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IntroductionLarge-scale, international data sharing opens the door to the study of so-called ‘Big Data’, which holds great promise can you buy viagra online for improving patient-centred care. Big Data health research is envisioned to take precision medicine to the can you buy viagra online next level through increased understanding of disease aetiology and phenotypes, treatment effects, disease management and healthcare expenditure.1 However, lack of public trust is proven to be detrimental to the goals of data sharing.2 The case of care.data in the UK offers a blatant example of a data sharing initiative gone awry. Criticism predominantly focused on limited public awareness can you buy viagra online and lack of clarity on the goals of the programme and ways to opt out.3 Citizens are becoming increasingly aware and critical of data privacy issues, and this warrants renewed investments to maintain public trust in data-intensive health research.

Here, we use the term data-intensive health research to refer to a practice of grand-scale capture, (re)use and/or linkage of a wide variety of health-related data on individuals.Within the European can you buy viagra online Union (EU), the recently adopted General Data Protection Regulation (GDPR) (EU 2016/679) addresses some of the concerns the public may have with respect to privacy and data protection. One of the primary goals of the GDPR is to give individuals control over their personal data, most notably through consent.4 Other lawful grounds for the processing of personal data are listed, but it is unclear how these would exactly apply to scientific research. Legal norms remain open to interpretation and thus offer limited guidance to researchers.5 6 In Recital 33, the GDPR actually mentions that additional ethical can you buy viagra online standards are necessary for the processing of personal data for scientific research.

This indicates a recognised need for entities undertaking activities likely to incite public unease to go beyond compliance with legal requirements.7 Complementary ethical governance then becomes a prerequisite for securing public trust in data-intensive health research.A concept that can you buy viagra online could be of use in developing ethical governance is that of a ‘social license to operate’.7 The social license captures the notion of a mandate granted by society to certain occupational groups to determine for themselves what constitutes proper conduct, under the condition that such conduct is in line with society’s expectations. The term ‘social license’ was first used in the 1950s by American sociologist Everett Hughes to address relations between professional occupations and society.8 The concept has been used since to frame, for example, corporate social responsibility in the mining can you buy viagra online industry,9 governance of medical research in general8 and of data-intensive health research more specifically.7 10 As such, adequate ethical governance then becomes a precondition for obtaining a social license for data sharing activities.Key to an informed understanding of the social license is identifying the expectations society may hold with regard to sharing of and access to health data. Here, relevant societal actors are the subjects of Big Data health research, constituting can you buy viagra online both patients and the general public.

Identification of patients’ and public views and attitudes allows for a better understanding of the elements of a socially sanctioned governance framework. We know can you buy viagra online of the existence of research papers that have captured these views using quantitative or qualitative methods or a combination of both. So far, systematic reviews of the literature have limited their scope to citizens of specific countries,11 12 qualitative studies only13 or the sharing of genomic data.14 Therefore, we performed an up-to-date narrative review of both quantitative and qualitative studies can you buy viagra online to explore predominant patient and public views and attitudes towards data sharing for health research.MethodsWe searched the literature databases PubMed (MEDLINE), Embase, Scopus and Google Scholar in April 2019 for publications addressing patients’ and public views and attitudes towards the use of health data for research purposes.

Synonyms of the following terms (connected by ‘AND’) were used to search titles and/or abstracts of can you buy viagra online indexed references. Patient or public can you buy viagra online. Views.

Data sharing can you buy viagra online. Research (See can you buy viagra online box 1 and online supplementary appendix 1). To merit inclusion, an article had to report results from an original research study (qualitative, quantitative or mixed methods) on attitudes of individuals can you buy viagra online regarding use of data for health research.

We restricted eligibility to records published in English and studies performed between can you buy viagra online 2009 and 2019. We chose 2009 as a lower limit because we assume that patients’ and public perspectives might have changed substantially with increasing awareness and use of digital (health) technologies. Systematic reviews can you buy viagra online and meta-analyses synthesising the empirical literature on this topic also qualified for review.

Reports from stakeholder meet-ups and workshops were eligible as long as can you buy viagra online they included patients or the public as participants. Since we were only interested in empirical evidence, expert opinion and publications merely advocating for the inclusion of patients’ and public views in Big Data health research were excluded can you buy viagra online. Studies that predominantly reported can you buy viagra online on views of other stakeholders—such as clinicians, researchers, policy makers or industry—were excluded.

Articles reporting on conference proceedings, or views regarding (demographic) data collection in low or middle income countries or for public health and care/quality improvement were not considered relevant to this review. Despite our specific interest in data sharing within the European can you buy viagra online context, we broadened eligibility criteria to include studies performed in the USA, Canada, Australia and New Zealand. Additional articles were identified through consultation with experts and review of references in can you buy viagra online the manuscript identified through the literature database searches.

Views and attitudes of patients and the public were identified from selected references and reviewed by means of thematic content analysis.Supplemental materialBox 1 Key search terms(patient* OR public OR citizen*)AND(attitude* OR view* OR perspective* OR opinion* OR interview* OR qualitative* OR questionnaire* OR survey*)AND(“data sharing” OR “data access” OR “data transfer”)ANDResearchResultsStudy characteristicsSearches in can you buy viagra online PubMed (MEDLINE), Embase, Scopus and Google Scholar resulted in a total of 1153 non-unique records (see online supplementary appendix 1). We identified 27 papers for review, including 12 survey can you buy viagra online or questionnaire studies (quantitative), 8 interview or focus group studies (qualitative), 1 mixed methods study and 6 systematic reviews (see table 1). Most records were excluded because they were not relevant to our research question or because they did not report on findings from original (empirical) research studies.

Ten studies reported on views of patients, 11 on views of the public/citizens and 6 studies combined views of patients, research participants and the public.View this table:Table 1 Study characteristicsWillingness to share data for health researchReviewed papers suggest widespread support for the sharing of data for health research.Four systematic reviews synthesising the views of patients and the public report that willingness for data to be linked and shared for research purposes is high11–14 and that people are generally open to and can you buy viagra online understand the benefits of data sharing.15Outpatients from a German university hospital who participated in a questionnaire study (n=503) expressed a strong willingness (93%) to give broad consent for secondary use of data,16 and 93% of a sample of UK citizens with Parkinson’s disease (n=306) were willing to share their data.17 Wide support for sharing of data internationally18 19 and in multicentre studies20 was reported among patient participants. Goodman et al found that most participants in a sample of US patients with cancer (n=228) were willing to have their data made available for ‘as many research studies as possible’.21 Regarding the use of anonymised healthcare data for research purposes, a qualitative study found UK rheumatology patients and patient representatives in support of data sharing (n=40).22Public respondents in survey studies recognised the benefits of storing electronic health information,23 and 78.8% (n=151) of surveyed Canadians felt positive about the use of routinely collected data for health research.24 The majority (55%) of a sample of older Swiss citizens (n=40) were in favour of placing genetic data at disposal for research.25 Focus group discussions convened in the UK showed that just over 50% of the members of the Citizens Council of The National Institute for Health and Care Excellence (NICE) said they would have no concerns about can you buy viagra online NICE using anonymised data derived from personal care records to evaluate treatments,26 and all participants in one qualitative study were keen to contribute to the National Healthcare Service (NHS)-related research.27Motivations to share dataPatients and public participants expressed similar reasons and motivations for their willingness to share data for health research, including contributing to advancements in healthcare, returning incurred benefits and the hope of future personal health benefits (tables 2–4).View this table:Table 2 Patients’ views and attitudes towards the sharing of health data for researchView this table:Table 3 Public views and attitudes towards the sharing of health data for researchView this table:Table 4 Patients’ and public views and attitudes towards the sharing of health data for researchIn the two systematic reviews that addressed this topic, sharing data for ‘the common good’ or ‘the greater good’ was identified as one of the most prevalent motivations.12 14For patients specifically, to help future patients or people with similar health problems was an important reason.14 16 One survey study conducted among German outpatients found that 72% listed returning their own benefits incurred from research as a driver for sharing clinical data.16 Patients with rare disease were also motivated by ‘great hope and trust’ in the development of international databases for health research.19 Among patients, support of research in general,16 the value attached to answering ‘important’ research questions,20 and a desire to contribute to advancements in medicine14 were prevalent reasons in favour of data sharing. Ultimately, the belief that data sharing could lead to improvements in health outcome and care was reported.20Only can you buy viagra online one original study research paper addressed public motivations.

This study found that older citizens mentioned auistic reasons and the greater good in a series of interviews as reasons to share genetic data for research.25 In these interviews, citizens expressed no expectations of an immediate can you buy viagra online impact or beneficial return but ultimately wanted to help the next generation.Perceived benefits of data sharingPatients and the public perceive that data sharing could lead to better patient care through improved diagnosis and treatment options and more efficient use of resources. Patients seem to also value the potential of (direct) personal health benefits.Two systematic reviews reported on perceived benefits of data sharing for health research purposes. Howe et al mentioned perceived benefits to research participants or the immediate community, benefits to the public and benefits to research and science.15 Shabani et al also listed accelerating research advancement and maximising the value of resources as perceived benefits.14Surveyed patients perceived that data sharing could help their doctor ‘make better decisions’ about their health (94%, n=3516)28 or result in an increased chance of receiving personalised health information (n=228).21In the original studies reviewed, advantages and potential benefits of data sharing were generally recognised by public and patient participants.22 29 Data sharing was believed to enable the study of long-term treatment effects and rare events, as well as the study of large numbers of people,24 to improve diagnosis25 and treatment quality,20 23 as well as to stimulate innovation30 and identify new treatment options.25 A cross-sectional online survey among patient and citizen groups in Italy (n=280) also identified the perception that data sharing could reduce waste in research.30Perceived risks of data sharingThe most significant risks of data sharing were perceived to results from breaches of confidentiality, commercial use and potential abuse of the data.Systematic reviews report on patients’ and public concerns about confidentiality in general,13 15 sometimes linked to the risk of reidentification,14 concerns about a party's competence in keeping data secure,12 and concerns that personal information could be mined from genomic data.14 A systematic review by Stockdale et al identified concerns among the public (UK and Ireland) about the motivation a party might have to use the data.14Patients in a UK qualitative study (n=40) perceived ‘detrimental’ consequences of data ‘falling into the wrong hands’, such as insurance companies.22 Respondents from the online patient community PatientsLikeMe were fearful of health data being ‘stolen by hackers’ (87%, n=3516).28Original research studies flagged data security and privacy as major public concerns.16 18 20 25 26 29–32 More specifically, many studies found that participants worried about who would have access to the data and about risk of misuses or abuses.13 15 18 25 27 33 A large pan-European survey among respondents from 27 EU member states revealed public concerns about different levels of access by third parties (48.9%–60.6%, n=20 882).23 Overall, reviewed can you buy viagra online papers suggest that patients and the public are concerned about the use of their data for commercial purposes.14 27 For example, the NICE Citizens Council expressed concerns about the potential for data to be sold to other organisations and used for profit and for purposes other than research.26 The Citizens Council also highlighted the need for transparency about how data are used and how it might be used in the future and for ensuring the research is conducted according to good scientific practice and that data are used to benefit society.

Concerns about control and ownership can you buy viagra online of data were identified13 33 and about re-use of data for purposes that participants do not agree on.30 Fear of discrimination, stigmatisation, exploitation or other repercussions as a consequence of data being shared was widely cited by individuals.14 15 18Barriers to share dataStudies showed that patients and the public rarely mention barriers to data sharing in absolute terms. Rather, acceptance seemed to decrease if data sharing was financially motivated, and if people did not know how and with whom their data would be shared.First, individuals often opposed data sharing if it was motivated by financial gain or profit20 or if the data were shared with commercial/private companies.14 15 In one large pan-European survey (n=20 882), respondents were found to be strongly averse to health insurance companies and private sector pharmaceutical companies viewing their data.23 Second, lack of understanding and awareness around the use of data was viewed as a barrier to data sharing.15 22 Third, lack of transparency and controllability in releasing data were mentioned as factors compromising public trust in data sharing activities.14 22Factors affecting willingness to share dataA wide range of factors were identified from the literature that impacted individuals’ willingness to share data for health research, including geographical factors, age, individual-specific and research-specific characteristics.Geographical factorsMcCormack et al found that European patients’ expressions of trust and attitudes to risk were often affected by the regulatory and cultural practices in their home countries, as well as by the nature of the (rare) disease the patient participant had.18 Shah et al conducted a survey among patients in four Northern European countries (n=855) and found a significant association between country and attitudes towards sharing of deidentified data.34 Interestingly, Dutch respondents were less likely to support sharing of their deidentified data compared with UK citizens.AgeAmong a sample of surveyed patients with Parkinson’s disease (UK), a significant association was found between higher age and increased support for data sharing.17 According to a study based on semistructured interviews with older Swiss citizens, generational differences impacted willingness to share.25 With respect to public attitudes towards data sharing, findings of one systematic review suggest that males and older people are more likely to consent to sharing their medical data.27 A systematic review by Shabani et al suggests that patient and public participants with higher mean age are substantially less worried about privacy and confidentiality than other groups.14Individual-specific characteristicsA systematic review into patients’ and public perspectives on data sharing in the USA suggests that individuals from under-represented minorities are less willing to share data.11 A large multisite survey (n=13 000) among the US public found that willingness to share was associated with self-identified white race, higher educational attainment and lower religiosity.31 In another systematic review, race, gender, age, marital status and/or educational level all seemed to influence how people perceived sensitivity of genomic data and the sharing thereof.14 However, a UK study among patients with Parkinson’s disease found no clear relationship between data sharing and the number of years diagnosed, sex, medication class or health confidence.17Factors that clearly positively affected attitudes towards data sharing were perceptions of the (public) benefits and value of the research,13 20 fewer concerns and fewer information needs,31 and higher trust in and reputation of individuals or organisations conducting and/or overseeing data sharing.12–14 35 Conversely, willingness decreased with higher privacy and confidentiality concerns11 and higher distrust of the government as an oversight body for (genetic) research data.35Research-specific characteristicsPrivacy measures increased people’s willingness to share their data for health research, such as removal of social security numbers (90%, n=3516) and insurance ID (82%, n=3516), the sharing of only summary-level or aggregate data20 and deposition of data in a restricted can you buy viagra online access online database.29 Expressions of having control over what data are shared and with whom positively affected attitudes towards data sharing.34 In one study, being asked for consent for each study made participants (81%) feel ‘respected and involved’, and 74% agreed that they would feel that they ‘had control’.14 With respect to data sharing without prospective consent, participants became more accepting after being given information about the research processes and selection bias.27 Less support was observed for data sharing due to financial incentives25 and, more specifically, if data would be shared with private companies, such as insurance or pharmaceutical companies.11 25Conditions for sharingWidespread willingness to share data for health research very rarely led to participants’ unconditional support. Studies showed agreement on the following conditions for responsible data sharing.

Value, privacy, minimising risks, data security, transparency, control, information, trust, responsibility and accountability.ValueOne systematic review found that participants found it important that the research as a result of data sharing should be in the public’s interest and should reflect participants’ values.15 The NICE Citizens Council advocated for appropriate systems and good working practices to ensure a consistent approach to research planning, data capture and analysis.26Privacy, risks and data securityThe need to protect individuals’ privacy was considered paramount11 14 21 34 and participants often viewed deidentification of personal data as a top privacy measure.11 24 30 36 One survey among US patients with cancer found that only 20% (n=228) of participants found linkage of individuals with their deidentified data acceptable for return of individual health results and to support further research.21 Secured access to databases was considered an important measure to ensure data security in data sharing activities.30 34 A systematic review of participants’ attitudes towards data sharing showed that people established risk minimisation as another condition for data sharing.15 Findings by Mazor et al suggest that patients only support studies that offer value and minimise security risks.20Transparency and controlConditions regarding transparency were information about how data will be shared and with whom,14 35 the type of research that is to be performed, by whom the research will be performed,16 information on data sharing and monitoring policies and database governance,35 conditions framing access to data and data access agreements,24 28 30 and any partnerships with the pharmaceutical industry.19 More generally, can you buy viagra online participants expressed the desire to be involved in the data sharing process,35 to be notified when their data are (re)used and to be informed of the results of studies using their data.15 Spencer et al identified use of an electronic interface as a highly valued means to enable greater control over consent choices.22 When asked about the use of personal data for health research by the NHS, UK citizens were typically willing to accept models of consent other than the ones they would prefer.37 Acceptance of consent models with lower levels of individual control was found to be dependent on a number of factors, including adequate transparency, control over detrimental use and commercialisation, and the ability to object, particularly to any processing considered to be inappropriate or particularly sensitive.37Information and trustOne systematic review identified trust in the ability of the original institution to carry out the oversight tasks as a major condition for responsible data sharing.14 Appropriate education and information about data sharing was thought to include public campaigns to inform stakeholders about Big Data32 and information communicated at open days of research institutions (such as NICE) to ensure people understand what their data are being used for and to reassure them that personal data will not be passed on or sold to other organisations.26 The informed consent process for study participation was believed to include information about the fact that individuals’ data could potentially be shared,15 30 the objectives of data sharing and (biobank) research, the study’s data sharing plans,29 governance structure, logistics and accountability.33Responsibility and accountabilityParticipants often placed the responsibility for data sharing practices on the shoulders of researchers. Secondary use of data collected earlier for scientific research was viewed to require a data access committee that involves a researcher from the original research project, a clinician, patient representative and a participant in the original study.36 Researchers of the original study were required to monitor data used by other researchers.36 In terms of accountability, patient and public groups in Italy (n=280) placed high value on sanctions for misuse of data.30 Information on penalties or other consequences of a breach of can you buy viagra online protection or misuse was considered important by many.31 35DiscussionIn this study, we narratively reviewed 27 papers on patients’ and public views on and attitudes towards the use of health data for scientific research. Studies reported a widespread—though conditional—support for the linkage and sharing of data for health can you buy viagra online research.

The only outlier seems to be the finding that just over half (n=25) of the NICE Citizens Council answered ‘no’ to the question whether they had any concerns if NICE used anonymised data to fill in the gaps if NICE was not getting enough evidence can you buy viagra online in ‘the usual ways’.26 However, we hasten to point out that the question about willingness to share is different from the question whether people have concerns or not. In addition, after a 2-day discussion meeting Council members were perhaps more sensitised to the potential concerns regarding data sharing. Therefore, we can you buy viagra online suggest that the way and context within which questions are phrased may influence the answers people give.Overall, people expressed similar motivations to share their data, perceived similar benefits (despite some variation between patients and citizens), yet at the same time displayed a range of concerns, predominantly relating to confidentiality and data security, awareness about access and control, and potential harms resulting from these risks.

Both patient and public participants conveyed that certain can you buy viagra online factors would increase or reduce their willingness to have their data shared. For example, the presence of privacy-protecting measures (eg, data deidentification and the use of secured databases) seemed can you buy viagra online to increase willingness to share, as well as transparency and information about data sharing processes and responsibilities. The identified views and attitudes appeared to come together in can you buy viagra online the conditions stipulated by participants.

Value, privacy and confidentiality, minimising risks, data security, transparency, control, information, trust, responsibility and accountability.In our Introduction, we mentioned that identifying patients’ and public views and attitudes allows for a better understanding of the elements of a socially sanctioned governance framework. In other words, can you buy viagra online what work should our governance framework be doing in order to obtain a social license?. This review urges researchers and institutions to address people’s diverse can you buy viagra online concerns and to make an effort to meet the conditions identified.

Without these conditions, institutions lack trustworthiness, which is vital can you buy viagra online for the proceedings of medicine and biomedical science. As such, a social license is not a can you buy viagra online ‘nice to have’ but a ‘need to have’. Our results also confirm that patients and the public indeed care about more than legal compliance alone, and wish to be engaged through information, transparency and control.

This work supports the findings of a recent systematic review into ethical principles of data sharing as specified in various international ethical guidelines and literature.38 What this body of research implies is considerable can you buy viagra online diversity of values and beliefs both between and within countries.The goal of this narrative review was to identify the most internationally dominant, aggregated patient and public views about the broad topic of data sharing for health research. We deliberately opted for the methodology of a narrative can you buy viagra online review rather than a systematic review. Most narrative reviews deal with a broad range of issues to a given can you buy viagra online topic rather than addressing a particular topic in depth.39 This means narrative reviews may be most useful for obtaining a broad perspective on a topic, and that they often are less useful in generating quantitative answers to specific clinical questions.

However, because narrative reviews do not require specification of the search can you buy viagra online and selection strategy and the way of critically appraising literature can be variable, the connection between evidence generated by narrative reviews and (clinical) recommendations is less rigorous and risk of bias exists. This is something to take into account in this study. A risk of bias assessment was not possible due to can you buy viagra online the heterogeneity of the findings.

We acknowledge that our methodological choices may have affected the discriminative power or granularity can you buy viagra online of our findings. For example, there is a difference can you buy viagra online between sharing of routinely collected health data versus secondary use of health data collected for research purposes. And we can only make loose assumptions about potential differences between patient and public views.In addition, we should mention that this work is centred around studies conducted in Western countries as the whole Big Data space and literature is can you buy viagra online dominated by Western countries, higher socioeconomic status and Caucasians.

However, most of the disease burden globally and within countries is most probably not represented in the ‘Big Data’ and so we have to stress the lack of generalisability to large parts of the world.Nevertheless, we believe our findings point towards essential elements of a governance framework for data sharing for health research purposes. If we are to can you buy viagra online conclude that the identified conditions ought to act as the pillars of a governance framework, the next step is to identify how these conditions could be practically operationalised. For example, if people value information, transparency and control, what type of consent is most likely to can you buy viagra online valorise these conditions?.

And what policy for returning can you buy viagra online research results would be desirable?. Once we know what to value, can you buy viagra online we can start thinking about the ways to acknowledge that value. A new challenge arising here, however, is what to do when people hold different or even conflicting values or preferences.

Discrete choice experiments could help to test people’s can you buy viagra online preferences regarding specific topics, such as preferred modes of informed consent. Apart from empirical work, conceptual analysis is needed to clarify how public trust, trustworthiness of institutions and accountability are interconnected.ConclusionThis narrative review suggests widespread—though conditional—support among patients and the public for data sharing can you buy viagra online for health research. Despite the can you buy viagra online fact that participants recognise actual or potential benefits of health research, they report a number of significant concerns and related conditions.

We believe identified conditions (eg, social value, data security, transparency and accountability) ought to be operationalised in a value-based governance framework that incorporates the diverse patient and public values, needs and interests, and which reflects the way these same conditions are met, to strengthen the social license for Big Data health research.Ethics statementsPatient consent for publicationNot required.AcknowledgmentsWe thank Susanne Løgstrup (European Heart Network) and Evert-Ben van Veen (Medlaw) for their valuable feedback during various stages in drafting the manuscript..

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While lower vertebrates can repair http://theirishathomeandabroadtvshow.com/buy-generic-cialis-online/ their adult hearts after a heart attack, mammals -- including humans low dose viagra -- cannot. The ability to regenerate dead muscle tissue low dose viagra in mammalian hearts disappears just a few days after birth because the heart muscle cells, called cardiomyocytes, exit the cell cycle.After that, all growth of the heart comes from enlargement of existing cells, not from creation of new muscle cells. In an adult heart attack, heart failure results when the lost cardiomyocytes are replaced by fibrous scar tissue, instead of new muscle cells. This starts a vicious cycle of heart enlargement, loss of pumping function and eventual death.In 2020, University of Alabama at Birmingham researchers reported that surgery to remove the left ventricle apex of the heart of pigs, one day after birth, somehow extended the replication ability of heart muscle cells low dose viagra. In fact, after such surgery, pigs can completely recover from a heart attack four weeks after birth, without scarring or decline in heart function.To better understand the underlying gene expression changes in this extended regeneration window, UAB researchers now report nuclear RNA-sequencing of heart muscle cells, using this porcine model.

From such knowledge, and much further research yet to come, clinicians may potentially learn how to regenerate adult heart cardiomyocytes low dose viagra after a heart attack.This study, led by Jianyi "Jay" Zhang, M.D., Ph.D., chair of the UAB Department of Biomedical Engineering, is published as a Circulation research letter.The researchers compared nuclei from heart tissue of five groups of pigs. Two groups were regeneration models that had left ventricle apical resections, or AR, at postnatal day one, or P1. One of those two groups then had low dose viagra ligation of the left anterior descending coronary artery four weeks after birth, or P28, to induce a myocardial infarction, or MI. This group is called ARP1MIP28. The other group, called ARP1, did not have low dose viagra ligation.

advertisement Two non-regenerative controls did not low dose viagra have the P1 apical resection, but one of those did have the induced heart attack at P28. Those two groups were called Control and MIP28.Hearts were removed for single-nucleus RNA-sequencing at P30 through P56 for the ARP1MIP28 animals, and hearts from all other groups were explanted for sequencing on P1, P28 or P56.The fifth group were fetal hearts, or FH, at embryonic day 80.A total of 218,945 high-quality nuclei were captured, and a network biology clustering analysis identified all eight major heart cell types. Complete gene low dose viagra nucleus data were available for 94,844 cardiomyocytes. The cardiomyocytes were distributed among six clusters, named cardiomyocyte 1 through cardiomyocyte 6.Three clusters were almost entirely composed of cardiomyocytes from a single experimental group. Cardiomyocyte 2 from control-P56, cardiomyocyte 3 from control-P1, and cardiomyocyte 6 from FH low dose viagra.

advertisement The cardiomyocyte 4 and 5 clusters contained primarily ARP1MIP28-P35 cardiomyocytes. The cardiomyocyte 1 cluster included cardiomyocytes from all other animal groups and time points and a small low dose viagra number of ARP1MIP28-P35 cardiomyocytes, but few fetal or control-P56 cardiomyocytes.The cardiomyocyte 4 and 5 clusters that contained primarily ARP1MIP28-P35 cardiomyocytes showed increased cell cycle activity and proliferation, changes that helped remuscularize the left ventricle after experimental heart attack, without scarring. The researchers also found 506 genes that were positively correlated with the highly proliferative ARP1MIP28-P30 and ARP1MIP28-P35 cardiomyocytes. These genes participated in pathways that low dose viagra regulated heart development, cell proliferation and cardiomyocyte proliferation."It will be interesting to examine these two distinct cell populations from the ARP1MIP28 injury in future studies," Zhang said. "The findings are highly impactful because they show, for the first time, that the left ventricle can remuscularize the myocardial infarct beyond postnatal day seven, or P7, in large mammals.

These observations provide a foundation for future investigations of the molecular mechanisms and signaling molecules that regulate the injury-induced preservation of cardiomyocyte cell cycle activity in newborn large mammals, and ultimately to remuscularize the heart muscle in patients suffering from heart attacks, thus preventing heart low dose viagra failure."The study is titled "Single nucleus transcriptomics. Apical resection in newborn pigs extends the time window of cardiomyocyte proliferation and myocardial regeneration." Co-authors with Zhang are Yuji Nakada, Yang low dose viagra Zhou, Eric Y. Zhang, Yuhua Wei, Meng Zhao, Wangping Chen, Jiacheng Sun and S. Naqi Raza, UAB Department of low dose viagra Biomedical Engineering. Thanh Nguyen and Jake Y.

Chen, UAB Informatics low dose viagra Institute. Gregory P. Walcott, UAB low dose viagra Department of Medicine, Division of Cardiovascular Disease. And Wuming Gong, Erik Skie and Daniel J. Garry, School of Medicine, University of Minnesota, Minneapolis.Support came from National Institutes of Health grants HL114120, HL131017, HL149137 and low dose viagra HL134764.At UAB, Zhang holds the T.

Michael and Gillian Goodrich Endowed Chair of Engineering Leadership. Biomedical Engineering is a joint department of the UAB Marnix low dose viagra E. Heersink School of Medicine and the UAB School of Engineering low dose viagra. The Informatics Institute and the Department of Medicine are part of the Heersink School of Medicine.Along with high blood pressure, diabetes, and smoking, environmental factors such as air pollution are highly predictive of people's chances of dying, especially from heart attack and stroke, a new study shows.Led by researchers at NYU Grossman School of Medicine and the Icahn School of Medicine at Mount Sinai, the study showed that exposure to above average levels of outdoor air pollution increased risk of death by 20%, and risk of death from cardiovascular disease by 17%.Using wood- or kerosene-burning stoves, not properly ventilated through a chimney, to cook food or heat the home also increasd overall risk of death (by 23% and 9%) and cardiovascular death risk (by 36% and 19%). Living far from specialty medical clinics and near busy roads also increased risk of death.Publishing in the journal PLOS ONE online low dose viagra June 24, the findings come from personal and environmental health data collected from 50,045 mostly poor, rural villagers living in the northeast Golestan region of Iran.

All study participants were over age 40 and agreed to have their health monitored during annual visits with researchers dating as far back as 2004.Researchers say their latest investigation not only identifies environmental factors that pose the greatest risk to heart and overall health, but also adds much-needed scientific evidence from people in low- and middle-income countries. Traditional research on environmental risk factors, the researchers note, has favored urban populations in high-income countries with much greater access to modern health care services.Compared with those who have easier access to specialized medical services, those living farther away low dose viagra from clinics with catheterization labs able to unblock clogged arteries, for example, were at increased risk of death by 1% for every 10 kilometers (6.2 miles) of distance. In Golestan, most people live more than 50 miles (80 kilometers) away from such modern facilities. advertisement Study results also showed that the one-third of study participants who lived within 500 meters (1,640 feet) of a major roadway had a 13% increased risk of death."Our study highlights the role that key environmental factors of indoor/outdoor air pollution, access to modern health services, and proximity to noisy, polluted roadways play in all causes of death and deaths from cardiovascular disease in particular," says study senior author and cardiologist Rajesh Vedanthan, MD, MPH."Our findings help broaden the disease-risk profile beyond age and traditional personal risk factors," says Vedanthan, an associate professor in the Department of Population Health and the Department of Medicine at NYU Langone Health."These results illustrate a new opportunity for health policymakers to reduce the burden of disease in their communities by mitigating the impact of environmental risk factors like air pollution on cardiovascular health," says study lead author Michael Hadley, MD, a fellow in cardiology and incoming assistant professor of medicine at Mount Sinai.By contrast, the study showed that other environmental factors included in the analysis -- low neighborhood income levels, increased population density, and too much nighttime light exposure -- were not independent predictors of risk of death, despite previous research low dose viagra in mostly urban settings suggesting otherwise.For the investigation, researchers analyzed data gathered through December 2018. They then created a predictive model on overall death risk and death risk from cardiovascular disease.The research team plans to continue its analysis and hopes to apply the predictive model to other countries with the aim of fine-tuning its predictive capacity.

They say their new tool could serve as a guide for evaluating the effectiveness of environmental, lifestyle, and personal health changes in reducing mortality rates worldwide.According to the World Health Organization, one-quarter of all deaths worldwide are now attributable to environmental factors, including poor air and water quality, lack of sanitation, and exposure to toxic chemicals.Funding for the study was provided by U.S. National Institutes of Health grant R21HL140474..

While lower vertebrates can repair their adult hearts after a heart attack, mammals -- including humans -- cannot can you buy viagra online. The ability to regenerate dead muscle tissue in mammalian hearts disappears just a few days after birth because the heart muscle cells, called cardiomyocytes, exit the cell cycle.After that, all growth can you buy viagra online of the heart comes from enlargement of existing cells, not from creation of new muscle cells. In an adult heart attack, heart failure results when the lost cardiomyocytes are replaced by fibrous scar tissue, instead of new muscle cells. This starts a vicious cycle of heart enlargement, loss of pumping function and eventual death.In 2020, University of Alabama at Birmingham researchers reported that surgery to remove the left ventricle apex of the heart of pigs, one day after birth, somehow extended the replication ability of can you buy viagra online heart muscle cells. In fact, after such surgery, pigs can completely recover from a heart attack four weeks after birth, without scarring or decline in heart function.To better understand the underlying gene expression changes in this extended regeneration window, UAB researchers now report nuclear RNA-sequencing of heart muscle cells, using this porcine model.

From such knowledge, and much further research yet to come, clinicians may potentially learn how to regenerate adult heart cardiomyocytes after a heart can you buy viagra online attack.This study, led by Jianyi "Jay" Zhang, M.D., Ph.D., chair of the UAB Department of Biomedical Engineering, is published as a Circulation research letter.The researchers compared nuclei from heart tissue of five groups of pigs. Two groups were regeneration models that had left ventricle apical resections, or AR, at postnatal day one, or P1. One of those two groups then had ligation of the left anterior descending coronary artery four weeks after birth, or P28, to induce a myocardial infarction, or MI can you buy viagra online. This group is called ARP1MIP28. The other group, called ARP1, did not can you buy viagra online have ligation.

advertisement Two non-regenerative controls did not have the P1 apical resection, but one of those did have the induced can you buy viagra online heart attack at P28. Those two groups were called Control and MIP28.Hearts were removed for single-nucleus RNA-sequencing at P30 through P56 for the ARP1MIP28 animals, and hearts from all other groups were explanted for sequencing on P1, P28 or P56.The fifth group were fetal hearts, or FH, at embryonic day 80.A total of 218,945 high-quality nuclei were captured, and a network biology clustering analysis identified all eight major heart cell types. Complete gene can you buy viagra online nucleus data were available for 94,844 cardiomyocytes. The cardiomyocytes were distributed among six clusters, named cardiomyocyte 1 through cardiomyocyte 6.Three clusters were almost entirely composed of cardiomyocytes from a single experimental group. Cardiomyocyte 2 from control-P56, cardiomyocyte 3 from control-P1, and cardiomyocyte can you buy viagra online 6 from FH.

advertisement The cardiomyocyte 4 and 5 clusters contained primarily ARP1MIP28-P35 cardiomyocytes. The cardiomyocyte 1 cluster included cardiomyocytes from all other animal groups and time points and a small number of ARP1MIP28-P35 cardiomyocytes, but few fetal or control-P56 cardiomyocytes.The cardiomyocyte 4 and 5 clusters that contained primarily ARP1MIP28-P35 cardiomyocytes showed increased cell cycle activity and proliferation, changes that can you buy viagra online helped remuscularize the left ventricle after experimental heart attack, without scarring. The researchers also found 506 genes that were positively correlated with the highly proliferative ARP1MIP28-P30 and ARP1MIP28-P35 cardiomyocytes. These genes participated in pathways that regulated heart development, cell proliferation and cardiomyocyte proliferation."It will be interesting to examine these two distinct cell can you buy viagra online populations from the ARP1MIP28 injury in future studies," Zhang said. "The findings are highly impactful because they show, for the first time, that the left ventricle can remuscularize the myocardial infarct beyond postnatal day seven, or P7, in large mammals.

These observations provide a foundation for future investigations of the molecular mechanisms and signaling molecules that regulate the injury-induced preservation of cardiomyocyte cell cycle activity in newborn large mammals, and ultimately to remuscularize the heart can you buy viagra online muscle in patients suffering from heart attacks, thus preventing heart failure."The study is titled "Single nucleus transcriptomics. Apical resection in newborn pigs extends the time window of cardiomyocyte proliferation and myocardial regeneration." can you buy viagra online Co-authors with Zhang are Yuji Nakada, Yang Zhou, Eric Y. Zhang, Yuhua Wei, Meng Zhao, Wangping Chen, Jiacheng Sun and S. Naqi Raza, UAB can you buy viagra online Department of Biomedical Engineering. Thanh Nguyen and Jake Y.

Chen, UAB can you buy viagra online Informatics Institute. Gregory P. Walcott, UAB Department of Medicine, Division of Cardiovascular can you buy viagra online Disease. And Wuming Gong, Erik Skie and Daniel J. Garry, School can you buy viagra online of Medicine, University of Minnesota, Minneapolis.Support came from National Institutes of Health grants HL114120, HL131017, HL149137 and HL134764.At UAB, Zhang holds the T.

Michael and Gillian Goodrich Endowed Chair of Engineering Leadership. Biomedical Engineering is a joint department of the UAB can you buy viagra online Marnix E. Heersink School of Medicine and the UAB School can you buy viagra online of Engineering. The Informatics Institute and the Department of Medicine are part of the Heersink School of Medicine.Along with high blood pressure, diabetes, and smoking, environmental factors such as air pollution are highly predictive of people's chances of dying, especially from heart attack and stroke, a new study shows.Led by researchers at NYU Grossman School of Medicine and the Icahn School of Medicine at Mount Sinai, the study showed that exposure to above average levels of outdoor air pollution increased risk of death by 20%, and risk of death from cardiovascular disease by 17%.Using wood- or kerosene-burning stoves, not properly ventilated through a chimney, to cook food or heat the home also increasd overall risk of death (by 23% and 9%) and cardiovascular death risk (by 36% and 19%). Living far can you buy viagra online from specialty medical clinics and near busy roads also increased risk of death.Publishing in the journal PLOS ONE online June 24, the findings come from personal and environmental health data collected from 50,045 mostly poor, rural villagers living in the northeast Golestan region of Iran.

All study participants were over age 40 and agreed to have their health monitored during annual visits with researchers dating as far back as 2004.Researchers say their latest investigation not only identifies environmental factors that pose the greatest risk to heart and overall health, but also adds much-needed scientific evidence from people in low- and middle-income countries. Traditional research can you buy viagra online on environmental risk factors, the researchers note, has favored urban populations in high-income countries with much greater access to modern health care services.Compared with those who have easier access to specialized medical services, those living farther away from clinics with catheterization labs able to unblock clogged arteries, for example, were at increased risk of death by 1% for every 10 kilometers (6.2 miles) of distance. In Golestan, most people live more than 50 miles (80 kilometers) away from such modern facilities. advertisement Study results also showed that the one-third of study participants who lived within 500 meters (1,640 feet) of a major roadway had a 13% increased risk of death."Our study highlights the role that key environmental factors of indoor/outdoor air pollution, access to modern health services, and proximity to noisy, polluted roadways play in all causes of death and deaths from cardiovascular disease in particular," says study senior author and cardiologist Rajesh Vedanthan, MD, MPH."Our findings help broaden the disease-risk profile beyond age and traditional personal risk factors," says Vedanthan, an associate professor in the Department of Population Health and the Department of Medicine at NYU can you buy viagra online Langone Health."These results illustrate a new opportunity for health policymakers to reduce the burden of disease in their communities by mitigating the impact of environmental risk factors like air pollution on cardiovascular health," says study lead author Michael Hadley, MD, a fellow in cardiology and incoming assistant professor of medicine at Mount Sinai.By contrast, the study showed that other environmental factors included in the analysis -- low neighborhood income levels, increased population density, and too much nighttime light exposure -- were not independent predictors of risk of death, despite previous research in mostly urban settings suggesting otherwise.For the investigation, researchers analyzed data gathered through December 2018. They then created a predictive model on overall death risk and death risk from cardiovascular disease.The research team plans to continue its analysis and hopes to apply the predictive model to other countries with the aim of fine-tuning its predictive capacity.

They say their new tool could serve as a guide for evaluating the effectiveness of environmental, lifestyle, and personal health changes in reducing mortality rates worldwide.According to the World Health Organization, one-quarter of all deaths worldwide are now attributable to environmental factors, including poor air and water quality, lack of sanitation, and exposure to toxic chemicals.Funding for the study was provided by U.S. National Institutes of Health grant R21HL140474..

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Associate Professor Sylvia Gustin, The University of NSW, Neuroscience Research Australia – received $2.5 can you buy viagra online million for her research project on using virtual reality training to restore touch sensation. Professor Jane Butler – Neuroscience Research Australia, The University of NSW, received $1.5 million to develop a treatment to restore voluntary function after spinal cord injury. And Dr Euan McCaughey, Neuroscience Research Australia, The University of NSW, received $2.4 million for his research into using muscle stimulation to improve respiratory function for people with tetraplegia.

The projects have been can you buy viagra online awarded through the NSW Government’s Spinal Cord Injury Research Grants program, launched in November 2019, with guidance from an advisory committee of spinal cord injury experts. NeuRA CEO, Professor Peter Schofield, said the range and scope of the funded research projects held exciting promise for health related outcomes. €œNeuroscience Research Australia is at the forefront of spinal cord injury research in Australia can you buy viagra online.

Our new Spinal Cord Injury Research Centre and these research projects will dramatically improve Australia’s understanding of how to best treat people with these life-long injuries,” Professor Schofield said. €œNeuRA thanks the NSW Government for funding the Spinal Cord Injury Research Grants Program, and SpinalCure Australia for its tireless efforts in campaigning for more research funding to improve the quality of life for people with a spinal cord injury.” Information on grant recipients and their research projects is available on the OHMR Funded Research Directory​​.​​​.

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