Finding a place for genomics in health disparities research.

The existence of pronounced differences in health outcomes between US populations is a problem of moral significance and public health urgency. Pursuing research on genetic contributors to such disparities, despite striking data on the fundamental role of social factors, has been controversial. Still, advances in genomic science are providing an understanding of disease biology at a level of precision not previously possible. The potential for genomic strategies to help in addressing population-level disparities therefore needs to be carefully evaluated. Using 3 examples from current research, we argue that the best way to maximize the benefits of population-based genomic investigations, and mitigate potential harms, is to direct research away from the identification of genetic causes of disparities and instead focus on applying genomic methodologies to the development of clinical and public health tools with the potential to ameliorate healthcare inequities, direct population-level health interventions or inform public policy. Such a transformation will require close collaboration between transdisciplinary teams and community members as well as a reorientation of current research objectives to better align genomic discovery efforts with public health priorities and well-recognized barriers to fair health care delivery.

Patient physical characteristics and primary care physician decision making in preconception genetic screening.

BACKGROUND: There has been growing emphasis on preconception care as a strategy to improve maternal and child health since the 1980s. Increasingly, development of genetic tests will require primary care providers to make decisions about preconception genetic screening. Limited research has been conducted on how primary care providers interpret patients' characteristics and use constructs, such as ethnicity and race, to decide whom to offer preconception genetic screening. OBJECTIVE: This report assessed the influence of patient characteristics on decisions to offer preconception genetic screening. METHODS: A web-based survey of family physicians was conducted. Physicians reviewed a clinical vignette that was accompanied by a picture of either a black or a white patient. Physicians indicated whether they would offer genetic screening, and if yes, what tests they would offer and what factors influenced their decisions. RESULTS: The majority (69.2%) of physicians reported that they would not offer genetic screening. Respondents who reviewed the vignette accompanied by a picture of the black patient were more likely to offer screening (35% vs. 26%, p = 0.0034) and rated race as more important to their decision to offer testing than those who viewed the picture of the white patient (76% vs. 49%, p < 0.0001). CONCLUSIONS: Our findings suggest that patient race is important to physicians when making decisions about preconception genetic testing and that decision making is influenced by patients' physical characteristics. The reticence of physicians in this sample to offer preconception screening is an important finding for public health and clinical practice.

Ion transport during hypothermia in cultured heart cells: implications for protection of the immature myocardium.

In non-adult hearts, hypothermia influences protection of the myocardium by exerting effects on specific ion transporters, thereby altering the normal balance between ion pumps and ion leaks. We studied the effects of hypothermia on individual ion transporters in cardiac myocytes to better understand how to preserve the normal ion balance at reduced temperatures, and thereby enhance myocardial protection. Cardiocytes obtained from 11 day chick embryos were cultured for 3 days, and then equilibrated in a glucose containing HEPES-TRIS buffered salt solution at 37 degrees C (pH = 7.4). The cells were incubated at 10 +/- 2 degrees C for 5 to 360 min in the absence or presence of specific ion transport inhibitors, and ion contents were assessed by atomic absorption spectrophotometry. Intracellular Na content increased from approximately 90 nmol/mg protein (control) to 2-3 times this value within 30 min, and then returned to control levels by 60 min. This increase in Na was accompanied by a small rise in total Ca (1.5 times control). Acidotic pH (6.4) and/or ethylisopropyl amiloride (100 microM), but not bumetanide (100 microM) prevented the rise in Na content, suggesting the Na/H exchanger contributed to the initial Na influx. Ouabain (1 mM), exacerbated the Na rise and prevented its recovery to control values at 10 degrees C, although Rb flux measurements revealed only a low level of Na/K ATPase activity throughout 240 min at 10 degrees C (15% of 37 degrees C activity). Calcium content rose to 10 times control values in the presence of ouabain at 37 degrees C only, consistent with a lack of significant Na/Ca exchange activity during hypothermia. In conclusion, the effects of hypothermia on ion pumps and ion leaks in embryonic heart cells are as follows: (1) a low level of Na/K ATPase activity contributes significantly to ion regulation; (2) activity of the Na/H exchanger must be attenuated to minimize Na loading; (3) slowing of the Na/Ca exchange may reduce Ca induced cell injury. We suggest that reducing Na/H exchange activity during hypothermia, using cardioplegic solutions with a slightly acidic pH or with added ethylisopropyl amiloride, may enhance the protective effects of hypothermia in non-adult hearts.

Handwritten digit recognition by neural networks with single-layer training.

It is shown that neural network classifiers with single-layer training can be applied efficiently to complex real-world classification problems such as the recognition of handwritten digits. The STEPNET procedure, which decomposes the problem into simpler subproblems which can be solved by linear separators, is introduced. Provided appropriate data representations and learning rules are used, performance comparable to that obtained by more complex networks can be achieved. Results from two different databases are presented: an European database comprising 8700 isolated digits and a zip code database from the US Postal Service comprising 9000 segmented digits. A hardware implementation of the classifier is briefly described.