Monday, November 30, 2015

Monday, November 23, 2015

Not the Onion: "Scharf even offered to rebrand the program as a 'mindful stretching' class to distance it from any controversy over cultural appropriation, but that idea was rejected because a suitable French translation of the phrase could not be reached."

U of O students' decision to cancel yoga class sparks Internet backlash

"Scharf even offered to rebrand the program as a 'mindful stretching' class to distance it from any controversy over cultural appropriation, but that idea was rejected because a suitable French translation of the phrase could not be reached."


"Determining which charities should receive donations is at the heart of effective altruism."

Better ways to help

"Determining which charities should receive donations is at the heart of effective altruism. Singer and MacAskill begin by noting the thoughtlessness with which most people give – motivated by sentimental media appeals, associations with personal experience (funding research on a disease that killed one’s child), local connections (the local museum or hospital or community chest), or salient current disasters (earthquakes, tsunamis), without any attempt to find out how much good a donation would do by comparison with other destinations for that amount of money. This is partly a matter of motivation: a great deal of charitable giving is just a form of self-expression or a mark of solidarity rather than an attempt to have an effect. Or if it aims to do good, it does not aim to do so impartially, by the utilitarian metric, but deliberately favours some types of good and some people over others. Still, there are plenty of donors who want to benefit the worst-off people in the world, but who still make no effort to determine on the basis of evidence how to do so most efficiently. Or they rely on irrelevant evidence, such as the percentage of the charity’s budget that is spent on fund-raising and administration. As MacAskill says, one would never decide to buy a computer based on the size of the manufacturer’s executive salaries or its advertising budget. What one wants to know is how much value one is getting for the price, compared with the alternatives, and that is what should determine charitable giving as well."

Sunday, November 22, 2015

To what do psychiatric diagnoses refer? A two-dimensional semantic analysis of diagnostic terms

 2015 Nov 12;55:1-10. doi: 10.1016/j.shpsc.2015.10.001. [Epub ahead of print]

To what do psychiatric diagnoses refer? A two-dimensional semantic analysis of diagnostic terms.

Author information

  • 1Department of Politics, Philosophy, and Religion, Lancaster University, Lancaster LA1 4YL, United Kingdom. Electronic address:


In somatic medicine, diagnostic terms often refer to the disease processes that are the causes of patients' symptoms. The language used in some clinical textbooks and health information resources suggests that this is also sometimes assumed to be the case with diagnoses in psychiatry. However, this seems to be in tension with the ways in which psychiatric diagnoses are defined in diagnostic manuals, according to which they refer solely to clusters of symptoms. This paper explores how theories of reference in the philosophy of language can help to resolve this tension. After the evaluation of descriptive and causal theories of reference, I put forward a conceptual framework based on two-dimensional semantics that allows the causal analysis of diagnostic terms in psychiatry, while taking seriously their descriptive definitions in diagnostic manuals. While the framework is presented as a solution to a problem regarding the semantics of psychiatric diagnoses, it can also accommodate the analysis of diagnostic terms in other medical disciplines.

Costs of lung cancer in the Netherlands

 2015 Oct 17. pii: S0169-5002(15)30084-2. doi: 10.1016/j.lungcan.2015.10.015. [Epub ahead of print]

Costs of non-small cell lung cancer in the Netherlands.

Author information

  • 1Institute for Medical Technology Assessment, Erasmus University Rotterdam, the Netherlands; CHERE (Centre for Health Economics Research and Evaluation), University of Technology Sydney, Australia. Electronic address:
  • 2Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
  • 3Pulmonology, VU University Medical Center, Amsterdam, the Netherlands and Thoracic Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
  • 4Pulmonology, University Medical Center Groningen, the Netherlands.
  • 5Pulmonology, Medical Center Alkmaar, the Netherlands.
  • 6Pulmonology, St. Antonius Hospital, Nieuwegein, the Netherlands.
  • 7Institute for Medical Technology Assessment, Erasmus University Rotterdam, the Netherlands.



Real-world resource use and cost data on non-small cell lung cancer (NSCLC) are scarce. This data is needed to inform health-economic modelling to assess the impact of new diagnostic and/or treatment technologies. This study provides detailed insight into real-world medical resource use and costs of stage I-IV NSCLC in the Netherlands.


A random sample of patients newly diagnosed with NSCLC (2009-2011) was selected from four Dutch hospitals. Data was retrospectively collected from patient charts. This data included patient characteristics, tumour characteristics, treatment details, adverse events, survival and resource use. Resource use was multiplied by Dutch unit costs expressed in EUR 2012. Total mean costs were corrected for censoring using the Bang and Tsiatis weighted complete-case estimator. Furthermore, costs of adverse events, costs per phase of NSCLC management and costs of second opinions are presented.


Data was collected on 1067 patients. Total mean costs for NSCLC diagnosis, treatment and follow-up are €28,468 during the study period and €33,143 when corrected for censoring. Adverse events were recorded in the patient charts for 369 patients (41%) and 82 patients (9%) experienced an adverse event of grade III or higher. For these patients, adverse event-related hospital admissions cost on average €2,091. Mean total costs are €1,725 for the diagnostic period, €17,296 for first treatment line, and €13,236 for each later treatment line. Costs of providing a second opinion are €2,580 per patient.


Total mean hospital costs per NSCLC patient are €33,143 for the total duration of the disease. Ignoring censoring in our data underestimates these costs by 14%. Main limitations of the study relate to the short follow-up time, staging difficulties and missing data. Its main strength is that it provides highly detailed, real-world data on the costs of NSCLC.

Moralising sleep medicines

 2015 Nov 20. doi: 10.1111/1467-9566.12383. [Epub ahead of print]

Prescriptions and proscriptions: moralising sleep medicines.

Author information

  • 1Centre for Criminology & Sociology, Royal Holloway, University of London.
  • 2Centre for Global Health Policy, University of Sussex.
  • 3Department of Sociology, University of Warwick.


The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a 'bad press' due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long-term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non-use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the 'deserving' patient, the 'responsible' user, the 'compliant' patient, the 'addict', the 'sinful' user and the 'noble' non user. These users and non-users are constructed drawing on cross-cutting themes of addiction and control, ambivalence and reflexivity. Such issues are in turn discussed in relation to recent sociological debates on the pharmaceuticalisation/de-pharmaceuticalisation of everyday life and the consumption of medicines in the UK today.

Known since Wilbur

Signs of Intelligent Life

Pigs possess complex ethological traits similar to dogs and chimpanzees.

"Pigs’ ability to differentiate each other, part of what is termed social cognition, provides evidence that pigs are as socially complex as other intelligent mammals, including primates. This capacity forms the basis for all pig social relationships, including the establishment of dominance hierarchies. Dogs can discriminate between barks recorded in different contexts from the same individual, and also from different individuals in the same context. Elephants are well known for their sophisticated recognition of other individual elephants even over long distances. Pigs have the ability to discriminate between individuals, even closely-related individuals, by smell and by auditory cues, a finding that suggests pigs vocalize in ways unique to each individual. In one study, sows listening to the calls of piglets responded more strongly to the vocalizations of their own offspring than to unfamiliar piglets, suggesting pigs can tell each other apart by vocal cues alone." 

“You remember when a million dollars was a lot of money?” The Ski Lift Operator just stares at me, perplexed. “It isn’t?”

Not Ideas About the Thing But the Thing Itself: A Visit to the 2015 Aspen Ideas Festival by Ian MacAllister-McDonald

You must have seen a lot of changes, then,” I say, gesturing down to the town.
The Ski Lift Operator suddenly gets quiet, as though remembering something unpleasant and looks away. “Yeah, I guess I have,” he says. The sun passes behind some clouds and the sky darkens. “Millionaires moved in and now there’s no room for the working man.”
“Tell me about it,” I say, trying to sound sympathetic. “You remember when a million dollars was a lot of money?”
The Ski Lift Operator just stares at me, perplexed. “It isn’t?”

Pizza: the new biceps

Men Overeat In Order To Impress Women

Lynette Rhodes | 

"There's now a scientific explanation why men eat more in front of women-and it may not be why you think. They recorded the number of pizza slices and how many bowls of salad each diner ate. A conclusion, that sounds nearly comical.

Of all of the ways men try to impress the ladies, from big wallets to big muscles, here is one that has finally been quantified by science. In other words, men eat mass amounts to show that they "possess extraordinary skills, advantages, and/or surplus energy in degrees that are superior to other men", the study's authors wrote. A universal truth, indeed."

Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons-Pro and Con Arguments

 2015 Nov 20. [Epub ahead of print]

Expected and Unexpected Consequences of the Affordable Care Act: The Impact on Patients and Surgeons-Pro and Con Arguments.

Author information

  • 1Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
  • 2Department of Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
  • 3Department of Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA.
  • 4Department of Surgery, St. Vincent's Medical Center, Bridgeport, CT, USA.
  • 5Advocate Health Care, Downers Grove, IL, USA.
  • 6Institute for Hepatobiliary and Pancreatic Surgery Beth Israel Deaconess Medical Center and Dana Farber Harvard Cancer Center, Harvard Medical School, Boston, MA, USA.
  • 7Department of Surgery, Mayo Clinic, Rochester, MN, USA.
  • 8Division of Subspecialty General Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55902, USA.


The Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) or "ObamaCare" for short, was enacted in 2010. The Public Policy and Advocacy Committee of the Society for Surgery of the Alimentary Tract (SSAT) hosted a debate with an expert panel to discuss the ACA and its impact on surgical care after the first year of patient enrollment. The purpose of this debate was to focus on the impact of ACA on the public and surgeons. At the core of the ACA are insurance industry reforms and expanded coverage, with a goal of improved clinical outcomes and reduced costs of care. We have observed supportive and opposing views on ACA. Nonetheless, we will witness major shifts in health care delivery as well as restructuring of our relationship with payers, institutions, and patients. With the rapidly changing health care landscape, surgeons will become key members of health systems and will likely need to lead transition from solo-practice to integrated care systems. The full effects of the ACA remain unrealized, but its implementation has begun to change the map of the American health care system and will surely impact the practice of surgery. Herein, we provide a synopsis of the "pro" and "con" arguments for the expected and unexpected consequences of the ACA on society and surgeons.

Saturday, November 21, 2015

"Like sugar, there can be a demand to tax salt."

Clamour for sugar tax to combat diabetes, obesity growing; industry unfazed 

Abinash Verma,director general, Indian Sugar Mills Association, the representative of the private sugar mills in the country also does not think that a sugar tax can work. "First of all, I question the basis of imposing a sugar tax. It is not sugar but fat and non-exercise that are responsible for obesity. Few countries tried imposing sugar tax. But it did not work there. Like sugar, there can be a demand to tax salt." 

The First Step in Health Reform for Those With Serious Mental Illness: Integrating the Dis-Integrated Mental Health System

 2015 Nov 19. [Epub ahead of print]

The First Step in Health Reform for Those With Serious Mental Illness: Integrating the Dis-Integrated Mental Health System.

Author information

  • 1Worcester Recovery Center and Hospital, Department of Psychiatry, University of Massachusetts Medical School, Worcester.


Increasing attention is being directed toward meeting the psychiatric and medical needs of persons with persistent or recurrent mental illness through the integration of behavioral and medical healthcare. There are many models being considered or tested to achieve this objective. These models, however, generally ignore the challenge of integrating systems that are themselves dis-integrated. Also ignored is the fact that many persons with persistent or recurrent mental illness operate in the context of an array of entitlements; receive "services" from the criminal justice, as well as the health and behavioral health systems; and all these systems are both siloed and fail to meet the needs of this population. This article examines the current state of the cornucopia of services available to individuals with persistent or recurrent mental illness inclusive of federal statutes and policies to impact these services. Recommendations are made to move the dis-integrated system of mental health services toward an internally integrated system that would have the capacity to become integrated with a medical system of care and treatment to achieve a behavioral-medical integrated health delivery system.

Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries

 2015 Nov 20;10(11):e0141157. doi: 10.1371/journal.pone.0141157.

Implementation of Departmental Quality Strategies Is Positively Associated with Clinical Practice: Results of a Multicenter Study in 73 Hospitals in 7 European Countries.

Author information

  • 1Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain.
  • 2Red de investigación en servicios de salud en enfermedades crónicas REDISSEC, Barcelona, Spain.
  • 3NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
  • 4Department of Public and Occupational Health,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
  • 5Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America.
  • 6Danish Clinical Registries, Aarhus, Denmark.
  • 7Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
  • 8Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany.
  • 9Center for Health Services Research Cologne, University of Cologne, Cologne, Germany.
  • 10Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
  • 11Palo Alto Medical Foundation Research Institute (PAMFRI), Palo Alto, California, United States of America.
  • 12Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
  • 13Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.



Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness.


To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems.


Multicenter, multilevel cross-sectional study.


Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries.




Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding.


Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities.


There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality standards for hospital departments, which appear to be more effective than generic hospital-wide quality systems.

microRNAs: An Emerging Paradigm in Lung Cancer Chemoresistance

 2015 Nov 4;2:77.

microRNAs: An Emerging Paradigm in Lung Cancer Chemoresistance.

Author information

  • 1Transcriptional Networks in Lung Cancer Group, Cancer Research UK Manchester Institute, University of Manchester , Manchester , UK.


Lung cancer is considered the most deadly of all cancers, with limited therapeutic options. Although advanced drugs have been tried in clinic, the therapeutic success has largely been hampered due to rapid development of drug-resistance mechanisms. Recently, microRNAs (miRNAs), a class of small non-coding RNAs, have occupied center stage in cancer biology. miRNAs negatively regulate gene expression either by promoting degradation or by interfering with translation of messenger RNA targets. Several lines of evidence have confirmed the crucial role of miRNAs in carcinogenesis, and, importantly, in the acquisition of resistance to chemotherapeutics. Modulation of miRNA expression levels has been proven to increase the efficacy of genotoxic drugs in various preclinical cancer studies. Therefore, comprehensive understanding of the role(s) of these key players in drug resistance may provide novel opportunities to design effective combinatorial therapeutic strategies forcancer treatment. In this review, we highlight recent findings on miRNAs acting as oncomiRs and tumor suppressor genes in lung cancer. Moreover, we discuss the involvement of miRNAs in different mechanisms of drug resistance in this deadly disease.

"It is an unfeasibly expensive First World luxury to pretend that the entire baroque panoply of European Human Rights can be completely unaffected by this change."

The real clash of civilisation is in the West’s attitude to terror

A great deal was revealed by the different reactions to Paris of our PM and the US Secretary of State

"For the past 200 years and more, our country has not (with the exception of IRA supporters) contained significant numbers of people dedicated to preaching hatred of its way of life and violence against its people. Today, it does, and so does almost every country in the Western world. It is an unfeasibly expensive First World luxury to pretend that the entire baroque panoply of European Human Rights can be completely unaffected by this change."

Geoffrey Stone: Woodrow Wilson, Princeton University, and the Battles We Choose to Fight

"The revolutions of our own time offer neither national liberation nor national renewal."

Michael Walzer, Revolutionologist

The political theorist’s new book on national liberation can’t answer one key question: Why have those words become obsolete?

Acute Abdomen in the Emergency Department: Is CT a Time-Limiting Factor?

 2015 Dec;205(6):1222-1229.

Acute Abdomen in the Emergency Department: Is CT a Time-Limiting Factor?

Author information

  • 11 Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
  • 22 Department of Medical Imaging, University Hospital of Wales, Cardiff, United Kingdom.
  • 33 Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada.
  • 44 Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON Canada.
  • 55 Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada.



The purpose of this study was to quantify and integrate key emergency department (ED) and radiology department workflow time intervals within the ED length of stay (LOS) for patients presenting with acute abdomen who require CT.


An 11-month retrospective review was performed of all patients presenting to the ED with an acute abdomen who required abdominal CT. Nine key time points associated with ED LOS and CT workflow were collected: triage, physician assessment, CT request, porter schedule, CT start, CT complete, provision of first CT report, ED disposition decision, and physical discharge. The median and 90th percentile times for each interval were reported.


Ninety-six percent (2194/2292) of ED encounters during the study period met the inclusion criteria. The median ED LOS was 9.22 hours (90th percentile, 15.7 hours). Intervals associated with CT workflow accounted for 29% of the total LOS. Radiology turnaround time accounted for 32% of the entire CT workflow interval. Timeline analysis found three unique patterns of ED disposition: disposition after initial imaging report, disposition before report, and disposition before CT.


To our knowledge, this study is the first to quantify the contribution of CT-related workflow time intervals within the context of ED LOS. We have shown that patients do not have identical ED transit pathways, and this may under- or overestimate time interval calculations. These results show the importance of site-specific ED LOS timeline analysis to identify potential targets for quality improvement and serve as baseline targets for measuring future quality improvement initiatives.

Weekend Sleep Recovery May Not Reverse All The Effects Of Sleep Lost During The Workweek

Weekend Sleep Recovery May Not Reverse All The Effects Of Sleep Lost During The Workweek

"In simple words, waking early on workdays and sleeping in on the weekend could be detrimental to one’s health, as suggested by the latest findings."

Friday, November 20, 2015

"What can be done to realign economic and bureaucratic incentives to help reduce costs and overmedicalization?"

It's Time to End the Incentives to 'Overmedicalize'

By Stuart Butler

"What can be done to realign economic and bureaucratic incentives to help reduce costs and overmedicalization? It's not easy but some strategies are promising.
One approach is counter-incentives to induce more sensible patterns of behavior. An example of this is the hospital "readmission penalty," included in the Affordable Care Act,which works like this: For certain medical conditions, such as heart attacks or pneumonia, if a hospital discharges a Medicare patient and that patient is readmitted to any hospital within 30 days, then the discharging hospital is essentially fined by Medicare. That makes hospitals focus on what happens outside their walls, not just within them. Indeed, the penalty is beginning to push many hospitals to explore ways they can help improve the recovery of discharged patients by working with housing and social services, and increasingly with community-based organizations so that there is patient follow up."

Depression, Anxiety, and Severity of Obesity in Adolescents: Is Emotional Eating the Link?

 2015 Nov 18. pii: 0009922815615825. [Epub ahead of print]

Depression, Anxiety, and Severity of Obesity in Adolescents: Is Emotional Eating the Link?

Author information

  • 1University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA
  • 2University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA.
  • 3University of Minnesota, School of Public Health, Minneapolis, MN, USA.
  • 4University of Minnesota, Department of Pediatrics, Minneapolis, MN, USA University of Minnesota, Department of Medicine, Minneapolis, MN USA.


The purposes of this study were to characterize the impact of depression and anxiety on the severity of obesity among youth seeking weight management treatment and to determine the extent to which emotional eating mediates the relationship between depression and/or anxiety and degree of obesity. This cross-sectional, retrospective chart review of 102 adolescent patients from a weight management clinic analyzed demographics, body mass index, depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder Scale-7) screens and the Child Eating Behavior Questionnaire, Emotional Over-Eating subscale. After adjusting for demographics and emotional eating, the odds of having severe obesity versus obesity were 3.5 times higher for patients with depression compared with those without (odds ratio [OR] = 3.5; 95% CI = 1.1, 11.3; P = .038) and nearly 5 times higher for those with anxiety (OR = 4.9; CI = 1.2, 20.9; P = .030). Emotional eating, however, was not a mediator between depression/anxiety and degree of adiposity.