The spectre of coercion: is public health genetics the route to policies of enforced disease prevention?

The paper discusses options for disease prevention in Public Health Genetics and attempts to assess the probability that coercive strategies might be chosen in public health policies that impose duties to undergo genetic testing. Given the social values, legal and political cultures and professional orientations in Western Europe and the United States, which provide the terms of reference for this assessment, it is unlikely that the preventive options which might emerge from human genetics in the future will trigger policies that force preventive behavior upon people, except in the cases where such enforcement is designed to protect third parties.     

Strengthening genetic services in primary care for Asian Americans and Pacific Islanders

The Association of Asian Pacific Community Health Organizations (AAPCHO) is a national membership organization of community health centers (CHCs) that serve medically underserved Asian Americans and Pacific Islanders (AAPIs) with limited English-speaking proficiency and low income. OBJECTIVES: In 1995, AAPCHO was funded for a 3-year national genetics training project to improve genetics training among primary care providers at CHCs and strengthen linkages with tertiary genetic centers (TGCs). Three model linkages between CHCs and TGCs were documented on the coordination of genetic services for medically underserved AAPIs. METHODS: Guidelines were developed for three CHCs to document their genetic programs and linkages with TGCs. In addition, one clinic conducted a mail survey to assess understanding of prenatal genetic counseling sessions by patients that visited the clinic during the past 2 years. RESULTS: Model linkages between CHCs and TGCs to improve cultural and linguistic accessibility for patients include formal coordination between the CHCs and TGCs for the delivery of genetic services and the provision of varying levels of genetic services at the CHC. From the patient survey, there was a 59% response rate among 70 surveys mailed to former patients. The survey results showed that while a majority of patients understood and recalled key genetic concepts, one-fifth of patients experienced difficulty understanding their genetic counseling sessions. CONCLUSION: Based on model linkages between CHCs and TGCs and the patient satisfaction survey results, the following strategies are recommended to improve accessibility of genetic services for medically underserved AAPIs: (1) genetics education should be developed for all levels of health center staff; (2) counseling should be culturally sensitive and focus on key issues that must be conveyed for appropriate informed consent; (3) genetics education should employ the use of translated audiovisual aids and brochures to improve understanding; (4) genetic services should be coordinated between CHCs and TGCs to provide culturally and linguistically competent care for medically underserved AAPIs, and (5) financial mechanisms should be available to support genetic testing of patients and their families with little or no coverage for genetic services.     

Integrating genetics into advanced practice nursing curriculum: strategies for success

Keeping up with the volume of new genetic information emerging from the human genome project is a challenge for almost all healthcare providers, but nurses who received little or no formal genetic training often find it particularly intimidating. Nursing faculty may be reluctant to add genetic content to existing courses, much less tackle the work of teaching an entire course in genetics. This article provides nursing faculty with some strategies and straightforward curriculum modifications to assist them in integrating genetic content into graduate-level nursing curriculum. Advanced Practice Nurses in particular should understand genetics well enough to be aware of and appreciate the wide variety of genetic conditions that might be encountered in a clinical setting. The authors offer practical suggestions for incorporating genetics into Advanced Practice Nursing curricula.     

粒子图像测速技术研究进展

粒子图像测速技术(PIV)作为一种全新的无扰、瞬态、全场速度测量方法,在流体力学及空气动力学研究领域具有极高的学术意义和实用价值.本文对PIV技术的原理、分类作了简要地介绍,详细归纳和评述了现有的各种速度信息的提取方法,并对拓扑图论、神经网络、遗传算法、模糊聚类等新技术在PIV中的应用以及三维PIV技术、两相流PIV测试技术进行了介绍.指出当前PIV技术除了向三维和多相流方向发展外,如何提高PIV的测量精度以及缩短计算时间仍然是目前研究的主要目标.PIV技术随着计算机技术、激光技术和CCD性能的发展,必将取得更大的发展与突破      

The challenge of validating genetic testing

Validation of genetic testing is a multidisciplinary task that involves medical/clinical geneticists, other medical specialists, legislative authorities and the public. It is an area in which many issues are unresolved. Validation should not focus on the laboratory process alone, but should also include the prerequisites for service delivery, such as education and staffing, data collection and banking and information transfer, as well as pre- and post-test genetic counselling in a cost-effective perspective. It must thus be seen as an ongoing process at laboratory, familial and societal levels which involves many different actors. The challenges for the near future are to continue to develop technical standards for the laboratory and counselling procedures, and, in collaboration among professionals, lay persons and state authorities, to define a legal framework for the actions of the various players. This chapter discusses some problems related to the validation process for genetic testing, broadly defined.     

Common autosomal recessive diseases in Oman derived from a hospital-based registry

OBJECTIVES: The local frequencies of genetic disorders in Oman apart from hemoglobinopathies are largely unknown. The aim of the present study was to evaluate birth prevalence of commonly diagnosed autosomal recessive diseases and to estimate needs and priorities of genetic services. METHODS: Analysis of the years 1993-2002 using a hospital-based registry of genetic diseases was attempted. More than 3,000 records were reviewed. Only patients with definite diagnosis were included in the analysis. Genetically determined diseases occurring less frequently than 1 in 50,000 births are not included. RESULTS: A number of rare autosomal recessive diseases are found to have a prevalence at least 1 in 50,000 livebirths. CONCLUSIONS: The data suggest that genetic diseases are important as major contributors to perinatal and childhood mortality and morbidity. The need for preventive genetic service is essential for the health of the community in Oman. Autosomal recessive diseases were frequently concentrated in specific geographical areas, which can be explained by founder effect and genetic drift. However, the hospital-based registry may present incomplete information. Further prospective studies are needed to provide more detailed data.     

Legal and policy issues in genetics and insurance

Genetic screening and testing techniques provide a powerful diagnostic tool for the acquisition of predictive information. The potential value of such diagnostic techniques cannot be overstated. However, commercial organisations such as insurance companies and employers are also highly interested in the acquisition and use of genetic information. Concerns about the potential abuse of genetic information have stimulated a counter-current of public pressure for restrictions on the use which can be made of genetic diagnostic information. In a number of countries this pressure has generated enough concern to stimulate legislatures to enact laws which curtail the use and acquisition of genetic information. This pattern has clearly emerged in the United States of America and there are indications that similar trends are developing in Europe. This paper examines the law and policy issues arising from the interface between genetics and insurance.     

Preventing congenital anomalies in developing countries

The birth prevalence of congenital anomalies in developing countries is similar to that observed in developed countries. However, the health impact of birth defects is higher because of a lack of adequate services for the care of affected infants and a higher rate of exposures to infections and malnutrition. A number of successful measures for the prevention of congenital anomalies are being taken in a number of developing nations. Primary prevention programs are based on public education about preconceptional and prenatal risks. Prevention based on reproduction options includes teratogen information services and prenatal screening for fetal anomalies. In addition, programs for the detection of congenital malformations at birth, followed by early treatment, are contributing to secondary prevention. Prevention of congenital anomalies in the developing world requires: (a) good epidemiological data on the prevalence and types of birth defects and genetic disorders; (b) educating health professionals in the goals and methods of preventing birth defects at low cost but with high impact, and (c) expansion of family planning and improvement of antenatal care combined with educational campaigns to avoid the risks for birth defects. The basis for public health preventive measures should be the primary health care level. In a sizable proportion of developing countries, the stage is already set for these measures to be implemented. Required are education, political will, and proper organization and allocation of resources.     

TOPOLOGY OPTIMIZATION OF TRUSS STRUCTURE WITH FUNDAMENTAL FREQUENCY AND FREQUENCY DOMAIN DYNAMIC RESPONSE CONSTRAINTS

In this paper, adaptive genetic algorithm (AGA) is applied to topology optimization of truss structure with frequency domain excitations. The optimization constraints include fundamental frequency, displacement responses under force excitations and acceleration responses under foundation acceleration excitations. The roulette wheel selection operator, adaptive crossover and mutation operators are used as genetic operators. Some heuristic strategies are put forward to direct the deletion of the extra bars and nodes on truss structures. Three examples demonstrate that the proposed method can yield the optimum structure form and the lightest weight of the given ground structure while satisfying dynamic response constraints.     

Two techniques for PIV-based aeroacoustic prediction and their application to a rod-airfoil experiment

In this paper, we discuss techniques by which the aeroacoustic properties of the turbulent flow in a rod-airfoil benchmark experiment can be inferred from time-resolved PIV measurement. While acoustic measurements can be made directly using microphones, the proposed techniques provide a means to directly link acoustic waves with specific flow events, which is invaluable in devising noise mitigation strategies. The approaches are possible thanks to recent improvements in digital and camera technology that can provide time-resolved measurements in air flows, necessary for the determination of unsteady flow quantities related to aeroacoustic production. Both techniques are based on Curle’s acoustic analogy, where one is based on Lagrangian determination of the required quantities, while the other requires all flow quantities to be converted into Fourier modes. Application of both techniques yields results that are in reasonable agreement with microphone noise measurements for the rod-airfoil experiment.     

Parental attitudes and beliefs regarding the genetic testing of children

OBJECTIVES: To explore parental attitudes and beliefs about genetic testing of children for conditions that present throughout the life cycle. METHODS: Twelve semi-structured focus groups with black and white parents were conducted. RESULTS: Across racial groups, most respondents want access to genetic testing and believe that parents should be the final decision-makers. While most respondents believe it is important to share genetic information with relatives, white respondents want physicians to respect confidentiality absolutely, whereas some black respondents accept physician disclosures in specific situations. CONCLUSIONS: Professional policy statements are restrictive about access to predictive genetic testing of children. This conflicts with parental attitudes about who should have decisional authority. While there is consensus among respondents that genetic information should be shared with relatives, respondents disagree as to who should be responsible for disclosure, and when professionals should breach patient confidentiality.     

Are fem solutions of incompressible flows really incompressible? (or how simple flows can cause headaches!)

It is generally accepted that mixed and penalty finite element methods can routinely solve the incompressible Navier–Stokes equations. This paper shows by means of simple examples that problems can arise even for the simpler Stokes equations. The causes of the problem fall in either of two categories: round-off and ill conditioning, or a poor choice of pressure discretization. Nonsensical solutions can be obtained. Computation of the discrete divergence of the flow field is a simple and powerful tool to diagnose such conditions. In the first part of the paper several simple techniques for minimizing the effect of round-off are reviewed. In the second part it is shown that, for coupled flow problems, care must be exercised in the choice of the pressure approximation. A unified treatment of various observations by different workers is presented. This should prove useful for general users of the finite element method.     

Modulation of reactive oxygen species to enhance sonodynamic therapy

Reactive oxygen species (ROS), involving in many biological reactions, play an important role in disease treatment. Among the various ROS-based therapeutic modalities, sonodynamic therapy (SDT) stands out with its unique advantages. In turn, the SDT efficacy is mainly dependent on the ROS levels in the disease microenvironment. Therefore, in recent years, researchers have extensively investigated SDT with high ROS generation capacity. In this review, we focus on effective strategies to improve the therapeutic efficiency of SDT by modulating ROS, overview the basic mechanisms of ROS generation by sonosensitizers, highlight the rational design of sonosensitizers, and summarize strategies to improve the SDT efficacy by modulating disease microenvironment. In addition, multiple ROS synergistic treatment modalities and the prospect of SDT are discussed. We believe that the understanding and exploration of SDT enhancement strategies will facilitate the clinical translation of SDT.     

Implications of genetic testing for the insurance industry: the UK example

This report summarises the controversy of genetic tests and insurance, with a focus on the UK situation during the past decade. UK experience provides insight for future strategies to help people with genetic disadvantages make insurance provision for themselves and their families. Non-disclosure of genetic test results (already carried out for clinical purposes) may not benefit people at risk of genetic disorders or with positive genetic tests. The pressure of geneticists over a decade to prevent disclosure to insurers may have masked opportunities to use insurance to provide help for people with genetic disadvantages. To seize the opportunities now, there must be collaboration, not conflict. Politicians, geneticists, social scientists and all elements of the insurance industry can contribute to wise solutions.     

Controllable microfluidic strategies for fabricating microparticles using emulsions as templates

Microfluidic techniques provide flexible strategies for fabrication of uniform advanced microparticles with well-tailored sizes, shapes, structures, and functions from controllable emulsion templates. This review highlights recent progress on controllable synthesis of microparticles using versatile microfluidic emulsions as templates. First, highly controllable and scalable microfluidic techniques for the generation of defined emulsions are introduced. Versatile microfluidic strategies for fabricating microparticles from diverse controllable emulsion templates are then summarized, including solid microparticles with spherical, non-spherical, and Janus configurations, porous microparticles with flexible pore structures, and compartmental microparticles with controlled internals. Finally, the future development of microfluidic techniques for microparticle fabrication is briefly discussed.     

Brownian configuration fields and variance reduced CONNFFESSIT

Stochastic simulation techniques, such as Brownian dynamics, provide us an extremely powerful tool for solving the usually nonlinear equations describing polymer dynamics in solutions and melts [1]. However, the most challenging problems (e.g. the investigation of the universal behaviour of long polymer chains, or the flow calculation based on stochastic simulation techniques) involve a very large number of degrees of freedom and hence require an enomous amount of computer time. In order to solve such problems on currently available computers it is therefore necessary to develop strategies to drastically suppress the level of the fluctuations in the simulations. The purpose of this note is to show that the recently proposed concept of Brownian configuration fields [2] in viscoelastic flow calculations can be regarded as an extremely powerful extension of variance reduction techniques based on parallel process simulation.     

Genetic counseling for the public?

The widespread availability of diagnostic tools for numerous inherited diseases requires diligent decision-making regarding the risks and benefits, not only for the individual but also at the population level. Should therefore genetic counseling be offered to the entire population at risk for genetic diseases? In our opinion, the goals of public health may only be reached by serving primarily the individual at risk and his/her family. Efforts in public health genetics should be focused on appropriate genetic counseling, especially regarding common diseases with complex genetic components in the near future.     

Generation and visualisation of some complex shock wave interactions

There are a number of complex compressible flow fields, many containing a variety of features, that require special treatment in order to establish the true geometry in both a spatial and temporal sense. In order to make visual interpretation easier it may be necessary to compare images obtained using different techniques, or to extract salient features to simplify presentation. In this paper we deal with a combination of various techniques such as interferometry, shadow and schlieren imaging, coupled with CFD and surface reconstruction in virtual space, for a variety of shock wave studies.