referral process.     

Depauperate freshwater fish communities in Sabah: the role of barriers to movement and habitat quality

Up to 30 species of fish were generally found in medium-sized rainforest streams in Sabah, Malaysia. However, depauperate fish communities were found in two streams above large (>8 m) waterfalls (five and nine species) and in two very small streams located in deep forest (five and six species). A fifth stream with small cascades and waterfalls had a faunal list of 12 species. Species resident above waterfalls were predominantly herbivores while fishes in the two forest streams were from a variety of trophic groups. Abundance and biomass of fishes above waterfalls were significantly lower than all other sites. A translocation experiment was performed in one stream to distinguish between the hypotheses that fish communities above waterfalls were determined solely by colonization ability and were unsaturated with species or that they were limited by habitat quality or food. Seven species (775 individuals) were trans located into one isolated section and four species (570 individuals) into another. Species that were trans located included trophic groups that were not represented by resident species. Twelve months after translocation, only four and one trans located species were collected in the two sections, all at greatly reduced densities. After 20 months, the number of species were three and two, respectively. One trans located species, Rasbora sumatrana , had increased in abundance from 12 months and juveniles were present in the population. Individuals of other trans located species appeared to be remnants of stocked populations. Abundance and biomass of resident species fluctuated widely between years. Interpretation of results was complicated by a large flood which substantially changed habitat conditions about a month after translocations were performed. It is suggested that two different factors were responsible for depauperate communities: movement barriers for waterfall sites and physicochemical conditions and/or habitat availability at other sites.     

Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review

Background

Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have shown significant positive effects for patients suffering from depression, but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing collaborative care for patients with anxiety and depression.

Methods

We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsycINFO, ProQuest, and CINAHL). All authors independently screened titles and abstracts and reviewed full-text articles. Studies were included if they were published in English and based on the original qualitative data on the implementation of a collaborative care intervention targeted at depression or anxiety in an adult patient population in a high-income country. Our subsequent analysis employed the normalization process theory (NPT).

Results

We included 17 studies in our review of which 11 were conducted in the USA, five in the UK, and one in Canada. We identified several barriers and enablers within the four major analytical dimensions of NPT. Securing buy-in among primary care providers was found to be critical but sometimes difficult. Enablers included physician champions, reimbursement for extra work, and feedback on the effectiveness of collaborative care. The social and professional skills of the care managers seemed critical for integrating collaborative care in the primary health care clinic. Day-to-day implementation was also found to be facilitated by the care managers being located in the clinic since this supports regular face-to-face interactions between physicians and care managers.

Conclusions

The following areas require special attention when planning collaborative care interventions: effective educational programs, especially for care managers; issues of reimbursement in relation to primary care providers; good systems for communication and monitoring; and promoting face-to-face interaction between care managers and physicians, preferably through co-location. There is a need for well-sampled, in-depth qualitative studies on the implementation of collaborative care in settings outside the USA and the UK.