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June 22, 2006

RESEARCH NOTES

Grant expands study of minority access to government contracts

On the heels of their research showing that local minority business enterprises (MBEs) have been squeezed out of the bidding for local government contracts, researchers Ralph Bangs and Audrey Murrell have received a $200,000 grant from the Ford Foundation-initiated Fulfilling the Dream Fund that will allow them to study the process in cities similar to Pittsburgh, compare figures and suggest changes in the way projects are awarded.

The Fulfilling the Dream Fund works to dismantle the structures of racial and gender inequality and assist institutions in becoming more inclusive and democratic.

Through Pitt’s Center on Race and Social Problems, part of the School of Social Work, Bangs and Murrell examined every City of Pittsburgh and Allegheny County prime contract of more than $25,000 during the first four months of 2004. They determined local MBEs received 3 percent of the prime contracts and 2 percent of the prime contract dollars.

While the MBEs were successful in the contracts they did bid on, they bid on very few, claiming they lacked information on opportunities, lacked contacts and believed that discriminatory practices made bidding pointless. Many MBE firms said bid specifications were inaccurate, opportunities were announced too late and calls were not returned.

Bangs and Murrell plan to expand their research to include city and county governments and school districts in two cities similar in demographics to Pittsburgh — possibly Boston and Chicago. Government leaders as well as owners of 40-60 minority- and women-owned businesses will be interviewed in both cities, and actions by those cities’ governments will be compared to those here.

With assistance from strong community and legal partners, Bangs and Murrell hope to work with the government leaders to increase their understanding of discriminatory barriers and to encourage adoption of affirmative action programs.

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Brain hormone behavior research presented:

Several Pitt studies are among the research presented at the sixth International Congress of Neuroendocrinology at the David L. Lawrence Convention Center, Downtown. This year’s conference, “Bridging Neuroscience and Endocrinology” was sponsored by the American Neuroendocrine Society and Pitt’s School of Medicine. Among the Pitt research results presented were:

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Genes a factor in some male aggression

A study of 531 white men of European descent shows belligerence may be due to variations in one of two genes involved in the activity of the neurotransmitter serotonin. Stephen Manuck, professor of psychology and director of the Behavioral Physiology Laboratory, found the genetic aspect is associated with aggression only if men also have more cynical and hostile attitudes toward others, or fathers who didn’t complete high school.

The Pitt study is the first to look at whether aggression in “normal” men may, in part, be attributed to the same serotonin-related genetic alterations that have been associated with aggressive behaviors in certain psychiatric and criminal populations.

The study found those who reported past fights, conflicts with authority figures or breaking objects in bouts of anger were more likely to carry the “low activity” monoamine oxidase-A, (MAOA) gene variant that’s been linked to criminal violence.

MAOA is an enzyme that inactivates serotonin, helping to keep its levels in proper balance. Yet the low-activity MAOA gene was associated only with aggressive actions among men with oppositional attitudes.

Variation in another serotonin gene, the serotonin 2A receptor, necessary for activating the neurotransmitter, also was predictive of antagonistic behavior, but only among men whose fathers had less than a high school education. The same gene has been implicated in personality and antisocial disorders and in some criminal offenders.

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Lack of oxytocin feeds sweet tooth

Oxytocin, the hormone that influences physical and emotional responses, induces labor, encourages maternal behavior and promotes positive relationship interactions, also may have a role in food preferences.

Pitt pharmaceutical sciences professors Janet Amico and Regis Vollmer have identified an oxytocin deficiency as a contributing factor in developing a sweet tooth and began research into whether oxytocin figures into the desire for fatty foods as well.

Amico’s team compared normal mice with mice unable to produce oxytocin to see if they had a particular preference for drinks with either added sugar or fat.

The oxytocin-deficient mice showed markedly greater intake of a sugar solution than their wild-type counterparts, but both groups seemed to like the fat-enhanced drink just the same.

Whether oxytocin also plays this same role in humans is not yet known, but the investigators hope to extend these studies to people to determine whether abnormalities in the production of oxytocin may lead to overconsumption of sweets in humans.

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UCSUR names faculty development award winners

The University Center for Social and Urban Research (UCSUR) has awarded the sixth annual Steven D. Manners Faculty Development Awards to Larissa Myaskovsky, of the VA Pittsburgh Healthcare System Center for Health Equity Research and Promotion, and to Graduate School of Public and International Affairs assistant professors Shanti Gamper-Rabindran and Aaron Swoboda.

The awards were established in memory of UCSUR’s assistant director who died in 2000 at age 49.

UCSUR director Richard Schulz said the awards are intended to “continue the trend begun by Steve Manners, which was to support faculty members and their research and to improve the research infrastructure at the University.”

UCSUR offers annual awards in two categories: research development grants to support pilot research in the social, behavioral and policy sciences; and infrastructure development awards aimed at enhancing faculty capabilities to carry out interdisciplinary research in the social, behavioral and policy sciences.

Myaskovsky’s proposed research, “Understanding and Reducing Racial Depression: Stigma, Race and Treatment-Seeking Behavior and Attitudes,” seeks to determine the role of culturally based patient characteristics in the race disparities found in kidney transplantation.

Culturally based patient characteristics — including differences in health care attitudes and perceived racism in the health care system — have been shown to play significant roles in African-Americans’ health behaviors and outcomes in other diseases like HIV, heart disease and infant health.

The new study to be conducted by Myaskovsky and colleagues at UPMC will determine whether these characteristics may help to explain race disparities in kidney transplantation as well.

End-stage renal disease (ESRD) patients from both UPMC and the VA Pittsburgh Healthcare System will be asked to participate in two telephone interviews during the time that they are being evaluated medically for a transplant. The interviews will focus on their experiences with health care and their social and health background. A long-term goal of this project is to translate research findings into successful educational interventions that reduce racial disparities in kidney transplantation.

African Americans are disproportionately affected by ESRD in part because two major causes of ESRD — diabetes and hypertension — are more prevalent among African Americans than whites.

These diseases are related to a combination of differences among African Americans and whites, including differences in access to health care, socioeconomic status and health behaviors.

And, while the best treatment for ESRD is a living donor kidney transplant, African Americans are much less likely to identify a living donor, or receive a living donor kidney transplant than whites. Although this disparity has been recognized for several years, relatively little is known about its causes.

Gamper-Rabindran and Swoboda’s project, “Does the U.S. Public Disclosure Program on Factories’ Emissions Truly Cause Emissions Reductions in Poor and Minority Urban Neighborhoods?” examines the impact of the public dissemination of information about plants’ state-level toxic release inventory (TRI) rankings.

The TRI is a nationwide public disclosure program that has made plant-level emissions available to the public since 1987 and has been perceived as a major innovation in U.S. environmental policy. Advocates of the Right-to-Know movement argue that this information disclosure program has enabled the public to exert pressure on plants to reduce their emissions.

The researchers seek to discover whether plants reduced their pounds of emissions as a result of public pressure and also assess whether the changes translate into reductions in health-indexed emissions.

Given the reliance of TRI programs on public pressure, they seek to determine whether plant emissions are correlated with neighborhood socioeconomic variables.

Results from this study will assist the Environmental Protection Agency, policymakers, activists and members of the public to understand whether the TRI program has been effective at reducing health-indexed emissions.

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‘Warm autopsy’ tissue donation advances IPF study

Thanks in part to a dying patient’s generosity, researchers have begun to analyze the progression of idiopathic pulmonary fibrosis (IPF), a degenerative illness marked by lung inflammation, scarring and reduced breathing capacity that typically leads to death within about five years of diagnosis.

The project, involving the examination of lung tissue recovered shortly after death in a process called warm autopsy, is described by School of Medicine researchers in the June issue of PLoS Medicine, an on-line journal of the Public Library of Science.

“Up until now, what we have been able to do has been limited by the lack of availability of lung tissue for study,” said Naftali Kaminski, director of the Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease in the Division of Pulmonary, Allergy and Critical Care Medicine at the School of Medicine and senior author of the PLoS essay, “Lessons from Our Patients: Development of a Warm Autopsy Program.”

Warm autopsy — a practice involving retrieval of organs within six hours of death — has been in use for more than 25 years, mostly in the study of Alzheimer’s disease and multiple sclerosis. However, the Pitt program, which began at the suggestion of an IPF patient, is among the first to use the technique for lung disease research. “Obtaining such prompt access to the organs will, we hope, allow us to approximate disease conditions in a living patient,” said Kathleen Oare Lindell, a clinical nurse specialist at the Simmons Center and the essay’s first author. “The goal is to learn as much as we can about how IPF works.”

Since 2003, Kaminski and his colleagues have examined donated lungs from 12 patients, beginning with tissue from a retired firefighter who suggested the idea after participating in support group sessions. “We had never had patients wanting to donate their lungs before and had not even discussed the possibility,” said Lindell. “The tissue that is available from lungs is rare and primarily from cancer patients,” explained Kaminski. “Most IPF patients will have one biopsy for diagnostic purposes and, because of surgical risks and their fragile health, some may not get a biopsy at all.”

But, thanks to warm autopsy donors, tissue studied soon after death can be compared to tissue collected in earlier biopsies. Preliminary analysis has revealed some promising paths for further research.

“With IPF, many areas of the lung look normal, while others are scarred,” said Kaminski. “Using these donated lungs, we can retrieve tissue from multiple locations within the organ and see how they compare.”

Collagen- and connective tissue-making cells in lungs affected by IPF begin to look and act more like muscle cells, he said. These cells, called fibroblasts, secrete more connective tissue proteins and fibers than normal and become more resistant to killing, in a way similar to cancer cells.

“Looking at the genes as if they are molecules in a computer program, you can see where in IPF, the program is distinct and very different from normal,” said Kaminski. “With this new direction of research, we will be trying to reverse the process.”

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Orthopaedic surgery chair endowed

A gift from Henry Posner Jr. and the Posner family, matched by UPMC, has established a new faculty chair in orthopaedic surgery at Pitt’s School of Medicine. The gift will support ongoing research in degenerative disc disease at the University’s Ferguson Laboratory for Orthopaedic Research.

The Ferguson laboratory is directed by James D. Kang, who is the anticipated first holder of the new chair, awaiting academic confirmation. Kang is an orthopaedic spine surgeon and vice chairman of the Department of Orthopaedic Surgery at UPMC and an associate professor in the departments of orthopaedic and neurological surgery at the School of Medicine.

Posner recently received what he called “superb” care by Kang and UPMC.

As director of the Ferguson laboratory, Kang is leading the development of novel therapies for intervertebral disc disease based on the latest gene transfer and stem cell technologies. Currently, Kang’s research team is performing comprehensive preclinical studies addressing feasibility, safety and efficacy of these technologies.

Intervertebral discs are soft, cushion-like tissue structures between the vertebrae of the spinal column that help keep the spine flexible. Degeneration of intervertebral discs frequently leads to back pain as well as other inflammatory and disabling conditions such as “slipped disc” that sometimes may require invasive spinal fusion surgery.

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Checklist better informs surgical patients

Obtaining and documenting informed patient consent prior to surgery is of vital importance, but both the process and documentation of consent can be inadequate. In the June issue of the journal Neurosurgery, UPMC physicians report on a study of a procedure-based consent form they developed to improve this process.

“Appropriate physician conduct in medical/legal matters begins with the informed consent process. This leads to an understanding of the patient’s diagnosis, the planned procedure, the therapeutic alternatives — both medical and surgical — and the inherent procedural risks,” said Douglas Kondziolka, Peter J. Jannetta Professor and vice chairman of neurological surgery, and professor of radiation oncology at the School of Medicine.

In the study, 120 consecutive patients were evaluated prior to different neurological surgery procedures. Surgeons used a standard hospital consent form and a specialized form created for the neurological surgery practice listing specific diagnoses, procedures, alternatives and risks.

Each point discussed with the patient was checked off by the surgeon, and the form was signed by both. Ten to 20 minutes later, a non-medical member of the office staff questioned the patient.

All of the 120 patients using the new form correctly recalled their diagnosis and the procedures they were going to receive. Of 428 treatment alternatives discussed with patients before surgery, 420 (98 percent) subsequently were recalled. Of 1,207 risks discussed with patients before surgery, 1,176 (97 percent) later were recalled.

When 20 randomly selected patients were re-evaluated four-five months later, all patients correctly recalled their procedure and diagnosis. Of 79 treatment alternatives discussed before surgery, 73 (92 percent) were recalled.

Previous studies evaluating patient recall using traditional consent forms found considerably lower retention rates. In a cardiothoracic surgery study, retention of preoperative information was 29 percent four-six months later. A study of patients undergoing surgeries or emergency room procedures found a 35 percent retention rate at seven days.


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