PARTAKE Survey of Public Knowledge and Perceptions of Clinical Research in India

Background

A public that is an informed partner in clinical research is important for ethical, methodological, and operational reasons. There are indications that the public is unaware or misinformed, and not sufficiently engaged in clinical research but studies on the topic are lacking. PARTAKE – Public Awareness of Research for Therapeutic Advancements through Knowledge and Empowerment is a program aimed at increasing public awareness and partnership in clinical research. The PARTAKE Survey is a component of the program.

Objective

To study public knowledge and perceptions of clinical research.

Methods

A 40-item questionnaire combining multiple-choice and open-ended questions was administered to 175 English- or Hindi-speaking individuals in 8 public locations representing various socioeconomic strata in New Delhi, India.

Results

Interviewees were 18–84 old (mean: 39.6, SD±16.6), 23.6% female, 68.6% employed, 7.3% illiterate, 26.3% had heard of research, 2.9% had participated and 58.9% expressed willingness to participate in clinical research. The following perceptions were reported (% true/% false/% not aware): ‘research benefits society’ (94.1%/3.5%/2.3%), ‘the government protects against unethical clinical research’ (56.7%/26.3%/16.9%), ‘research hospitals provide better care’ (67.2%/8.7%/23.9%), ‘confidentiality is adequately protected’ (54.1%/12.3%/33.5%), ‘participation in research is voluntary’ (85.3%/5.8%/8.7%); ‘participants treated like ‘guinea pigs’’ (20.7%/53.2%/26.0%), and ‘compensation for participation is adequate’ (24.7%/12.9%/62.3%).

Conclusions

Results suggest the Indian public is aware of some key features of clinical research (e.g., purpose, value, voluntary nature of participation), and supports clinical research in general but is unaware of other key features (e.g., compensation, confidentiality, protection of human participants) and exhibits some distrust in the conduct and reporting of clinical trials. Larger, cross-cultural surveys are required to inform educational programs addressing these issues.     

Low VHL mRNA Expression is Associated with More Aggressive Tumor Features of Papillary Thyroid Carcinoma

Alterations of the von Hippel–Lindau (VHL) tumor suppressor gene can cause different hereditary tumors associated with VHL syndrome, but the potential role of the VHL gene in papillary thyroid carcinoma (PTC) has not been characterized. This study set out to investigate the relationship of VHL expression level with clinicopathological features of PTC in an ethnically and geographically homogenous group of 264 patients from Serbia, for the first time. Multivariate logistic regression analysis showed a strong correlation between low level of VHL expression and advanced clinical stage (OR = 5.78, 95% CI 3.17–10.53, P<0.0001), classical papillary morphology of the tumor (OR = 2.92, 95% CI 1.33–6.44, P = 0.008) and multifocality (OR = 1.96, 95% CI 1.06–3.62, P = 0.031). In disease-free survival analysis, low VHL expression had marginal significance (P = 0.0502 by the log-rank test) but did not appear to be an independent predictor of the risk for chance of faster recurrence in a proportion hazards model. No somatic mutations or evidence of VHL downregulation via promoter hypermethylation in PTC were found. The results indicate that the decrease of VHL expression associates with tumor progression but the mechanism of downregulation remains to be elucidated.     

Believing is seeing: expectations alter visual awareness

Expectations have been shown to be powerful modulators of pain [1] and emotion [2] in placebo studies. In such experiments, expectations are induced by instructions combined with manipulation of the sensory experience that is unknown to the subjects. After an expectation learning phase where a painful stimulation is surreptitiously lowered following placebo application, the placebo effectively reduces subjective pain intensity in a subsequent test phase [3]. The strength of this placebo effect is closely related to the induced expectation [4]. Here, we asked whether this powerful cognitive bias reflects a general property of sensory information processing and tested whether the contents of visual awareness could be altered by a placebo-like expectation manipulation. We found a dramatic effect of experimentally induced expectations on the perception of an ambiguous visual motion stimulus. This shows that expectations have a strong and general influence on our experience of the sensory input independently of its specific type and content.     

Developmental patterns of caspase-3, bax and bcl-2 proteins expression in the human spinal ganglia

The distribution of the bcl-2, bax and caspase-3 proteins was investigated in the cells of developing human spinal ganglia. Paraffin sections of 10 human conceptuses between 5th and 9th gestational weeks were analysed morphologically, immunohistochemically and by TUNEL-method. Cells positive to caspase-3 had brown stained nuclei or nuclear fragmentations. At earliest stages, 6% of ganglion population were caspase-3 positive cells. Later on, a significant increase in number of caspase-3 positive cells appeared, particularly in the ventral part of ganglia (12%), and subsequently decreased to 6%. TUNEL-positive cells had the same distribution pattern as caspase-3 positive cells. Bax-positive cells followed the developmental pattern similar to caspase-3 cells, changing in range between 20% and 32%. There were 8% of bcl-2 positive cells at earliest stages. They increased significantly in dorsal part of the ganglion during the 7th week (28%), and than dropped to 15% by the end of the 8th week. These findings suggest a ventro-dorsal course of development in human spinal ganglia. Number of bcl-2, bax and caspase-3 positive cells changed in a temporally and spatially restricted manner, coincidently with ganglion differentiation. While apoptosis might control cell number, bcl-2 could act in suppression of apoptosis and enhancement of cell differentiation.     

Assessment of microbial carcass contamination of hunted wild boars

To investigate the microbiological conditions of hunted wild boar carcasses and factors that contribute to the microbial carcass contamination, skin and carcass meat swab samples from 210 hunted wild boars were collected from freshly shot animals. The mean aerobic colony counts (ACCs) and Enterobacteriaceae counts on the skin were 5.2 and 3.6 log₁₀ CFU/cm², with 1.4% of animals’ skin tested positive for Salmonella spp. Slightly higher mean ACC and Enterobacteriaceae counts of 5.4 and 3.8 log₁₀ CFU/cm² were obtained from carcass meat with Salmonella spp. prevalence of 1.9%. Inadequate hygiene practices in handling and dressing wild boar carcasses, such as evisceration in the laying position on the ground and practice of skin and interior carcass surface washing after evisceration, were found to have the most significant influence on the microbiological conditions of final carcasses. Therefore, these findings indicate the need for the implementation and strict adherence to good hygiene practice in hunting estates and game handling establishments.     

Apolipoprotein E gene polymorphism effects triglycerides but not CAD risk in Caucasian women younger than 65 years

The pathogenesis of CAD is similar in man and woman, yet some risk factors have a greater impact on the CAD risk in woman than in man. In this study we assessed the effect of the apoE gene polymorphism on lipid metabolism and risk for CAD in women younger than 65 years (premature CAD). In a cross-sectional case-control study, 147 female Caucasian patients with premature CAD (confirmed by coronarography) were compared with a control group of 114 healthy Caucasian women. The apoE allele frequencies of patients vs. controls were 5.1% vs. 5.7% for 2, 85.4% vs. 83.3% for 3, and 9.5% vs. 11% for epsilon4. The subjects with epsilon2/3 genotype had statistically significantly higher triglycerides levels than the subjects with epsilon3/3 genotype (2.23 +/- 2.13 mmol.L(-1) vs. 1.73 +/- 0.84 mmol.L(-1); p<0.05). Logistic regression analysis revealed no association between risk genotypes (3/4 and 4/4) of the apoE gene polymorphism and CAD risk (OR 0.9; 95% CI 0. 5-1.7, P=0.7). We observed metabolic clustering of diabetes mellitus, arterial hypertension, higher BMI and triglycerides, and lower HDL cholesterol in the CAD group compared to the control group. Arterial hypertension, diabetes, HDL cholesterol level, and BMI were independent risk factors for premature CAD in female population, whereas, the risk genotype of the apoE gene polymorphism was not. In conclusion, in Slovene women risk genotypes of the apoE gene polymorphism are not associated with premature CAD; a metabolic clustering of diabetes, HDL, triglycerides and arterial hypertension is frequently present in Caucasian women with premature CAD.     

Beam rate influence on dose distribution and fluence map in IMRT dynamic technique

AimTo examine the impact of beam rate on dose distribution in IMRT plans and then to evaluate agreement of calculated and measured dose distributions for various beam rate values.BackgroundAccelerators used in radiotherapy utilize some beam rate modes which can shorten irradiation time and thus reduce ability of patient movement during a treatment session. This aspect should be considered in high conformal dynamic techniques.Materials and methodsDose calculation was done for two different beam rates (100 MU/min and 600 MU/min) in an IMRT plan. For both, a comparison of Radiation Planning Index (RPI) and MU was conducted. Secondly, the comparison of optimal fluence maps and corresponding actual fluence maps was done. Next, actual fluence maps were measured and compared with the calculated ones. Gamma index was used for that assessment. Additionally, positions of each leaf of the MLC were controlled by home made software.ResultsDose distribution obtained for lower beam rates was slightly better than for higher beam rates in terms of target coverage and risk structure protection. Lower numbers of MUs were achieved in 100 MU/min plans than in 600 MU/min plans. Actual fluence maps converted from optimal ones demonstrated more similarity in 100 MU/min plans. Better conformity of the measured maps to the calculated ones was obtained when a lower beam rate was applied. However, these differences were small. No correlation was found between quality of fluence map conversion and leaf motion accuracy.ConclusionExecution of dynamic techniques is dependent on beam rate. However, these differences are minor. Analysis shows a slight superiority of a lower beam rate. It does not significantly affect treatment accuracy.     

An invisible ubiquitin conformation is required for efficient phosphorylation by PINK1

The Ser/Thr protein kinase PINK1 phosphorylates the well‐folded, globular protein ubiquitin (Ub) at a relatively protected site, Ser65. We previously showed that Ser65 phosphorylation results in a conformational change in which Ub adopts a dynamic equilibrium between the known, common Ub conformation and a distinct, second conformation wherein the last β‐strand is retracted to extend the Ser65 loop and shorten the C‐terminal tail. We show using chemical exchange saturation transfer (CEST) nuclear magnetic resonance experiments that a similar, C‐terminally retracted (Ub‐CR) conformation also exists at low population in wild‐type Ub. Point mutations in the moving β5 and neighbouring β‐strands shift the Ub/Ub‐CR equilibrium. This enabled functional studies of the two states, and we show that while the Ub‐CR conformation is defective for conjugation, it demonstrates improved binding to PINK1 through its extended Ser65 loop, and is a superior PINK1 substrate. Together our data suggest that PINK1 utilises a lowly populated yet more suitable Ub‐CR conformation of Ub for efficient phosphorylation. Our findings could be relevant for many kinases that phosphorylate residues in folded protein domains.