, 2011) We hypothesized that, given a good in vitro DC model is

, 2011). We hypothesized that, given a good in vitro DC model is available, such cells could be explored for biomarkers

for sensitization, due to their roles as decision-makers in the immunologic response to foreign substances. MUTZ-3 is a human acute myelomonocytic leukemia cell line, which mimics primary DCs in terms of transcriptional profile and their ability to induce specific T cell responses ( Larsson et al., 2006, Masterson et al., 2002 and Santegoets et al., 2006). Furthermore, proliferating MUTZ-3 express an immunologically relevant phenotype similar to immature primary DCs, with expression of CD1a, HLA-DR and CD54, as well as low expression of CD80 and CD86 ( Johansson et al., 2011). Using a panel of reference Tenofovir cost chemicals, including 18 well-known sensitizers, 20 non-sensitizers and vehicle controls, we were indeed able to identify differentially ABT-888 in vivo regulated transcripts in MUTZ-3, depending on if the cells were exposed to a sensitizer or a non-sensitizer. The identified transcripts where found to be involved in immunologically relevant pathways, regulating recognition of foreign substances and leading to DC maturation. Thus, these biomarkers are potent predictors

of different sensitizers. We have developed the usage of this biomarker signature into a novel assay for skin sensitization, called genomic allergen rapid detection, GARD. The assay is based on the measurement

of these transcripts, collectively termed the GARD Prediction Signature, using a complete genome expression array. Classifications of unknown compounds as sensitizers or non-sensitizers are performed with a support vector machine (SVM) model, trained on the 38 reference chemicals used for GARD development. In this paper, we present a detailed method description for how to accurately predict skin sensitization, using GARD. The human myeloid leukemia-derived cell line MUTZ-3 (DSMZ, Braunschweig, Germany) is maintained in α-MEM (Thermo Scientific Hyclone, Logan, UT) supplemented with 20% (volume/volume) fetal calf serum (Life Technologies, Carlsbad, CA) and 40 ng/ml rhGM-CSF (Bayer HealthCare Pharmaceuticals, Seattle, WA), as described (Johansson et al., 2011). A media Glutathione peroxidase change every 3–4 days is recommended, or when cell-density exceeds 500.000–600.000 cells/ml. Proliferating progenitor MUTZ-3 are used for the assay, with no further differentiation steps applied. During media exchange, cells should be counted and resuspended to 200.000 cells/ml. Working stocks of cultures should not be grown for more than 20 passages or 2 months after thawing. For chemical stimulation of cells, 1.8 ml MUTZ-3 is seeded in 24-well plates at a concentration of 222.222 cells/ml. The compound to be used for stimulation is added in a volume of 200 μl, diluting the cell density to 200.000 cells/ml during incubation.

Flavonoid-type phenolics can possibly detoxify Al inside plant ce

Flavonoid-type phenolics can possibly detoxify Al inside plant cells. Kidd et al. [77] found that phenolics including catechol and quercetin were released in maize treated with Al and Si, and the release was dependent on Al concentration. However, due to a lack of efficient methodologies, our understanding of internal mechanisms of Al tolerance in plants is still fragmentary. Genetic markers are useful tools to reveal Al tolerance mechanisms in higher plants following their detection by inheritance studies and identification

of relevant genes or loci. During the last two decades, molecular markers based on DNA sequence variations were widely used to study Al tolerance. By detecting molecular markers, the gene or trait could be easily identified and traced [78]. Based on the techniques used, molecular markers could be classified as PCR-based check details or hybridization-based [79]. DArT (Diversity Arrays Technology) and RFLP (restriction fragment length polymorphism) are hybridization-based markers, whereas AFLP (amplified fragment length polymorphism), RAPD (randomly amplified of polymorphic DNA), SSR (simple sequence repeat) BMS-777607 mw and SNP (single

nucleotide polymorphism) are based on polymerase chain reaction (PCR) techniques. PCR-based markers are preferred and widely used as they are highly efficient, use less DNA, are less labor intensive and amenable to automation and avoidance of autoradiography [80]. The use of molecular markers in Al-tolerance studies includes Al-tolerance gene/loci identification and molecular mapping as well as MAS. One RFLP marker bcd1230, co-segregating with a major gene for Al tolerance, on wheat chromosome 4DL, explained 85% of the phenotypic variation in Al tolerance [81]. Using an F2 population derived from barley varieties Dayton and Harlan, three RFLP markers, Xbcd1117, Xwg464 and Xcdo1395, were closely linked to Alp on chromosome 4H [82]. The authors pointed out that Al tolerance in barley was controlled by a single gene that could be an ortholog of AltBH on wheat chromosome

4D. Five AFLP markers, AMAL1, AMAL2, AMAL3, AMAL4 and AMAL5, were closely linked to, and flanked Alt3 on the long arm of chromosome 4R [83]. After screening 35 Al-tolerant wheat landrace accessions using ten AFLP primer combinations, Stodart et al. [84] found that these accessions had diverse O-methylated flavonoid genetic background and were therefore valuable germplasms for Al tolerance breeding. RAPD marker OPS14705 was linked to the Alt3 locus in rye. A SCAR marker ScOPS14705 derived from a RAPD marker, was further shown to be linked to Alt3 locus [85]. Ma et al. [86] reported SSR markers Xwmc331 and Xgdm125 flanking the ALMT locus and they indicated that these markers could be used for MAS in breeding Al-tolerant wheat cultivars. In barley, several SSR markers, Bmag353, HVM68 and Bmac310, were closely linked with an Al tolerance gene [87] and [88]. Wang et al.

Even in steady state conditions, some

Even in steady state conditions, some Ibrutinib cost interconversion occurs between Lgr5+ cells and cells residing at higher crypt levels, defined by Hopx expression indicating a ready accessibility of early committed cells to the stem compartment [20]. Recent discoveries indicate more dramatic plasticity within the absorptive lineage (Figure 3). Hyperactivation of pathways synergising with Wnt signalling are apparently able to generate stem cells as part of an oncogenic process even within terminally differentiated villus cells [21••]. Hyper-elevation of NF-κB

signalling, by deletion of negative regulators of the pathway, synergises with Wnt signalling, elevating targets such as Ascl2 and leading to ectopic formation in villi of crypt-like structures expressing stem cell markers [21•• and 22]. Further 3-D spheroid culture of isolated villi confirms the potential of these cells to proliferate over several passages and show multilineage differentiation in xenografts. Evidence that secretory progenitors can also contribute to regeneration comes from functional studies of cells expressing Delta-like 1 (see below). Lineage tracing in Dll1-CreER mice following Tamoxifen treatment demonstrates that single Dll1+ cells in the steady state give rise

mainly to short lived secretory clones [13•]. Equivalent lineage tracing following damage shows that many Dll1+ cells can give rise to long lived clones comprising both absorptive CDK inhibition and secretory lineages, demonstrating that they have regained stem cell activity [13•]. Further, elevated Notch signalling in intestinal villi can cause phenotypic

switching of mature differentiated cells from an absorptive to secretory lineage [23]. Subsequently the status of quiescent or label-retaining cells (LRCs) in the epithelium was investigated using a conditionally expressed, histone-conjugated fluorescent protein (H2BYFP) that could be widely induced initially and subsequently retained in cells that are quiescent [24••]. Characterisation heptaminol of isolated YFP-LRCs shows these cells have a secretory signature associated with Paneth and enteroendocrine cells. Moreover, inheritance of the label into these cell types is observed over time. Functional lineage tracing of these YFP-LRCs shows that they do not normally give rise to multilineage clones but do so after regenerative stimuli. Together these findings suggest that quiescent cells are committed to become Paneth and enteroendocrine cells but after damage and regeneration are capable of reacquiring stem cell potential. In summary both absorptive and secretory lineages display plasticity in experimental settings. For cells of either type, plasticity requires responsive cells not only to proliferate but also to demonstrate acquisition of the opposing phenotype, that is, multipotentiality.

A study of 342 rheumatoid patients showed that 11 8% of doxycycli

A study of 342 rheumatoid patients showed that 11.8% of doxycycline users had some sort of side effect.2 Major side effects were nausea (15.5%), other skin abnormalities (10%), photosensitivity (8.2%), and dizziness (8.2%). The major side effect was Poly-Morph Nuclear Leukocytes (PMNL) suspensions, which were exposed to ultraviolet (UV) light showed an increase in oxygen consumption. The PMNL were then damaged when the light was suddenly shut off. It is not known if PMNLs are involved in skin damage in a photosensitive reaction3 although this is not completely

understood, it is thought click here to be due to the change during irradiation of molecular oxygen to excited oxygen species. One theory is that UVA radiation penetrates deeper into the skin in a spectrum of 320–400 nm (tetracycline is at 289–342 nm).4 After UV irradiation the drug molecule is in an excited energy state and causes chemical reactions as they relax to their energetic base level, which results in a synthesis of photoproducts that act as antigens, which cause an allergic reaction.5 Photo onycholysis has been reported

multiple times before. The mechanism is unknown but is thought to be caused by the learn more unprotecting from sun light of the nail bed that has less melanin and therefore less UV protection.6 This case study shows a possible complication and its resolution of symptoms. Patients on doxycycline should be made aware of the effect of the sun light on the skin and should avoid sun exposure while receiving the medication. “
“Current Histamine H2 receptor Opinion in Chemical Biology 2014, 20:9–15 This review comes from a themed issue on Molecular imaging Edited

by Christian Eggeling and Mike Heilemann For a complete overview see the Issue and the Editorial Available online 25th April 2014 1367-5931/$ – see front matter, © 2014 The Authors. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.cbpa.2014.03.019 Mitochondria usually exist within cells as an extended, dynamic, interconnected network of tubules that is intimately integrated with other cellular compartments [1]. An outer membrane and a highly folded inner membrane constitute the intricate inner architecture of mitochondria. The invaginations of the inner membrane, called cristae, are not simply random wide infolds. Rather they are topologically complicated and their shape and number is adapted to the cellular requirements. The inner membrane hosts the oxidative phosphorylation system (OXPHOS). This system facilitates energy conversion resulting in the production of ATP, which makes mitochondria indispensable ‘power plants’ of eukaryotic cells. Since the 1950s, various forms of electron microscopy (EM) have provided a detailed view on the membrane architecture of these organelles (reviewed, for example, in [2 and 3]).

More than 100 indents were made in the selected region of size va

More than 100 indents were made in the selected region of size varying from 300 to 500 μm. http://www.selleckchem.com/products/MDV3100.html A maximum load of 5000 μN was used. Anatomical areas were selected based on qBEI images, and results were normalized for calcium content. The elastic modulus was calculated using the method of Oliver and Pharr [29], by fitting the unloading curve with a second order

polynomial, differentiating and therefore evaluating the elastic recovery at maximum load to determine the contact depth. The parameters measured during the experiment were peak load (Pmax), peak displacement hmax, contact area Ac, and stiffness S. The stiffness was calculated from the slope of the initial unloading curve; the region between 20 and 95% of the maximum load was used to determine the slope of the unloading curve. The hardness H and reduced modulus Er are calculated from unloading contact stiffness, S, and the indenter contact area Ac: H=Pmax/AcH=Pmax/Ac Er=π1/2S/2Ac1/2Er=π1/2S/2Ac1/2 Thin sections (~ 4 μm) were cut from the L5 vertebrae, and spectral images acquired in the area of trabecular bone using a Bruker Equinox 55 (Bruker Optics) spectrometer interfaced to a Mercury Cadmium Telluride (MCT) focal plane array detector (64 × 64 array) imaged onto the focal plane of an IR microscope (Bruker Hyperion 3000; Bruker Optics). Each area imaged was 400 × 400 μm, corresponding to an optimal spatial resolution of ~ 6.3 × 6.3 μm.

SCR7 ic50 Spectral resolution was 4 cm− 1. Background spectral images were collected under identical conditions from the same BaF2 windows at the beginning and end of each experiment to ensure instrument stability. Both instruments were continuously powered to minimize warm-up instabilities and purged with dry-air (Bruker Optics) to minimize the water vapor and CO2 interference. Following this, individual spectra were extracted

from trabecular surfaces that were exhibiting either primary mineralization packets, or resorption pits, based on the previously acquired qBEI images (six different trabecular surfaces per animal were analyzed). Thiamet G The individual spectra were processed as published elsewhere to derive the following spectroscopic parameters: (i) Mineral/matrix ratio (integrated areas under the phosphate (mineral) 900–1200 cm− 1 and amide I 1592–1728 cm− 1 (matrix; mainly collagen) absorbance peaks, respectively; corresponds to ash weight measurements) [30], (ii) mineral maturity/crystallinity (through curve-fitting of the phosphate (mineral) 900–1200 cm− 1 peak and the calculation of the 1030 to 1020 cm− 1 sub-band peak area) [31] and [32], and (iii) the ratio of PYD/divalent collagen cross-links (through curve-fitting of the Amide I and II peaks and the calculation of the 1660 to 1690 cm− 1 sub-band peak area) [33]. For each animal, the values of each parameter at a particular anatomical site (forming or resorbing) were averaged and the resultant value was treated as a single statistical unit.

ostreatus ( Nunes et al , 2012) Thus, the contents of phorbol es

ostreatus ( Nunes et al., 2012). Thus, the contents of phorbol ester and antinutritional factors found in jatropha seed cake do not inhibit the fungal growth and mushrooms production. Besides, selleck we did not observe any morphological changes in the mushrooms. The nutritional composition of the mushrooms produced in J. curcas seed cake showed that this food is a source of protein, carbohydrates, phosphorus and ergosterol ( Table 1). The contents of these nutrients were similar to those found in P. ostreatus mushroom grown in different agroindustrial residues ( Dundar et al., 2009; Nunes

et al., 2012; Tewari, 1986; Wang et al., 2001). According to Tewari (1986), the mushrooms contain 85 (g/100 g) to 95 (g/100 g) water, 3 (g/100 g) protein, 4 (g/100 g) carbohydrates, and 1 (g/100 g) minerals and vitamins. However, these nutrient contents, mainly the proteins, depend on the substrate composition ( Dundar et al., 2009).

Potassium, phosphorus, ZD6474 clinical trial copper, iron and calcium are the main minerals found in mushrooms ( Wang et al., 2001). P. ostreatus mushrooms are also rich in amino acids, fibers and vitamins, including thiamine, riboflavin, pyridoxine and niacin ( Dundar et al., 2009; Wang et al., 2001). The ergosterol content found in the P. ostreatus mushroom ( Table 1) was greater than the content of this compound observed in commercial mushrooms by Jasinghe and Perera (2005). In the P. ostreatus mushrooms of this study, neither tannins nor phytic acid were detected ( Table 1), but low levels of phorbol ester were found. The concentration of this compound decreased in function of incubation time ( Table 2). Furthermore, phorbol ester concentration of the mushrooms ( Table 2) was around 1000-fold lower than the concentration of this compound found in the non-toxic variety of J. curcas ( Makkar et al., 1998). This Mexican

variety has 0.11 mg/g of phorbol ester and was not toxic to fish, chickens or rats ( Makkar et al., 1997). According to these authors, the seeds of this non-toxic variety were typically consumed by humans and chickens. Phorbol ester concentrations of 0.8 mg/g or higher caused 3-mercaptopyruvate sulfurtransferase appetite loss, diarrhea and reduced motor activity in rats fed with the seed meal Jatropha ( Rakshit, Darukeshwara, Raj, Narasimhamurthy, Saibaba, & Bhagya, 2008). As phorbol ester content in the mushrooms was from 0.009 to 0.081 μg g−1 ( Table 2), it could be used as food, even so, we suggest to test in animals to guarantee the food security. In this study we show the potential to use the residue of biodiesel to produce mushroom, a food with high nutritional value. Also, the antinutritional factors degradation allows using this residue as animal feed, adding economic value and avoiding inadequate disposal in the environment.

, 2000), we conducted experiments in order to verify the effect o

, 2000), we conducted experiments in order to verify the effect of

BbV on hydrogen peroxide production. After 90 min of incubation the venom significantly stimulated human neutrophils to produce hydrogen peroxide compared to the negative control; however, there was no difference when compared with PMA (a positive control). BbV induced a significant release of hydrogen peroxide indicating that the BbV is able to stimulate neutrophils to activate the respiratory burst. In addition to our data, the literature shows that Bothrops alternatus venom induced the release of superoxide anion, another AT13387 cost reactive oxygen intermediate, by mice thioglycollate-elicited macrophages ( Setubal et al., 2011). Yet, the literature indicates that the injection of B. asper Selleck Anti-cancer Compound Library and Bothrops jararaca venoms in the peritoneal cavity of mice induced the production of hydrogen peroxide by peritoneal leukocytes meaning they are capable of priming leukocytes for the respiratory burst ( Souza et al., 2012; Zamunér et al., 2001). In addition to the well-known capacity of neutrophils to phagocytose and kill invading microorganisms intracellularly, they can also capture and kill pathogens extracellularly through

the release of neutrophil extracellular traps (NETs). In order to understand the effect of BbV on neutrophil function, NETs liberation was assessed. Our results showed that BbV induced the liberation of NETs. However, there is no data in the literature so far showing the effect of Bothrops venom on NETs liberation which is the first description. Taking this into account and to complement Osimertinib manufacturer other studies we designed an experiment to investigate the ability of BbV to induce IL-8 release. Results showed that BbV induced the release of this chemokine. Since BbV induces IL-8 release as well as ROS production and the literature shows that cytokines and ROS induce NETs liberation (Fuchs et al., 2007 and von Köckritz-Blickwede and Nizet, 2009), we suggest that IL-8 and ROS may contribute to NETs liberation induced by BbV. To

confirm our understanding of the effect of BbV on neutrophil function we decided to perform an experiment investigating the ability of BbV to induce IL-6 release. The results obtained indicate that BbV induced the release of this cytokine. Like IL-8 there is no data in the literature showing the effect of BbV on the production of IL-6 by isolated human neutrophils. Since BbV induces ROS production, we suggest that ROS may contribute to IL-6 release induced by BbV. Accordingly, the literature shows that intramuscular injection of B. asper venom induced an increase in IL-1beta and IL-6 in the muscle ( Chaves et al., 2005). In addition, levels of proinflammatory cytokines IL-6 and TNF-α were significantly increased after B. asper venom injection ( Zamunér et al., 2005).

We reviewed 3 class I95 and 96 or Ia97 studies, 2 class II studie

We reviewed 3 class I95 and 96 or Ia97 studies, 2 class II studies,98 and 99 and 14 class III studies100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112 and 113

addressing the remediation of executive functioning, including training in metacognitive strategies to increase awareness. Two of the class I and Ia studies95 and 97 compared an awareness-training protocol with conventional occupational therapies after moderate or severe TBI (n=33) or stroke (n=8). In 1 of these studies,97 the awareness-training protocol incorporated feedback selleckchem to increase participants’ awareness of their abilities, with experiential exercises requiring participants to predict, self-monitor, and self-evaluate their performance. Improvements in awareness, performance of IADLs, and overall function were evident for both

groups. The awareness intervention was associated with greater increase in self-awareness of deficits after VE-822 price treatment, but not with better performance of IADLs or general functioning compared with conventional rehabilitation. The second class I study95 employed self-awareness and verbal self-regulation strategies during performance of IADLs tasks. Participants were asked to define their performance goals, predict task performance, anticipate difficulties, select a strategy to circumvent difficulties, assess the amount of assistance required to successfully perform the task, and self-evaluate performance. Participants in the control condition performed the same IADLs tasks as the treatment group, but received conventional practice without the awareness intervention. Participants who received the awareness intervention demonstrated significant improvements in self-regulation skills and cognitive aspects of IADLs performance when compared with participants receiving conventional therapy, whose performance either did not improve or decline. No differences between groups were evident

on either general or task-specific measures of awareness or a measure of community integration after the 6 treatment sessions. Phosphoglycerate kinase A number of single-case studies support the benefits of metacognitive training and suggest that the most consistent benefits of this treatment are apparent on participants’ online monitoring, awareness of errors, and error management.104 and 108 One class I study96 evaluated the use of autobiographical memory cuing to improve performance on a planning task by people with TBI. Participants in the experimental group received a single session of instruction on the use of specific examples from their memory of similar activities in order to solve a functional problem situation (eg, planning a vacation). The intervention was successful in increasing the recall of specific memories and effectiveness of functional planning, suggesting that this procedure might be an effective component of training on problem-solving techniques.

Of the 251 cases of salvage brachytherapy reported in the literat

Of the 251 cases of salvage brachytherapy reported in the literature from 1990 to 2007, the weighted average rate of incontinence was 6%, Grade 3–4 rectal toxicity PF-06463922 cost was 5.6%, Grade 3–4 urinary toxicity was 17%, and fistula was 3.4% (3). This particular patient presented with extracapsular extension, Gleason score of 8, and PSA level of 12.6 ng/mL. Given the patient’s good overall health state and long life expectancy, we felt that some type of local treatment was important, in light of the two recent randomized trials showing that for patients with locally advanced prostate cancer, local radiation plus ADT improves overall

survival compared with ADT alone. Specifically, the Scandinavian Prostate Cancer

Group (SPCG)-7/Swedish Association Bortezomib manufacturer for Urologic Oncology (SFUO)-3 trial randomized 875 men with locally advanced prostate cancer (78% of men had T3 disease) to ADT ± radiation and found that radiation cut the relative risk of death by 32% among men with a 10-year minimum life expectancy (overall mortality at 10 years was 39.4% vs. 29.6% favoring the combined modality arm) (14). Similarly, the Intergroup trial (National Cancer Institute of Canada-Clinical Trials Group [NCIC-CTG], Southwest Oncology Group [SWOG], Medical Research Council of the United Kingdom [MRC-UK], INT: T94-0110; NCT00002633) presented by Warde et al. (15) at ASCO 2010 randomized 1205 men with locally advanced disease and found that the addition of radiation to ADT reduced the relative risk of death by 23%. There is both a radiobiologic and dosimetric rationale for considering HDR brachytherapy for prostate cancer. The α/β ratio of the prostate has been commonly estimated to be less than 2, and certainly lower than that of the rectum, which suggests that the hypofractionation achievable with HDR can provide a radiobiologic advantage in terms of improved tumor control with less or equal risk of rectal toxicity [16], [17], [18] and [19]. In addition, tuclazepam although a posteriorly

placed permanent LDR seed cannot be retracted, HDR dosimetry is much more forgiving of the placement of catheters because dose can be optimized after placement, which is particularly important in the salvage setting where minimizing dose to the rectum is critical. Currently, HDR brachytherapy is not widely used as monotherapy for patients with a new diagnosis of prostate cancer, although there are prospective series as well as Phase II trials evaluating it. Martinez et al. (20) of William Beaumont reported on the first series of 41 patients treated with HDR monotherapy to a dose of 3800 cGy treated in four fractions of 950 cGy delivered twice a day over 2 days. They found excellent dosimetric coverage of the gland with good urethral and rectal sparing and a low rate of short-term morbidity. Martin et al.

Although an older person with diabetes has a high likelihood of b

Although an older person with diabetes has a high likelihood of being well and enjoying a good quality of life, many are functionally dependent or have evidence of cognitive problems, which alters goals of care and influences management strategies. This Position Statement attempts to embody these aspects selleck inhibitor in the conclusions and statements given. We feel that it is timely to establish a collaborative initiative between key international diabetes and gerontological organizations to enhance diabetes care for older people worldwide. This Position Statement represents the

first stage in developing such a global initiative. It was produced to influence the clinical behavior and approach of all health professionals engaged in delivering diabetes care

to older people. Following a round GDC 941 table discussion by key participants at the European Association of for the Study of Diabetes in Rome in September 2008, we identified a list of priorities and developed a concerted action plan for enhancing diabetes care in older people. This Position Statement on diabetes in older people is designed to give an overview of the present state of diabetes care of this group of people. In addition, the statement will outline a consensus view on the perceived priorities for improving diabetes care and achieving the best possible clinical outcomes during the next decade. Diabetologists from around the globe and both the International Association of Gerontology and Geriatrics and the European Diabetes Working Party have been involved in developing this work. Purpose of the Position Statement: (1) Arrive at a

consensus on how we approach the management of key issues of diabetes care for older people. An expert roundtable was organized in June 2010 in Frankfurt as an opportunity to critically discuss and evaluate views and experience of some of the complex issues of diabetes in old people. This group communication process was complemented by 2 audio teleconferences with other global experts in the field. Selleckchem 5 FU An audio record of all discussions was made to assist the moderator (A.S.) to produce a draft report of the proceedings. An important purpose was to arrive at a consensus on how we approach the management of significant issues including those that require further study (see Figure 1). We agreed that by defining at least 2 recommendations per domain based on this process we would have a workable set of conclusions on which to base the Position Statement. Discussants participated in a brief Delphi process, combined with a traditional evidenced-based approach (see Appendix A at www.jamda.com), which aimed to address the main areas from several perspectives. We chose 4 perspectives for each of the domains of interest (to provide an initial structure) but participants in the roundtable discussion had the opportunity to define other perspectives that needed to be considered.