Allergic rhinitis (AR) affects ~60 million people in the United States. This study evaluates awareness, attitudes, and behaviors of AR sufferers on the management of their condition. This U.S.-based survey evaluated 1600 adult AR sufferers to assess their perceptions of AR diagnosis, treatment preferences, and interactions with health care practitioners (HCPs). Two consumer groups of AR sufferers were assessed: users of over-the-counter (OTC) medications only (n = 1020) and users of prescription (Rx) ± OTC medications (n = 580). The Rx group included 451 intranasal steroid (INS) users. Eighty-two percent of respondents indicated that they require minimal to no HCP guidance to manage AR; 51% had not visited an HCP in the past 2 years. Eighty-six percent of respondents agreed that they can self-recognize AR symptoms, and 69% suspected allergies before diagnosis. On suspecting nasal allergies, 52% of sufferers purchased an OTC medication. Seventy-two percent of AR sufferers said they are likely to go to an HCP if symptoms persist after they tried multiple OTC options. Rx users perceived INSs to be more beneficial in treating AR and showed a high level of satisfaction (a score of 7.4 out of 10). Forty-eight percent of AR sufferers felt the need for more efficacious OTC medications to better manage their AR symptoms. This study indicated that AR sufferers perceive that they self-recognize AR symptoms and initiate their management with OTC options. The availability of OTC medications did not deter AR sufferers from visiting HCPs for advice when symptoms worsen. Nonetheless, more efficacious OTC options are still desired.
Allergic rhinitis (AR) is a common health problem in the United States, with significant comorbidities and impairment of quality of life despite the availability of many prescription (Rx) and over-the-counter (OTC) medications. The health-care practitioners (HCPs) arm of the Current Allergic Rhinitis Experiences Survey (CARES) assessed HCPs' perceptions about the current management of AR. This U.S.-based national survey included 375 primary care physicians and 375 nurse practitioners/physician assistants. Participants were screened to ensure that they treat ?15 AR sufferers per month during allergy season. The majority of HCPs (86%) agreed that AR patients can easily recognize allergy symptoms after diagnosis and that 57% of their patients come to them self-recognizing their symptoms. A total of 82% strongly agreed that AR sufferers are primarily diagnosed via history and physical and do not typically undergo diagnostic testing until after pharmacologic intervention. HCPs reported that 63-77% of AR sufferers can easily manage AR once treatment is established. According to surveyed HCPs, OTC medication should precede an Rx medication for AR management. A total of 82% HCPs considered intranasal steroids (INSs) to be the gold standard AR treatment and have minimal safety concerns about INS use. HCPs perceive that patients can easily recognize and self-manage their AR symptoms. Patient history/symptoms and physical examination are the primary methods of AR diagnosis. INSs are considered the gold standard for treatment of AR. However, most HCPs feel OTC medication should be tried before Rx medication for AR management.
Cellular decision making in differentiation, proliferation, or cell death is mediated by molecular signaling processes, which control the regulation and expression of genes. Vice versa, the expression of genes can trigger the activity of signaling pathways. We introduce and describe a statistical method called Dynamic Nested Effects Model (D-NEM) for analyzing the temporal interplay of cell signaling and gene expression. D-NEMs are Bayesian models of signal propagation in a network. They decompose observed time delays of multiple step signaling processes into single steps. Time delays are assumed to be exponentially distributed. Rate constants of signal propagation are model parameters, whose joint posterior distribution is assessed via Gibbs sampling. They hold information on the interplay of different forms of biological signal propagation. Molecular signaling in the cytoplasm acts at high rates, direct signal propagation via transcription and translation act at intermediate rates, while secondary effects operate at low rates. D-NEMs allow the dissection of biological processes into signaling and expression events, and analysis of cellular signal flow. An application of D-NEMs to embryonic stem cell development in mice reveals a feed-forward loop dominated network, which stabilizes the differentiated state of cells and points to Nanog as the key sensitizer of stem cells for differentiation stimuli.
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