One For All,All For One? Collective Representation in Healthcare Policy

Healthcare collectives, such as patient organizations, advocacy groups, disability organizations, professional associations, industry advocates, social movements, and health consumer organizations have been increasingly involved in healthcare policymaking. Such collectives are based on the idea that individual interests can be aggregated into collective interests by participation, deliberation, and representation. The topic of collectivity in healthcare, more specifically collective representation, has only rarely been addressed in (Western) bioethics. This symposium, entitled: “Collective Representation in Healthcare Policy” of the Journal of Bioethical Inquiry draws attention to this understudied topic from a variety of disciplines, within a variety of socio-cultural contexts. We draw attention to important ethical, cultural, and social questions, and into the practices, justifications for, and implications of collective representation of patients in healthcare policy.     

Schwartz Formula: Is One k-Coefficient Adequate for All Children?

Background/Objective

Plasma-creatinine-based equations to estimate the glomerular filtration rate are recommended by several clinical guidelines. In 2009, Schwartz et al. adapted the traditional Schwartz equation to children and adolescents but did not find different k-coefficients between children and adolescents (k = 36.5 for all patients). We reevaluated the coefficient of the 2009-Schwartz formula according to sex and age in a pediatric population.

Patients/Methods

We used linear mixed-effects models to reestimate the 2009-Schwartz k-coefficient in 360 consecutive French subjects aged 1 to 18 years referred to a single centre between July 2003 and July 2010 (965 measurements). We assessed the agreement between the estimated glomerular filtration rate obtained with the new formula (called Schwartz-Lyon) and the rate measured by inulin clearance. We then compared this agreement to the one between the measured glomerular filtration rate and 2009-Schwartz formula, first in the French then in a Swedish cohort.

Results

In Schwartz-Lyon formula, k was estimated at 32.5 in boys <13 years and all girls and at 36.5 in boys aged ≥13 years. The performance of this formula was higher than that of 2009-Schwartz formula in children <13 years. This was first supported by a statistically significant reduction of the overestimation of the measured glomerular filtration rate in both cohorts, by better 10% and 30% accuracies, and by a better concordance correlation coefficient.

Conclusions

The performance and simplicity of Schwartz formula are strong arguments for its routine use in children and adolescents. The specific coefficient for children aged <13 years further improves this performance.     

Sequence Search Algorithms for Single Pass Sequence Identification: Does One Size Fit All?

Bioinformatic tools have become essential to biologists in their quest to understand the vast quantities of sequence data, and now whole genomes, which are being produced at an ever increasing rate. Much of these sequence data are single-pass sequences, such as sample sequences from organisms closely related to other organisms of interest which have already been sequenced, or cDNAs or expressed sequence tags (ESTs). These single-pass sequences often contain errors, including frameshifts, which complicate the identification of homologues, especially at the protein level. Therefore, sequence searches with this type of data are often performed at the nucleotide level. The most commonly used sequence search algorithms for the identification of homologues are Washington University's and the National Center for Biotechnology Information's (NCBI) versions of the BLAST suites of tools, which are to be found on websites all over the world. The work reported here examines the use of these tools for comparing sample sequence datasets to a known genome. It shows that care must be taken when choosing the parameters to use with the BLAST algorithms. NCBI's version of gapped BLASTn gives much shorter, and sometimes different, top alignments to those found using Washington University's version of BLASTn (which also allows for gaps), when both are used with their default parameters. Most of the differences in performance were found to be due to the choices of default parameters rather than underlying differences between the two algorithms. Washington University's version, used with defaults, compares very favourably with the results obtained using the accurate but computationally intensive Smith-Waterman algorithm.     

Should Health Professionals Screen All Women for Domestic Violence?

BACKGROUND TO THE DEBATE: The US and Canadian task forces on preventive health recently declared that there is not enough evidence to recommend for or against routine universal screening of women for domestic violence. Yet some experts argue that routine enquiry is justified.     

Mitochondria: One of the origins for autophagosomal membranes?

Macroautophagy is a transport pathway to the lysosome/vacuole that contributes to the degradation of numerous intracellular components. Despite the recent advances achieved in the understanding of the molecular mechanism underlying macroautophagy, the membrane origin of autophagosomes, the hallmark of this process is still a mystery. It has been suggested that mitochondria may be one of the lipid sources for autophagosome formation and that possibly this organelle provides the phosphatidylethanolamine (PE) that covalently links to the members of the ubiquitin-like Atg8/microtubule-associated protein 1 light chain 3 (LC3) protein family. These lipidated proteins are inserted into the outer and inner surface of autophagosomes and are essential for the biogenesis of these large double-membrane vesicles. However, because PE is an integral component of all cellular membranes, designing appropriate experiments to determine the origin of the autophagosomal PE is not easy. In this review, we discuss the idea that mitochondria provide the pool of PE necessary for the autophagosome biogenesis and we propose some possible experimental approaches aimed to explore this possibility.     

Is “Football for All” Safe for All? Cross-Sectional Study of Disparities as Determinants of 1-Year Injury Prevalence in Youth Football Programs

Background

Football (soccer) is endorsed as a health-promoting physical activity worldwide. When football programs are introduced as part of general health promotion programs, equal access and limitation of pre-participation disparities with regard to injury risk are important. The aim of this study was to explore if disparity with regard to parents’ educational level, player body mass index (BMI), and self-reported health are determinants of football injury in community-based football programs, separately or in interaction with age or gender.

Methodology/Principal Findings

Four community football clubs with 1230 youth players agreed to participate in the cross-sectional study during the 2006 season. The study constructs (parents’ educational level, player BMI, and self-reported health) were operationalized into questionnaire items. The 1-year prevalence of football injury was defined as the primary outcome measure. Data were collected via a postal survey and analyzed using a series of hierarchical statistical computations investigating associations with the primary outcome measure and interactions between the study variables. The survey was returned by 827 (67.2%) youth players. The 1-year injury prevalence increased with age. For youths with parents with higher formal education, boys reported more injuries and girls reported fewer injuries than expected; for youths with lower educated parents there was a tendency towards the opposite pattern. Youths reporting injuries had higher standardized BMI compared with youths not reporting injuries. Children not reporting full health were slightly overrepresented among those reporting injuries and underrepresented for those reporting no injury.

Conclusion

Pre-participation disparities in terms of parents’ educational level, through interaction with gender, BMI, and self-reported general health are associated with increased injury risk in community-based youth football. When introduced as a general health promotion, football associations should adjust community-based youth programs to accommodate children and adolescents with increased pre-participation injury risk.     

All thumbs?

In this otherwise insightful line of investigation, some aspects of rules of thumb (RoT) remain underspecified: their evolution and function, how they are selected for a task, how they are learned, and the dependence of their apparent simplicity on their embodiment and context. Theories of operant and respondent conditioning may serve as the theoretical framework required to flesh out those details.     

‘One Health' for the people of Hong Kong and the world

正Translational medicine refers to the conversion of scientific discoveries into improvements in medical practice.‘From bench to bedside and back’is a phrase that is often used to describe the two-way information flow in translational medicine.On one hand,scientists working at the bench make new discoveries that enable clinicians to revolutionize     

One ring to rule them all? Another cellular responsibility for PCNA

To prevent duplication or loss of genomic regions during DNA replication, it is essential that the entire genome is copied precisely once every S phase. Cells achieve this by mutually exclusive regulation of origin firing and licensing. A crucial protein that is involved in origin licensing is chromatin licensing and DNA replication factor 1 (CDT1) and, therefore, activity of this protein must be strictly controlled. Four recent articles have demonstrated that proliferating cell nuclear antigen (PCNA), an essential sliding clamp used in replication and DNA repair, has a crucial role in this process by mediating the proteasomal degradation of CDT1.     

Lightweight GPS-Tags,One Giant Leap for Wildlife Tracking? An Assessment Approach

Recent technological improvements have made possible the development of lightweight GPS-tagging devices suitable to track medium-to-small sized animals. However, current inferences concerning GPS performance are based on heavier designs, suitable only for large mammals. Lightweight GPS-units are deployed close to the ground, on species selecting micro-topographical features and with different behavioural patterns in comparison to larger mammal species. We assessed the effects of vegetation, topography, motion, and behaviour on the fix success rate for lightweight GPS-collar across a range of natural environments, and at the scale of perception of feral cats (Felis catus). Units deployed at 20 cm above the ground in sites of varied vegetation and topography showed that trees (native forest) and shrub cover had the largest influence on fix success rate (89% on average); whereas tree cover, sky availability, number of satellites and horizontal dilution of position (HDOP) were the main variables affecting location error (±39.5 m and ±27.6 m before and after filtering outlier fixes). Tests on HDOP or number of satellites-based screening methods to remove inaccurate locations achieved only a small reduction of error and discarded many accurate locations. Mobility tests were used to simulate cats' motion, revealing a slightly lower performance as compared to the fixed sites. GPS-collars deployed on 43 cats showed no difference in fix success rate by sex or season. Overall, fix success rate and location error values were within the range of previous tests carried out with collars designed for larger species. Lightweight GPS-tags are a suitable method to track medium to small size species, hence increasing the range of opportunities for spatial ecology research. However, the effects of vegetation, topography and behaviour on location error and fix success rate need to be evaluated prior to deployment, for the particular study species and their habitats.     

NTE: One target protein for different toxic syndromes with distinct mechanisms?

Epidemics of organophosphate-induced delayed neuropathy (OPIDN) have paralysed thousands of people. This syndrome of nerve axon degeneration is initiated by organophosphates which react with neuropathy target esterase (NTE). Dosing experiments with adult chickens raise the possibility that OPIDN is initiated by a gain-of-function mechanism. By contrast, loss of NTE function by mutation causes massive apoptosis in Drosophila brain. Now, Winrow et al. show that nte(-/-) mice die by mid-gestation, but nte(+/-) mice appear hyperactive and are more sensitive than wild-type mice to a fatal form of OP toxicity. Thus, different toxic syndromes may be initiated via a single target protein.