Design and Implementation of the All of Us Research Program COVID-19 Participant Experience (COPE) Survey

In response to the rapidly evolving coronavirus disease 2019 (COVID-19) pandemic, the All of Us Research Program longitudinal cohort study developed the COVID-19 Participant Experience (COPE) survey to better understand the pandemic experiences and health impacts of COVID-19 on diverse populations within the United States. Six survey versions were deployed between May 2020 and March 2021, covering mental health, loneliness, activity, substance use, and discrimination, as well as COVID-19 symptoms, testing, treatment, and vaccination. A total of 104,910 All of Us Research Program participants, of whom over 73% were from communities traditionally underrepresented in biomedical research, completed 275,201 surveys; 9,693 completed all 6 surveys. Response rates varied widely among demographic groups and were lower among participants from certain racial and ethnic minority populations, participants with low income or educational attainment, and participants with a Spanish language preference. Survey modifications improved participant response rates between the first and last surveys (13.9% to 16.1%, P < 0.001). This paper describes a data set with longitudinal COVID-19 survey data in a large, diverse population that will enable researchers to address important questions related to the pandemic, a data set that is of additional scientific value when combined with the program's other data sources.

Measurement of hemoglobin synthesis rate in vivo using a stable isotope method

We developed a method to measure hemoglobin synthesis rate (SynHb) in humans, assuming that free glycine in the red blood cell (RBC) represents free glycine in bone marrow for hemoglobin synthesis. The present rat study examines this assumption of the method and quantifies SynHb in rats. Sprague-Dawley rats (n = 9) were studied, [2-(13)C]glycine was intravenously infused over 24 h (2.5 mg kg(-1) h(-1)), blood was drawn for glycine and heme isolation, and bone marrow was harvested for glycine isolation. Isotopic enrichments of glycine and heme were measured, fractional hemoglobin synthesis rate (fSynHb% day(-1)) was calculated, and from this a value for SynHb (mg g(-1) day(-1)) was derived. Mean body weight was 446 +/- 10 g (mean +/- SE) and hemoglobin concentration was 14 +/- 0.5 g dl(-1). At 24 h, the mean isotopic enrichment, atom percentage excess (APE), of the RBC free glycine (1.56 +/- 0.18 APE) was similar to the bone marrow (1.68 +/- 0.15 APE). The rate of incorporation of (13)C into heme increased over time from 0.0004 APE/h between 6 and 12 h, to 0.0014 APE/h between 12 and 18 h, and 0.0024 APE/h between 18 and 24 h. Consequently, fSynHb (1.19 +/- 0.32, 2.92 +/- 0.66, and 4.22 +/- 0.56% day(-1), respectively) and SynHb (0.11 +/- 0.03, 0.28 +/- 0.05, and 0.42 +/- 0.05 mg g(-1) day(-1), respectively) showed similar patterns over the 24-h study period. We conclude that (1) enrichment of free glycine in the circulating RBC approximates enrichment of bone marrow free glycine for heme formation and (2) this pattern of hemoglobin synthesis rate is reflecting the characteristic release and gradual maturation of reticulocytes in the circulation.

Assessment of human colon cancer protein kinetics in vivo

BACKGROUND

Malignancies enlarge because protein synthesis exceeds the rate of breakdown; however, the specific protein kinetic pattern remains unknown. Determining in vivo protein kinetic rates for a tumor may be useful for quantifying individual responses to a specific therapy. The aim of this study was to assess whether the growth of tumors is related to an increase in protein synthesis or an inhibition of protein breakdown.

METHODS

Five patients (age, 59 +/- 3 years) with adenocarcinoma of the colon undergoing colonoscopy were studied. Tissue protein synthesis and breakdown rates were measured in vivo for both segments of colon cancer and adjacent normal-appearing colonic mucosa by using a primed, continuous infusion of 1(13)C leucine with tissue biopsy and quantitation of regional blood flow by laser Doppler flowmetry.

RESULTS

Segments of colon cancer had a significantly (p < 0.05) greater rate of protein synthesis as quantitated by both the fractional rate of protein synthesis (Ca 45.4% +/- 5.0%/day versus nl mucosa 35.7% +/- 3.1%/day; mean +/- SEM) and by the tissue synthesis rate (Ca 69.4 +/- 9.0 versus nl mucosa 51.6 +/- 5.2 mumol/L leucine/day/100 gm tissue). Regional blood flow was significantly elevated in the cancer (Ca 110.9 +/- 5.8 versus nl mucosa 91.2 +/- 2.9 ml/min/100 gm), which contributed to commensurate rates of tissue breakdown (Ca 28.6 +/- 2.0 versus nl mucosa 28.2 +/- 2.4 mumol/L leucine/day/100 gm).

CONCLUSIONS

These results illustrate that human colon cancers grow in vivo as a result of increases in protein synthesis. Furthermore, increases in regional blood flow limit the rate of tissue protein breakdown of colon cancer, thereby contributing to growth of the malignancy. These findings support the contention that therapeutic strategies aimed at negating this inherent increase in protein synthesis or limiting blood flow may effectively limit the growth of malignancies. This methodology may also provide an index for evaluating the effectiveness of future therapies aimed at reducing tumor growth for individual patients.

The quality professional's expanding role as internal consultant: practical tips and survival strategies--Part 2

Part 1 of this two-part article addressed the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility was emphasized and a number of ethical dilemmas were reviewed, including confidentiality issues. Part 2 addresses strategies for handling difficult psychological issues that often come up in the process of internal consulting. Transference, resistance, regressions, and counterproductive group dynamics are reviewed. These psychological issues may be the predominant source of stress in an internal consulting experience. Case examples are presented along with some empowering strategies. It is hoped that through this review, the quality professional will be better prepared to meet the exciting and rewarding challenges of internal consulting.

The quality professional's expanding role as internal consultant: practical tips and survival strategies--Part I

Expertise in quality and process improvement is becoming widely recognized as a valuable resource. The more objective viewpoint and experience of consulting firms or outside professionals in quality and change management often is critical to the success of organization-wide quality or change implementation. Outside consultants, however, are not inexpensive. It is predictable that there will be an increasing tendency for healthcare systems to look internally for organizational and quality expertise. Part one of this article discusses the approach and skills needed to gain a clearly defined and agreed-upon direction for the consulting mission. The importance of mental preparation and flexibility is discussed. Ethical dilemmas are a core challenge, and a number of real-life scenarios and associated strategies are presented.

Threshold Amsler grid testing in diabetic retinopathy

The Amsler grid is a suprathreshold target used to assess the central 10 degrees of the visual field; thus, it may fail to detect relative central scotomas. Low luminance conditions can be created by viewing the white grid on a black background through two cross-polarizing filters that vary light transmission and change the procedure to a threshold Amsler grid (TAG) test, thereby increasing its sensitivity. A total of 26 patients with diabetic retinopathy were tested by standard Amsler grid, TAG, and tangent screen. Four scotomas were detected by Amsler grid testing; each of these scotomas expanded in size on retesting with the TAG. TAG testing revealed 22 scotomas more than five times the number seen with conventional Amsler grid testing; tangent-screen examination confirmed 9 of these defects. In many cases, fundus photography and fluorescein angiography revealed pathology that correlated with the scotomas detected only by TAG testing. It thus appears that the TAG test is a rapid, high-yield, and sensitive means of assessing the central visual field in patients with diabetic retinopathy.

Transformation of glucocorticoid receptors bound to the antagonist RU 486: effects of alkaline phosphatase

RU 486 is a synthetic steroid that binds avidly to glucocorticoid receptors without promoting their transformation into activated transcription factors. A significant part of this behavior has been shown to be due to a failure of the RU 486 bound receptor to be efficiently released from a larger (sedimenting at 8-9 S) multimeric complex containing the 90-kDa heat shock protein. Our studies have found that in vitro at 15 degrees C the RU 486-receptor was slowly released from the 8-9S complex and converted into a DNA binding protein by a process that could be blocked by sodium fluoride. Moreover, this transition was significantly accelerated by treatment with alkaline phosphatase. High-resolution anion-exchange chromatography showed that the profile of receptor subspecies released from the 8-9S complex (in the absence of phosphatase treatment) was different for the RU 486 bound receptor when compared to the receptor occupied by the agonist triamcinolone acetonide. Production of the earliest eluting receptor form (peak A) was inhibited with RU 486. Peak A had previously been shown to be the predominant form of the receptor possessing a capacity to bind DNA. Treatment of the RU 486-receptor with alkaline phosphatase increased the formation of the peak A subspecies as well as the capacity of receptor to bind DNA-cellulose. Taken together, the results indicate that phosphorylation of the receptor or a tightly bound factor contributes to defining the capacity with which individual steroids can promote dissociation of the 8-9S complex and conversion of the glucocorticoid receptor into a DNA-binding protein.

Transformed glucocorticoid receptors consist of multiple subspecies with differing capacities to bind DNA-cellulose

The glucocorticoid receptor can be transformed into a DNA-binding protein by a process that is both hormone and temperature dependent. We have used a modification of the conventional method of anion-exchange chromatography to separate and analyze a variety of receptor subspecies that result from this transition. One receptor form (peak A) was found to have a capacity to bind DNA-cellulose which was significantly greater than that of the other species. Under conditions of mild heating (15 degrees C), the relative abundance of peak A in the receptor population and the rate of receptor transformation were both increased as a result of incubating samples with alkaline phosphatase. The mechanism appears to involve the conversion of the more "acidic" forms into that of peak A. The results indicate that receptor transformation is a multistep process which may be promoted by the removal of phosphate from either the receptor or a receptor-bound regulatory factor.

Analysis of glucocorticoid receptor subspecies binding to DNA-cellulose and isolated nuclei

Conversion of the glucocorticoid receptor into a DNA-binding protein results in the generation of several distinct receptor subspecies (peaks A-E) which can be resolved by anion exchange chromatography. In vitro, the fraction of the receptor population (approx. 40%) which gains a capacity to bind DNA-cellulose is preferentially transformed into the peak A species by a process that was enhanced by the presence of KCl. At 0.4 M KCl, virtually all of the DNA-binding receptor was in the peak A form. Isolated nuclei also exhibit a receptor binding profile similar to that observed with DNA-cellulose.