Does extrapleural pneumonectomy still have a role in the management of pleural mesothelioma?

J Thorac Cardiovasc Surg. 2014 Jan 15. pii: S0022-5223(14)00044-0. doi: 10.1016/j.jtcvs.2014.01.007. [Epub ahead of print]

Is there life after the Mesothelioma and Radical Surgery trial? Does extrapleural pneumonectomy still have a role in the management of pleural mesothelioma? A 13-year, single-center experience.

Qadri SS1, Cale A2, Loubani M2, Chaudhry MA2, Cowen ME2.

Author information

• 1Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, United Kingdom. Electronic address: ssaq98@yahoo.com.
• 2Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull, United Kingdom.

Abstract

OBJECTIVES:

The Mesothelioma and Radical Surgery trial has shown no survival benefit for extrapleural pneumonectomy (EPP) in the treatment of malignant mesothelioma. We present our results and contrast it with the Mesothelioma and Radical Surgery trial results.

METHODS:

The data from patients who had undergone EPP for malignant mesothelioma from March 1999 to April 2011 were analyzed retrospectively, and patient survival was observed until February 2013. Risk was calculated using the Thoracic Surgery Scoring System.

RESULTS:

Thirty patients underwent EPP during this period. The mean age was 61 ± 9 years, with 29 men and 1 woman, and the mean Thoracic Surgery Scoring System was 7.9 ± 2.5. No in-hospital or 30-day mortality occurred. The overall median survival was 20 ± 24 months and increased to 47.5 ± 24 months for patients who completed trimodality treatment; 31% of patients survived ≥4 years and 2 were still alive at 6 and 7 years postoperatively. Survival was significantly longer for those with epithelioid versus biphasic mesothelioma, right versus left pneumonectomy, age < 65 years, and no stage N2 disease. Survival at 6, 12, and 18 months was 80%, 65%, and 55% versus 65%, 52%, and 34% in the Mesothelioma and Radical Surgery trial, respectively.

CONCLUSIONS:

Epithelioid mesothelioma, right pneumonectomy, negative extrapleural lymph nodes, and age < 65 years were associated with prolonged survival. Our results have shown that EPP has a role in the management of malignant mesothelioma in selected patients by experienced surgeons.

"...it has become common to use “tsar” in this way, even though one might think that the buried historical allusion suggests that any such role is not going to end well…"

The battle for the English language

by Stefan Collini 

/ FEBRUARY 20, 2014 / 7 COMMENTS

Why are books about English grammar and correct usage so popular?

But they are all how the style tsar of the Guardian rules that things must be—which must make it the dream job for anyone who combines progressive politics with a marked hostility to capital letters (incidentally, it has become common to use “tsar” in this way, even though one might think that the buried historical allusion suggests that any such role is not going to end well…). Marsh is good on the peculiar idiom of news reporting, and especially on the distinctive art form that is the newspaper headline; you have to forgive a lot to anyone who, for a story about funding cuts to some Essex libraries, would use the headline “Book lack in Ongar.”

From U Georgia: Seventy-five years of policy on alcohol problems: an American perspective

J Stud Alcohol Drugs Suppl. 2014 Mar;75 Suppl 17:116-24.

Seventy-five years of policy on alcohol problems: an American perspective.

Roman PM.

Author information

• Owens Institute for Behavioral Research and Department of Sociology, University of Georgia, Athens, Georgia.

Abstract

Objective: This article traces the evolution of alcohol-related social policy over the past 75 years. 

Method: The literature was reviewed and is critically discussed. 

Results: The social history of alcohol policies over the last 75 years began with the scientific approach to alcohol in the 1930s and later shifted to a central interest in the disease of alcoholism. Beginning with the National Council on Alcoholism Education, advocates struggled to "mainstream" treatment for this disease into the health care system. Major steps included decriminalization of public intoxication, emphasis of the social respectability of persons with alcohol problems, development of a treatment system that was accompanied by health insurance coverage, and work-based programs to identify and attract employed patients with health insurance coverage. These structures were considerably altered by the War on Drugs, managed care, and the merger of drug and alcohol treatment. The Affordable Care Act, however, has the potential for achieving the mainstreaming goals for alcohol problems originally conceived in the early 1940s. 

Conclusions: Responsible involvement of the alcoholic beverage industry could greatly enhance current activities but is not likely to occur. Stigma persists in part because of associations with prevention and treatment of illegal drug use problems. The Affordable Care Act offers opportunities and challenges to the specialty of treating alcohol use disorders.

"...the practice of using organs from executed prisoners will be abandoned in the near future. It is time for a big hug..."

Hepatobiliary Surg Nutr. 2013 Dec;2(6):304-6. doi: 10.3978/j.issn.2304-3881.2013.11.05.

Organ transplantation is getting back its "true" luster in China.

Guo Z, Lu Y.

Author information

• Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.

Abstract

Although a great success has been made in the field of organ transplantation in China, the practice of organ donation from executed prisoners has long been rebuked by the international transplant community. The "boycott" attitude of western countries has stifled the development of transplant science and medicine in China. With the efforts of the Chinese government and transplant community, a voluntary organ donation system has been successfully established. The medical authorities have committed that the practice of using organs from executed prisoners will be abandoned in the near future. It is time for a big hug from the international transplant community to its Chinese partner. And it is time for a rapid development of organ transplantation in China.

"Why do states with high levels of public good provision tend to rely more on citizen-driven peer punishment?"

J R Soc Interface. 2014 Jan 29;11(93):20131044. doi: 10.1098/rsif.2013.1044. Print 2014.

Corruption drives the emergence of civil society.

Abdallah S1, Sayed R, Rahwan I, Leveck BL, Cebrian M, Rutherford A, Fowler JH.

Author information

• 1Informatics Department, The British University in Dubai, , Dubai, United Arab Emirates.

Abstract

Centralized sanctioning institutions have been shown to emerge naturally through social learning, displace all other forms of punishment and lead to stable cooperation. However, this result provokes a number of questions. If centralized sanctioning is so successful, then why do many highly authoritarian states suffer from low levels of cooperation? Why do states with high levels of public good provision tend to rely more on citizen-driven peer punishment? Here, we consider how corruption influences the evolution of cooperation and punishment. Our model shows that the effectiveness of centralized punishment in promoting cooperation breaks down when some actors in the model are allowed to bribe centralized authorities. Counterintuitively, a weaker centralized authority is actually more effective because it allows peer punishment to restore cooperation in the presence of corruption. Our results provide an evolutionary rationale for why public goods provision rarely flourishes in polities that rely only on strong centralized institutions. Instead, cooperation requires both decentralized and centralized enforcement. These results help to explain why citizen participation is a fundamental necessity for policing the commons.

Learn Behav. 2014 Feb 25. [Epub ahead of print]

Do monkeys choose to choose?

Perdue BM1, Evans TA, Washburn DA, Rumbaugh DM, Beran MJ.

Author information

• 1Agnes Scott College, 141 E. College Avenue, Atlanta, Georgia, 30030, bonnie.m.perdue@gmail.com.

Abstract

Both empirical and anecdotal evidence supports the idea that choice is preferred by humans. Previous research has demonstrated that thispreference extends to nonhuman animals, but it remains largely unknown whether animals will actively seek out or prefer opportunities to choose. Here we explored the issue of whether capuchin and rhesus monkeys choose to choose. We used a modified version of the SELECT task-a computer program in which monkeys can choose the order of completion of various psychomotor and cognitive tasks. In the present experiments, each trial began with a choice between two icons, one of which allowed the monkey to select the order of task completion, and the other of which led to the assignment of a task order by the computer. In either case, subjects still had to complete the same number of tasks and the same number of task trials. The tasks were relatively easy, and the monkeys responded correctly on most trials. Thus, global reinforcement rates were approximately equated across conditions. The only difference was whether the monkey chose the task order or it was assigned, thus isolating the act of choosing. Given sufficient experience with the task icons, all monkeys showed a significant preference for choice when the alternative was a randomly assigned order of tasks. To a lesser extent, some of the monkeys maintained a preference for choice over a preferred, but computer-assigned, task order that was yoked to their own previous choice selection. The results indicated that monkeys prefer to choose when all other aspects of the task are equated.

Why 'Ghostbusters' is the most libertarian Hollywood blockbuster of all time

BY PHILIP KLEIN | FEBRUARY 24, 2014 AT 2:04 PM 

"After learning the sad news that comedy actor and filmmaker Harold Ramis had died, I remarked on Twitter that the 1984 classic "Ghostbusters" (which he co-wrote and co-starred in) was the most libertarian Hollywood blockbuster ever made. I assumed that this was perfectly clear to everybody and that I was making a non-controversial claim -- even asserting the banal conventional wisdom -- but a number of people evidently didn't see where I was coming from."

HT:MC

"...the respondents generally agreed that Snow had identified a genuine problem, though no one had a clear sense of what, if anything, could be done about it."

ALAN JACOBS

The Two Cultures, Then and Now

The sciences, the humanities, and their common enemy.

"When, in May of 1959 at Cambridge University, C. P. Snow delivered a lecture called "The Two Cultures and the Scientific Revolution," it did not generate a great deal of controversy. Soon thereafter it was published in Encounter with a series of largely positive responses: the respondents generally agreed that Snow had identified a genuine problem, though no one had a clear sense of what, if anything, could be done about it.

What most readers took from Snow's lecture was this simple point: that academic and (more generally) intellectual specialization had in the 20th century proceeded to the point that the sciences and humanities had become mutually incomprehensible—and, perhaps more worryingly, each side had come to accept and even take some pleasure in the irrelevance to its own work of the other side."

Drugs Aging. 2014 Feb 25. [Epub ahead of print]

Intentional Non-Adherence to Medications by Older Adults.

Mukhtar O1, Weinman J, Jackson SH.

Author information

• 1Clinical Pharmacology and Therapeutics, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK, o.mukhtar@nhs.net.

Abstract

'The extent to which an individual's medication-taking behaviour and/or execution of lifestyle changes, corresponds with agreed recommendations from a healthcare provider', is a highly complex behaviour, defined as adherence. However, intentional non-adherence is regularly observed and results in negative outcomes for patients along with increased healthcare provision costs. Whilst this is a consistent issue amongst adults of all ages, the burden of chronic disease is greatest amongst older adults. As a result, the absolute prevalence of intentional non-adherence is increased in this population. This non-systematic review of intentional non-adherence to medication highlights the extent of the problem amongst older adults. It notes that age, per se, is not a contributory factor in intentionally non-adherent behaviours. Moreover, it describes the difference in methodology required to identify such behaviours in contrast to reports of non-adherence in general: the use of focus groups, semi-structured, one-to-one interviews and questionnaires as opposed to pill counts, electronic medication monitors and analysis of prescription refill rates. Using Leventhal's Common-Sense Model of Self-Regulation, it emphasizes six key factors that may contribute to intentional non-adherence amongst older adults: illness beliefs, the perceived risks (e.g. dependence, adverse effects), benefits and necessity of potential treatments, the patient-practitioner relationship, inter-current physical and mental illnesses, financial constraints and pharmaceutical/pharmacological issues (poly-pharmacy/regimen complexity). It describes the current evidence for each of these aspects and notes the paucity of data validating Leventhal's model in this regard. It also reports on interventions that may address these issues and explicitly acknowledges the lack of evidence-based interventions available to healthcare practitioners. As a result, it highlights five key areas that require urgent research amongst older adults: (1) the overlap between intentional and unintentional non-adherence, particularly amongst those who may be frail or isolated; (2) the potential correlation between symptomatic benefit and intentional vs. unintentional non-adherence to medication; (3) an evaluation of the source of prescribing (i.e. a long-standing provider vs. an acute episode of care) and the patient-prescriber relationship as determinants of intentional and unintentional non-adherence; (4) the decision-making processes leading to selective intentional non-adherence amongst older adults with multiple medical problems; and (5) the development and evaluation of interventions designed to reduce intentional non-adherence, specifically addressing each of the aspects listed above.

World J Stem Cells. 2014 Jan 26;6(1):33-42.

Distinction of white, beige and brown adipocytes derived from mesenchymal stem cells.

Park A, Kim WK, Bae KH.

Author information

• Anna Park, Won Kon Kim, Kwang-Hee Bae, Research Center for Integrated Cellulomics, KRIBB, Daejeon 305-806, South Korea.

Abstract

Adipose tissue is a major metabolic organ, and it has been traditionally classified as either white adipose tissue (WAT) or brown adipose tissue (BAT). WAT and BAT are characterized by different anatomical locations, morphological structures, functions, and regulations. WAT and BAT are both involved in energy balance. WAT is mainly involved in the storage and mobilization of energy in the form of triglycerides, whereas BAT specializes in dissipating energy as heat during cold- or diet-induced thermogenesis. Recently, brown-like adipocytes were discovered in WAT. These brown-like adipocytes that appear in WAT are called beige or brite adipocytes. Interestingly, these beige/brite cells resemble white fat cells in the basal state, but they respond to thermogenic stimuli with increased levels of thermogenic genes and increased respiration rates. In addition, beige/brite cells have a gene expression pattern distinct from that of either white or brown fat cells. The current epidemic of obesity has increased the interest in studying adipocyte formation (adipogenesis), especially in beige/brite cells. This review summarizes the developmental process of adipose tissues that originate from the mesenchymal stem cells and the features of these three different types of adipocytes.

J Nerv Ment Dis. 2014 Mar;202(3):181-5. doi: 10.1097/NMD.0000000000000109.

Psychiatry on trial: the Norway 2011 massacre.

Roth WT1, Dager SR.

Author information

• 1*Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California; †Departments of Radiology and Bioengineering, University of Washington, Seattle, WA; and ‡Department of Psychiatry, University of Utah, Salt Lake City, UT.

Abstract

On July 22, 2011, Anders Breivik, a Norwegian citizen, detonated a fertilizer bomb near government buildings in Oslo, killing eight people, and then proceeded to a nearby island where the Labor Party was holding a youth camp. There, he killed 69 people before being arrested. Just before these events, he posted a "compendium" on the Web explaining his actions and encouraging others to do likewise. Much of the ensuing media coverage and trial focused on whether he was sane and whether he had a psychiatric diagnosis. One team of court-appointed psychiatrists found him to be psychotic with a diagnosis of paranoid schizophrenia and legally insane. A second team found him neither psychotic nor schizophrenic and, thus, legally sane. Their contrary opinions were not reconciled by observing his behavior in court. We discuss why experienced psychiatrists reached such fundamentally opposing diagnostic conclusions about a "home-grown" terrorist holding extreme political views.

From Princeton: Kyrgyzstan - A virtual narco-state?

Int J Drug Policy. 2014 Jan 31. pii: S0955-3959(14)00015-2. doi: 10.1016/j.drugpo.2014.01.012. [Epub ahead of print]

Kyrgyzstan - A virtual narco-state?

Kupatadze A.

Author information

• Niehaus Center for Globalization and Governance, Princeton University, United States. Electronic address: akupatad@gmail.com.

Abstract

Numerous myths have surrounded the drug trade in Central Asia over the past two decades. Analysts writing on the issue and the law enforcement structures of the respective countries often have no complete and accurate information about the scale of the trade, the different groups involved and the role of drugs-related money in politics. Generally there are two dominating views: the first considers Kyrgyzstan to be a virtual narco-state and overstates the involvement of politicians and police officials; the alternative underestimates the role of state representatives, describes the smuggling as more decentralised and chaotic and emphasises the role of organised crime gangs and radical Islamic organisations. Based on the interviews in the field conducted in January-March 2012, this paper analyses these alternative perspectives and the empirical evidence supporting these views. It highlights methodological problems relating to research on similar issues, elucidates networks of smuggling and their links with politics and reflects on complexities in addressing these challenges.

J Phys Act Health. 2014 Feb;11(2):233-40. doi: 10.1123/jpah.2012-0083.

National policy on physical activity: the development of a policy audit tool.

Bull FC1, Milton K, Kahlmeier S.

Author information

• 1School of Population Health, The University of Western Australia, Crawley, WA, Australia.

Abstract

Background: Physical inactivity is a leading risk factor for noncommunicable disease worldwide. Increasing physical activity requires large scale actions and relevant, supportive national policy across multiple sectors. 

Methods: The policy audit tool (PAT) was developed to provide a standardized instrument to assess national policy approaches to physical activity. A draft tool, based on earlier work, was developed and pilot-tested in 7 countries. 

Results: After several rounds of revisions, the final PAT comprises 27 items and collects information on 1) government structure, 2) development and content of identified key policies across multiple sectors, 3) the experience of policy implementation at both the national and local level, and 4) a summary of the PAT completion process. 

Conclusions: PAT provides a standardized instrument for assessing progress of nationalpolicy on physical activity. Engaging a diverse international group of countries in the development helped ensure PAT has applicability across a wide range of countries and contexts. Experiences from the development of the PAT suggests that undertaking an audit of health enhancing physical activity (HEPA) policy can stimulate greater awareness of current policy opportunities and gaps, promote critical debate across sectors, and provide a catalyst for collaboration on policy level actions. The final tool is available online.

From the Cleveland Clinic: Ethics of facial transplantation revisited

Curr Opin Organ Transplant. 2014 Feb 22. [Epub ahead of print]

Ethics of facial transplantation revisited.

Coffman KL1, Siemionow MZ.

Author information

• 1Cleveland Clinic, Cleveland, Ohio, USA.

Abstract

PURPOSE OF REVIEW:

There have been 26 cases of facial transplantation reported, and three deaths, 11.5%. Mortality raises the issue of risk versus benefit for face transplantation, a procedure intended to improve quality of life, rather than saving life. Thus, one of the most innovative surgical procedures has opened the debate on the ethical, legal, and philosophical aspects of face transplantation.

RECENT FINDINGS:

Morbidity in face transplant recipients includes infections and metabolic consequences. No graft loss caused by technical failure, hyperacute, or chronic graft rejection or graft-versus-host disease has been reported. One case of posttransplant lymphoproliferative disorder, 3.45% and one case of lymphoma in an HIV-positive recipient were reported. Psychological issues in candidates can include chronic pain, mood disorders, preexisting psychotic disorders, post-traumatic stress disorder (PTSD), and substance abuse.

SUMMARY:

Early publications on ethical aspects of face transplantation focused mainly on informed consent. Many other ethical issues have been identified, including lack of coercion, donor family consent and confidentiality, respect for the integrity of the donor's body, and financial promotion of the recipient and transplant team, as well as the cost to society for such a highly technical procedure, requiring lifelong immunosuppression.

Pathology. 2014 Feb;46 Suppl 1:S3. doi: 10.1097/01.PAT.0000443417.32251.14.

Mindfulness: why attention matters.

Hassed C.

Author information

• Monash University Department of General Practice, Notting Hill, Vic, Australia.

Abstract

The importance of training attention is not a new idea and it may be the single most important life-skill we ever develop. Attention training is an important aspect of what is called mindfulness which is a form of meditation, a way of living, and a foundation for new approaches to psychotherapy such as mindfulness-based cognitive therapy (MBCT). Mindfulness-based approaches are receiving considerable interest from a number of disciplines on the back of an emerging evidence base. Particular areas of interest in the basic sciences include studies on neuroplasticity, genetics, and immunity. But it is the applications which are of particular importance in areas such as enhanced mental health, improved executive functioning, greater mental flexibility and memory, and improved physical health. In the medical setting it is also attracting interest because of its capacity to enhance clinical performance and reduce burnout. This interactive and experiential masterclass will explore the science, philosophy and practice of mindfulness including its importance for enhancing wellbeing and performance. Discussion will also focus on how it can be applied in personal and professional life.

"...the Marxian tradition has made modern sleep a matter of alienation rather than belonging."

Benjamin Reiss on The Slumbering Masses : Sleep, Medicine, and Modern American Life and24/7 : Late Capitalism and the Ends of Sleep andDangerously Sleepy : Overworked Americans and the Cult of Manly Wakefulness

Sleep’s Hidden Histories

February 15th, 2014

"Closer to the concerns of the authors under review here, the Marxian tradition has made modern sleep a matter of alienation rather than belonging. In chapter 10 of Das Kapital (1867) — “The Working Day” — Marx himself described the process by which capital squeezed ever more labor out of the proletariat: “It reduces the sound sleep needed for the restoration, reparation, refreshment of the bodily powers to just so many hours of torpor as the revival of an organism, absolutely exhausted, renders essential.” The English labor historian E. P. Thompson elaborated on this theme in his classic essay “Time, Work-Discipline, and Industrial Capitalism” (1967), arguing that industrial labor relations were established on an entirely unnatural temporal system — clock time — divorced from the diurnal and seasonal rhythms that had guided preindustrial labor. Thompson had little to say about how circadian rhythms governing the biological sleep-wake cycle were affected by the wrenching of the laboring body into industrial time, but many of his sources — poems, sermons, moral reform tracts — warn of the perils of oversleeping, or improper sleeping, implicitly as a way of producing temporal compliance from workers: sleep, it seemed, needed to conform to the dictates of the new economic order."

From U Michigan: Migrant Values and Beliefs: How Are They Different and How Do They Change?

J Ethn Migr Stud. 2014 Jan 1;40(5):796-813.

Migrant Values and Beliefs: How Are They Different and How Do They Change?

Williams NE1, Thornton A2, Young-Demarco LC3.

Author information

1Jackson School of International Studies and Department of Sociology, University of Washington.
2Population Studies Center, University of Michigan, arlandt@umich.edu.
3Population Studies Center, University of Michigan, lyoungdm@umich.edu.

Abstract

This is a study of the values of migrants. We examine processes of selection-how values affect migration-and adaptation-how migration influencesvalue changes. Empirical analyses use a unique collection of data that combines detailed information on values from a representative sample of non-migrants in Nepal with a representative sample of Nepali migrants living in the Persian Gulf. Results suggest that migrants were selected from those who were more materialistic, less committed to religion and more family-oriented. In terms of adaptation, our results are consistent with the idea that migrants become more religious, less committed to historical Nepali values, and change ideas about family-orientation in mixed ways. Thus, we find that value adaptations of migrants are complex processes that could have immense impacts on ideational diffusion around the world.

From U Melbourne: The timeless influence of Hippocratic ideals on diet, salicytates and personalized medicine

Hell J Nucl Med. 2014 Feb 21. pii: s002449910110. [Epub ahead of print]

The timeless influence of Hippocratic ideals on diet, salicytates and personalized medicine.

Karagiannis TC.

Author information

Epigenomic Medicine, BakerIDI Heart and Diabetes Institute, Melbourne, 3004, Vic, Australia 75 Commercial Road, Melbourne. Department of Pathology, The University of Melbourne, Parkville, 3052, Vic, Australia. tom.karagiannis@bakeridi.edu.au.

Abstract

At a time when superstition and deities were thought to be responsible for health and disease, Hippocrates of Kos emerged as a rational thinker assigning disease to natural causes. His insights, which principally arose from what may be considered almost compulsive examination and comparison, formed the basis of Hippocratic Medicine. There are still unresolved questions regarding the authenticity of the approximately 70 works shaping the Hippocratic Corpus. Assigning authorship precisely presents difficulties and given that the various treatises in the collection appear to span a period of between 100 and 300 years, it is clear that they may not be ascribed to a single author. Ancient commentaries, including translation and annotation by the Hellenic physician Galen and more recently by Emile Littré have helped preserve and structure our knowledge of Hippocratic ideals. Further, a large school of contemporary scholars are constantly refining our understanding. Despite the controversies and uncertainties, the underlying themes of Hippocrates' influence on medicine which involve meticulous observation, comparison, prognosis and prediction are evident. Importantly, the Hippocratic Oath remains a masterpiece of medical morals and ethics, analogous forms of which are still used today. Indeed, the Hippocratic Corpus teaches timeless concepts which do not only relate to medical thought and methodology but also to the more gentle aspects of the art. In this essay Hippocratic observations are considered in relation to three important matters preoccupying modern medicine: a) nutrition, b) drug development and c) personalized medicine.

From Duke: Research Participants' Understanding of and Reactions to Certificates of Confidentiality

AJOB Prim Res. 2014 Jan 1;5(1):12-22.

Research Participants' Understanding of and Reactions to Certificates of Confidentiality.

Beskow LM1, Check DK2, Ammarell N3.

Author information

1Duke Institute for Genome Sciences & Policy, 240 North Building, Duke University, Campus Box 90141, Durham, NC 27708 USA, Tel: 919-668-2293, FAX: 919-668-0799.
2Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
3Duke University Medical Center, Durham, NC, USA.

Abstract

BACKGROUND:

Certificates of Confidentiality are intended to facilitate participation in critical public health research by protecting against forced disclosure of identifying data in legal proceedings, but little is known about the effect of Certificate descriptions in consent forms.

METHODS:

To gain preliminary insights, we conducted qualitative interviews with 50 HIV-positive individuals in Durham, North Carolina to explore their subjective understanding of Certificate descriptions and whether their reactions differed based on receiving a standard versus simplified description.

RESULTS:

Most interviewees were neither reassured nor alarmed by Certificate information, and most said it would not influence their willingness to participate or provide truthful information. However, compared with those receiving the simplified description, more who read the standard description said it raised new concerns, that their likelihood of participating would be lower, and that they might be less forthcoming. Most interviewees said they found the Certificate description clear, but standard-group participants often found particular words and phrases confusing, while simplified-group participants more often questioned the information's substance.

CONCLUSIONS:

Valid informed consent requires comprehension and voluntariness. Our findings highlight the importance of developing consent descriptions of Certificates and other confidentiality protections that are simple and accurate. These qualitative results provide rich detail to inform a larger, quantitative study that would permit further rigorous comparisons.

Understanding Public Opinion in Debates over Biomedical Research

PLoS One. 2014 Feb 18;9(2):e88473. doi: 10.1371/journal.pone.0088473. eCollection 2014.

Understanding Public Opinion in Debates over Biomedical Research: Looking beyond Political Partisanship to Focus on Beliefs about Science and Society.

Nisbet M1, Markowitz EM2.

Author information

1American University, School of Communication, Washington, DC, United States of America.
2Earth Institute and Center for Research on Environmental Decisions, Columbia University, New York, New York, United States of America ; Princeton Institute for International and Regional Studies, Princeton University, Princeton, New Jersey, United States of America.

Abstract

As social scientists have investigated the political and social factors influencing public opinion in science-related policy debates, there has been growing interest in the implications of this research for public communication and outreach. Given the level of political polarization in the United States, much of the focus has been on partisan differences in public opinion, the strategies employed by political leaders and advocates that promote those differences, and the counter-strategies for overcoming them. Yet this focus on partisan differences tends to overlook the processes by which core beliefs about science and society impact public opinion and how these schema are often activated by specific frames of reference embedded in media coverage and popular discourse. In this study, analyzing cross-sectional, nationally representative survey data collected between 2002 and 2010, we investigate the relative influence of political partisanship and science-related schema on Americans' support for embryonic stem cell research. In comparison to the influence of partisan identity, our findings suggest that generalized beliefs about science and society were more chronically accessible, less volatile in relation to media attention and focusing events, and an overall stronger influence on public opinion. Classifying respondents into four unique audience groups based on their beliefs about science and society, we additionally find that individuals within each of these groups split relatively evenly by partisanship but differ on other important dimensions. The implications for public engagement and future research on controversies related to biomedical science are discussed.

From UNC-Chapel Hill: Policies and politics that promote HIV infection in the Southern United States

AIDS. 2014 Feb 19. [Epub ahead of print]

Policies and politics that promote HIV infection in the Southern United States.

Adimora AA1, Ramirez C, Schoenbach VJ, Cohen MS.

Author information

• 1aSchool of Medicine bUNC Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, North Carolina, USA.

Abstract

The South has the highest rates of HIV infection, HIV-related mortality, and many other adverse health outcomes in the United States. A number of social, structural, and policy factors drive the poorer health and HIV status of Southerners relative to other Americans. The South's worse health partly reflects its larger proportion of African Americans, who experience disadvantages in health in all US regions, due to poverty and racial discrimination. But after adjustment for race/ethnicity, HIV case-fatality rates for nearly all Southern states are double those of the state with the lowest rate. Challenges to HIV prevention and care in the region include its large rural population combined with a shortage of providers with expertise in HIV treatment, lingering distrust of the healthcare system, homophobia, and stigma toward people with HIV infection. Moreover, government policies, facilitated by restrictions on voting, often reduce access to HIV prevention and care through Medicaid, antiretroviral drugs, sex education, and syringe exchange programs. Many Southern states have pursued - and continue to pursue - policies that impede earlier detection and treatment. These policies directly and indirectly fuel the increased HIV incidence, morbidity, and mortality that characterize the region and arguably represent a human rights violation.