Publications

Health information technology (HIT) is a cornerstone of health care reform, is critical for transformation of current outpatient practices to patient-centered health homes (PCHHs), and has potential to improve health outcomes. To determine the current level of electronic health record (EHR) implementation in California's outpatient safety-net, we conducted a web-based survey of the California Primary Care Association's member clinics (response rate 127/181 (70%)). Seventy-two (59%) clinics had not implemented electronic health records (EHR), 26 (21%) were all electronic, 23 (19%) were both paper and electronic, and two (2%) had no plans to implement EHR; the remaining four responses are missing. The majority of clinics allotted less than 6% of their budget to health information technology and 64% of those planning on implementing an EHR reported needing additional staff. California's safety net systems are likely to need additional support to successfully benefit from health care reform incentives.

In 2011, an expert panel from the National Heart, Lung, and Blood Institute released recommendations for universal lipid screening and treatment of high cholesterol in children. There is no evidence that universal screening will help children lead longer, healthier lives. These recommendations will, however, fuel the epidemic of overtreatment that is currently threatening our healthcare system and our patients.

Gender-specific data focused on cardiovascular disease (CVD) are becoming increasingly available. This is of great importance, given that CVD has become the number 1 killer of women, and unlike for men, mortality rates do not seem to be declining. Many factors are cited as the causes of sex-based differences, including delays in recognizing symptoms, underutilization of diagnostic tests and treatments, as well as anatomic, physiological, and genetic factors. Evidence of fundamental biological differences in vascular function and the underlying pathologic processes is only beginning to elucidated, motivated by growing evidence of differences in clinical presentations and outcomes between men and women. The good news is that we are starting to see improvements in outcomes for women, such as after coronary revascularization; decrease in complication rates with the advent of new techniques, such as radial access for cardiac catheterizations; as well as increased participation of women in clinical trials. The underlying mechanisms of ischemic heart disease remain to be elucidated, and will help guide therapy and ultimately may explain the higher prevalence of : subendocardial myocardial infarctions, spontaneous arterial dissections, plaque erosion, increased vasospastic disorders, such as coronary microvascular disease, and pulmonary hypertension in women compared with men. We have made great progress in understanding gender-related differences in CVDs, but much remains to be done to optimize the prevention of CVD for both men and women.

The yeast Candida albicans transitions between distinct lifestyles as a normal component of the human gastrointestinal microbiome and the most common agent of disseminated fungal disease. We previously identified Sef1 as a novel Cys(6)Zn(2) DNA binding protein that plays an essential role in C. albicans virulence by activating the transcription of iron uptake genes in iron-poor environments such as the host bloodstream and internal organs. Conversely, in the iron-replete gastrointestinal tract, persistence as a commensal requires the transcriptional repressor Sfu1, which represses SEF1 and genes for iron uptake. Here, we describe an unexpected, transcription-independent role for Sfu1 in the direct inhibition of Sef1 function through protein complex formation and localization in the cytoplasm, where Sef1 is destabilized. Under iron-limiting conditions, Sef1 forms an alternative complex with the putative kinase, Ssn3, resulting in its phosphorylation, nuclear localization, and transcriptional activity. Analysis of sfu1 and ssn3 mutants in a mammalian model of disseminated candidiasis indicates that these post-transcriptional regulatory mechanisms serve as a means for precise titration of C. albicans virulence.

BACKGROUND

The antiretroviral drug efavirenz (EFV) and the antimalarial artemisinin-based combination therapy artemether-lumefantrine (AL) are commonly co-administered to treat HIV and malaria. EFV is a known inducer of cytochrome P450 3A4, which converts artemether to dihydroartemisinin (DHA) that is also active and metabolizes longer acting lumefantrine (LR). A study in healthy volunteers was completed to address the concern that EFV impacts AL pharmacokinetics (PKs).

METHODS

Adults received AL (80/480 mg twice daily) for 3-days before and during EFV co-administration (600 mg daily for 26 days) with intensive PK for artemether, DHA, and LR conducted after the last AL dose for each period. EFV PK was evaluated with and without AL. PK parameters were estimated using noncompartmental methods.

RESULTS

Twelve subjects completed the 2-period study. PK exposure for artemether, DHA, and LR [as estimated by the area under the concentration time curve (AUClast)] decreased or trended toward decrease with EFV, compared with when administered alone [-51% (P = 0.084), -46% (P = 0.005), and -21% (P = 0.102), respectively]. Day-7 LR levels, previously deemed predictive of treatment success, were 46% lower (P = 0.002) with EFV, but the LR half-life was unchanged. EFV PK exposure was minimally altered after AL co-administration [AUC0-24 hrs decreased by 17% (P = 0.034)].

CONCLUSIONS

Exposure to DHA, but not LR, was significantly lower during EFV-AL co-administration compared with that during administration of AL alone. These findings may have implications for the treatment efficacy of AL, particularly in children. However, the observed modest changes probably do not warrant dosage adjustment during co-administration of AL with EFV.

The American Association of Occupational Health Nurses, Inc. (AAOHN) conducted a web-based membership survey of 2123 members (41% response rate) in May and June 2012. This column presents educational, certification, and selected industry data for registered nurse and advanced practice nurse AAOHN members. Members are highly experienced, with 57% reporting more than 16 years of experience. Sixty-eight percent of AAOHN members are educated at or above the baccalaureate level. An additional 8.4% are currently enrolled in an educational program. Seventy-six percent are nationally certified as occupational health nurses or occupational health nurse specialists (COHN/COHN-S), case managers, safety professionals, ergonomists, or nurse practitioners. The majority (89%) work full-time as employees of their facility (85%), with manufacturing (34%), hospital/health care (26%), and government/military (10%) being the top three industry sectors. Ten percent work for small employers (fewer than 500 employees), whereas 12% work with more than 50,000 employees. Thirteen percent of AAOHN members work globally. Future columns will present additional 2012 AAOHN member survey data.