Saturday, April 25, 2015

Zombie allusions: They just keep on coming™: "the grabbiest new role"

What Role Do You Want to Play?


"From 2000 to 2020, the grabbiest new role is that of zombie. This popularity raises a disquieting, not to say humiliating, question: Why should we let TV producers play a role in our self-formation? After all, we know TV shows exist to sell products or subscriptions to Netflix. But if not from television or the movies, where are we supposed to get the roles we play to fill the fleeting days of our lives? Are we expected to be able just to tear them out of our brains, like zombies?"



Cancer: The Emperor of All Maladies

Cancer: The Emperor of All Maladies


Cancer: The Emperor of All Maladies, based on the Pulitzer Prize-winning book by Siddhartha Mukherjee, tells the complete story of cancer, from its first description in an ancient Egyptian scroll to the gleaming laboratories of modern research institutions. At six hours, the film interweaves a sweeping historical narrative; with intimate stories about contemporary patients; and an investigation into the latest scientific breakthroughs that may have brought us, at long last, to the brink of lasting cures.

"...increased physical activity...is associated with a reduced risk of prostate cancer..."

 2015 Apr 24. doi: 10.1111/bju.13157. [Epub ahead of print]

Physical activity as a risk factor for prostate cancer diagnosis: a prospective biopsy cohort analysis.

Abstract

OBJECTIVES:

To assess the association between physical activity, evaluated by the Physical activity scale for elderly (PASE) questionnaire, and prostate cancer (PC) risk in a consecutive series of men undergoing prostate biopsy.

MATERIALS AND METHODS:

From 2011 onwards, a consecutive men undergoing 12-core prostate biopsy were enrolled into a prospective database. Indications for a prostatic biopsy were a PSA value ≥ 4 ng/ml and/or a positive digital rectal examination (DRE). Body mass index (BMI) and waist circumferences were measured before the biopsy. Fasting blood samples were collected before biopsy and tested for: total PSA, glucose, HDL, trygliceridemia levels. Blood pressure was recorded. Metabolic syndrome (MetS) was defined according to the Adult Treatment panel III. PASE questionnaire was collected before the biopsy.

RESULTS:

286 patients were enrolled with a median age and PSA of 68 (IQR 62/74) years and 6.1 ng/ml (IQR 5/8.8) respectively. Median BMI was26.4 kg/m2 (IQR: 24.6/29); median waist circumference was 102 cm (IQR: 97/108) and 75 patients (26%) presented a Metabolic syndrome. One-hundred and six patients (37%) had prostate cancer on biopsy. Patients with PC presented an higher PSA (6.7 ng/ml, IQR: 5/10 vs 5.6 ng/ml, IQR: 4.8/8; p= 0.007) and a lower LogPASE score (2.03 (1.82/2.18) vs 2.10 (1.92/2.29); p=0.005). On multivariate analysis, in addition to well-recognized risk factors such as age, PSA, prostate volume, LogPASE score was an independent risk factor for prostate cancer diagnosis (OR: 0.146, 95%CI: 0.037 - 0.577; p= 0.006). Log PASE was also an independent predictor of high-grade cancer (OR: 0.07, 95% CI: 0.006-0.764; p= 0.029).

CONCLUSION:

In our single centre study, an increased physical activity evaluated by the PASE questionnaire is associated with a reduced risk of PC and of high-grade prostate cancer on biopsy. Further studies should clarify the molecular pathways behind this association. 

"The total estimated cost of diabetes, direct and indirect, is $245 billion."

Diabetes Follows Obesity's Lead: Trends Reveal Worsening Problems Across US

 By 

"Some of the epidemic comes from will power, but research is finding most of the blame lies with external factors. Low-income families are more obese because healthier food is expensive. Americans work longer hours than most other countries and get too little sleep, which can leave them with neither the time nor the energy to cook. Even if people did have the time, finding healthy food on the cheap has been a struggle. Government programs were recently found ineffective in promoting healthier food choices in grocery stores.
These conflicts translate into unhealthier citizens and a burdened health care system. Diabetes makes that effect clear: The total estimated cost of diabetes, direct and indirect, is $245 billion."


Hamlet's BlackBerry: Building a Good Life in the Digital Age

Hamlet's BlackBerry: Building a Good Life in the Digital Age


HT:AL

Liquid biopsy. It's here.

Photo

When doctors got a clean blood DNA test from MarySusan Sabini, they were afraid to rely on it because the test was so new. CreditÁngel Franco/The New York TimesContinue reading the main story







In the usual cancer biopsy, a surgeon cuts out a piece of the patient’s tumor, but researchers in labs across the country are now testing a potentially transformative innovation. They call it the liquid biopsy, and it is a blood test that has only recently become feasible with the latest exquisitely sensitive techniques. It is showing promise in finding tiny snippets of cancer DNA in a patient’s blood.

"...Dr. Oz is a symptom, not the problem."

Dr. Oz and the Pathology of 'Open-Mindedness'

In the pursuit of scientific discovery, where is the line between alternative therapies and "quackademic" medicine?


"One need not even look beyond the walls of Oz’s own university. Woodson C. Merrell, an assistant professor at Columbia Medical School and executive director of Mount Sinai Beth Israel’s Center for Health and Healing, lists homeopathy as one of his clinical interests—despite a scientific consensus that homeopathy is inconsistent with some of the basic laws of chemistry and physics.

Indeed, a vocal minority of physicians and scientists have long claimed that Dr. Oz is a symptom, not the problem. Most prominent among them are the Yale neurologist Steven Novella and the Wayne State University surgical oncologistDavid Gorski, who refer to the problem as “quackademic medicine.” For Novella and Gorski, the concern is not merely that people will waste money on homeopathic sugar pills or fruitless miracle diets. They emphasize that Dr. Oz and universities alike endanger public health by legitimating alternative medical traditions such as naturopathy and chiropractic. This, in turn, can lead people to reject standard medical care. Vaccination is a classic case: Though most people are unaware of it, the official position of the American Chiropractic Association supports “providing an alternative elective course of action regarding vaccination.” Similarly, the New York University medical ethicist Arthur Caplan expresses concern that naturopaths—who practice an unstandardized mix of therapies including traditional Chinese medicine, homeopathy, craniosacral therapy, iridology, and reiki— routinely grant vaccine exemptions, and are licensed to do so in 17 states."

Do We Really Need Physician Re-Certification Testing?

Do We Really Need Physician Re-Certification Testing?

There has to be a better way.

"Personally, I spent $1,720 in 2010 to enroll in the maintenance of certification program and take the internal medicine exam (the current fee is $1,940) and another $775 to take the infectious diseases exam, a total of $2,495. Doesn’t it seem reasonable that the ABIM should be able to administrate a re-certification program that is more efficient and streamlined for that amount of money per person?"


Uber, Lyft refuse to require driver fingerprints



    Uber, Lyft refuse to require driver fingerprints


    "But the ride-hailing companies, which use smartphone apps to connect passengers and drivers, have avoided doing fingerprint checks of drivers, and that rankles officials like Rep. Alan Powell, R-Hartwell, sponsor of HB 225, which came to be known as the "Uber" bill even though it applies to all companies.
    He says fingerprinting is the best way to ensure drivers don't have criminal records, but compromised on that point to ensure his bill's passage."

    Worrisome: Rapid Emergence of Multidrug Resistant, H58-Lineage Salmonella Typhi in Blantyre, Malawi

     2015 Apr 24;9(4):e0003748. doi: 10.1371/journal.pntd.0003748. eCollection 2015.

    Rapid Emergence of Multidrug Resistant, H58-Lineage Salmonella Typhi in Blantyre, Malawi.

    Author information

    • 1Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Wellcome Trust Sanger Institute, Hinxton, United Kingdom.
    • 2Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
    • 3Wellcome Trust Sanger Institute, Hinxton, United Kingdom.
    • 4Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; University of Malawi College of Medicine, Blantyre, Malawi.
    • 5University of Malawi, The Polytechnic, Blantyre, Malawi.
    • 6University of Malawi College of Medicine, Blantyre, Malawi.
    • 7Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Institute for Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
    • 8Institute for Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
    • 9Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

    Abstract

    INTRODUCTION:

    Between 1998 and 2010, S. Typhi was an uncommon cause of bloodstream infection (BSI) in Blantyre, Malawi and it was usually susceptible to first-line antimicrobial therapy. In 2011 an increase in a multidrug resistant (MDR) strain was detected through routine bacteriological surveillance conducted at Queen Elizabeth Central Hospital (QECH).

    METHODS:

    Longitudinal trends in culture-confirmed Typhoid admissions at QECH were described between 1998-2014. A retrospective review of patient cases notes was conducted, focusing on clinical presentation, prevalence of HIV and case-fatality. Isolates of S. Typhi were sequenced and the phylogeny of Typhoid in Blantyre was reconstructed and placed in a global context.

    RESULTS:

    Between 1998-2010, there were a mean of 14 microbiological diagnoses of Typhoid/year at QECH, of which 6.8% were MDR. This increased to 67 in 2011 and 782 in 2014 at which time 97% were MDR. The disease predominantly affected children and young adults (median age 11 [IQR 6-21] in 2014). The prevalence of HIV in adult patients was 16.7% [8/48], similar to that of the general population (17.8%). Overall, the case fatality rate was 2.5% (3/94). Complications included anaemia, myocarditis, pneumonia and intestinal perforation. 112 isolates were sequenced and the phylogeny demonstrated the introduction and clonal expansion of the H58 lineage of S. Typhi.

    CONCLUSIONS:

    Since 2011, there has been a rapid increase in the incidence of multidrug resistant, H58-lineage Typhoid in Blantyre. This is one of a number of reports of the re-emergence of Typhoid in Southern and Eastern Africa. There is an urgent need to understand the reservoirs and transmission of disease and how to arrest this regional increase.

    A novel approach to training students in delivering evidence-based obesity treatment

     2015 May;47(5):378-82.

    A novel approach to training students in delivering evidence-based obesity treatment.

    Author information

    • 1Medical University of South Carolina.

    Abstract

    BACKGROUND AND OBJECTIVES:

    Obesity is a major public health concern because of its prevalence, serious health consequences, and costs. Many health care providers believe they have been inadequately trained to treat obesity and, as a result, often do not address patients' weight. Despite recommendations to improve knowledge and skills so they can more effectively address obesity, health care educational curricula are already overburdened with content and have been slow to respond to these recommendations.

    METHODS:

    Interprofessional health care students voluntarily participated in an extracurricular service-learning opportunity to learn about the evidence-based treatment of obesity. A multidisciplinary team of weight management professionals taught didactic lessons and oversaw the service-learning component of training. An essential element of the training was the students' delivery of a free 10-week weight management intervention to low-income overweight and obese community residents.

    RESULTS:

    Patients in both the student-led (n=25) and professional-led (n=21) programs lost a statistically and clinically significant amount of weight. Additionally, there was no significant difference in weight loss between the two programs, even after taking into account differences in attendance between the two programs.

    CONCLUSIONS:

    An extracurricular service-learning program pairing brief didactic instruction with experiential learning appears to be a viable strategy for accomplishing the important dual objectives of preparing health care students to treat obesity and providing much-needed treatment to those in our community who are least able to afford it.

    The Impact of Legal Coercion on the Therapeutic Relationship in Adult Schizophrenia Patients

     2015 Apr 24;10(4):e0124043. doi: 10.1371/journal.pone.0124043.

    The Impact of Legal Coercion on the Therapeutic Relationship in Adult Schizophrenia Patients.

    Author information

    • 1Department of Forensic Psychiatry, University Hospital of Psychiatry, University of Zurich, Rheinau, Switzerland.
    • 2Department of General Psychiatry, University Hospital of Psychiatry, University of Basel, Basel, Switzerland.

    Abstract

    The quality of the therapeutic relationship between psychiatric patients and their attending physicians plays a key role in treatment success. We hypothesize that mandatory treatment is negatively associated with the quality of the therapeutic relationship. In a cross-sectional study design, data on psychopathological symptom load (as captured with the Brief Psychiatric Rating Scale) and on the quality of the therapeutic relationship (as measured with the Scale to Assess the Therapeutic Relationship) were collected from 113 adult male psychiatric patients and 35 attending physicians. Patients belonged to one of three groups: self-referred or involuntarily admitted patients from general psychiatry wards or patients from medium secure forensic psychiatric units. On average, self-referred patients rated the quality of the therapeutic relationship significantly more positive than did involuntarily admitted patients in general psychiatry wards. Forensic psychiatric patients, on average, gave an intermediate rating of the quality of the therapeutic relationship. There was no association between patients' ratings and physicians' ratings of the quality of the therapeutic relationship. Patients' ratings of the quality of the therapeutic relationship were inversely related to symptom severity in general and hostility in particular. Ratings of the quality of the therapeutic relationship are not associated with patients' legal status but rather with patients' symptoms of hostility.

    Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study

     2015 Apr 24. [Epub ahead of print]

    Clinical outcomes in patients with a diagnosis of "indefinite for dysplasia" in Barrett's esophagus: a multicenter cohort study.

    Author information

    • 1Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
    • 2Division of Gastroenterology and Hepatology, National Naval Medical Center, Bethesda, Maryland, USA.
    • 3Department of Gastroenterology, Washington University in St. Louis, St Louis, Missouri, USA.
    • 4Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA.
    • 5Division of Gastroenterology, University of Colorado, Denver, Colorado, USA.
    • 6Division of Gastroenterology, Loyola University, Maywood, Illinois, USA.
    • 7Department of Pathology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Missouri, USA.
    • 8Department of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
    • 9Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and Oregon Health and Science University, Portland, Oregon, USA.
    • 10Department of Pathology, University of Arizona Cancer Center, Tucson, Arizona, USA.

    Abstract

    Background and study aim: Data are limited on the natural history of patients with Barrett's esophagus with a diagnosis of "indefinite for dysplasia" (IND). The aims of this study were to: (i) determine rates of progression to high grade dysplasia (HGD) or esophageal adenocarcinoma, and compare these with rates for low grade dysplasia (LGD); and (ii) determine the proportion of patients whose histological IND diagnosis changed on follow-up endoscopy. 
    Patients and methods: Demographic, endoscopic, and histologic information of patients with diagnoses of IND and LGD and at least 12 months of follow-up were extracted from the database of a multicenter Barrett's esophagus study. Rates and times for progression to HGD and esophageal adenocarcinoma and regression to nondysplastic epithelium were calculated. Proportions of diagnoses upgraded to HGD/esophageal adenocarcinoma or downgraded to nondysplastic epithelium at first follow-up endoscopy were evaluated. 
    Results: Amongst 2264 patients, 83 with a diagnosis of IND (mean age 60 years, 95 % men, 95 % white; mean follow-up 5.6 years) and 79 with diagnosis of LGD were identified. In the IND group, annual incidences of esophageal adenocarcinoma and HGD were 0.21 % and 0.64 %, respectively, representing a combined incidence of 0.8 %. Mean time to progression was 4.72 years. Within the IND group 55 % patients showed regression to nondysplastic epithelium at first follow-up endoscopy and the overall regression rate was 80 %. Corresponding rates in LGD patients were similar. 
    Conclusions: Lesions diagnosed as IND and LGD show similar biological behavior and can be treated as a single category with respect to surveillance and follow-up.

    "We have morphed into a nation of po-faced prudes..."

    Obesity should not be a badge of pride

    Zombie allusions: They just keep on coming™: "...raising the qualifying age for Social Security..."

    Paul Krugman's Zombie Social Security Reform Idea


    "This is interesting from Paul Krugman. He describes Chris Christie’s idea of raising the qualifying age for Social Security as a “zombie idea.” Something that is, or at least should be, long dead but one that still stalks the night. This is something I find fascinating as I was originally convinced of the merits of the idea by Krugman’s sometime collaborator Brad Delong. Delong’s explanation of why we should raise the Social Security qualifying age seeming to me to be very good economics indeed."

    Health reform requires policy capacity

     2015 Apr 17;4(5):265-6. doi: 10.15171/ijhpm.2015.85.

    Health reform requires policy capacity.

    Author information

    • 1Institute for Health and Social Policy, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    • 2Ecole nationale d'administration publique, Montreal, QC, Canada.
    • 3Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York City, NY, USA.
    • 4Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.

    Abstract

    Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibility.

    Perceiving Political Polarization in the United States: Party Identity Strength and Attitude Extremity Exacerbate the Perceived Partisan Divide

     2015 Mar;10(2):145-158.

    Perceiving Political Polarization in the United States: Party Identity Strength and Attitude Extremity Exacerbate the Perceived Partisan Divide.

    Author information

    • 1Department of Psychology and Neuroscience, University of Colorado Boulder.
    • 2Department of Psychology and Neuroscience, University of Colorado Boulder vanboven@colorado.edu.
    • 3Department of Psychology, Saint Louis University, St. Louis, MO.

    Abstract

    An important component of political polarization in the United States is the degree to which ordinary people perceive political polarization. We used over 30 years of national survey data from the American National Election Study to examine how the public perceives political polarization between the Democratic and Republican parties and between Democratic and Republican presidential candidates. People in the United States consistently overestimate polarization between the attitudes of Democrats and Republicans. People who perceive the greatest political polarization are most likely to report having been politically active, including voting, trying to sway others' political beliefs, and making campaign contributions. We present a 3-factor framework to understand ordinary people's perceptions of political polarization. We suggest that people perceive greater political polarization when they (a) estimate the attitudes of those categorized as being in the "opposing group"; (b) identify strongly as either Democrat or Republican; and (c) hold relatively extreme partisan attitudes-particularly when those partisan attitudes align with their own partisan political identity. These patterns of polarization perception occur among both Democrats and Republicans.