Friday, May 31, 2013

Zombie allusions: They just keep on coming-"the result of a surreal convergence of neurological impairments"

Neuroscientist Addresses Zombie Science

Posted by  on Fri, May 31, 2013

"This discussion might leave participants weighing the nuances of that eternal question: Does sci-fi imitate science, or does science imitate sci-fi? That's because the traits that make zombies so iconic —their stiff lumbering stride, their inability to talk or experience pain — actually have some root in the scientific realm.
For Night of the Living Dead -heads, it’s that elusive quality that makes zombies so clumsily terrifying. For modern neuroscientists, these features can be explained as the result of a surreal convergence of neurological impairments."

Shoshana Weissmann: "Adversity is undervalued..."

Hardship Could Be the Best Thing That Ever Happens to You

The paranoia continuum

 2013 May 9. [Epub ahead of print]

The structure of paranoia in the general population.


PhD, FRCP, FRCPsych, Mental Health Sciences Unit, University College London Faculty of Brain Sciences, UK; Orla McBride, PhD, School of Psychology, University of Ulster, Northland Road, Londonderry, Northern Ireland, UK; Craig Steel, PhD, Charlie Waller Institute, School of Psychology and Clinical Language Sciences, University of Reading, UK; Elizabeth Kuipers, BSC, MSc, PhD, Department of Psychology, Institute of Psychiatry, King's College London, and NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, UK; Mirjana Radovanovič, MD, MSc, University Psychiatric Hospital, Alcoholism Treatment Center, Ljubljana, Slovenia; Traolach Brugha, MD, FRCPsych, Department of Health Sciences, University of Leicester, UK; Rachel Jenkins, MD, FRCPsych, WHO Collaborating Centre, Institute of Psychiatry, Kings College London, UK; Howard I. Meltzer (deceased), PhD, Department of Health Sciences, University of Leicester, UK; Daniel Freeman, PhD, DClinPSy, FBPsS, Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK.



Psychotic phenomena appear to form a continuum with normal experience and beliefs, and may build on common emotional interpersonal concerns.


We tested predictions that paranoid ideation is exponentially distributed and hierarchically arranged in the general population, and that persecutory ideas build on more common cognitions of mistrust, interpersonal sensitivity and ideas of reference.


Items were chosen from the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) questionnaire and the Psychosis Screening Questionnaire in the second British National Survey of Psychiatric Morbidity (n = 8580), to test a putative hierarchy of paranoid development using confirmatory factor analysis, latent class analysis and factor mixture modelling analysis.


Different types of paranoid ideation ranged in frequency from less than 2% to nearly 30%. Total scores on these items followed an almost perfect exponential distribution (r = 0.99). Our four a priori first-order factors were corroborated (interpersonal sensitivity; mistrust; ideas of reference; ideas of persecution). These mapped onto four classes of individual respondents: a rare, severe, persecutory class with high endorsement of all item factors, including persecutory ideation; a quasi-normal class with infrequent endorsement of interpersonal sensitivity, mistrust and ideas of reference, and no ideas of persecution; and two intermediate classes, characterised respectively by relatively high endorsement of items relating to mistrust and to ideas of reference.


The paranoia continuum has implications for the aetiology, mechanisms and treatment of psychotic disorders, while confirming the lack of a clear distinction from normal experiences and processes.

From Mass General: Planning cancer control in Latin America and the Caribbean

 2013 Apr;14(5):391-436. doi: 10.1016/S1470-2045(13)70048-2.

Planning cancer control in Latin America and the Caribbean.


Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA. Electronic address:


Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.

The New Genetics and Informed Consent: Differentiating Choice to Preserve Autonomy

 2013 May 30. doi: 10.1111/bioe.12030. [Epub ahead of print]

The New Genetics and Informed Consent: Differentiating Choice to Preserve Autonomy.


The advent of new genetic and genomic technologies may cause friction with the principle of respect for autonomy and demands a rethinking of traditional interpretations of the concept of informed consent. Technologies such as whole-genome sequencing and micro-array based analysis enable genome-wide testing for many heterogeneous abnormalities and predispositions simultaneously. This may challenge the feasibility of providing adequate pre-test information and achieving autonomous decision-making. At a symposium held at the 11th World Congress of Bioethics in June 2012 (Rotterdam), organized by the International Association of Bioethics, these challenges were presented for three different areas in which these so-called 'new genetics' technologies are increasingly being applied: newborn screening, prenatal screening strategies and commercial personal genome testing. In this article, we build upon the existing ethical framework for a responsible set-up of testing and screening offers and reinterpret some of its criteria in the light of the new genetics. As we will argue, the scope of a responsible testing or screening offer should align with the purpose(s) of testing and with the principle of respect for autonomy for all stakeholders involved, including (future) children. Informed consent is a prerequisite but requires a new approach. We present preliminary and general directions for an individualized or differentiated set-up of the testing offer and for the informed consent process. With this article we wish to contribute to the formation of new ideas on how to tackle the issues of autonomy and informed consent for (public) healthcare and direct-to-consumer applications of the new genetics.

The ethics of imposing healthy professional lifestyles on professionals

 2013 Jun;57(6):1693-1694. doi: 10.1016/j.jvs.2013.04.021.

The ethics of imposing healthy professional lifestyles on professionals.


The Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Tex. Electronic address:


As chief of surgery at Salubrus, a large for-profit group practice, you received notification from the board of trustees that you cannot hire a surgeon you wanted to hire because she chain-smokes cigarettes. No other physician at Salubrus smokes. At the last board meeting, you presented your objections to the healthy lifestyle policy. It is the establishment of a policy of forcing healthy lifestyles on employees, especially those involved in direct patient care. The candidate has outstanding credentials and has initiated a new revolutionary treatment for vascular disease. Your ethical stance should be?

From U Colorado: Rapid Diagnosis of Mycobacterium tuberculosis Infection and Drug Susceptibility Testing

Rapid Diagnosis of Mycobacterium tuberculosis Infection and Drug Susceptibility Testing

Michael L. Wilson MD
From the Department of Pathology and Laboratory Services, Denver Health, Denver, Colorado; and the Department of Pathology, University of Colorado School of Medicine, Aurora.
Context.—The global control of tuberculosis remains a challenge from the standpoint of diagnosis, detection of drug resistance, and treatment. This is an area of special concern to the health of women and children, particularly in regions of the world with high infant mortality rates and where women have limited access to health care.
Objective.—Because treatment can only be initiated when infection is detected, and is guided by the results of antimicrobial susceptibility testing, there recently has been a marked increase in the development and testing of novel assays designed to detect Mycobacterium tuberculosis complex, with or without simultaneous detection of resistance to isoniazid and/or rifampin. Both nonmolecular and molecular assays have been developed. This review will summarize the current knowledge about the use of rapid tests to detect M tuberculosis and drug resistance.
Data Sources.—Review of the most recent World Health Organization Global Tuberculosis Report, as well as selected publications in the primary research literature, meta-analyses, and review articles.
Conclusions.—To a large extent, nonmolecular methods are refinements or modifications of conventional methods, with the primary goal of providing more rapid test results. In contrast, molecular methods use novel technologies to detect the presence of M tuberculosis complex and genes conferring drug resistance. Evaluations of molecular assays have generally shown that these assays are of variable sensitivity for detecting the presence of M tuberculosis complex, and in particular are insensitive when used with smear-negative specimens. As a group, molecular assays have been shown to be of high sensitivity for detecting resistance to rifampin, but of variable sensitivity for detecting resistance to isoniazid.

Perinatal Pathology: Practice Suggestions for Limited–Resource Settings

Perinatal Pathology: Practice Suggestions for Limited–Resource Settings

Drucilla J. Roberts MD
From the Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
The practice of perinatal pathology in much of the world suffers, as do all subspecialties of anatomic pathology, from inadequate resources (equipment, consumables, and both professional and technical personnel), from lack of education (not only of the pathologist but also of the clinicians responsible for sending the specimens, and the technicians processing the specimens), and from lack of appropriate government sector support. Perinatal pathology has significant public health–related utility and should be championing its service by providing maternal and fetal/infant mortality and morbidity data to governmental health ministries. It is with this pathologic data that informed decisions can be made on health-related courses of action and allocation of resources. These perinatal pathology data are needed to develop appropriate public health initiatives, specifically toward achieving the Millennium Developmental Goals as the best way to effectively decrease infant and maternal deaths and to determine causes of perinatal mortality and morbidity. The following overview will focus on the utility of perinatal pathology specifically as related to its public health function and will suggest methods to improve its service in resource-poor settings. This article is offered not as a critique of the current practice that most pathologists find themselves working in globally, but to provide suggestions for improving perinatal pathology services, which could be implemented with the limited available resources and manpower most pathology departments currently have. In addition, we offer suggestions for graded improvements (“ramping up”) over time.

Drucilla Roberts: "Anatomic pathology services are nearly nonexistent in much of the world..."

Pathology: Functionality in Resource-Poor Settings

Drucilla J. Roberts MD

"exquisitely termed duel warhead folate conjugate"

Targeted Molecular Therapy for Lung Cancer: Exuberance Reestablished

From Mass General: Screening for Cervical Cancer in Low-Resource Settings in 2011

Screening for Cervical Cancer in Low-Resource Settings in 2011

Rosemary Tambouret MD
From the Department of Pathology, Massachusetts General Hospital, Boston.
Context.—Cervical cancer remains the most common malignancy in women living in low- and middle-income countries, despite the decline of the disease in countries where cervical cytology screening programs have been implemented.
Objectives.—To review the current incidence of cervical cancer in low-resource countries, the availability and types of screening programs, and the treatment options.
Data Sources.—Literature review through PubMed, Internet search, and personal communication.
Conclusions.—Although data are incomplete, available figures confirm that the rate of cervical cancer deaths and the availability of cervical cancer screening programs are inversely proportional and vary, in general, by the wealth of the nation. Despite the success of cervical cytology screening, many major health care organizations have abandoned screening by cytology in favor of direct visualization methods with immediate treatment of lesions by cryotherapy provided by trained, nonmedical personnel.

The Practice of Pathology in Africa

The Practice of Pathology in Africa

Ronald Otto Christian Kaschula MB, ChB, MMed(Path)
From the Divisions of Forensic Pathology, University of Cape Town, and Forensic Pathology, Stellenbosch University, Cape Town, South Africa.
In attempting to advance the health of women and children in Africa, practitioners should be cognizant of the history of health care delivery in the continent and the nature of the existing systems. Although autopsies began in Africa several millennia ago, traditional healers have held sway for many centuries and continue to do so for most of Africa's people. The role of laboratory medicine in advancing modern health care has been impeded by its ever-increasing high cost, lack of confidence in the system, lack of adequately trained personnel, and inadequate provision of facilities and training opportunities. This is partly caused by the continent having the highest proportion of young children in the world, an exceptionally heavy disease burden, and a low proportion of tax payers. For laboratory medicine to have its intended effect in making accurate diagnoses, national, minimal standards for certification and practice should be formulated. There should be periodic inspections, rewards for excellence, and opportunities for professional development. It is recommended that laboratory medicine be practiced in a 4-tier system, with the highest in teaching hospitals, and the lowest in primary health care clinics. For the practice of anatomic pathology to advance, an effective referral system and an equitable minimal and maximal workload for each pathologist are needed. The changing dynamics of urbanization, with massive unemployment rates, unhealthy life styles, and the continued role of traditional healers calls for gifted leaders to come to the fore and facilitate internal and external cooperation with diverse health care agencies.

Excellent Archives of Pathology and Laboratory Medicine Special Section: CONTRIBUTIONS OF ANATOMIC PATHOLOGY TO WOMEN'S AND PERINATAL HEALTH


Thursday, May 30, 2013

'No thanks'-reasons why pregnant women declined an offer of cystic fibrosis carrier screening

 2013 May 29. [Epub ahead of print]

'No thanks'-reasons why pregnant women declined an offer of cystic fibrosis carrier screening.


Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia.


The objective of this study was to assess attitudes and opinions of women declining the offer of cystic fibrosis (CF) carrier screening through a population-based programme in Victoria, Australia. Between December 2009 and May 2011, women declining an offer of CF carrier screening were invited to participate in a questionnaire-based study. Recruitment was at two private obstetric ultrasound clinics and two private obstetric practices in Melbourne. Of the participants (n = 54), the majority were well educated (76%), aged 30-34 years (54%), with a household income of >AUD$100,000 (76%). Compared to those who accepted screening (reported in a previous study) (Ioannou et al., Public Health Genomics 13:449-56, 2010), knowledge levels were significantly lower in participants declining screening (t = 3.32, p < 0.01). The main reasons for declining screening were having no family history of CF (58%) and not considering a termination of pregnancy for CF (53%). Providers and consumers should be informed that most children born with autosomal-recessive conditions such as CF have no family history of the condition.

New worry for fungal meningitis patients: relapse

New worry for fungal meningitis patients: relapse

By JoNel Aleccia, Senior Writer, NBC News

"The more than 740 patients who developed fungal meningitis and other infections after receiving tainted back pain shots may have yet another worry: relapses of illness despite months of powerful treatment.

Officials with the Centers for Disease Control and Prevention say an 80-year-old man who developed fungal meningitis at the start of the nationwide outbreak last fall thought he was in the clear in February after more than four months of antifungal drugs.

But within weeks of stopping the therapy, the patient was back in the emergency room with headache and neck pain and sky-high signs of fungal infection, according to a report Wednesday in the New England Journal of Medicine."

Veteran Internet Use and Engagement With Health Information Online

 2013 Apr;178(4):394-400.

Veteran Internet Use and Engagement With Health Information Online.


eHealth Quality Enhancement Research Initiative and Center for Health Quality, Outcomes and Economic Research, Department of Veterans Affairs, 200 Springs Road (152), Bedford, MA 01730.


Veterans represent a unique population in need of accessing health services online. Data from a random-digit dialed survey conducted by the Pew Research Center's Internet & American Life Project were used to assess differences in online use of health information among Veterans in the Veterans Health Administration (VHA) of the U.S. Department of Veteran Affairs (VA), Veterans not in VA, and non-Veterans. This survey of 3,001 U.S. citizens oversampled lower-income households. Questions assessed Veteran status and use of VA health care services, self-reported Internet use and Internet searching for health-related information, and social engagement related to health online. Overall results suggest Veterans represent an opportune population to utilize personal health records and health services via the Internet. Veterans in VA are more likely to search for health issues related to Alzheimer's disease and memory loss (odds ratio = 3.07; confidence interval = 1.41-8.28) compared to Veterans not in VA. Veterans receiving VA health care also reported higher proportions of social engagement related to health about tracking diet, weight, and exercise than Veterans not in VA, although not statistically significant. Veterans in VA are using the Internet for health information, and there is an opportunity to engage them more.

"Professionalism requires that the acquisition of knowledge and skills go hand in hand with moral education in the intellectual virtues of humility, perseverance, adaptability, communicativeness, and commitment to resist self-deception or conflicts of interest."

 2013;2013:152-156. doi: E10.1200/EdBook_AM.2013.33.152.

Professionalism in Global, Personalized Cancer Care.


From the Department of Medicine, New York University Medical School, New York, NY.


Personalized medicine is revolutionizing cancer care and creating new expectations among oncologists and patients. At present the benefit is still marginal, however, and must be understood as incremental. In addition, cultural and resource disparities limit the sustainability of new cancer therapies on a global scale. Adequate instruments are needed to enable our exercise of sound and honest judgment in distinguishing breakthrough treatments from those that yield only marginal or doubtful improvements, and to develop strategies for formulation and correct application of balanced guidelines for sustainable cancer care. Professionalism requires that the acquisition of knowledge and skills go hand in hand with moral education in the intellectual virtues of humility, perseverance, adaptability, communicativeness, and commitment to resist self-deception or conflicts of interest. Hidden curricula undermine the moral values of medicine: these must be understood and uncovered. We should possess a special body of knowledge, skills, and values that allow us to change our practices when appropriate and to be stewards of society's limited resources through proper communication with our patients and families. In the era of personalized oncology and global issues of sustainability, professional authenticity andintegrity in cancer clinical practice are key to bridging the gaps between true and false expectations of patients and the public.

How Patient Centered Are Medical Decisions?: Results of a National Survey

 2013 May 27:1-7. doi: 10.1001/jamainternmed.2013.6172. [Epub ahead of print]

How Patient Centered Are Medical Decisions?: Results of a National Survey.


IMPORTANCE Informing and involving patients in their medical decisions is increasingly becoming a standard for good medical care, particularly for primary care physicians. 
OBJECTIVE To learn how patients describe the decision-making process for 10 common medical decisions, including 6 that are most often made in primary care. 
DESIGN A survey of a national sample of adults 40 years or older who in the preceding 2 years had either experienced or discussed with a health care provider 1 or more of 10 decisions: medication for hypertension, elevated cholesterol, or depression; screening for breast, prostate, or colon cancer; knee or hip replacement for osteoarthritis, or surgery for cataract or low back pain. 
SETTING Adults living in households in the United States in 2011. 
PARTICIPANTS A national sample of adults drawn from a probability sample-based web panel developed by Knowledge Networks. 
MAIN OUTCOMES AND MEASURES Patients' perceptions of the extent to which the pros and cons were discussed with their health care providers, whether the patients were told they had a choice, and whether the patients were asked for their input. RESULTS Responses were obtained from 2718 patients, with a response rate of 58.3%. Respondents reported much more discussion of the pros than the cons of all tests or treatments; discussions about the surgical procedures tended to be more balanced than those about medications to reduce cardiac risks and cancer screening. Most patients (60%-78%) said they were asked for input for all but 3 decisions: medications for hypertension and elevated cholesterol and having mammograms (37.3%-42.7%). Overall, the reported decision-making processes were most patient centered for back or knee replacement surgery and least for breast and prostate cancer screening. 
CONCLUSIONS AND RELEVANCE Discussions about these common tests, medications, and procedures as reported by patients do not reflect a high level of shared decision making, particularly for 5 decisions most often made in primary care.

From UNC-Chapel Hill: The obesity epidemic and changes in self-report biases in BMI

 2013 Apr;21(4):856-60. doi: 10.1002/oby.20313.

The obesity epidemic and changes in self-report biases in BMI.


Carolina Population Center, University of North Carolina at Chapel Hill, CB# 8120, Chapel Hill, NC 27516-2524, USA. At the time of the study, the University of California, Los Angeles.



To assess time trends in measurement error of BMI and the sensitivity/specificity of classifying weight status in the United States by analyzing the difference in BMI between self-reported and measured height and weight.


Data from 18,394 respondents aged 20-89 years from the National Health and Nutrition Examination Survey (NHANES) from 1999 through 2008 were analyzed. Multiple linear regression and logistic regression models estimated trends in reporting bias and misclassification of weight status by BMI categories, sex, age, and racial/ethnic groups, adjusting for the sampling design.


We find no evidence that there are time trends in the accuracy of self-report by BMI categories, sex, age, or racial/ethnic groups. The well-known downward bias in self-report has remained stable over the last decade; approximately one in six to seven obese individuals were misclassified as nonobese due to underestimation of BMI.


Increases in obesity rates based on self-reported height and weight are likely to reflect actual weight increases and are not inflated by changes in reporting accuracy.

Wednesday, May 29, 2013

Transformation of pathologists: responding in a volatile, uncertain, complex, and ambiguous environment

 2013 May;137(5):603-5. doi: 10.5858/arpa.2012-0301-ED.

Transformation of pathologists: responding in a volatile, uncertain, complex, and ambiguous environment.

‘‘[T]oday’s VUCA environment is now a permanent condition.’’12 Pathologists need to be ready to do things that chafe. ‘‘It’s going to be a zigzag path. You have to learn how to fail early, fail often, and fail  cheaply, as a way of developing your strategy as you go. . . . [Be] very clear about where you’re going, but very flexible in how you get there.’’13

From U Kentucky: Low socioeconomic status and mental health outcomes in colorectal cancer survivors: disadvantage? advantage? … or both?

 2013 May 28. doi: 10.1002/pon.3309. [Epub ahead of print]

Low socioeconomic status and mental health outcomes in colorectal cancer survivors: disadvantage? advantage? … or both?


Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA.



The goal of this study is to examine the relationship between socioeconomic status (SES) and both positive and negative mental health (MH) outcomes in a population-based sample of colorectal cancer survivors. On the basis of theoretical conceptualizations of trauma and posttraumatic growth, low SES was hypothesized to be positively associated with both greater negative MH outcomes (e.g., distress) and greater positive MH outcomes (e.g., growth).


Colorectal cancer survivors (n = 1300; 57% male; mean age 69.4 and 4.0 years post-diagnosis) were recruited using a regional, population-based cancer registry in the Netherlands and completed a questionnaire assessing current negative and positive MH outcomes. Low, medium, and high SES respondents were identified using an area-level indicator of SES based on aggregated individual fiscal data on monetary home value and household income.


Analysis of covariance and logistic regression analyses indicated that low SES was a risk factor for greater negative MH outcomes. Relative to high SES survivors, low SES survivors reported poorer status on nine indices of MH, and high SES survivors were about 50% less likely to report clinically important levels of anxiety and depression. Results provided partial support for the hypothesis low SES was a 'risk' factor for greater positive MH outcomes. Relative to high SES survivors, low SES survivors reported greater positive MH outcomes on 2 of 5 positive MH indices examined (Positive Self-Evaluation, Meaning of Cancer).


Study findings are the first to suggest that low SES might increase the likelihood of both greater negative as well as positive MH outcomes in cancer survivors.