Tuesday, June 30, 2015

Intended and unintended effects of the war on poverty

 2015 Summer;34(3):639-96.

Intended and unintended effects of the war on poverty: what research tells us and implications for policy.

Author information

  • 1National Bureau of Economic Research, and University of California at Irvine, Irvine, CA 92697. mbitler@eci.edu
  • 2RAND Corporation, Arlington, VA 22202. karoly@rand.org

Abstract

During the mid-1960s, the United States adopted a series of cash and in-kind transfer programs, as well as human capital investment strategies, as part of the War on Poverty. A number of other programs were first proposed as part of this "war" but were not implemented until the mid-1970s. These programs had noble goals: to increase incomes at the bottom of the income distribution, reduce poverty, and improve nutrition, heath, and human capital. However, various features of the programs also had the potential to produce unintended consequences: for example, means-tested programs can discourage work. In this paper, we comprehensively evaluate the main War on Poverty programs that were aimed at the low-income nonelderly population along with several follow-on programs. We focus on both intended and unintended consequences, drawing on the most compelling causal evidence. We conclude with a series of lessons learned and questions that are outstanding.

From NYU: Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM: The P18 Cohort Study

 2015 Aug 1;69(4):466-73. doi: 10.1097/QAI.0000000000000616.

Incidence of HIV Infection in Young Gay, Bisexual, and Other YMSM: The P18 Cohort Study.

Author information

  • 1Center for Health, Identity, Behavior and Prevention Studies, The Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY.

Abstract

CONTENT:

HIV infections continue to rise in a new generation of young gay, bisexual, and other young men who have sex with men (YMSM) despite 3 decades of HIV prevention and recent biomedical technologies to deter infection.

OBJECTIVES:

To examine the incidence of HIV and the demographic, behavioral, and structural factors associated with incident infections.

DESIGN:

A prospective cohort study.

PARTICIPANTS:

Six hundred YMSM who were aged 18-19 years at baseline.

RESULTS:

At baseline, 6 prevalent cases of HIV were detected. Over the course of 36 months and 6 additional waves of data collection, we identified 43 (7.2%) incident cases of HIV. Incident infections were marginally higher among those residing in neighborhoods with higher rates of HIV prevalence. Using Cox proportional hazards models, we detected that hazard ratios (HRs) for time to HIV seroconversion were significantly higher for black YMSM (HR = 7.46) and mixed/other race YMSM (HR = 7.99), and older age at sexual debut with another man was associated with a lower risk of HIV seroconversion (HR = 0.50), whereas low perceived familial socioeconomic status was marginally associated with an increased risk for HIV seroconversion (HR = 2.45).

CONCLUSIONS:

These findings support the disparities for HIV that exist within the population of sexual minority men and suggest that we attend to behavioral, structural, and social conditions to effectively tailor HIV prevention for a new generation of YMSM with keen eyes to the conditions faced by racial and ethnic minority YMSM, which heightened their risk for acquiring HIV.

Fair Is Not Fair Everywhere

Psychol Sci. 2015 Jun 26. pii: 0956797615586188. [Epub ahead of print]

Fair Is Not Fair Everywhere.

Author information

  • 1Department of Developmental and Comparative Psychology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany mschaefer@eva.mpg.de.
  • 2Department of Developmental and Comparative Psychology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands Department of Psychology, University of Jena.
  • 3Department of Developmental and Comparative Psychology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany.

Abstract

Distributing the spoils of a joint enterprise on the basis of work contribution or relative productivity seems natural to the modern Western mind. But such notions of merit-based distributive justice may be culturally constructed norms that vary with the social and economic structure of a group. In the present research, we showed that children from three different cultures have very different ideas about distributive justice. Whereas children from a modern Western society distributed the spoils of a joint enterprise precisely in proportion to productivity, children from a gerontocratic pastoralist society in Africa did not take merit into account at all. Children from a partially hunter-gatherer, egalitarian African culture distributed the spoils more equally than did the other two cultures, with merit playing only a limited role. This pattern of results suggests that some basic notions of distributive justice are not universal intuitions of the human species but rather culturally constructed behavioral norms.

Monday, June 29, 2015

Amniotic fluid as a source of multipotent cells for clinical use

 2015 Jun 26. pii: /j/jpme.ahead-of-print/jpm-2015-0152/jpm-2015-0152.xml. doi: 10.1515/jpm-2015-0152. [Epub ahead of print]

Amniotic fluid as a source of multipotent cells for clinical use.

Abstract

Amniotic fluid cells (AFC) from 2nd trimester amniocentesis have been found to be a source of multipotent stem cells which might overcome the limitations of expansion, histocompatibility, tumorigenesis, and ethical issues associated with using human embryonic cells, umbilical cord, cord blood, bone marrow, and induced pluripotent cells. Previous work by our group and others demonstrated multipotency and the ability to grow well in culture. However, all these studies were done in media containing fetal calf serum. We sought to observe the properties of AFC grown in serum-free media as that would be required for clinical transplantation in humans. Fresh samples were obtained from three patients, and each sample divided into a culture whose cells were not exposed to fetal calf serum, and the other half into a standard culture medium containing fetal calf serum. Doubling time and stem cell marker expression by flow cytometry were assessed. Differentiation to neural, osteoid, and chondrogenic lineages was induced using appropriate media and confirmed by fluorescent microscopy, histology, and immunohistochemistry. There were no statistically significant differences between cells grown serum-free and in standard media in any of these parameters. The data supports the possibility of clinical use of AFC in stem cell transplantation.

Thursday, June 25, 2015

"ACA 'Is Here to Stay'"

Supreme Court Upholds Obamacare Subsidies, President Says ACA 'Is Here to Stay'

"Read the opinion and weep."

So Much for the Rule of Law




Justice Scalia’s final paragraph in his dissent today in King v. Burwell pretty much says it all. Read the opinion and weep.


"...the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites."

Federalism is dead

Supreme Court Upholds Obamacare Subsidies

In siding with the administration in King v. Burwell, the justices deal a blow to opponents of the Affordable Care Act.



"King v. Burwell centered on whether plaintiffs' arguments that middle- and low-income adults who purchased health insurance through the federally run Healthcare.gov marketplace were entitled to subsidies based on the language of the law that says tax credits are only to be distributed for marketplaces 'established by the state.'"

Wednesday, June 24, 2015

Safety and Efficacy of Buparlisib (BKM120) in Patients With PI3K Pathway-Activated Non-Small Cell Lung Cancer (NSCLC): Results From the Phase II BASALT-1 Study

 2015 Jun 19. [Epub ahead of print]

Safety and Efficacy of Buparlisib (BKM120) in Patients With PI3K Pathway-Activated Non-Small Cell Lung Cancer (NSCLC): Results From the Phase II BASALT-1 Study.

Author information

  • 11University Hospitals KU Leuven, Leuven, Belgium; 2Grand Hôpital de Charleroi, Charleroi, Belgium; 3Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy; 4AOU San Martino IST, Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy; 5European Institute of Oncology, Milan, Italy; 6Moffitt Cancer Center, Tampa, FL; 7National Cheng Kung University Hospital, Tainan, Taiwan; 8Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; 9Kurashiki Central Hospital, Kurashiki, Japan; 10S.G. Moscati Hospital, Avellino, Italy; 11Roswell Park Cancer Institute, Buffalo, NY; 12Chiang Mai University, Chiang Mai, Thailand; 13LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany; 14Novartis Pharma AG, Basel, Switzerland; 15Novartis Pharmaceuticals Corporation, East Hanover, NJ; 16Novartis Institutes for BioMedical Research, Cambridge, MA; 17Gustave Roussy Cancer Campus and University Paris-Sud, Villejuif, France.

Abstract

INTRODUCTION:

The phosphatidylinositol 3-kinase (PI3K) pathway promotes tumor growth and treatment resistance in non-small cell lung cancer (NSCLC). The aim of the open-label, two-stage, Phase II study BASALT-1 (NCT01820325) was to investigate the pan-PI3K inhibitor buparlisib (BKM120) in patients with PI3K pathway-activated, relapsed NSCLC.

METHODS:

After pre-screening for PI3K pathway activation, patients with PI3K pathway-activated, metastatic, squamous or non-squamous NSCLC who had relapsed after prior systemic antineoplastic therapy, were enrolled. In Stage 1, patients received single-agent buparlisib (100 mg/day). A futility analysis was performed independently in each histology group, based on the 12-week progression-free survival (PFS) rate for the first 30 patients treated in each group being <50%. Exploratory biomarker analyses were performed in archival tissue samples andcirculating tumor DNA (ctDNA).

RESULTS:

Of 1242 pre-screened patients, 13.5% exhibited PI3K pathway activation. As of June 5, 2014, 63 patients (30 squamous and 33 non-squamous) were treated in Stage 1. The 12-week PFS rates were 23.3% (95% confidence interval [CI] 9.9-42.3) and 20.0% (95% CI 7.7-38.6) in the squamous and non-squamous groups, respectively. Stage 2 was therefore not initiated in either group. PI3K pathway mutations in ctDNA were more concordant with metastatic tissue than with primary biopsies.

CONCLUSIONS:

Despite preselecting patients for targeted treatment, BASALT-1 did not meet its primary objective during Stage 1. PI3K pathway activation can be detected using ctDNA, but may not be the main oncogenic driver in NSCLC. Combinations of PI3K inhibitors with other agents may demonstrate greater efficacy than monotherapy.

Reactive oxygen species a double-edged sword for mesothelioma

 2015 Jun 10. [Epub ahead of print]

Reactive oxygen species a double-edged sword for mesothelioma.

Author information

  • 1Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy.
  • 2Molecular Medicine Area, Regina Elena National Cancer Institute, Rome, Italy.

Abstract

It is well known that oxidative stress can lead to chronic inflammation which, in turn, could mediate most chronic diseases including cancer. Oxidants have been implicated in the activity of crocidolite and amosite, the most powerful types of asbestos associated to the occurrence ofmesothelioma. Currently rates of mesothelioma are rising and estimates indicate that the incidence of mesothelioma will peak within the next 10-15 years in the western world, while in Japan the peak is predicted not to occur until 40 years from now. Although the use of asbestos has been banned in many countries around the world, production of and the potentially hazardous exposure to asbestos is still present with locally high incidences of mesothelioma. Today a new man-made material, carbon nanotubes, has arisen as a concern; carbon nanotubes may display 'asbestos-like' pathogenicity with mesothelioma induction potential. Carbon nanotubes resulted in the greatest reactive oxygen species generation. How oxidative stress activates inflammatory pathways leading to the transformation of a normal cell to a tumor cell, to tumor cell survival, proliferation, invasion, angiogenesis, chemoresistance, and radioresistance, is the aim of this review.

The ethics of placebo treatments in clinical practice: a reply to Glackin

 2015 Jun 22. pii: medethics-2014-102651. doi: 10.1136/medethics-2014-102651. [Epub ahead of print]

The ethics of placebo treatments in clinical practice: a reply to Glackin.

Author information

  • 1Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA.
  • 2Weill Cornell Medical College, New York, NY, USA.

Abstract

In 'Placebo treatments, informed consent, and "the grip of a false picture"' Shane Nicholas Glackin argues that if a physician offers a patient an inert placebo with the following disclosure, this is compatible with informed consent and is not deceptive: 'I would like to offer you a pill which I believe can help lessen your suffering. I do not know exactly how it works. I have other pills to offer whose mechanism is clearer, but I am not sure that they will work better for you, and they may also entail more serious side effects'. According to Glackin, telling patients that the recommended treatment is an inert placebo is providing incidental information, analogous to telling a patient the chemical details of an active drug. He argues that this information would influence a patient's decision only if she was 'in the grip of a false picture' that inert drugs do not have physical effects on patients' bodies. We contend that this disclosure typically is incompatible with informed consent and typically is deceptive. We give an example of a transparent placebo disclosure, that is, a disclosure that is compatible with informed consent and is not deceptive.

Jindal is in

Bobby Jindal announces entry into 2016 presidential race

Friday, May 29, 2015

Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy? [or none of them...]

 2015 Mar-Apr;20(2):376-80.

Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy?

Author information

  • 1Department of Thoracic and Cardiovascular Surgery, Athens Naval and Veterans Hospital, Athens, Greece.

Abstract

Malignant pleural mesothelioma (MPM) is an asbestos-related disease with a dismal prognosis. Ethic, social, legal and economic parameters are implicated in its management. It is quite clear that multimodality therapy is necessary to improve long-term results but precise treatment schemes have not yet been equivocally accepted. The extent of surgery is questioned and radical operations are highly debatable. On the other hand, debulking or cyto-reductive surgery have been also proposed within a multimodality approach. However, the role and order of adjuvant or neoadjuvant use of chemotherapy, radiotherapy and surgery has not been established. The aim of this study was to analyze contemporary studies on the impact of different surgical approaches on outcome of patients with MPM.

An update on human stem cell-based therapy in Parkinson`s disease

 2015 May 28. [Epub ahead of print]

An update on human stem cell-based therapy in Parkinson`s disease.

Author information

  • 1Unidad de Regeneracion Neural, Unidad Funcional de Investigacion de Enfermedades Cronicas. Instituto de Salud Carlos III (ISCIII) 28220 Majadahonda, Madrid, Spain. iliste@isciii.es.

Abstract

Parkinson `s disease (PD) is the second most common neurodegenerative disorder after Alzheimer`s disease and it is characterized by the progressive loss of dopaminergic neurons of the substantia nigra pars compacta (SNpc). Current pharmacological treatments for PD are only symptomatic and unfortunately there is still no cure for this disorder. Stem cell technology has become an attractive option to investigate and treat PD. Indeed, transplantation of fetal ventral mesencephalic cells into PD brains have provided proof of concept that cell replacement therapy can be beneficial for some patients, greatly improving their motor symptoms. However, ethical and practical aspects of tissue availability limit its widespread clinical use. Hence, the need of alternative cell sources based on the use of different types of stem cells. Stem cell-based therapies can be beneficial by acting through several mechanisms such as cell replacement, trophic actions and modulation of inflammation. Here we review recent and current remarkable clinical studies involving stem cell-based therapy for PD and provide an overview of the different types of stem cells available nowadays, their main properties and how they are developing as a possible therapy for PD treatment.

Inactivity is putting kids as young as 15 at risk of obesity, heart disease and Type 2 diabetes

Inactivity is putting kids as young as 15 at risk of obesity, heart disease and Type 2 diabetes


"The study provided clear evidence that the negative effects of inactivity in childhood are evident well before adulthood, he said."

Teaching telehealth consultation skills

 2015 May 28. doi: 10.1111/tct.12378. [Epub ahead of print]

Teaching telehealth consultation skills.

Author information

  • 1Graduate School of Medicine, University of Wollongong, New South Wales, Australia.

Abstract

BACKGROUND:

Although teleconsultations have been used for many years in Australia, there has been a recent increase following new government incentives. There is a paucity of literature on enabling medical students to acquire the relevant skills. With a focus on equipping students for practice in rural and remote areas, our medical school has developed an innovative clinical skills lesson to prepare our students for their rural practice placements.

METHODS:

This lesson was delivered to all students in their third year of training in small groups to enable interactive learning. The objectives of the lesson were to familiarise students with: the various methods of conducting teleconsultations currently in use; the legal and ethical considerations; the technical and procedural issues; and the barriers and benefits for patients and doctors. Students rotated through four different stations over 2 hours and the lesson was evaluated using a student survey.

RESULTS:

Medical students self-reported statistically significant improvements in understanding the issues and procedures, and in confidence in conducting a telehealth consultation.

DISCUSSION:

Analysis of the results and student comments demonstrated that students recognise the value of telemedicine learning, and benefit from formal teaching on all aspects of telemedicine, including technology, ethics and protocols. Interestingly, the students found the opportunity to discuss areas such as the ethics of, and barriers to, the use of teleconsultations to be the most challenging and helpful of all of the stations. There is a paucity of literature on enabling medical students to acquire the relevant [teleconsultation] skills.

Tuesday, May 12, 2015

Teen responses when a younger school-age sibling has been bullied

 2015 Apr 3;20(2):131-147. Epub 2014 Dec 10.

Teen responses when a younger school-age sibling has been bullied.

Author information

  • 1Department of Child and family Studies, Syracuse University , Syracuse , NY , USA.
  • 2Horsham Clinic , Philadelphia , PA , USA.

Abstract

The prevalence of bullying among children, and the sometimes tragic consequences as a result, has become a major concern in schools. The larger research for this study reported on in-depth interviews with 28 elementary and middle school-age boys and girls (7-12 years) who had experienced various forms of bullying and relational aggression by their peers, mostly on school grounds, and the responses of their parents and teachers. Responses of the children's teen siblings to the younger child's revelations of being bullied are the focus of this report. In-depth interviews with each teen sibling (n = 28) and with each bullied child revealed how the children viewed the teen siblings' supportive strategies. Almost all the children (89%) reported that their older siblings talked with them and offered advice. The teen siblings shared with the younger ones that they too (71%) had been bullied, or they knew someone who had been bullied (18%). Teens gave the advice to 'bully back' to 11% and advice to 'tell someone' to 32% of the younger children. The children felt quite positive about their older siblings' advice (89%), which did differ depending on the bullied child's gender. Teen siblings gave advice to 'avoid bullies' to 77% of female and to 27% of male younger children.

Classroom Norms of Bullying Alter the Degree to Which Children Defend in Response to Their Affective Empathy and Power

 2015 May 11. [Epub ahead of print]

Classroom Norms of Bullying Alter the Degree to Which Children Defend in Response to Their Affective Empathy and Power.

Abstract

This study examined whether the degree to which bullying is normative in the classroom would moderate associations between intra- (cognitive and affective empathy, self-efficacy beliefs) and interpersonal (popularity) factors and defending behavior. Participants were 6,708 third- to fifth-grade children (49% boys; Mage = 11 years) from 383 classrooms. Multilevel modeling analyses revealed that children were more likely to defend in response to their affective empathy in classrooms with high levels of bullying. In addition, popular students were more likely to support victims in classrooms where bullying was associated with social costs. These findings highlight the importance of considering interactions among individual and contextual influences when trying to understand which factors facilitate versus inhibit children's inclinations to defend others.

A relational framework for understanding bullying: Developmental antecedents and outcomes

 2015 May-Jun;70(4):311-321.

A relational framework for understanding bullying: Developmental antecedents and outcomes.

Author information

  • 1Department of Educational Psychology.
  • 2T. Denny Sanford School of Social and Family Dynamics, Arizona State University.

Abstract

This article reviews current research on the relational processes involved in peer bullying, considering developmental antecedents and long-term consequences. The following themes are highlighted: (a) aggression can be both adaptive and maladaptive, and this distinction has implications for bullies' functioning within peer social ecologies; (b) developmental antecedents and long-term consequences of bullying have not been well-distinguished from the extant research on aggressive behavior; (c) bullying is aggression that operates within relationships of power and abuse. Power asymmetry and repetition elements of traditional bullying definitions have been hard to operationalize, but without these specifications and more dyadic measurement approaches there may be little rationale for a distinct literature on bullying-separate from aggression. Applications of a relational approach to bullying are provided using gender as an example. Implications for future research are drawn from the study of relationships and interpersonal theories of developmental psychopathology. 

Translating research to practice in bullying prevention

 2015 May-Jun;70(4):322-332.

Translating research to practice in bullying prevention.

Author information

  • 1University of Virginia.

Abstract

Bullying continues to be a concern in schools and communities across the United States and worldwide, yet there is uncertainty regarding the most effective approaches for preventing it and addressing its impacts on children and youth. This paper synthesizes findings from a series of studies and meta-analyses examining the efficacy of bullying prevention programs. This paper considers some methodological issues encountered when testing the efficacy and effectiveness of bullying prevention and intervention approaches. It also identifies several areas requiring additional research in order to increase the effectiveness of bullying prevention efforts in real-world settings. Drawing upon a public health perspective and findings from the field of prevention science, this paper aims to inform potential future directions for enhancing the adoption, high quality implementation, and dissemination of evidence-based bullying prevention programs. It is concluded that althoughbullying prevention programs can be effective in reducing bullying and victimization among school-aged youth, there is a great need for more work to increase the acceptability, fidelity, and sustainability of the existing programs in order to improve bullying-related outcomes for youth. The findings from this review are intended to inform both policy and public health practice related to bullying prevention. 

Law and policy on the concept of bullying at school

 2015 May-Jun;70(4):333-343.

Law and policy on the concept of bullying at school.

Author information

  • 1Curry School of Education.
  • 2Institute on Family & Neighborhood Life, Clemson University.

Abstract

The nationwide effort to reduce bullying in U.S. schools can be regarded as part of larger civil and human rights movements that have provided children with many of the rights afforded to adult citizens, including protection from harm in the workplace. Many bullied children find that their schools are hostile environments, but civil rights protections against harassment apply only to children who fall into protected classes, such as racial and ethnic minorities, students with disabilities, and victims of gender harassment or religious discrimination. This article identifies the conceptual challenges that bullying poses for legal and policy efforts, reviews judicial and legislative efforts to reduce bullying, and makes some recommendations for school policy. Recognition that all children have a right to public education would be one avenue for broadening protection against bullying to all children. 

Understanding the psychology of bullying: Moving toward a social-ecological diathesis-stress model

 2015 May-Jun;70(4):344-353.

Understanding the psychology of bullying: Moving toward a social-ecological diathesis-stress model.

Author information

  • 1Department of Educational Psychology.
  • 2Faculty of Education, Department of Educational and Counselling Psychology and Special Education, University of British Columbia.

Abstract

With growing recognition that bullying is a complex phenomenon, influenced by multiple factors, research findings to date have been understood within a social-ecological framework. Consistent with this model, we review research on the known correlates and contributing factors in bullying/victimization within the individual, family, peer group, school and community. Recognizing the fluid and dynamic nature of involvement in bullying, we then expand on this model and consider research on the consequences of bullying involvement, as either victim or bully or both, and propose a social-ecological, diathesis-stress model for understanding the bullying dynamic and its impact. Specifically, we frame involvement in bullying as a stressful life event for both children who bully and those who are victimized, serving as a catalyst for a diathesis-stress connection between bullying, victimization, and psychosocial difficulties. Against this backdrop, we suggest that effectivebullying prevention and intervention efforts must take into account the complexities of the human experience, addressing both individual characteristics and history of involvement in bullying, risk and protective factors, and the contexts in which bullying occurs, in order to promote healthier social relationships.