Exploring Potential for a Personalized Medicine Approach to Smoking Cessation With an American Indian Tribe.

INTRODUCTION: A potential precision medicine approach to smoking cessation is tailoring pharmacotherapy to a biomarker known as the nicotine metabolite ratio (NMR). Little is known about the potential impact and acceptability of this approach for American Indian (AI) persons. AIMS AND METHODS: Tribal-academic collaboration was formed and during 2019-2020 AI adults who smoke(N = 54) were recruited to (1) examine correlations between NMR, dependence, and smoking exposure; (2) assess the extent to which pharmacotherapy preference aligned with NMR-informed recommendations; (3) explore acceptability of NMR-informed pharmacotherapy selection. Participants provided samples for assessment of salivary NMR and urinary total nicotine equivalents (TNE) and completed a questionnaire that assessed cigarettes per day (CPD), Fagerstrom Test for Cigarette Dependence (FTCD), pharmacotherapy preference, and perceptions of NMR-informed pharmacotherapy selection. RESULTS: Significant positive correlations were observed between NMR and FTCD (r = 0.29;p = .0383) and its abbreviated version Heaviness of Smoking Index (HIS) (r = 0.28;p =.0426). Post-hoc analyses suggest that relationships between dependence and NMR were driven by time to first cigarette. Nonsignificant, but directionally consistent, relationships were observed between NMR and CPD (r = 0.21; p =0.1436) and TNE (r = 0.24;p = .2906). Most participants preferred nicotine replacement therapy (71%) over varenicline (29%) and preference for pharmacotherapy matched NMR-based recommendations in 54% of participants. NMR-informed pharmacotherapy selection was supported by 62% of participants. CONCLUSION: In a sample of AI adults who smoke, NMR was related to cigarette dependence and about one-half of participants' pharmacotherapy preference matched their NMR-informed recommendation. There was lower acceptability of NMR-informed approach in this sample of AI adults than prior studies among white or black/African American people who smoke. IMPLICATIONS: Relationships between NMR, dependence, and self-preference for pharmacotherapy suggest that NMR-informed pharmacotherapy selection may have potential for enhancing smoking quitting success in this Tribe. Lower acceptability of NMR-informed pharmacotherapy in this Tribe suggests that this approach may not be equitably utilized. Future work could include identifying community-driven solutions to mitigate precision medicine concerns.

[Social frailty among older people]. / Definición de fragilidad social en personas mayores: una revisión bibliográfica.

Social frailty is a seldom explored concept in older people. There is dissent if it should be considered a multidimensional syndrome or it should be limited to the physical sphere. We conducted a review aiming to develop a concept of social frailty in older people using PubMed, BVS and CINAHL databases. We found ten articles. One exposes the concept of social frailty, nine operationalize social frailty using questions or items on social behavior and two use scales or measuring instruments to classify older people as "socially frail". It is concluded that social frailty is a new concept in gerontology: there are divergences as to whether it should be considered as another dimension of frailty or as an independent concept with a predictive capacity by itself to detect risk among older people.

The Tribal Tobacco Education and Policy Initiative: Findings From a Collaborative, Participatory Evaluation.

While the reduction in the overall U.S. smoking prevalence has been declared one of the top 10 public health achievements of the past century, the growing disparity in smoking between American Indians and the general population is one of the biggest challenges of the 21st century. Minnesota in particular has very high smoking rates among American Indians (59%). Tribal Nations in Minnesota share a past of attempted cultural genocide and a present of restoring the strength of their cultural teachings, including the prominence of traditional tobacco as a sacred "first medicine." The Tribal Tobacco Education and Policy initiative works to address this complex and challenging context. This article describes results of a participatory evaluation from 2010 to 2013 in four Minnesota Tribal Nations-three Ojibwe and one Dakota. Tribal Tobacco Education and Policy coordinators used their cultural knowledge to develop community-level strategies, identifying appropriate strategies from best practices on tobacco advocacy, while drawing on the strengths of their own sovereignty and sacred tobacco traditions. Tribal coordinators generated support for policy change by conducting culturally relevant education, engaging tribal members, and nurturing relationships. This approach resulted in norm changes, practices toward restoring traditional tobacco, informal policies, and tribal resolutions to advance smoke-free policies.

Why the World Will Never Be Tobacco-Free: Reframing "Tobacco Control" Into a Traditional Tobacco Movement.

As successes mount in reducing commercial tobacco use, an alarming disparity has taken shape in Minnesota. Recent studies revealed that overall smoking rates have dropped to 14%, whereas American Indians' rates remain higher than 50%. With support from ClearWay Minnesota, the organization created from the state's tobacco settlement, advocates working within sovereign tribal governments to create smoke-free policies came together to discuss effective strategies within tribal Nations. We discussed the history behind mainstream tobacco control's failure to resonate with Native audiences and the need to reframe the movement to a goal of restoring traditional tobacco practices. We share our insights on this critical area for achieving health equity and provide recommendations for tribes, non-Indian advocates, and funders, with a plea for tribal inclusion in commercial tobacco "end-game" strategies.

An integrative approach to understanding the evolution and diversity of Copiapoa (Cactaceae), a threatened endemic Chilean genus from the Atacama Desert.

PREMISE OF THE STUDY: Species of the endemic Chilean cactus genus Copiapoa have cylindrical or (sub)globose stems that are solitary or form (large) clusters and typically yellow flowers. Many species are threatened with extinction. Despite being icons of the Atacama Desert and well loved by cactus enthusiasts, the evolution and diversity of Copiapoa has not yet been studied using a molecular approach. METHODS: Sequence data of three plastid DNA markers (rpl32-trnL, trnH-psbA, ycf1) of 39 Copiapoa taxa were analyzed using maximum likelihood and Bayesian inference approaches. Species distributions were modeled based on geo-referenced localities and climatic data. Evolution of character states of four characters (root morphology, stem branching, stem shape, and stem diameter) as well as ancestral areas were reconstructed using a Bayesian and maximum likelihood framework, respectively. KEY RESULTS: Clades of species are revealed. Though 32 morphologically defined species can be recognized, genetic diversity between some species and infraspecific taxa is too low to delimit their boundaries using plastid DNA markers. Recovered relationships are often supported by morphological and biogeographical patterns. The origin of Copiapoa likely lies between southern Peru and the extreme north of Chile. The Copiapó Valley limited colonization between two biogeographical areas. CONCLUSIONS: Copiapoa is here defined to include 32 species and five heterotypic subspecies. Thirty species are classified into four sections and two subsections, while two species remain unplaced. A better understanding of evolution and diversity of Copiapoa will allow allocating conservation resources to the most threatened lineages and focusing conservation action on real biodiversity.

Validation of the PESI Scale to Predict in-Hospital Mortality in Patients with Pulmonary Thromboembolism Secondary to SARS CoV - 2 Infection.

OBJECTIVE: To evaluate the discriminative ability and the calibration of the Pulmonary Embolism Severity Index (PESI) to predict in-hospital mortality in patients with Pulmonary Embolism (PE) secondary to COVID 19 in two hospitals in Bogotá. METHODS: External validation study of a prediction model based on a retrospective cohort of patients with PE secondary to COVID-19 treated at Hospital Universitario San Ignacio and Hospital universitario La Samaritana, between March 2020 and August 2021. Calibration of the scale was evaluated using the Hosmer-Lemeshow test and a calibration belt diagram. Discrimination ability was evaluated using a ROC curve. RESULTS: 272 patients were included (median age 61.5 years, male 58.8%). PE was diagnosed in 45.6% of the patients at the time of admission. Of the remaining 54.4%, 95.9% received thromboprophylaxis until the time of diagnosis.17.6% of the patients died. Regarding calibration, the scale systematically underestimates risk in all classes of PESI. For class I, the ratio of observed/expected events was 4.4 vs 0.8%, class II 4.8 vs 1.8%, class III 15.2 vs 4.2%, class IV 14.3 vs 5.9% and class V 46.7 vs 5.8%. The calibration test rejected the adequate calibration hypothesis (p < 0.001). The discriminatory ability was adequate (AUC = 0.7128, 95% CI 0.63-0.79). CONCLUSIONS: The PESI scale in patients with PE secondary to COVID 19 underestimates the risk of in-hospital mortality, while maintaining adequate discrimination. It is suggested not to use the PESI scale until it is recalibrated in this context.

Recommendations to researchers for aiding in increasing American Indian representation in genetic research and personalized medicine.

Increasing American Indian/Alaska Native (AI/AN) representation in genetic research is critical to ensuring that personalized medicine discoveries do not widen AI/AN health disparities by only benefiting well-represented populations. One reason for the under-representation of AIs/ANs in research is warranted research distrust due to abuse of some AI/AN communities in research. An approach to easing the tension between protecting AI/AN communities and increasing the representation of AI/AN persons in genetic research is community-based participatory research. This approach was used in a collaboration between a tribe and academic researchers in efforts to increase AI/AN participation in genetic research. From the lessons learned, the authors propose recommendations to researchers that may aid in conducting collaborative and respectful research with AI/AN tribes/communities and ultimately assist in increasing representation of AIs/ANs in personalized medicine discoveries.

Definición de fragilidad social en personas mayores: una revisión bibliográfica

Social frailty is a seldom explored concept in older people. There is dissent if it should be considered a multidimensional syndrome or it should be limited to the physical sphere. We conducted a review aiming to develop a concept of social frailty in older people using PubMed, BVS and CINAHL databases. We found ten articles. One exposes the concept of social frailty, nine operationalize social frailty using questions or items on social behavior and two use scales or measuring instruments to classify older people as "socially frail". It is concluded that social frailty is a new concept in gerontology: there are divergences as to whether it should be considered as another dimension of frailty or as an independent concept with a predictive capacity by itself to detect risk among older people.

Conocimientos, prácticas y actitudes sobre la malaria en el municipio de Lloró, Chocó, Colombia / Knowledge, practices and attitudes about malaria in the municipality of Lloró, Chocó, Colombia

Objetivo: determinar los conocimientos, actitudes y prácticas acerca de la malaria en el municipio de Lloró, Chocó, Colombia. La malaria es una enfermedad prevenible y curable si se plantean las estrategias correctas para lograrlo; Lloró, es uno de los municipios con índices de malaria más altos en Colombia; muy pocos estudios evalúan el conocimiento, prácticas y actitudes frente a esta enfermedad y ninguno está dirigido a esta población. Es necesario identificar falencias y fortalezas para reforzar los métodos de prevención, diagnóstico oportuno y adherencia al tratamiento. Materiales y métodos: estudio de corte transversal realizado mediante muestreo probabilístico por conveniencia. Se aplicó́ una encuesta dirigida de 50 preguntas. En el análisis descriptivo se utilizaron frecuencias absolutas y relativas Resultados: se realizaron 374 encuestas en la cabecera municipal de Lloró. El 78.96 % de la población ha sufrido malaria, 88,76 % conoce la enfermedad como paludismo, 86,46 % conoce el mecanismo de infección, 96,4 % reconoce la malaria como un problema, 51 % realiza acciones preventivas contra la malaria, 52,74 % usa mosquitero como método de prevención, 98,27 % acude al centro de salud cuando enferman de malaria, 75,5 % consume la totalidad del tratamiento antimalárico. Conclusión: la población tiene conocimientos adecuados sobre la enfermedad, sin embargo, se encontraron prácticas y actitudes inadecuadas, susceptibles de ser intervenidas con educación preventiva..(AU)

Objective: to determine the knowledge, attitudes and practices about malaria in the municipality of Lloró, Chocó, Colombia. Malaria is a preventable and treatable disease if the right strategies are presented; Lloró, is one of the municipalities with the highest rates of malaria in Colombia; very few studies evaluate the knowledge, practices and attitudes towards this preventable disease and none is directed to this population. In order to strengthen the strategies of prevention, timely diagnosis and adherence to treatment, this study was conducted. Material and Methods: cross-sectional study performed by consecutive probabilistic convenience sampling. A 50 questions personal interview survey was applied. In order to analyze relative and absolute frequencies were used; Results: 374 surveys were applied in the urban area of Lloró, Chocó.78,96 % of the population has suffered malaria, 88,76 % recognized the disease as malaria, 86,46 % understand the mechanism of infection, 96,4 % recognize malaria as a problem, 51 % takes preventive action against malaria, 52.74 % uses mosquito netting as a prevention method, 98,27 % goes to the health provider when they get malaria, 75,5 % consumes the whole antimalarial treatment. Conclusion: the population has adequate knowledge about the disease, however practices and attitudes were inadequate, which could be intervened by the use of preventive education..(AU)

Training the Trainers of Tomorrow Today - driving excellence in medical education.

Training the Trainers of Tomorrow Today (T4) is a new way to deliver "Training for Trainers". Responding to local dissatisfaction with existing arrangements, T4 builds on 3 essential requirements for a future shape of training: 1. Clinical Leadership and a Collaborative Approach 2. Cross-Specialty Design and Participation 3. Local Delivery and Governance Networks Design principles also included: 3 levels of training to reflect differing needs of clinical supervisors, educational supervisors and medical education leader, mapping to GMC requirements and the London Deanery's Professional Development Framework; alignment of service, educational theory and research; recognition of challenges in delivering and ensuring attendance in busy acute and mental health settings, and the development of a faculty network. The delivery plan took into account census of professional development uptake and GMC Trainee Surveys. Strong engagement and uptake from the 11 Trusts in NW London has been achieved, with powerful penetration into all specialties. Attendance has exceeded expectations. Against an initial 12 month target of 350 attendances, 693 were achieved in the first 8 months. Evaluation of content demonstrates modules are pitched appropriately to attendees needs, with positive feedback from trainers new to the role. Delivery style has attracted high ratings of satisfaction: 87% attendees rating delivery as "good\excellent". External evaluation of impact demonstrated improved training experiences through changes in supervision, the learning environment and understanding of learning styles. We have addressed sustainability of the programme by advertising and recruiting Local Faculty Development Trainers. Volunteer consultants and higher trainees are trained to deliver the programme on a cascade model, supported by the Specialty Tutors, individual coaching and educational bursaries. The Trainers are local champions for excellence in training, provide a communication between the programme and local providers, are a repository of expertise in their service, and trouble shoot local barriers to engagement.

Angiotensin-(1-9) regulates cardiac hypertrophy in vivo and in vitro.

BACKGROUND: Angiotensin-(1-9) is present in human and rat plasma and its circulating levels increased early after myocardial infarction or in animals treated with angiotensin-converting enzyme inhibitor. However, the cardiovascular effects of this peptide are unknown. OBJECTIVE: To determine whether angiotensin-(1-9) is a novel anti-cardiac hypertrophy factor in vitro and in vivo and whether this peptide is involved in the pharmacological effects of cardiovascular drugs acting on the renin-angiotensin system. METHODS AND RESULTS: The administration of angiotensin-(1-9) to myocardial infarcted rats by osmotic minipumps (450 ng/kg per min, n = 6) vs. vehicle (n = 8) for 2 weeks decreased plasma angiotensin II levels, inhibited angiotensin-converting enzyme activity and also prevented cardiac myocyte hypertrophy. However, cardiac myocyte hypertrophy attenuation triggered by angiotensin-(1-9) was not modified with the simultaneous administration of the angiotensin-(1-7) receptor antagonist A779 (100 ng/kg per min, n = 6). In experiments in vitro with cultured cardiac myocytes incubated with norepinephrine (10 micromol/l) or with insulin-like growth factor-1 (10 nmol/l), angiotensin-(1-9) also prevented hypertrophy. In other experimental setting, myocardial infarcted rats (n = 37) were randomized to receive either vehicle (n = 12), enalapril (10 mg/kg per day, n = 12) or angiotensin II receptor blocker candesartan (10 mg/kg per day, n = 13) for 8 weeks. Both drugs prevented left ventricle hypertrophy and increased plasma angiotensin-(1-9) levels by several folds. Angiotensin-(1-9) levels correlated negatively with different left ventricular hypertrophy markers even after adjustment for blood pressure reduction. CONCLUSION: Angiotensin-(1-9) is an effective and a novel anti-cardiac hypertrophy agent not acting via the Mas receptor.

Nurse practitioner educators' perceived knowledge, beliefs, and teaching strategies regarding evidence-based practice: implications for accelerating the integration of evidence-based practice into graduate programs.

UNLABELLED: The paradigm shift to evidence-based practice (EBP) in the United States has been slow. Evidence has supported that one barrier to accelerating this paradigm shift is that many nurses have negative attitudes toward research, in large part due to the manner in which they were taught research in their educational programs. The primary aims of this study were to (a) describe nurse educators' knowledge, beliefs, and teaching practices regarding EBP; (b) determine whether relationships exist among these variables; and (c) describe major barriers and facilitators to the teaching of EBP in nurse practitioner curriculums. A descriptive survey was conducted with a sample of 79 nurse practitioner educators who are members of the Association of Faculties of Pediatric Nurse Practitioners (AFPNP) and the National Organization of Nurse Practitioner Faculties (NONPF). The 25 AFPNP participants completed the survey while attending a national conference in Orlando, FL. The remaining 54 NONPF randomly selected participants responded to an e-mail version of the survey. Participants' self-reported knowledge and beliefs about the benefits of EBP and the need to integrate it into academic curricula were strong, although their responses indicated a knowledge gap in EBP teaching strategies. Few academic programs offered a foundational course in EBP. Significant relationships were found among educators' knowledge of EBP and (a) their beliefs that EBP improves clinical care, (b) beliefs that teaching EBP will advance the profession, (c) how comfortable they feel in teaching EBP, and (d) whether EBP clinical competencies are incorporated into clinical specialty courses. CONCLUSION AND IMPLICATIONS: Graduate programs need to offer a foundational course in EBP and integrate EBP throughout clinical specialty courses in order for advanced practice nurses to implement this type of care upon entry into practice. There is a need to educate faculty to become proficient in EBP as knowledge of EBP is highly related to its teaching and incorporation into graduate education. Further research is needed to describe the knowledge and state of teaching EBP in graduate faculty who are not active in clinical practice.