Understanding Barriers and Facilitators to Signing Up for a Mobile-Responsive Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies.

BACKGROUND: Alzheimer's disease (AD) disproportionately affects Black/African American and Hispanic/Latino adults, yet they are underrepresented in AD studies. Recruitment challenges for these populations limit generalizability of findings. OBJECTIVES: This study explores barriers and facilitators to signing up for an AD participant recruitment registry website intended to optimize recruitment of these adults. The registry is geared toward recruitment on smartphones and tablets (mobile devices), as research suggests that mobile-first approaches may be more successful within these populations. DESIGN: In 2020, we conducted four focus groups (n = 39) and an online survey (n = 1010) with Black/African American and Hispanic/Latino adults. The survey also included Whites as a comparison group. SETTING: Focus groups were in-person at research facilities in New Orleans, Louisiana, and Los Angeles, California. The online survey was distributed by a survey panel company to participants nationwide. PARTICIPANTS: Black/African American (n = 360), Hispanic/Latino (n = 359), or White (n = 330) individuals, 45-75 years old, who self-reported not having mild cognitive impairment (MCI), dementia, or AD. MEASUREMENTS: Barriers and facilitators explored in the focus groups and survey were related to health and AD (e.g., AD-related concerns and past participation/willingness to participate in health or AD studies); current use of mobile devices (e.g., comfort using devices and receptivity to the AD recruitment registry); and participant characteristics and beliefs (e.g., demographics, health literacy level, and trust in government and the scientific community). RESULTS: The focus groups and survey revealed similar findings. Participants commonly use mobile devices to go online and perform health-related activities. They were aware of AD, expressed concerns with developing it, and were willing to participate in AD-related studies (motivated by personal connection to AD, altruism, and compensation). When presented with the AD recruitment registry, most provided positive feedback (e.g., easy to use and informative) and shared an interest in joining. Barriers to joining the registry with a mobile device included complex or multistep enrollment processes, beliefs that studies are primarily for those with a specific disease, and confusion about how studies can prevent AD among those low-risk for AD. The focus groups also revealed that Black/African American participants expressed more hesitation than Hispanic/Latinos in joining the registry due to greater distrust in the government and scientific community. CONCLUSIONS: Recruiting more Black/African American and Hispanic/Latino participants into AD studies is vitally important. This mixed methods study suggests that adults in these underrepresented groups are motivated to prevent AD and willing to sign up for an AD participant recruitment registry using mobile devices. Most barriers to joining a registry can be addressed through slight modifications to the registry's design and functionality and by adding content. These findings can help enhance the appeal of joining AD recruitment registries to ultimately enroll more diverse, representative groups of participants and increase the generalizability of AD study findings.

Development of a Mobile-First Registry to Recruit Healthy Volunteers and Members of Underrepresented Communities for Alzheimer's Disease Prevention Studies.

BACKGROUND: Web-based participant recruitment registries can be useful tools for accelerating enrollment into studies, but existing Alzheimer's disease (AD)-focused recruitment registries have had limited success enrolling individuals from underrepresented racial and ethnic groups. Designing these registries to meet the needs of individuals from these communities, including designing mobile-first, may facilitate improvement in the enrollment of underrepresented groups. OBJECTIVES: Evaluate the usability of a prototype mobile-first participant recruitment registry for AD prevention studies; assess users' perceptions of and willingness to sign up for the registry. DESIGN AND SETTING: Quantitative usability testing and an online survey; online setting. PARTICIPANTS: We recruited 1,358 adults ages 45-75 who self-reported not having a diagnosis of mild cognitive impairment, AD, or other forms of dementia (Study 1: n=589, Study 2: n=769). Black/African American and Hispanic/Latino participants were specifically recruited, including those with lower health literacy. METHODS AND MEASUREMENTS: Study 1 measures the prototype's usability through observed task success rates, task completion times, and responses to the System Usability Scale. Study 2 uses an online survey to collect data on perceptions of and willingness to sign up for the mobile-first registry. RESULTS: Study 1 findings show the prototype mobile-first recruitment registry website demonstrates high usability and is equally usable for Black / African American, Hispanic/Latino, and White user groups. Survey results from Study 2 indicate that users from underrepresented communities understand the registry's purpose and content and express willingness to sign up for the registry on a mobile device. CONCLUSIONS: Designing mobile-first participant recruitment registries based on feedback from underrepresented communities may result in more sign-ups by individuals from minoritized communities.

Visualization and quantitation of peroxisomes using fluorescent nanocrystals: treatment of rats and monkeys with fibrates and detection in the liver.

Peroxisome proliferation in the liver is a well-documented response that occurs in some species upon treatment with hypolipidemic drugs, such as fibrates. Typically, liver peroxisome proliferation has been estimated by direct counting via electron microscopy, as well as by gene expression, enzyme activity, and immunolabeling. We have developed a novel method for the immunofluorescent labeling of peroxisomes, using an antibody to the 70-kDa peroxisomal membrane protein (PMP70) coupled with fluorescent nanocrystals, Quantum Dots. This method is applicable to standard formalin-fixed, paraffin-embedded tissues. Using this technique, a dose-dependent increase in PMP70 labeling was evident in formalin-fixed liver sections from fenofibrate-treated rats. In formalin-fixed liver sections from cynomolgus monkeys given ciprofibrate, quantitative image analysis showed a statistically significant increase in PMP70 labeling compared to control; the increase in hepatic PMP70 protein levels was corroborated by immunoblotting using total liver protein. An increase in hepatic peroxisome number in ciprofibrate-treated monkeys was confirmed by electron microscopy. An advantage of the Quantum Dot/PMP70 method is that a single common protocol can be used to label peroxisomes from several different species, and many of the common problems that arise with immunolabeling, such as fading and low signal strength, are eliminated.

Differences in outpatient corticosteroid prescribing patterns between attending and house staff physicians as an indicator of the quality of supervision.

Computerized information systems have become an indispensable source of quality improvement data in the healthcare field. The degree to which we are successful in using these systems is limited only by our ability to ask the right questions. In this study, computerized patient records were used to evaluate the uniformity in the prescribing patterns for oral corticosteroids among house staff and attending physicians as a measure of the adequacy of resident supervision in the outpatient setting. Retrospective analysis of the records of 771 outpatients receiving prescriptions for oral corticosteroid preparations over 1 year in a large tertiary-care university-affiliated Department of Veterans Affairs Medical Center indicated different prescribing patterns for attending physicians and house staff. Additionally, it was noted that house staff tended to manage more complex patients than did attending physicians. We further evaluated the clinical outcomes of these patients to assess the quality, appropriateness, and comparability of care within cohorts of patients and to determine the degree to which resident supervision may have affected outcomes. The study results suggest that there is an opportunity to improve the management of patients treated with oral corticosteroid therapy by increasing staff physician involvement either through direct care of the most complex cases or through enhanced resident supervision.

Effect of ethanol on cholesteryl ester hydrolases in adrenal.

An assay of cholesteryl ester hydrolase activity of microsomes from guinea pig adrenal indicated maximal activity at pH at pH 4.0 and 5.5. When ethanol was added to the microsomes, these enzymes showed differences in response with increasing ethanol concentration. Rats administered 15% ethanol as drink for 4--5 months showed a small (20%) increase in cholesteryl ester hydrolase (pH 4.0) activity in adrenal as compared to controls. However, a 50% decrease in cholesteryl ester hydrolase activity resulted when rats were administered ethanol by intragastric tubing technique (15 days) as compared to controls treated similarly with saline. The decrease in cholesteryl ester hydrolase activity was correlated with an increase in cholesteryl ester level in serum. In a different study, rats intubated with an acute dose of ethanol showed an increase in adrenal cholesteryl ester hydrolase activity as early as 1 hr after administration. This effect seemed to last for about 24 hr before activity returned to control level. It is concluded that different modes of ethanol administration to rats may elicit a change in cholesteryl ester hydrolase activity in the adrenal. An increase in cholesteryl ester hydrolase activity may be related to an increase in steroidogenic activity and activation of adrenocortical function.

The effect of chronic ethanol administration on arachidonyl transfer to 1-acyl-glycerophosphorylcholine in rat brain synaptosomal fraction.

Enzymatic transfer of arachidonate to synaptosomal diacyl-GPC in a group of rats (n=14) administered 30% ethanol by intragastric intubation for 21 days was 24% higher than controls (n=5) (P less than 0.05). No apparent difference in enzymic activity was observed with respect to different periods of withdrawal (8-24 hrs). The acyl transferase activity in another group of rats (n=5) which were given 15% ethanol as the sole drinking source for 13 months was 58% higher than controls (P less than 0.025). The increase in acyl transferase activity with respect to the two types of chronic ethanol administration may be due to an adaptive mechanism in brain to facilitate the increase in membrane transport activities which are known to occur under the influence of ethanol.

Effects of ethanol and dihydroergotoxine on mouse brain myelin components.

The effects of prolonged consumption of ethanol, dihydroergotoxine (Hydergine) and Hydergine-plus-ethanol on brain myelin components isolated from the medulla oblongata of mouse brain were examined. Based on protein content, the amount of myelin isolated from the brain tissue was not different with regard to the various treatments. However, there was a significant decrease (20%) in myelin phospholipid and cholesterol to protein ratios in the ethanol group as compared to controls and the Hydergine-treated group. On the contrary, the Hydergine and Hydergine-ethanol groups had higher cholesterol to phospholipid ratios than controls. In spite of the changes in membrane components, little change in acyl group composition of the phosphoglycerides was found in myelin.

Generic screening as an integral part of quality management.

Comprehensive quality management programs are vital to the evaluation and improvement of the delivery of health care today and in the future. These programs must address issues which include quality assurance, risk management, and utilization management. The programs should be designed to promote and assist in the safe delivery of patient care as well as the provision of a safe environment for all patients, visitors, and employees. Various methodologies have been advocated to ensure quality care, the majority of which are retrospective evaluations. One of the more recent methodologies developed is generic screening. The Boston Veterans Medical Center has utilized generic screening since 1986 in its Quality Management Program. Our generic screening program has been successful as a result of multidisciplinary collaboration, commitment, and support from the medical center's top management, both administrative and clinical. We have developed a credible system that may be used to fulfill many requirements of both internal and external reviews. The program is easily reproducible and provides a basis for trend analysis within specific groups in order to better plan and meet patient care needs, minimize risk, and maximize outcome.