Building Research Capacity in Vascular Biology in Rhode Island.

The CardioPulmonary Vascular Biology Center for Biomedical Research Excellence (CPVB COBRE) was funded in 2013 by the National Institute for General Medical Sciences to establish a collaborative center for research excellence in vascular biology in Rhode Island. The CPVB COBRE has funded successful junior faculty investigators and pilot projects spanning the research spectrum from basic vascular development mechanisms using zebrafish to clinical research on pulmonary hypertension to the effects of mindfulness on hypertension in pregnancy. The Administrative Core has united the group with an active seminar program with visiting experts, a focus on career development, and the use of evaluation to support continuous improvement. The Cell Isolation and Organ Function Core has provided high-quality research services and expertise. Most importantly, hard-working and creative physicians and basic scientist investigators and mentors have worked together to expand the spectrum of vascular biology research in Rhode Island.

Formative evaluation results of a phase 2 Center of Biomedical Research Excellence (COBRE).

INTRODUCTION: Because a primary focus of Centers of Biomedical Research Excellence (COBRE) is the development of junior-level investigators into competent and successful research scientists, evaluation of their skills, mentoring experiences, and usefulness of COBRE services is paramount to the transition of the Center to a self-sustaining, collaborative, multidisciplinary research environment. A formative evaluation, focused on the processes of a COBRE, was undertaken and is presented here. METHODS: Two instruments, one for completion by junior investigators and one for completion by mentors, were developed for the purpose of evaluating this COBRE. Areas of inquiry were relationships between junior investigators and mentors, research self-efficacy, mentee progress, and satisfaction with the COBRE. All eight of the COBRE's current junior investigators and six of their mentors completed the online questionnaires. RESULTS: Junior investigators were very positive about mentors and vice versa. Junior investigators were least positive about their progress as academicians and most positive about their abilities to develop collaborations with other scholars/professionals. Mentors felt as though junior investigators could benefit most by increasing the number of publications they had generated. CONCLUSIONS: Activities provided by the CardioPulmonary Vascular Biology (CPVB) COBRE were extremely positive. Junior investigators felt as though the scientific, academic, and professional development opportunities afforded by this COBRE were integral to their success as researchers; however they would like more assistance developing professional networks (i.e., serving on committees of professional societies). Leadership of the CPVB COBRE may consider expanding the role of their advisory committee to ensure these opportunities are provided.

Multiplexed real-time polymerase chain reaction cell-free DNA assay as a potential method to monitor stage IV colorectal cancer.

BACKGROUND: Liquid biopsy is a new area in cancer diagnostics that measures cell-free DNA in plasma from tumor that may serve as a monitoring tool in colorectal cancer patients. METHODS: Multiplexed real-time polymerase chain reaction based on multicopy retro-transposable elements (targeting 80 base pair and 265 base pair sequences and an internal-positive-control) was used to evaluate the ability of cell-free DNA concentration and DNA Integrity Index to discriminate cancer from healthy patients. A cohort of 40 healthy controls and 39 stage IV colorectal patient's plasma were interrogated. The potency of each biomarker was measured by using receiver operating characteristic curves and derived area under the curve measures. RESULTS: Significant differences in cell-free DNA concentration and DNA integrity index were observed between controls and stage IV patients with a limit of detection <0.1 pg/µL. Investigation of the ability of both biomarker candidates to differentiate cancer from healthy patients showed an area under the curve of 0.9891 and 0.9859 for 80 base pair and 265 amplicons respectively and 0.8603 for DNA integrity index-265/80. CONCLUSIONS: After establishing differences in cell-free DNA levels between healthy and treated and untreated stage IV patients, the multiplexed real-time polymerase chain reaction measurements of retro-transposable elements in cancer patient plasma potentially possess the ability to monitor therapy responsiveness in near real time.

"Strange and otherwise unaccountable actions": category, conundrum, and trans identities.

Despite recognizing that gender identity is a complex compromise formation, psychotherapists struggle to tolerate gender variance. We still tend to favor binary gender identities and clear developmental lines, rather than embracing a stance of subversive curiosity about the variability and fluidity of gender in our patients. When gender identity is fluid or ambiguous, countertransferential affective disturbances can arise that meld states of abjection and excitement, challenging theoretical constructs and threatening therapeutic neutrality. Case material from the treatment of a female-to-male trans person is presented from the perspective of the transference-countertransference matrix.

Seduction and revenge in Virginia Woolf's Orlando.

Virginia Woolf's Orlando was characterized by Nigel Nicolson as a "charming love letter" to his mother, Vita Sackville-West. The fictional biography was actually an attempt by Woolf to organize herself after the unbearable humiliation of Vita's abandoning her for another woman. In imagining, writing, and publishing Orlando, Woolf turns her despair about Vita's betrayal into a monument of revenge, defending against disorganizing feelings of humiliation, powerlessness, rage, and loss by creating her own scathing portrait of Vita. In the novel, Woolf also intermittently merges herself with Orlando/Vita to create a permanent tie to the woman who--like her mother and sister--excited and rejected her.

A syringe prescription program to prevent infectious disease and improve health of injection drug users.

Injection drug users (IDUs) are at increased risk for many health problems, including acquisition of human immunodeficiency virus (HIV) and hepatitis B and C. These risks are compounded by barriers in obtaining legal, sterile syringes and in accessing necessary medical care. In 1999, we established the first-ever syringe prescription program in Providence, Rhode Island, to provide legal access to sterile syringes, reduce HIV risk behaviors, and encourage entry into medical care. Physicians provided free medical care, counseling, disease testing, vaccination, community referrals, and prescriptions for sterile syringes for patients who were not ready to stop injecting. We recruited 327 actively injecting people. Enrolled participants had limited stable contact with the health care system at baseline; 45% were homeless, 59% were uninsured, and 63% did not have a primary care physician. Many reported high-risk injection behaviors such as sharing syringes (43% in the last 30 days), reusing syringes (median of eight times), and obtaining syringes from unreliable sources (80%). This program demonstrates the feasibility, acceptability, and unique features of syringe prescription for IDUs. The fact that drug use is acknowledged allows an open and frank discussion of risk behaviors and other issues often not disclosed to physicians. The syringe prescription program in Providence represents a promising and innovative approach to disease prevention and treatment for IDUs.

Pharmacist support for selling syringes without a prescription to injection drug users in Rhode Island.

OBJECTIVE: To examine pharmacists' attitudes and obstacles to syringe sales to IDUs without prescriptions in Rhode Island, around the time that such sales became legal in the state. DESIGN: Self-administered written survey. SETTING: Rhode Island. PARTICIPANTS: 400 randomly selected pharmacist members of the Rhode Island Pharmacists Association. MAIN OUTCOME MEASURES: Responses to survey items. RESULTS: Of the 400 pharmacists contacted, 131 (33%) completed and returned the survey; of these, 101 (77%) were pharmacists who worked in stores that provided direct nonprescription syringe sales to the public. The majority of these 101 pharmacists were willing to sell syringes to a suspected IDU without a prescription (65%), favored providing free sharps containers for disposal (68%), and supported providing pamphlets on safer injection practices (88%). Willingness to sell syringes to IDUs without a prescription was significantly correlated with various beliefs about possible consequences of sales. CONCLUSION: The high level of support for nonprescription syringe sales to IDUs is promising. The correlation between the willingness to sell syringes to IDUs without a prescription and various beliefs suggests that future educational interventions might encourage pharmacists to sell syringes to this population without a prescription to decrease HIV and hepatitis transmission.