1Department of Pathology, University of Texas Health Center, 11937 US Hwy 271, Tyler, TX 75708, USA.
Anti-interleukin 8 autoantibody:interleukin 8 (anti-IL-8 autoantibody:IL-8) complexes are present in lung fluids of patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), and levels of these complexes correlate with progression to and the outcome of ARDS. Fc gammaRIIa, an immunoglobulin G (IgG) receptor, mediates proinflammatory activity of the complexes.
To evaluate lung tissues from patients with ARDS for presence of anti-IL-8 autoantibody:IL-8 complexes and to establish whether the complexes associate with Fc gammaRIIa.
Lung tissue sections from 3 patients with ARDS and sections of normal lung tissues from 3 patients were stained with antibodies against IL-8 and IgG to detect immune complexes and with antibody against Fc gammaRIIa. In some experiments, sections were blocked with anti-Fc gamma RIIa antibody before staining. Samples were analyzed using confocal microscopy.
Interleukin 8 costained with IgG and Fc gammaRIIa in lung tissues from patients with ARDS but not in control tissues, suggesting that anti-IL-8 autoantibody:IL-8 complexes are deposited in lungs of patients with ARDS via Fc gammaRIIa. Further, colocalization between IL-8 and Fc gammaRIIa could be blocked by anti-Fc gammaRIIa.
Our data demonstrate that anti-IL-8 autoantibody:IL-8 complexes are present in lung tissues of patients with ARDS, and are attached to Fc gammaRIIa.
Z. Laura Tabatabai, Manon Auger, Daniel F. I. Kurtycz, Rodolfo Laucirica, Rhona J. Souers, Ritu Nayar, Walid E. Khalbuss, Ann T. Moriarty, and Mostafa Fraig (2015) Do Liquid-Based Preparations of Pulmonary Bronchial Brushing Specimens Perform Differently From Classically Prepared Cases for the Diagnosis of Malignancies? Observations From the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Archives of Pathology & Laboratory Medicine: February 2015, Vol. 139, No. 2, pp. 178-183.
Z. LauraTabatabai, MD; ManonAuger, MD; Daniel F. I.Kurtycz, MD; RodolfoLaucirica, MD; Rhona J.Souers, MS; RituNayar,MD; Walid E.Khalbuss, MD, PhD; Ann T.Moriarty, MD; MostafaFraig, MD
From the Department of Pathology, University of California, San Francisco (Dr Tabatabai); the Department of Pathology, McGill University Health Center, Montreal, Quebec, Canada (Dr Auger); the Department of Pathology, Wisconsin State Lab of Hygiene, Madison (Dr Kurtycz); the Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas (Dr Laucirica); the Department of Biostatistics, College of American Pathologists, Northfield (Ms Souers), and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago (Dr Nayar), Illinois; the Department of Pathology, University of Pittsburgh Medical Center–Shadyside, Pittsburgh, Pennsylvania (Dr Khalbuss); the Department of Pathology, AmeriPath Indiana, Indianapolis (Dr Moriarty); and the Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, Kentucky (Dr Fraig).
Context.— Pulmonary bronchial brushing specimens can be processed by liquid-based or conventional methods. The ability to accurately diagnose a pulmonary malignancy with a liquid-based preparation (LBP) versus a conventional preparation may differ.
Objective.— To compare the performance of LBPs of malignant pulmonary bronchial brushing specimens with the performance of conventional preparations.
Design.— Participant responses from 553 malignant pulmonary bronchial brushing samples were evaluated for concordance with the general diagnosis. The performance of LBPs was compared with that of classic preparations. A nonlinear mixed model was used to analyze the performance by reference diagnosis, preparation type, program years, participant type, and the interaction terms between these 4 factors.
Results.— Concordance with the general category of malignant disease was observed in 95.2% of conventional Papanicolaou-stained, 90.9% of modified Giemsa-stained, and 96.9% of LBP (P < .001) samples. The results were significantly different between individual reference diagnoses (P < .001). The performance of LBPs was consistently higher for most diagnoses and was significantly better for squamous cell carcinoma (P = .005), small cell carcinoma (P < .001), and metastatic carcinoma not otherwise specified (P < .001). All participant types performed significantly better with LBPs of small cell carcinoma. Pathologists and cytotechnologists performed significantly better with LBPs of squamous cell carcinoma. A significantly higher concordance was observed between the general diagnosis and program years 2007–2011 versus 2001–2006 (P = .006).
Conclusions.— Liquid-based preparations performed better than conventional methods, with significantly higher performance in squamous cell, small cell, and metastatic carcinomas. Improved performance over time may reflect more frequent use of LBP methods and increased familiarity with interpreting the morphologic findings.
1Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA; Jessica.Kendrick@ucdenver.edu.
2Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, Colorado, USA;
3Department of Community and Behavioral Health and Health Systems Management Policy, Colorado School of Public Health , Aurora, CO, USA.
To evaluate the attitudes and perceptions of primary care providers (PCPs) regarding the presence and underlying sources of racial/ethnic and socioeconomic disparities in hypertension control.
We conducted a survey of 115 PCPs from 2 large academic centers in Colorado. We included physicians, nurse practitioners, and physician assistants. The survey assessed provider recognition and perceived contributors of disparities in hypertension control.
Respondents were primarily female (66%), non-Hispanic White (84%), and physicians (80%). Among respondents, 67% and 73% supported the collection of data on the patients' race/ethnicity and socioeconomic status (SES), respectively. Eighty-six percent and 89% agreed that disparities in race/ethnicity and SES existed in hypertension care within the US health system. However, only 33% and 44% thought racial/ethnic and socioeconomic disparities existed in the care of their own patients. Providers were more likely to perceive patient factors rather than provider or health system factors as mediators of disparities. However, most supported interventions such as improving provider communication skills (87%) and cultural competency training (89%) to reduce disparities in hypertension control.
Most providers acknowledged that racial/ethnic and socioeconomic disparities in hypertension control exist in the US health system, but only a minority reported disparities in care among patients they personally treat. Our study highlights the need for testing an intervention aimed at increasing provider awareness of disparities within the local health setting to improve hypertension control for minority patients.
1School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.
2Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA.
3Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA.
Ecological and cross-sectional studies have indicated that conservative political ideology is associated with better health. Longitudinal analyses of mortality are needed because subjective assessments of ideology may confound subjective assessments of health, particularly in cross-sectional analyses.
Data were derived from the 2008 General Social Survey-National Death Index data set. Cox proportional analysis models were used to determine whether political party affiliation or political ideology was associated with time to death. Also, we attempted to identify whether self-reported happiness and self-rated health acted as mediators between political beliefs and time to death.
In this analysis of 32 830 participants and a total follow-up time of 498 845 person-years, we find that political party affiliation and political ideology are associated with mortality. However, with the exception of independents (adjusted HR (AHR)=0.93, 95% CI 0.90 to 0.97), political party differences are explained by the participants' underlying sociodemographic characteristics. With respect to ideology, conservatives (AHR=1.06, 95% CI 1.01 to 1.12) and moderates (AHR=1.06, 95% CI 1.01 to 1.11) are at greater risk for mortality during follow-up than liberals.
Political party affiliation and political ideology appear to be different predictors of mortality.
1CRICO Strategies, a division of the Risk Management Foundation of the Harvard Medical Institutions, Inc. in Cambridge, Massachusetts.
The landmark 1999 Institute of Medicine report, "To Err Is Human," challenged us all to reduce the number of preventable medical errors. While vulnerabilities and patient harm continue at unacceptable rates, there are also many success stories. This article presents a series of case studies that illustrate how healthcare organizations have used data-quantitative, qualitative, and comparative-to address vulnerabilities and guide meaningful change to improve patient safety. These examples are drawn from the data-sharing community of CRICO Strategies, a division of the Risk Management Foundation of the Harvard Medical Institutions, Inc. (CRICO). CRICO's data-driven strategy uses intelligence from thousands of medical malpractice cases across the country to examine what has gone wrong and why, and to help members and clients manage their risk and provide better care.
The last two decades have witnessed a crescendo of allegations that clinical translation is rife with waste and inefficiency. Patient advocates argue that excessively demanding regulations delay access to life-saving drugs, research funders claim that too much basic science languishes in academic laboratories, journal editors allege that biased reporting squanders public investment in biomedical research, and drug companies (and their critics) argue that far too much is expended in pharmaceutical development. But how should stakeholders evaluate the efficiency of translation and proposed reforms to drug development? Effective reforms require an accurate model of the systems they aspire to improve-their components, their proper functions, and their pathologies. However, there is currently no explicit and well-developed model of translation for evaluating such criticisms. In what follows, we offer an explicit model of clinical translation. Many discussions of clinical translation and its pathologies presume that its main output is tangible: new drugs, vaccines, devices, and diagnostics. We disagree. We argue that the principal output of clinical translation is information-in particular, information about the coordinated set of materials, practices, and constraints needed to safely unlock the therapeutic or preventive activities of drugs, biologics, and diagnostics. To develop this information calls for a process far different from a simple linear progression of clinical trials; it requires exploratory sampling of many different elements in this set. Our model points to some limitations and liabilities of influential proposals for reforming research. It also reveals some underrecognized opportunities for improving the efficiency of clinical translation.
1Centre for Values, Ethics and the Law in Medicine, Sydney School of Public health, University of Sydney, Level 1, Medical Foundation Building, K25, Sydney, NSW, 2006, Australia, email@example.com.
This article critically examines current responses to multi-drug resistant tuberculosis (MDR-TB) and argues that bioethics needs to be willing to engage in a more radical critique of the problem than is currently offered. In particular, we need to focus not simply on market-driven models of innovation and anti-microbial solutions to emergent and re-emergent infections such as TB. The global community also needs to address poverty and the structural factors that entrench inequalities-thus moving beyond the orthodox medical/public health frame of reference.
"Federal regulators announced their intention Thursday to ease up on the meaningful use electronic health records (EHR) program, one week after a coalition of 35 medical societies called for major changes."
"A wide of array of other sugary substances can still be found at the Berkeley Dollar Tree stores, but customers will no longer be able to find soft drinks or other liquid consumables packed with sugar, with the exception of fruit juices that are not affected by the newly imposed tax according to Nosh, an East bay news website focusing on food. The two stores still carry several types of sugary candies, along with ice creams, and other foods packed with sugar."
1Division of Oncology-Department of Oncology Azienda USL-6 of Livorno Viale Alfieri 36, 57100 LIVORNO, Italy. firstname.lastname@example.org.
The discovery of driver oncogene alterations in non-small cell lung cancer (NSCLC), such as EGFR, EML4-ALK, MET and RAS, as well as the identification of their specific targeted inhibitors have led to new opportunities for treatment of this tumour. Drug resistance, intrinsic or acquired, represents the major cause of failure of novel biological agents. MicroRNAs (miRNAs) are a family of small non-coding RNAs the bind to partially complementary recognition sequence of mRNA, coming either degradation of mRNA or inhibition of translation. The recent evidences that several micro-RNAs can modulate the oncogenic driver pathways in NSCLC and that they are involved in drug resistance of their targeted inhibitors, have opened the way to new therapeutic strategies. This minireview aims 1) to explore the potential mechanisms by which key miRNAs may up-regulate or down-regulate specific oncogenic driver pathways; 2) highlight the role of microRNAs in the mechanisms of resistance to targeted therapies; 3) discuss the therapeutic potential by using short-interfering RNAs or artificial miRNAs as anti-cancer therapies.
1Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Electronic address: email@example.com.
2Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
We sought to examine the sentiment and themes of marijuana-related chatter on Twitter sent by influential Twitter users and to describe the demographics of these Twitter users.
We assessed the sentiment and themes of a random sample (n = 7,000) of influential marijuana-related tweets (sent from February 5, 20114, to March 5, 2014). Demographics of the users tweeting about marijuana were inferred using a social media analytics company (Demographics Pro for Twitter).
Most marijuana-related tweets reflected a positive sentiment toward marijuana use, with pro-marijuana tweets outnumbering anti-marijuana tweets by a factor of greater than 15. The most common theme of pro-marijuana tweets included the Tweeter stating that he/she wants/plans to use marijuana, followed by tweeting about frequent/heavy/or regular marijuana use, and that marijuana has health benefits and/or should be legalized. Tweeters of marijuana-related content were younger and a greater proportion was African-American compared with the Twitteraverage.
Marijuana Twitter chatter sent by influential Twitter users tends to be pro-marijuana and popular among African-Americans and youth/young adults. Marijuana-related harms may afflict some individuals; therefore, our findings should be used to inform online and offline prevention efforts that work to target individuals who are most at risk for harms associated with marijuana use.
BY EMMANUELLE SALIBA
Kelli O'Laughlin, one of the doctor's at Brigham and Women's Hospital who skied to work, found her ride "fun" and "exhilarating." She told NBC's Miguel Almaguer that doctors have to come in to work because"the emergency department is one of those places where 24 hours a day, 7 days a week it's always going.""Our sincerest thanks to all employees that have gone to extraordinary lengths to get to the hospital during the storm," wrote the hospital in an Instagram post along with a photo of pathology technician Vivian Chan on snowshoes.
1School of Medical Sciences, The University of Adelaide, Frome Road, Adelaide, SA, 5005, Australia. Electronic address: firstname.lastname@example.org.
The frailty syndrome refers to the concurrence of a number of specific clinical manifestations that include unintentional weight loss, decreased muscle mass (sarcopenia), exhaustion, reduced physical strength and activity, and slow ambulation. It involves multiple systems, is an increasing problem in elderly populations, and is strongly associated with increases in both morbidity and mortality. Despite its recognition clinically, the frailty syndrome is not often identified in forensic situations and is only infrequently mentioned in the associated literature. As there is a direct relationship between the frailty syndrome and significant adverse health outcomes the syndrome has clear medicolegal significance.
1Moffitt Cancer Center 12902 Magnolia Drive, Tampa, FL 33612. email@example.com.
Hispanic/Latinos (H/L) are expected to grow to over 24% of the USA population by 2050 and lung cancer is the number one cause of cancer death among H/L men. Due to the information that is becoming available via genetic testing, lung cancermolecular profiling is allowing for increasing application of personalized lung cancer therapies. However, to benefit the most people, development of these therapies and genetic tests must include research on as many racial and ethnic groups as possible. The purpose of this review is to bring attention to the fact that the mutations driving lung cancer in H/Ls differ in frequency and nature relative to the non-Hispanic White (WNH) majority that dominate current databases and participate in clinical trials that test new therapies. Clinical trials using new agents targeting genetic alterations (driver mutations) in lung cancer have demonstrated significant improvements in patient outcomes (for example, gefitinib, erlotinib or crizotinib for lung adenocarcinomas harboring EGFR mutations or EML4-ALK fusions, respectively). The nature and frequencies of some lung cancer driver mutations have been shown to be considerably different among racial and ethnic groups. This is particularly true for H/Ls. For example, several reports suggest a dramatic shift in the mutation pattern from predominantly KRAS in a WNH population to predominantly EGFR in multiple H/L populations. However, these studies are limited, and the effects of racial and ethnic differences on the incidence of mutations in lung cancer remain incompletely understood. This review serves as a call to address this problem.
1Brittany Seymour and Elsbeth Kalenderian are with the Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA. Rebekah Getman is with the Harvard Global Health Institute, Cambridge, MA. Avinash Saraf and Lily H. Zhang are students at Harvard College, Cambridge, and interns at the Harvard Global Health Institute, Cambridge.
Objectives. In an antifluoridation case study, we explored digital pandemics and the social spread of scientifically inaccurate health information across the Web, and we considered the potential health effects. Methods. Using the social networking site Facebook and the open source applications Netvizz and Gephi, we analyzed the connectedness of antifluoride networks as a measure of social influence, the social diffusion of information based on conversations about a sample scientific publication as a measure of spread, and the engagement and sentiment about the publication as a measure of attitudes and behaviors. Results. Our study sample was significantly more connected than was the social networking site overall (P < .001). Social diffusion was evident; users were forced to navigate multiple pages or never reached the sample publication being discussed 60% and 12% of the time, respectively. Users had a 1 in 2 chance of encountering negative and nonempirical content about fluoride unrelated to the sample publication. Conclusions. Network sociology may be as influential as the information content and scientific validity of a particular health topic discussed using social media. Public health must employ social strategies for improved communication management.
2Teaching Hospital of Kigali (CHUK), 1024 Rue de la Paix, Kigali City, Kigali, PO Box 655, Rwanda.
3Kibagabaga Hospital, PO Box 6260, Kigali City, Rwanda.
4Rwanda Biomedical Centre, PO Box 640, Kigali, Rwanda.
574-2400 Tell Place, Regina, SK S4V 3E3, Canada.
We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said 'in the middle of difficulty lies opportunity' and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, Rwandan healthcare workers are proving how palliative care can be successfully integrated into a healthcare system. As a global healthcare community, we should be asking what opportunities exist to do this across the African continent. Champions of palliative care have a chance to forge lasting collaborations between international experts and African healthcare workers. This global network could not only advocate for palliative care programmes but it would also help to create a culture where palliative care is viewed as a necessary part of all healthcare systems.
When patients smoke cigarettes in psychiatric services, it brings to the forefront current ethical and political dilemmas. This study aims to explore the meaning attributed to smoking by mental health patients who smoke and who are hospitalized in a psychiatric ward of a general hospital. This qualitative descriptive study was conducted with 96 smokers who were hospitalized in a psychiatric ward in Brazil. Semi-structured interviews, test of nicotine dependence, and content thematic analysis were carried out. The results show that tobacco has an important role in the lives of psychiatric patients. The meanings they attribute to tobacco use are related to overcoming difficulties that are consequential of mental disorders and of side effects caused by their treatments.
"Using a culturally based hands-on educational approach, the Cook for Your Life program, or ¡Cocinar Para Su Salud! is geared toward Latina breast cancer survivors who are at higher risk of obesity, low physical activity, and poorer access to quality health care."
1Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany Department of Medical Humanities, Italian Hospital University, Buenos Aires, Argentina.
2Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany.
Even among advocates of legalising physician-assisted death, many argue that this should be done only once palliative care has become widely available. Meanwhile, according to them, physician-assisted death should be banned. Four arguments are often presented to support this claim, which we call the argument of lack of autonomy, the argument of existing alternatives, the argument of unfair inequalities and the argument of the antagonism between physician-assisted death and palliative care. We argue that although these arguments provide strong reasons to take appropriate measures to guarantee access to good quality palliative care to everyone who needs it, they do not justify a ban on physician-assisted death until we have achieved this goal.
1Ruth and Harry Roman Emergency Department, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA; Cedars-Sinai Center for Healthcare Ethics, Burns and Allen Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: firstname.lastname@example.org.
2Department of Emergency Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH.
3Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
4Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
5Center for Bioethics and Medical Humanities (Institute for Health and Society) Medical College of Wisconsin, Milwaukee, WI; Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
Ambulance diversion is a common and controversial method used by emergency departments (EDs) to reduce stress on individual departments and providers and relieve mismatches in the supply and demand for ED beds. Under this strategy, ambulances bound for one hospital are redirected to another, usually under policies established by regional emergency medical services systems. Other responses to this mismatch include maladaptive behaviors (such as "boarding" in "hallway beds") and the development of terminology intended to normalize these practices, all of which are reviewed in this article. We examine the history and causes of diversion as well as the ethical foundations and practical consequences of it. We contend that (1) from a moral viewpoint, the most important stakeholder is the individual patient because diversion decisions are usually relative rather than absolute; (2) decisions regarding ambulance diversion should be made with careful consideration of individual patient preferences, local and state emergency medical services laws, and institutional surge capacity; and (3) authorities should consider the potential positive effects of a regional or statewide ban on diversion.