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Beadles C.A.,Health Services Research and Development | Beadles C.A.,Duke University | Ryanne Wu R.,Health Services Research and Development | Ryanne Wu R.,Duke University | And 8 more authors.
Familial Cancer | Year: 2014

Background: Family health history (FHH) is an underutilized tool in primary care to identify and risk-stratify individuals with increased cancer risk. Objective: Evaluate the influence of patient education on quantity and quality of FHH entered into a primary care-based software program, and impact on the program's cancer risk management recommendations. Design: Two primary care practices within a larger type II hybrid implementation-effectiveness controlled clinical trial. Participants: English speaking non-adopted patients with a well visit appointment December 2012-March 2013. Interventions: One to two weeks prior to their well visit appointment, participants entered their FHH into the program. Participants were then provided educational materials describing key FHH components. They were instructed to use the interval to collect additional FHH information. Patients then returned for their scheduled appointment, and updated their FHH with any new information. Main Measures: Percentage per pedigree of relatives meeting individual quality criteria. Changes made after patient education and changes to recommendations for surveillance, chemoprevention or genetic counseling referral. Key Results: Post patient education, pedigrees exhibited a greater percentage (per pedigree) of: deceased relatives with age at death (84 vs. 81 % p = 0.02), deceased relatives with cause of death (91 vs. 87 % p = 0.02), relatives with a named health condition (45 vs. 42 % p = 0.002), and a greater percentage of relatives with high quality records (91 vs. 89 % p = 0.02). Of 43 participants with pedigree changes that could trigger changes in risk stratified prevention recommendations, 12 participants (28 %) received such changes. Conclusions: Patient education improves FHH collection and subsequent risk stratification utilized in providing actionable evidence-based care recommendations for cancer risk management. © 2014 Springer Science+Business Media. Source


Wu R.R.,Health Services Research and Development | Wu R.R.,Duke University | Himmel T.L.,Duke University | Buchanan A.H.,Duke University | And 6 more authors.
BMC Family Practice | Year: 2014

Background: Studies have shown that the quality of family health history (FHH) collection in primary care is inadequate to assess disease risk. To use FHH for risk assessment, collected data must have adequate detail. To address this issue, we developed a patient facing FHH assessment tool, MeTree. In this paper we report the content and quality of the FHH collected using MeTree. Methods. Design: A hybrid implementation-effectiveness study. Patients were recruited from 2009 to 2012. Setting: Two community primary care clinics in Greensboro, NC. Participants: All non-adopted adult English speaking patients with upcoming appointments were invited to participate. Intervention: Education about and collection of FHH with entry into MeTree. Measures: We report the proportion of pedigrees that were high-quality. High-quality pedigrees are defined as having all the following criteria: (1) three generations of relatives, (2) relatives' lineage, (3) relatives' gender, (4) an up-to-date FHH, (5) pertinent negatives noted, (6) age of disease onset in affected relatives, and for deceased relatives, (7) the age and (8) cause of death (Prim Care 31:479-495, 2004.). Results: Enrollment: 1,184. Participant demographics: age range 18-92 (mean 58.8, SD 11.79), 56% male, and 75% white. The median pedigree size was 21 (range 8-71) and the FHH entered into MeTree resulted in a database of 27,406 individuals. FHHs collected by MeTree were found to be high quality in 99.8% (N = 1,182/1,184) as compared to <4% at baseline. An average of 1.9 relatives per pedigree (range 0-50, SD 4.14) had no data reported. For pedigrees where at least one relative has no data (N = 497/1,184), 4.97 relatives per pedigree (range 1-50, SD 5.44) had no data. Talking with family members before using MeTree significantly decreased the proportion of relatives with no data reported (4.98% if you talked to your relative vs. 10.85% if you did not, p-value < 0.001.). Conclusion: Using MeTree improves the quantity and quality of the FHH data that is collected and talking with relatives prior to the collection of FHH significantly improves the quantity and quality of the data provided. This allows more patients to be accurately risk stratified and offered appropriate preventive care guided by their risk level. Trial number. NCT01372553. © 2014 Wu et al.; licensee BioMed Central Ltd. Source


Carpino G.,Foro Italico University of Rome | Onori P.,University of LAquila | Cantafora A.,University of Rome La Sapienza | Franchitto A.,University of Rome La Sapienza | And 6 more authors.
Journal of Hepatology | Year: 2012

Background & Aims: Biliary tree, liver, and pancreas share a common embryological origin. We previously demonstrated the presence of stem/progenitor cells of endodermal origin in the adult human extrahepatic biliary tree. This study evaluated the human foetal biliary trees as sources of stem/progenitor cells of multiple endodermal-derived mature fates. Methods: Human foetal intrahepatic and extrahepatic biliary tree tissues and isolated cells were tested for cytoplasmic and surface markers of stem cells and committed progenitors, as well as endodermal transcription factors requisite for a liver versus pancreatic fate. In vitro and in vivo experiments were conducted to evaluate the potential mature fates of differentiation. Results: Foetal biliary tree cells proliferated clonogenically for more than 1 month on plastic in a serum-free Kubota medium. After culture expansion, cells exhibited multipotency and could be restricted to certain lineages under defined microenvironments, including hepatocytes, cholangiocytes, and pancreatic islet cells. Transplantation of foetal biliary tree cells into the livers of immunodeficient mice resulted in effective engraftment and differentiation into mature hepatocytes and cholangiocytes. Conclusions: Foetal biliary trees contain multipotent stem/progenitor cells comparable with those in adults. These cells can be easily expanded and induced in vitro to differentiate into liver and pancreatic mature fates, and engrafted and differentiated into mature cells when transplanted in vivo. These findings further characterise the development of these stem/progenitor cell populations from foetuses to adults, which are thought to contribute to liver and pancreas organogenesis throughout life. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Source


Zhang Y.,Brookhaven National Laboratory | Lu F.,Brookhaven National Laboratory | Van Der Lelie D.,Brookhaven National Laboratory | Van Der Lelie D.,NC Biotechnology Center | Gang O.,Brookhaven National Laboratory
Physical Review Letters | Year: 2011

The phase behavior of 3D assemblies of nanocubes in a ligand-rich solution upon solvent evaporation was experimentally investigated using small-angle x-ray scattering and electron microscopy. We observed a continuous transformation of assemblies between simple cubic and rhombohedral phases, where a variable angle of rhombohedral structure is determined by ligand thickness. We established a quantitative relationship between the particle shape evolution from cubes to quasispheres and the lattice distortion during the transformation, with a pathway exhibiting the highest known packing. © 2011 American Physical Society. Source


Sun D.,Brookhaven National Laboratory | Stadler A.L.,Brookhaven National Laboratory | Gurevich M.,Brookhaven National Laboratory | Palma E.,Brookhaven National Laboratory | And 3 more authors.
Nanoscale | Year: 2012

Heterogeneous nanoclusters with trimeric and core-shell architectures containing nanoparticles of different size and composition have been fabricated via site-specific PNA-"invasion" of DNA double helix. This novel strategy facilitates the incorporation of double-stranded DNA into the nanoparticle assembly design. This journal is © 2012 The Royal Society of Chemistry. Source

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