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Dissemination of Evidence-Based Standards of Care
Andre Barkhordarian,Brett Hacker,Francesco Chiappelli
Bioinformation , 2011,
Abstract: Standards of care pertain to crafting and implementing patient-centered treatment interventions. Standards of care must take into consideration the patient’s gender, ethnicity, medical and dental history, insurance coverage (or socioeconomic level, if a private patient), and the timeliness of the targeted scientific evidence. This resolves into a process by which clinical decision-making about the optimal patient-centered treatment relies on the best available research evidence, and all other necessary inputs and factors to provide the best possible treatment. Standards of care must be evidence-based, and not merely based on the evidence – the dichotomy being a critical in contemporary health services research and practice. Evidence-based standards of care must rest on the best available evidence that emerges from a concerted hypothesis-driven process of research synthesis and meta-analysis. Health information technology needs to become an every-day reality in health services research and practice to ensure evidence-based standards of care. Current trends indicate that user-friendly methodologies, for the dissemination of evidence-based standards of care, must be developed, tested and distributed. They should include approaches for the quantification and analysis of the textual content of systematic reviews and of their summaries in the form of critical reviews and lay-language summaries.
Epigenetic regulation of osteogenesis: human embryonic palatal mesenchymal cells
Andre Barkhordarian,Jay Sison,Riana Cayabyab,Nicole Mahanian
Bioinformation , 2011,
Abstract: Mesenchymal stem cells (MSCs) provide an appropriate model to study epigenetic changes during osteogenesis and bone regeneration due to their differentiation potential. Since there are no unique markers for MSCs, methods of identification are limited. The complex morphology of human embryonic palatal mesenchyme stem cell (HEPM) requires analysis of fractal dimensions to provide an objective quantification of self-similarity, a statistical transformation of cellular shape and border complexity. We propose the hypothesis of a study to compare and contrast sequential steps of osteogenic differentiation in HEPMs both phenotypically using immunocytochemistry, and morphometrically using fractal analysis from undifferentiated passage 1 (P1) to passage 7 (P7) cells. The proof-of-concept is provided by results we present here that identify and compare the modulation of expression of certain epigenetic biomarkers (alkaline phosphatase, ALP; stromal interaction molecule-1, STRO-1; runt-related transcription factor-2, RUNX2), which are established markers of osteogenesis in bone marrow studies, of osteoblastic/skeletal morphogenesis, and of osteoblast maturation. We show that Osteoinductive medium (OIM) modulates the rate of differentiation of HEPM into Run-2+ cells, the most differentiated subpopulation, followed by ALP+ and STRO-1+ cells. Taken together, our phenotypical and morphometric data demonstrate the feasibility of using HEPM to assess osteogenic differentiation from an early undifferentiated to a differentiated stage. This research model may lay the foundation for future studies aimed at characterizing the epigenetic characteristics of osteoimmunological disorders and dysfunctions (e.g., osteoarthritis, temporomandibular joint disorders), so that proteomic profiling can aid the diagnosis and monitor the prognosis of these and other osteoimmunopathologies.
Influenza 2009 pandemic: Cellular immune-mediated surveillance modulated by TH17 & Tregs
Andre Barkhordarian,Natasha Iyer,Paul Shapshak,Charurut Somboonwit
Bioinformation , 2011,
Abstract: Influenza A virus is a serious public health threat. Most recently the 2009/H1N1 pandemic virus had an inherent ability to evade the host’s immune surveillance through genetic drift, shift, and genomic reassortment. Immune characterization of 2009/H1N1 utilized monoclonal antibodies, neutralizing sera, and proteomics. Increased age may have provided some degree of immunity, but vaccines against seasonal influenza viruses seldom yield cross-reactive immunity, exemplified by 2009/H1N1. Nonetheless, about 33% of individuals, over the age of 60, had cross-reactive neutralizing antibodies against 2009/H1N1, whereas only 6-9% young adults had these antibodies. Children characteristically had no detectable immunity against 2009/H1N1. Taken together, these observations suggest some degree of immune transference with at least certain strains of virus that have afflicted the human population in past decades. Because internal influenza proteins may exhibit less antigenic variation, it is possible that prior exposure to diverse strains of influenza virus provide some immunity to novel strains, including the recent pandemic strain (swine-avian A/H1N1). Current trends in immunological studies – specifically the modulation of cellular immune surveillance provided by TH17 and Tregs – also support the need for additional proteomic research for characterizing novel translational evidence-based treatment interventions based on cytokine function to help defeat the virus. Timely and critical research must characterize the impact of genetics and epigenetics of oral and systemic host immune surveillance responses to influenza A virus. The continued development and application of proteomics and gene expression across viral strains and human tissues increases our ability to combat the spread of influenza epidemics and pandemics.
Immune surveillance of nasopharyngeal carcinoma (NpC)
Oluwadayo O Oluwadara,Andre Barkhordarian,Luca Giacomelli,Xenia Brant
Bioinformation , 2011,
Abstract: In the U.S., nasopharyngeal carcinoma (NpC) kills >7,600 each year. Deaths are predominantly among adult men, and in most cases, early detection and treatment can save lives. Despite the annual spending of approximately 3.2 billion dollars on head and neck cancer research, NpC remains a neglected disease since its fatality rates are among the lowest nation wide. The relative survival rates from NpC have not improved in the U.S. in the last 20 years. Infection with Epstein Barr Virus (EBV) is an important co-factor in the etiology of NpC. In other regions of the word (e.g., South-East Asia, Latin America), EBV infection and NpC-related prevalence and mortality are substantially higher and more alarming. Epidemiological data indicate high prevalence of EBV infection and increased risk for NpC among Central and South American and Asian immigrants in the U.S., and also predict a sharp increase in NpC incidence in the next decade. To face this emerging threat, it is important to develop and validate novel modes of detection and intervention for NpC. To this end, we characterized the proteomic signature of NpC, and of the tumor infiltrating lymphocytes of the CD8+, activated (CD38+, mTOR+) and regulatory immune cell (FoxP3+) phenotype. Paraffinized biopsies were processed, and tissue microarrays constructed and tested by immunohistochemistry and tri-immunohistofluorescence for a battery of signaling markers, including AKT and PI3K, in conjunction with EBV status and ANKRD11, an NpC susceptibility biomarker. Microphotographs, analyzed and quantified by confocal microscopy and fractal analysis, suggest new avenues for immunotherapies of NpC.
Evidence-Based Dentistry: The Next Frontier in Translational and Trans-National Dental Practice
Reem Ajaj,André Barkhordarian,Linda Phi,Amy Giroux
Dental Hypotheses , 2011,
Abstract: Evidence-Based Dentistry (EBD) is a systematic approach for ob-taining the best available clini-cally relevant scientific evidence with the ultimate goal and intent of increasing effectiveness and efficacy in clinical decision-making. EBD pursues optimizing both the patient’s benefit through the best utilization of dentist’s experience and clinical expertise, and on making full use of the most reliable and va-lid research outcomes. EBD is initiated by the patient-dentist interaction, which is translated into a patient-centered P.I.C.O. question. The resulting literature bibliome is assessed and quantified for the level and quality of the evidence by means of fully validated and reli-able instruments based on common standard criteria of research methodology, design and statistical analysis. The outcomes are evaluated by acceptable sampling analysis, Such that studies, whose flaws have been identified to result potentially into misleading infor-mation to the patients and/or practitioner may be judiciously removed from further consideration". The research synthesis process tests for overarching statistical sig-nificance among non-heterogeneous outcomes, and yields a consensus of the best available evidence. The systematic nature of the re-search review and synthesis that characterizes EBD is reported in the literature as “systematic reviews”, “complex systematic reviews”, or “clinically relevant complex systematic reviews”. Thus the reported best available evidence ensures patient-centered clinical decision for interventions of the highest possible effectiveness and effi-cacy. EBD contrasts with traditional dentistry based on the evidence for its systematic stringency, coupled with its fundamental validity as a patient-centered optimization of clinical modes of interventions.
Tax Incentives, Competition and Welfare  [PDF]
Claudio Andre Gondim Nogueira
Modern Economy (ME) , 2012, DOI: 10.4236/me.2012.35080
Abstract: The main objective of this paper is to analyze the impacts of the concession of tax incentives as a tool for entry promotion in a developing region. The simple model and the numerical example presented indicate that the adoption of tax incentives can cause very important effects. The productive structure could be heavily changed and production could increase improving conditions to consumers that benefit from the larger output and lower prices. Furthermore, the need for strategic action by the government in order to increase the chance of success of their development strategies is also emphasized, especially if one considers that firms often behave strategically.
Estimate of an Hypoelliptic Heat-Kernel outside the Cut-Locus in Semi-Group Theory  [PDF]
Rémi Léandre
Applied Mathematics (AM) , 2012, DOI: 10.4236/am.2012.312A285

We give a proof in semi-group theory based on the Malliavin Calculus of Bismut type in semi-group theory and Wentzel-Freidlin estimates in semi-group of our result giving an expansion of an hypoelliptic heat-kernel outside the cut-locus where Bismut’s non-degeneray condition plays a preominent role.

Experimental Study in Out-Door Tanks of N and P Uptake by the Aquatic Communities of Lake Kinneret  [PDF]
Moshe Gophen, Andre Janurik
Open Journal of Ecology (OJE) , 2015, DOI: 10.4236/oje.2015.510043
Abstract: Two trials (1st Trial-46 and 2nd Trial-64 hrs duration) experiment in 8 out-door tanks (5 m3) were carried out with similar design: 4 fish densities (0, 1, 5, and 10), 2 densities of zooplankton (high and low) and 4 increasing levels of P and N concentrations of nutrient enrichments. The consecutive changes of N and P concentrations were measured at 3 (Trial 1) and 4 (Trial 2) time intervals. It was found that nutrient uptake of the entire community, which is the differences between initial and final concentrations, was mostly affected by the initial enrichment. The ecological implications are discussed.
Current Account & Real Exchange Rate Dynamics in the Caribbean and Latin America Compared to the G7 Countries  [PDF]
Andre Y. Haughton
Theoretical Economics Letters (TEL) , 2016, DOI: 10.4236/tel.2016.65109
Abstract: This paper analyses the impact of temporary monetary shocks and permanent productivity shocks on the exchange rate and current account in Jamaica, Argentina, Bolivia, Chile, Columbia, Costa Rica, Mexico, Paraguay and Peru following the technique by Lee and Chinn [1] who analysed the same for the G7 countries. Our findings indicate that during the period 2005-2014, permanent productivity shocks have a greater long term effect on the real exchange rate, but relatively little effect on the current account, while temporary shocks have greater effect on the current account and exchange rate in the short run, but not on either variable in the long run. The same results as in Lee and Chinn [1] for the G7 countries except the US hold for Argentina, Bolivia, Chile, Columbia, Costa Rica, Jamaica, Mexico, Paraguay and Peru. The results are also consistent with the sticky price model of Obstfeld and Rogoff [2]. Lee and Chinn [1] postulate that, the greater impact of a permanent productivity shock in the US economy may be due to a substantial swing in the US foreign currency policy relative to other G7 countries. The stronger impact of temporary shocks on the current account in the Caribbean and Latin American Countries as well as in the other G7 countries may be attributed to nominal price movements that alter the relative price structure between countries. The latter results, display no significant pricing to market effect resulting from exchange rate overshooting caused from a monetary shock.
Disseminating the Best Available Evidence: New Challenges in Public Reporting of Health Care
André Barkhordarian,Manisha H Ramchandani,Mahsa Dousti,Lauren Kelly-Gleason
Bioinformation , 2012,
Abstract: As a direct benefit of the Health Care Reform Act (2010), concerted effort has been deployed to define and characterize the process by which the best available evidence for diagnosis or treatment intervention prognosis can be obtained. The science of research synthesis in health care has established the systematic research protocol by which randomized clinical trials and other clinical studies must be reviewed and compared for the level and quality of the evidence presented, as well as the consensus of the best available evidence synthesized and shared. This process of systematic review yields a reliable and valid approach in comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions in terms of efficacy, and or of effectiveness. The resulting bioinformation outcome of comparative effectiveness and efficacy research review of the available clinical data is expressed as a consensus of the best available evidence, which finds its way in evidence-based clinical practice guidelines, standards of care and eventually, in policies: hence, the acronym CEERAP (comparative effectiveness and efficacy review and policy). The methodological and the procedural criteria that determine and regulate the public reporting dissemination of this sort of bioinformation, and the extent of benefit to the patient’s health literacy, which have remained a bit more elusive to this date, are investigated and discussed in this paper.
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