Synthesis of Reactive Polymers for Acrolein Capture Using AGET ATRP.

Acrolein is a toxic metabolite of the anticancer agent cyclophosphamide (CP). Current strategies to mitigate acrolein toxicity are insufficient, and in this brief article, we report the synthesis of well-defined low molecular weight block copolymers using activators generated by electron transfer atom transfer radical polymerization (AGET ATRP) capable of reacting with the cytotoxic small molecule acrolein. Acrolein reactivity was introduced into the block copolymers via incorporation of either (a) aminooxy or (b) sulfhydryl groups. The cytoprotective effect of the polymers was compared to sodium 2-sulfanylethanesulfonate (mesna) the current gold standard for protection from CP urotoxicity, and we found that the polymers bearing sulfhydryl moieties demonstrated superior cytoprotective activity.

Prescription opioid abuse: challenges and opportunities for payers.

OBJECTIVES: Prescription opioid abuse and addiction are serious problems with growing societal and medical costs, resulting in billions of dollars of excess costs to private and governmental health insurers annually. Although difficult to accurately assess, prescription opioid abuse also leads to increased insurance costs in the form of property and liability claims, and costs to state and local governments for judicial, emergency, and social services. This manuscript's objective is to provide payers with strategies to control these costs, while supporting safe use of prescription opioid medications for patients with chronic pain. METHOD: A Tufts Health Care Institute Program on Opioid Risk Management meeting was convened in June 2010 with private and public payer representatives, public health and law enforcement officials, pain specialists, and other stakeholders to present research and develop recommendations on solutions that payers might implement to combat this problem. RESULTS: While protecting access to prescription opioids for patients with pain, private and public payers can implement strategies to mitigate financial risks associated with opioid abuse, using internal strategies such as formulary controls, claims data surveillance, and claims matching; and external policies and procedures that support and educate physicians on reducing opioid risks among patients with chronic pain. CONCLUSIONS: Reimbursement policies, incentives, and health technology systems that encourage physicians to use universal precautions, to consult prescription monitoring program (PMP) data, and to implement Screening, Brief Intervention, and Referral to Treatment protocols have a high potential to reduce insurer risks while addressing a serious public health problem.

Restaurant volatility and the Iowa City, Iowa, smoke-free restaurant ordinance.

PURPOSE: To determine the economic impact of the Iowa City, Iowa, smoke-free restaurant ordinance (IC-SFRO) using an immediate and novel approach. DESIGN: In this retrospective study, food permit licensure served as the measure to assess the IC-SFRO impact. The Iowa City experience provided an excellent experimental setting, as the ordinance was enacted March 1, 2002, and repealed May 7, 2003, because of preemption. SETTING: The city of Coralville served as a natural control, as it is contiguous to Iowa City, has similar population demographics, and has never enacted a smoke-free restaurant ordinance. MEASURES: Food permit licensure data for all Iowa City and Coralville restaurants were obtained from the Johnson County Health Department. ANALYSIS: Differences in restaurant volatility were assessed using Fisher's exact probability test. RESULTS: The number of restaurants increased in both Iowa City and Coralville throughout the ordinance period. The ratio of the total number of restaurants in Iowa City to the total number of restaurants in the Iowa City-Coralville metropolitan area remained stable. The proportion of restaurants for each city did not differ significantly during the preordinance, ordinance, and postordinance periods. CONCLUSION: The IC-SFRO did not adversely impact the restaurant industry in terms of restaurant closures. The Iowa legislature was urged to draft evidence-based legislation, such as amending preemption of the IC-SFRO, to protect and promote the health of its communities.

Key questions for conducting role delineation research.

Role delineation research for the verification of professional competencies is essential in many professions to promote quality assurance and support capacity building and workforce development. In this article, guidance is provided about key aspects of role delineation research. The information contained in this article focuses on 13 key questions within three selected research phases when attempting to identify and verify the roles that are inherent within any given profession. The major sections in the paper include planning the research, collecting and analyzing the data, interpreting findings, and considering the future. Recommendations and examples related to each of the important questions are provided to assist others undertaking role delineation research.

Workforce development: using role delineation research findings for policy-making and professional practice.

For the health education profession in the United States, role delineation research has been ongoing to identify valid professional competencies as the basis for workforce development. During 1998-2004, a multi-phase national research study, the National Health Educator Competencies Update Project (CUP), was designed to re-verify the role of the entry-level health educator, and further define and verify the role of advanced level health educators. The CUP findings are the evidence that has influenced the professional preparation, credentialing, and professional development of health educators. The lessons learned include the importance of employing role delineation research with a discipline-specific representative sample to appropriately affect workforce development and sustainability through an empirically-based model.

A role delineation study of health educators in the United States: methodological innovations.

This paper focuses on methodological innovations used in the National Health Educator Competencies Update Project (CUP) in the United States. The CUP was a six-year research study designed to delineate the role of the health educator in the USA. Individuals who self-identified as health educators were included in the study. To provide context, the background for the research is presented, followed by a brief overview of the research process. Some of the key methodological innovations discussed are: selecting a representative sample when the total population of those working as health educators was not easily identified or readily accessible; assessing response methodology preferences through pilot studies; enhancing the response rate through accurate, up-to-date mailing lists and incentives; and exploring new approaches to large-scale data analyses. Insights gained are included for other researchers who may wish to undertake similar studies or draw from the CUP dataset for secondary analyses.

Fetal-maternal microchimerism in normal parous females and parous female cancer patients.

OBJECTIVE: The prevalence of male microchimerism (MC) in parous females, nonparous females, and parous female cancer patients was examined. MATERIALS AND METHODS: DNA extracted from peripheral blood leukocytes and male Y-chromosomal DNA was amplified using a sensitive two-stage polymerase chain reaction technique. Controls prepared by mixing human male and female cell lines demonstrated the sensitivity of the technique to be in the range of 1 male cell per 1 million female cells. RESULTS: Findings of this study showed that the percentage of MC-positive females was highly dependent on the amount of DNA analyzed; 57% of normal parous females who bore at least one son were found to have male cells in their blood when 25 mug DNA or more from the samples was analyzed. This frequency is much higher than previous reports indicating a prevalence of 33% for normal parous females. Analysis of samples obtained from 200 parous female cancer patients revealed an incidence of 34% MC(+); 7.4% of normal nonparous female controls had evidence of MC. CONCLUSION: The long-term persistence of male cells in the maternal circulation could indicate maternal immune tolerance of paternally inherited fetal antigens. This maternal tolerance might be exploited in female patients with malignant disease to deliver immune cellular therapy from their sons.

An assessment of emergency preparedness in western Wisconsin.

BACKGROUND: Emergency preparedness is important for our national defense. Preparedness has been prioritized in Wisconsin, but little has been done to gauge the knowledge, training, and resource gaps that remain-especially those that are necessary for a coordinated community response. OBJECTIVE: To determine the emergency preparedness knowledge, training, and resource needs of community-based professionals in Western Wisconsin, an assessment was conducted during 2004-2005, centering around a coordinated community response training exercise involving more than 100 civilian and military personnel. METHODS: The assessment used questionnaires, observation, and interviews to gather data. The target population was comprised of 10 professional cohorts: physicians, nurses, public health and mental health professionals, health educators, veterinarians, pharmacists, dental professionals, law enforcement, and emergency/ fire personnel. The survey was delimited to 7 Western Wisconsin counties. RESULTS: The findings revealed that training needs existed across all cohorts, with the most acute training needs being decontamination procedures and communication. The highest awareness and knowledge levels occurred with physicians, nurses, and public health professionals. On-site coordination and communication systems were the weakest aspects of coordinated community response.

Overview of the National Health Educator Competencies Update Project, 1998-2004.

The National Health Educator Competencies Update Project (CUP), conducted during 1998-2004, addressed what health educators currently do in practice, the degree to which the role definition of the entry-level health educator is still up-to-date, and the validation of advanced-level competencies. A 19-page questionnaire was sent to a representative sample of health educators in recognized practice settings in all states and the District of Columbia. A total of 4,030 health educators participated in the research (70.6% adjusted response rate) resulting in the largest national data set of its kind, with 1.6 million data points. The model derived from the research was hierarchical (7 areas of responsibility, 35 competencies, and 163 subcompetencies), with three levels of practice (Entry, Advanced 1, and Advanced 2) differentiated by degrees earned and years of experience. The findings affect professional preparation, credentialing, and professional development.

Flt3+ macrophage precursors commit sequentially to osteoclasts, dendritic cells and microglia.

BACKGROUND: Macrophages, osteoclasts, dendritic cells, and microglia are highly specialized cells that belong to the mononuclear phagocyte system. Functional and phenotypic heterogeneity within the mononuclear phagocyte system may reveal differentiation plasticity of a common progenitor, but developmental pathways leading to such diversity are still unclear. RESULTS: Mouse bone marrow cells were expanded in vitro in the presence of Flt3-ligand (FL), yielding high numbers of non-adherent cells exhibiting immature monocyte characteristics. Cells expanded for 6 days, 8 days, or 11 days (day 6-FL, day 8-FL, and day 11-FL cells, respectively) exhibited constitutive potential towards macrophage differentiation. In contrast, they showed time-dependent potential towards osteoclast, dendritic, and microglia differentiation that was detected in day 6-, day 8-, and day 11-FL cells, in response to M-CSF and receptor activator of NFkappaB ligand (RANKL), granulocyte-macrophage colony stimulating-factor (GM-CSF) and tumor necrosis factor-alpha (TNFalpha), and glial cell-conditioned medium (GCCM), respectively. Analysis of cell proliferation using the vital dye CFSE revealed homogenous growth in FL-stimulated cultures of bone marrow cells, demonstrating that changes in differential potential did not result from sequential outgrowth of specific precursors. CONCLUSIONS: We propose that macrophages, osteoclasts, dendritic cells, and microglia may arise from expansion of common progenitors undergoing sequential differentiation commitment. This study also emphasizes differentiation plasticity within the mononuclear phagocyte system. Furthermore, selective massive cell production, as shown here, would greatly facilitate investigation of the clinical potential of dendritic cells and microglia.