From Harvard U: Increasing socioeconomic disparities in adolescent obesity

Proc Natl Acad Sci U S A. 2014 Jan 28;111(4):1338-42. doi: 10.1073/pnas.1321355110. Epub 2014 Jan 13.

Increasing socioeconomic disparities in adolescent obesity.

Frederick CB, Snellman K, Putnam RD.

Author information

• Harvard Kennedy School, Harvard University, Cambridge, MA 02138.

Abstract

Recent reports suggest that the rapid growth in youth obesity seen in the 1980s and 1990s has plateaued. We examine changes in obesity among US adolescents aged 12-17 y by socioeconomic background using data from two nationally representative health surveys, the 1988-2010 National Health and Nutrition Examination Surveys and the 2003-2011 National Survey of Children's Health. Although the overall obesity prevalence stabilized, this trend masks a growing socioeconomic gradient: The prevalence of obesity among high-socioeconomic status adolescents has decreased in recent years, whereas the prevalence of obesity among their low-socioeconomic status peers has continued to increase. Additional analyses suggest that socioeconomic differences in the levels of physical activity, as well as differences in calorie intake, may have contributed to the growing obesitygradient.

PLoS One. 2014 Jan 16;9(1):e85531. doi: 10.1371/journal.pone.0085531. eCollection 2014.

Recidivism and rehabilitation of criminal offenders: a carrot and stick evolutionary game.

Berenji B1, Chou T1, D'Orsogna MR2.

Author information

• 1Department of Biomathematics, University of California Los Angeles, Los Angeles, California, United States of America.
• 2Department of Biomathematics, University of California Los Angeles, Los Angeles, California, United States of America ; Department of Mathematics, California State University at Northridge, Los Angeles, California, United States of America.

Abstract

Motivated by recent efforts by the criminal justice system to treat and rehabilitate nonviolent offenders rather than focusing solely on their punishment, we introduce an evolutionary game theoretic model to study the effects of "carrot and stick" intervention programs on criminal recidivism. We use stochastic simulations to study the evolution of a population where individuals may commit crimes depending on their past history, surrounding environment and, in the case of recidivists, on any counseling, educational or training programs available to them after being punished for their previous crimes. These sociological factors are embodied by effective parameters that determine the decision making probabilities. Players may decide to permanently reform or continue engaging in criminal activity, eventually reaching a state where they are considered incorrigible. Depending on parameter choices, the outcome of the game is a society with a majority of virtuous, rehabilitated citizens or incorrigibles. Since total resources may be limited, we constrain the combined punishment and rehabilitation costs per crime to be fixed, so that increasing one effort will necessarily decrease the other. We find that the most successful strategy in reducing crime is to optimally allocate resources so that after being punished, criminals experience impactful intervention programs, especially during the first stages of their return to society. Excessively harsh or lenient punishments are less effective. We also develop a system of coupled ordinary differential equations with memory effects to give a qualitative description of our simulated societal dynamics. We discuss our findings and sociological implications.

PLoS One. 2014 Jan 27;9(1):e86536. doi: 10.1371/journal.pone.0086536. eCollection 2014.

Dual Targeting of MEK and PI3K Pathways Attenuates Established and Progressive Pulmonary Fibrosis.

Madala SK1, Edukulla R1, Phatak M2, Schmidt S1, Davidson C1, Acciani TH3, Korfhagen TR3, Medvedovic M2, Lecras TD3, Wagner K1, Hardie WD1.

Author information

• 1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America.
• 2Laboratory for Statistical Genomics and Systems Biology, University of Cincinnati, Cincinnati, Ohio, United States of America.
• 3Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America.

Abstract

Pulmonary fibrosis is often triggered by an epithelial injury resulting in the formation of fibrotic lesions in the lung, which progress to impair gas exchange and ultimately cause death. Recent clinical trials using drugs that target either inflammation or a specific molecule have failed, suggesting that multiple pathways and cellular processes need to be attenuated for effective reversal of established and progressive fibrosis. Although activation of MAPK and PI3K pathways have been detected in human fibrotic lung samples, the therapeutic benefits of in vivo modulation of the MAPK and PI3K pathways in combination are unknown. Overexpression of TGFα in the lung epithelium of transgenic mice results in the formation of fibrotic lesions similar to those found in human pulmonary fibrosis, and previous work from our group shows that inhibitors of either the MAPK or PI3K pathway can alter the progression of fibrosis. In this study, we sought to determine whether simultaneous inhibition of the MAPK and PI3K signaling pathways is a more effective therapeutic strategy for established and progressive pulmonary fibrosis. Our results showed that inhibiting both pathways had additive effects compared to inhibiting either pathway alone in reducing fibrotic burden, including reducing lung weight, pleural thickness, and total collagen in the lungs of TGFα mice. This study demonstrates that inhibiting MEK and PI3K in combination abolishes proliferative changes associated with fibrosis and myfibroblast accumulation and thus may serve as a therapeutic option in the treatment of human fibrotic lung disease where these pathways play a role.

Sao Paulo Med J. 2014;132(1):41-7. doi: 10.1590/1516-3180.2014.1321525.

Continuous positive airway pressure (CPAP) after lung resection: a randomized clinical trial.

Roceto Ldos S1, Galhardo FD2, Saad IA3, Toro IF4.

Author information

• 1Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil.
• 2Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil, BSc. Physiotherapist (PT), Intensive Care Unit of Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
• 3Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil, PhD. Physiotherapist (PT), Pulmonary Rehabilitation Department of Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.
• 4Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas, CampinasSão Paulo, Brazil, MD, PhD. Head and Professor of Thoracic Surgery Department of Clinical Hospital, School of Medical Sciences, Universidade Estadual de Campinas (Unicamp), Campinas, São Paulo, Brazil.

Abstract

CONTEXT AND OBJECTIVE:

Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection.

DESIGN AND SETTING:

Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas.

METHOD:

Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated.

RESULTS:

There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score.

CONCLUSION:

CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains.

CPRIT: “How do we measure success?”

Texas’ cancer-fighting agency asks: “How do we measure success?”

By James Drew
jdrew@dallasnews.com
5:38 pm on January 26, 2014

      

   

"Kripke’s predecessor, Dr. Alfred Gilman, referred to this debate in an email to a colleague on the day he announced his resignation in May, 2012, referring to some members of the Oversight Committee as the “we should spend much more money on commercialization people.” He did not name them.

That oversight committee is gone, swept away by the CPRIT reform bill that the legislature approved last year.

In December, a Travis County grand jury indicted CPRIT’s former chief commercialization officer, Jerald “Jerry” Cobbs on a felony charge. He is accused of deceiving two of his bosses by failing to disclose that a 2010 grant proposal from a Dallas biotechnology company was not reviewed and approved by the proper committees." 

Zombie allusions: They just keep on coming-surfacing in the Northeast

'Zombie' Bees Surface in the Northeast

"They fly around in a disoriented way, get attracted to light, and then fall down and wander around in a way that's sort of reminiscent of zombies in the movies," Hafernik said. "Sometimes we've taken to calling [it], when they leave their hives, 'the flight of the living dead.'"

"Nearly half of kids who started kindergarten overweight became obese teens."

Study: Kids' obesity risk starts before school age

By The Associated Press

 

January 30, 2014

Nearly half of kids who started kindergarten overweight became obese teens. Overweight 5-year-olds were four times as likely as normal-weight children to become obese (32 percent versus 8 percent).




Read more: http://www.wjla.com/articles/2014/01/study-kids-obesity-risk-starts-before-school-age-99740.html#ixzz2rt5cJYzV
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Severely obese spend nearly twice as much on health care than healthy weight individuals

Report: Severely obese spend nearly twice as much on health care than healthy weight individuals

By Melissa Anders | manders@mlive.com 

Severely obese people were 1.25 to three times more likely to have a serious chronic condition and 50 percent more likely to have three or more comorbid conditions than those who were moderately obese. The differences were larger when compared to overweight and healthy weight individuals.

"They followed the stars and waited patiently for all their efforts to be destroyed."

Apocalypse Now

Is America really a land of creation? Or is this just the place we all came to wait for the end? Why the apocalypse is in America's DNA.

By Stefany Anne Golberg

"We are taught that America began as a home for exiles — but what does that really mean? The words “home” and “exile” are as seemingly opposed as two words could be. For Johannes Kelpius, those coming to America to make it into their home were missing the point. Kelpius saw America as temporary and transitory, a mere pit stop between the world and a more eternal Home.

Kelpius’ Apocalyptic approach to life does not seem conducive to building monuments or governments or making sure credit card debts are paid. And yet, it is interesting to note that the first mission of Kelpius and his monks when they came to Philadelphia was to build an Hermitage of stone. Though they intended to live there in solitude, the monks — respected scholars in Europe with training in medicine, science and music — found their lives immediately entangled with the small community of settlers around them. In the great hall of the Hermitage, they held public nondenominational religious services twice a day. The monks built a schoolhouse for the children of settlers and were consulted for medicinal cures. They offered all of their services for free and refused to trade for profit. In the evenings, the Monks of the Wissahickon would meditate and look through the telescope they had erected on the roof of the Hermitage. They followed the stars and waited patiently for all their efforts to be destroyed."

Eat Weight Disord. 2014 Jan 29. [Epub ahead of print]

Anorexia nervosa and its relation to depression, anxiety, alexithymia and emotional processing deficits.

Lulé D, Schulze UM, Bauer K, Schöll F, Müller S, Fladung AK, Uttner I.

Author information

• Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.

Abstract

PURPOSE:

Psychopathological changes and dysfunction in emotion processing have been described for anorexia nervosa (AN). Yet, findings are applicable to adult patients only. Furthermore, potential for discriminative power in clinical practice in relation to clinical parameters has to be discussed. The aim of this study was to investigate psychopathology and emotional face processing in adolescent female patients with AN.

METHODS:

In a sample of 15 adolescent female patients with AN (16.2 years, SD ± 1.26) and 15 age and sex matched controls we assessed alexithymia, depression, anxiety and empathy in addition to emotion labelling and social information processing.

RESULTS:

AN patients had significantly higher alexithymia, higher levels of depression, and state and trait anxiety compared to controls. There was a trend for a lower ability to recognize disgust. Happiness as a positive emotion was recognized better. All facial expressions were recognized significantly faster by AN patients. Associations of pathological eating behaviour and trait anxiety were seen.

CONCLUSION:

In accordance with the stress reduction hypothesis, typical psychopathology of alexithymia, anxiety and depression is prevalent in female adolescent AN patients. It is present detached from physical stability. Pathogenesis of AN is multifactorial and already fully present in adolescence. An additional reinforcement process can be discussed. For clinical practice, those parameters might have a better potential for early prognostic factors related to AN than physical parameters and possible implication for intervention is given.

Am J Bioeth. 2013;13(12):31-3. doi: 10.1080/15265161.2013.849308.

The weird divergence of ethics and regulation with regard to informed consent.

Lantos JD.

Author information

• Children's Mercy Hospital, University of Missouri-Kansas City.

"Nurses can promote exercise in patients to reduce social isolation, increase independence and improve quality of life."

Nurs Older People. 2014 Feb 1;26(1):20-6. doi: 10.7748/nop2014.02.26.1.20.e508.

Effects of a 12-week community exercise programme on older people.

Wallace R, Lees C, Minou M, Singleton D, Stratton G.

Author information

• Liverpool Community Health NHS Trust.

Abstract

Aim 

To measure the effectiveness of a 12-week exercise intervention in reducing the health risks associated with physical decline in people aged 60 and older. 

Method 

An intervention group took part in a 12-week exercise programme. The intervention and comparison groups undertook the Senior Fitness Test at baseline, 12 weeks, six months and 12 months. Focus groups were conducted with the intervention and comparison groups at 12 weeks, then again with the intervention group after 12 months. 

Results 

Fitness increased significantly (P>0.001) after 12 weeks of exercise in the intervention group. Results demonstrated significant difference between intervention and comparison groups' fitness at six months (P>0.01) and 12 months (P>0.001) respectively. Focus groups supported the results, suggesting exercise increased independence and quality of life. 

Conclusion 

Nurses can promote exercise in patients to reduce social isolation, increase independence and improve quality of life. The findings from this study may be useful during the development of community services for older adults.

There's no "I" in "team." But there is an amygdala

PLoS One. 2014 Jan 27;9(1):e87277. doi: 10.1371/journal.pone.0087277. eCollection 2014.

Relationship between Personality Traits and Brain Reward Responses when Playing on a Team.

Morawetz C1, Kirilina E2, Baudewig J3, Heekeren HR1.

Author information

• 1Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
• 2Dahlem Institute for Neuroimaging of Emotion, Freie Universität Berlin, Berlin, Germany.
• 3Biomedical Imaging, Department of Radiology, Christian-Albrecht University Kiel, Kiel, Germany.

Abstract

Cooperation is an integral part of human social life and we often build teams to achieve certain goals. However, very little is currently understood about emotions with regard to cooperation. Here, we investigated the impact of social context (playing alone versus playing on a team) on emotions while winning or losing a game. We hypothesized that activity in the reward network is modulated by the social context and that personality characteristics might impact team play. We conducted an event-related functional magnetic resonance imaging experiment that involved a simple game of dice. In the team condition, the participant played with a partner against another two-person team. In the single-player condition, the participant played alone against another player. Our results revealed that reward processing in the right amygdala was modulated by the social context. The main effect of outcome (gains versus losses) was associated with increased responses in the reward network. We also found that differences in the reward-related neural response due to social context were associated with specific personality traits. When playing on a team, increased activity in the amygdala during winning was a unique function of openness, while decreased activity in the ventromedial prefrontal cortex and ventral striatum during losing was associated with extraversion and conscientiousness, respectively. In conclusion, we provide evidence that working on a team influences the affective value of a negative outcome by attenuating the negative response associated with it in the amygdala. Our results also show that brain reward responses in a social context are affected by personality traits related to teamwork.

Proc Natl Acad Sci U S A. 2014 Jan 28;111(4):1265-70. doi: 10.1073/pnas.1321926111. Epub 2014 Jan 13.

Living liquid crystals.

Zhou S, Sokolov A, Lavrentovich OD, Aranson IS.

Author information

• Liquid Crystal Institute and Chemical Physics Interdisciplinary Program, Kent State University, Kent, OH 44242.

Abstract

Collective motion of self-propelled organisms or synthetic particles, often termed "active fluid," has attracted enormous attention in the broad scientific community because of its fundamentally nonequilibrium nature. Energy input and interactions among the moving units and the medium lead to complex dynamics. Here, we introduce a class of active matter--living liquid crystals (LLCs)--that combines living swimming bacteria with a lyotropic liquid crystal. The physical properties of LLCs can be controlled by the amount of oxygen available to bacteria, by concentration of ingredients, or by temperature. Our studies reveal a wealth of intriguing dynamic phenomena, caused by the coupling between the activity-triggered flow and long-range orientational order of the medium. Among these are (i) nonlinear trajectories of bacterial motion guided by nonuniform director, (ii) local melting of the liquid crystal caused by the bacteria-produced shear flows, (iii) activity-triggered transition from a nonflowing uniform state into a flowing one-dimensional periodic pattern and its evolution into a turbulent array of topological defects, and (iv) birefringence-enabled visualization of microflow generated by the nanometers-thick bacterial flagella. Unlike their isotropic counterpart, the LLCs show collective dynamic effects at very low volume fraction of bacteria, on the order of 0.2%. Our work suggests an unorthodox design concept to control and manipulate the dynamic behavior of soft active matter and opens the door for potential biosensing and biomedical applications.

Bioethics. 2014 Jan 29. doi: 10.1111/bioe.12079. [Epub ahead of print]

Bisphenol A and Risk Management Ethics.

Resnik DB, Elliott KC.

Abstract

It is widely recognized that endocrine disrupting compounds, such as Bisphenol A, pose challenges for traditional paradigms in toxicology, insofar as these substances appear to have a wider range of low-dose effects than previously recognized. These compounds also pose challenges for ethics and policymaking. When a chemical does not have significant low-dose effects, regulators can allow it to be introduced into commerce or the environment, provided that procedures and rules are in place to keep exposures below an acceptable level. This option allows society to maximize the benefits from the use of the chemical while minimizing risks to human health or the environment, and it represents a compromise between competing values. When it is not possible to establish acceptable exposure levels for chemicals that pose significant health or environmental risks, the most reasonable options for risk management may be to enact either partial or complete bans on their use. These options create greater moral conflict than other risk management strategies, leaving policymakers difficult choices between competing values.

J R Army Med Corps. 2014 Jan 24. doi: 10.1136/jramc-2013-000216. [Epub ahead of print]

Primary blast lung injury at a NATO Role 3 hospital.

Aboudara M, Mahoney PF, Hicks B, Cuadrado D.

Author information

• Department of Medicine, Pulmonary and Critical Care, Tripler Army Medical Center, Honolulu, Hawaii, USA.

Abstract

BACKGROUND:

Primary blast lung injury (PBLI) is defined as lung contusion from barotrauma following an explosive mechanism of injury (MOI). Military data have focused on PBLI characteristics following evacuation from the combat theatre; less is known about its immediate management and epidemiology in the deployed setting. We conducted a quality improvement project to describe the prevalence, clinical characteristics, management strategies and evacuation techniques for PBLI patients prior to evacuation.

METHODS:

Patients admitted to a Role 3 hospital in southwest, Afghanistan, from January 2008 to March 2013 with a blast MOI were identified through the Department of Defense Trauma Registry; International Classification of Diseases 9 codes and patient record review were used to identify the PBLI cohort from radiology reports. Descriptive statistics and Fishers exact test were used to report findings.

RESULTS:

Prevalence of PBLI among blast injured patients with radiology reports was 11.2% (73/648). The population exhibited high Injury Severity Scores median 25 (IQR 14-34) and most received a massive blood transfusion (mean 33.4±38.3 total blood products/24 h). The mean positive end expiratory pressure (PEEP) requirement was 6.2±3.7 (range 5-15) cm H₂O and PaO₂ to FiO₂ ratio was 297±175.2 (66-796) mm Hg. However, 16.6% of patients had a PaO₂ to FiO₂ ratio <200, 13.3% required PEEP ≥10 cm H₂O and one patient required specialised evacuation for respiratory failure. A dismounted MOI (72.8%) and evacuation from point of injury by the Medical Emergency Response Team (62.3%) appeared to be associated with worse lung injury. Only eight of the 73 PBLI patients died and of the five with retrievable records, none died from respiratory failure.

CONCLUSIONS:

PBLI has a low prevalence and conventional lung protective ventilator management is generally appropriate immediately after injury; application of advanced modes of ventilation and specialised evacuation assistance may be required. PBLI may be a marker of underlying injury severity since all deaths were not due to respiratory failure. Further work is needed to determine exact MOI in mounted and dismounted casualties.

From Ohio State U: Yoga's Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors

J Clin Oncol. 2014 Jan 27. [Epub ahead of print]

Yoga's Impact on Inflammation, Mood, and Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial.

Kiecolt-Glaser JK, Bennett JM, Andridge R, Peng J, Shapiro CL, Malarkey WB, Emery CF, Layman R, Mrozek EE, Glaser R.

Author information

• The Ohio State University, Columbus, OH.

Abstract

PURPOSE:

To evaluate yoga's impact on inflammation, mood, and fatigue.

PATIENTS AND METHODS:

A randomized controlled 3-month trial was conducted with two post-treatment assessments of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control. The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin-1β (IL-1β), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale.

RESULTS:

Immediately post-treatment, fatigue was not lower (P > .05) but vitality was higher (P = .01) in the yoga group compared with the control group. At 3 months post-treatment, fatigue was lower in the yoga group (P = .002), vitality was higher (P = .01), and IL-6 (P = .027), TNF-α (P = .027), and IL-1β (P = .037) were lower for yoga participants compared with the control group. Groups did not differ on depression at either time (P > .2). Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits (P = .019; P < .001), as well as vitality (P = .016; P = .0045), but not depression (P > .05) than simple group assignment; more frequent practice produced larger changes. At 3 months post-treatment, increasing yoga practice also led to a decrease in IL-6 (P = .01) and IL-1β (P = .03) production but not in TNF-α production (P > .05).

CONCLUSION:

Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.

Was the Bard a science-fiction writer 200 years before Mary Shelley?

William Shakespeare, the 'king of infinite space’

Was the Bard a science-fiction writer 200 years before Mary Shelley? 

By Dan Falk

8:26PM GMT 27 Jan 2014

Shakespeare could have seen evidence of the “new astronomy” with his own eyes. In November of 1572, a bright new star appeared in the constellation of Cassiopeia. (We now know it was a supernova, the explosive death of a massive star.) Shakespeare was only eight at the time – but we know Digges made observations of it, as did astronomer Tycho Brahe in Denmark. Today we call it “Tycho’s star”.

Donald Olson of Texas State University has argued that the star observed by Prince Hamlet shining “westward from the pole” was inspired by Shakespeare’s boyhood memory of Tycho’s star – reinforced, perhaps, by a reference to it in Holinshed’s Chronicles 15 years later. (At the very least, Shakespeare would have seen the next supernova, “Kepler’s star”, in 1604.) One might note that Brahe observed the stars from the Danish island of Hven, a stone’s throw from the castle of Elsinore, Shakespeare’s setting for Hamlet.

 

 

Arthritis Care Res (Hoboken). 2014 Jan 27. doi: 10.1002/acr.22289. [Epub ahead of print]

Rheumatoid arthritis - A case for Personalised Health Care?

Karsdal MA, Bay-Jensen AC, Henriksen K, Christiansen C, Genant HK, Chamberlain C, Platt A.

Author information

• Nordic Bioscience, Herlev Hovedgade, DK-2730, Herlev, Denmark.

Abstract

Ethical, clinical and economic considerations highlight the pressing need to advance the identification of optimal treatments for each individual patient. PHC may provide significant benefit in the treatment of a number of clinical indications, characterised by costly therapy, low response rates and significant problems associated with trial and error prescription, including the risk of serious side effects. As an example we will focus on the promise of PHC for the field of rheumatology, in particular in the use of diagnostic practice in guiding the treatment of rheumatoid arthritis (RA). While RA may seem a disease optimally suited for PHC, some stakeholders question the need, possibilities and benefits of such practice. In this review we offer a deconstruction of the application of novel predictive diagnostics on the practice of medicine in RA. We will outline the opportunities, the current success, and lack of the same, across the RA field and attempt to outline emerging opportunities that benefit patients, physicians, healthcare payers and the pharmaceutical industry in assuring the right patients are treated with the right drug.

Am J Orthop (Belle Mead NJ). 2013 Dec;42(12):E109-10.

Will the new milestone requirements improve residency training?

Tosti R.

Author information

• Temple University, Department of Orthopaedic Surgery and Sports Medicine.

Abstract

Education in orthopedic surgery is evolving. Recently, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Orthopaedic Surgery (ABOS) have implemented a set of clinical "milestones" by which training programs will use as progressive benchmarks to evaluate each resident's acquisition of medical knowledge and patient care skills. The milestones are a step toward standardizing resident education based on a progression model, which is already being used by European and Asian countries. The evaluations are disease-specific and graded from Level I (incoming resident) to Level V (career specialist). Contrary to many residents' first impressions, the milestone levels do not correspond to post-graduate year; the recommended target for graduates is actually Level IV. Although these milestones are not intended to supersede the program's decision to graduate an individual, program directors are now encouraged to complete these evaluations, with co-faculty, at the semi-annual review in order to identify possible weaknesses in either the resident or in the institution's teaching methods. Several pros and cons have been identified with the current paradigm shift in orthopedic education, and the following article will discuss those controversies from one resident's perspective.

"One-year mortality in patients with hip fractures was 17.9%."

Hippokratia. 2013 Jul;17(3):252-7.

Surgical treatment of hip fractures: factors influencing mortality.

Dailiana Z, Papakostidou I, Varitimidis S, Michalitsis S, Veloni A, Malizos K.

Author information

• Department of Orthopaedic Surgery, Faculty of Medicine, University of Thessalia, Larissa, Greece.

Abstract

Background: Data for osteoporotic hip fractures in Greece is limited and little is known upon the meaning of family support during the postoperative/rehabilitation period.

Objective: To identify the factors influencing the mortality after hip fractures in the elderly, the effect of rehabilitation and family support in the post-fracture course, and the impact of these fractures on the family of the injured elderly.

Methods: We conducted an observational study of 218 consecutive patients older than 60 years of age, who underwent surgical management of a unilateral hip fracture at a tertiary hospital of Central Greece, with follow-up contacts at 30 days, 3 months and one year. Demographic characteristics, pre- and post-fracture residential and functional status, assessment of basic activities of daily living (ADL), co-morbidities, type and mechanism of fracture and hospitalization data as well as the modification of activities of the patients' relatives were recorded.

Results: Fifteen patients (6.9%) died during hospitalization; thirty-nine (17.9%) died within one year of fracture. The factors that were predictive of in-hospital, 30-days and one-year mortality, based on multivariate analysis, were male sex, advanced age >85 and Charson index >3. There was a significant association between delayed surgery (>48 hours) and increased in-hospital mortality. The percentage of patients assessed as ADL A or B at baseline, decreased form 84% preoperatively to 50.4% one year postoperatively. Only one-third of patients walking without aid before the fracture returned to the previous state. Family members modified their activities in 48% of cases to assist their relatives with a hip fracture.

Conclusions: One-year mortality in patients with hip fractures was 17.9%. Surgical delay (>48 hours) increased in-hospital mortality. Comorbidities >3, male sex, and advanced age increased the risk of in-hospital and post-discharge mortality during the 1st year. Twelve months postoperatively, half of patients walking without aid before the fracture returned to the previous state. Despite the beneficial effect of family support, the lack of organized rehabilitation programs and geriatric units are potential negative factors for patients' functional outcome. In addition, 48% of patients' relatives changed their daily activities to assist their relatives.

Stud Hist Philos Biol Biomed Sci. 2014 Jan 10;45C:12-21. doi: 10.1016/j.shpsc.2013.12.004. [Epub ahead of print]

Chimpocentrism and reconstructions of human evolution (a timely reminder).

Vaesen K.

Author information

• Philosophy & Ethics, Eindhoven University of Technology, Den Dolech 2 (IPO 1.13), 5612 AZ Eindhoven, The Netherlands. Electronic address: k.vaesen@tue.nl.

Abstract

Chimpanzees, but very few other animals, figure prominently in (recent) attempts to reconstruct the evolution of uniquely human traits. In particular, the chimpanzee is used (i) to identify traits unique to humans, and thus in need of reconstruction; (ii) to initialize the reconstruction, by taking its state to reflect the state of the last common ancestor of humans and chimpanzees; (iii) as a baseline against which to test evolutionary hypotheses. Here I point out the flaws in this three-step procedure, and show how they can be overcome by taking advantage of much broader phylogenetic comparisons. More specifically, I explain how such comparisons yield more reliable estimations of ancestral states and how they help to resolve problems of underdetermination inherent to chimpocentric accounts. To illustrate my points, I use a recent chimpocentric argument by Kitcher.