AORN J. 2014 Apr;99(4):466-79. doi: 10.1016/j.aorn.2013.07.021.

Understanding medication compounding issues.

Hicks RW.

Abstract

The potential for contamination of compounded products and the resulting infections are a serious threat to patient safety. Immediate use products are used frequently in the perioperative department, and perioperative nurses should be familiar with the guidelines and practices that aim to reduce the contamination that can occur during the sterile compounding process. Four common themes lead to successful compounding: quality (eg, product identification, purity, stability, compatibility, risk level assessment), the environment (eg, using a segregated compounding area with specialized airflow capabilities, reducing particulate matter, practicing proper hand hygiene, performing gloved fingertip sampling, properly cleaning equipment and work areas), personnel activities (eg, familiarity with types of containers used and how often they can be accessed, following expiration dates and the number of times containers can be accessed), and the control process (eg, process monitoring, quality improvement). If a third-party vendor is contracted to handle compounding for a facility, perioperative personnel should be aware of the responsibilities for the facility and the vendor to ensure a quality compounding program.

"Believing in professionalism means accepting the premise that health professionals must come together to continually define, debate, declare, distribute, and enforce the shared competency standards and ethical values that govern their work."

Acad Med. 2014 Mar 24. [Epub ahead of print]

More Than a List of Values and Desired Behaviors: A Foundational Understanding of Medical Professionalism.

Wynia MK1, Papadakis MA, Sullivan WM, Hafferty FW.

Author information

1Dr. Wynia is director of patient and physician engagement, Improving Health Outcomes Team, American Medical Association, and clinical assistant professor, Department of Medicine, University of Chicago, Chicago, Illinois. Dr. Papadakis is professor of medicine, Department of Medicine, University of California, San Francisco, and staff physician, San Francisco Veterans Association Medical Center, San Francisco, California. Dr. Sullivan is founding director, Educating Tomorrow's Lawyers, University of Denver, Denver, Colorado. Dr. Hafferty is professor of medical education and associate director, Program in Professionalism and Ethics, Mayo Clinic, Rochester, Minnesota.

Abstract

The term "professionalism" has been used in a variety of ways. In 2012, the American Board of Medical Specialties (ABMS) Standing Committee on Ethics and Professionalism undertook to develop an operational definition of professionalism that would speak to the variety of certification and maintenance-of-certification activities undertaken by ABMS and its 24 member boards. In the course of this work, the authors reviewed prior definitions of professions and professionalism and found them to be largely descriptive, or built around lists of proposed professional attributes, values, and behaviors. The authors argue that while making lists of desirable professional characteristics is necessary and useful for teaching and assessment, it is not, by itself, sufficient either to fully define professionalism or to capture its social functions. Thus, the authors sought to extend earlier work by articulating a definition that explains professionalism as the motivating force for an occupational group to come together and create, publicly profess, and develop reliable mechanisms to enforce shared promises-all with the purpose of ensuring that practitioners are worthy of patients' and the public's trust.Using this framework, the authors argue that medical professionalism is a normative belief system about how best to organize and deliver health care. Believing in professionalism means accepting the premise that health professionals must come together to continually define, debate, declare, distribute, and enforce the shared competency standards and ethical values that govern their work. The authors identify three key implications of this new definition for individual clinicians and their professional organizations.

From U Maryland: Who Owns the Radiology Images?

J Am Coll Radiol. 2014 Feb 4. pii: S1546-1440(13)00429-8. doi: 10.1016/j.jacr.2013.07.006. [Epub ahead of print]

Who Owns the Image? Archiving and Retention Issues in the Digital Age.

Mezrich JL1, Siegel E2.

Author information

• 1Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: jmezrich@umm.edu.
• 2Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland.

Abstract

Patients are often confused with respect to the ownership of radiologic images and the extent to which they may exert rights over their own imaging. In general, a facility that generates imaging maintains "ownership" rights. Patients have a right to inspect their images and obtain copies but they may not have the images or reports modified or stricken. Facilities may use images not only for treatment purposes but also have rights to use images with respect to educational training, quality control, and research, subject to HIPAA requirements. A facility has statutory obligations with respect to record retention and may face financial penalty and malpractice consequences for failure to retain images. Bankruptcy and state laws address issues of transfer of ownership of a patient's images in cases in which a facility goes out of business. Future questions remain as to whether the length of time a facility maintains images should increase as digital storage media improve and whether the use of inter-facility image sharing via "cloud" technology should alter obligations with respect to which facility must retain the images.

Given what he did, please excuse me for not caring.

Hum Pathol. 2013 Oct;44(10):1967-72. doi: 10.1016/j.humpath.2012.11.017. Epub 2013 Feb 18.

Vessels of Stone: Lenin's "circulatory disturbance of the brain".

Vinters H1, Lurie L, Mackowiak PA.

Author information

• 1Departments of Neurology, and Pathology and Laboratory Medicine (Neuropathology), the David Geffen School of Medicine at UCLA, Los Angeles California 90095, USA.

Abstract

Many have wondered what might have become of the totalitarian state Lenin founded on merciless terror, had he not died so young. He was 52 and at the height of his power when he had his first stroke. Six months later he had another and then a third stroke three months after that. He died 3 months shy of his 54th birthday with cerebral arteries so calcified that when tapped with tweezers at the time of his autopsy, they sounded like stone. The reason for his premature atherosclerosis has yet to be explained. He had a family history of cardiovascular disease and, therefore, is suspected of having had an inherited lipid disorder. Stress too might have had a role in the progression of his atherosclerosis. However, neither would explain the extent of the calcification of his cerebral arteries identified at post mortem examination. A recently described variant of the NT5E mutation might explain such calcification, as well as Lenin's family history of cardiovascular disease, and his premature cerebrovascular attacks.

Clin Anat. 2014 Mar 28. doi: 10.1002/ca.22260. [Epub ahead of print]

Classic versus millennial medical lab anatomy.

Benninger B1, Matsler N, Delamarter T.

Author information

• 1Department of Medical Anatomical Sciences, Western University of Health Sciences, COMP-Northwest, Lebanon, Oregon; Department of Neuromuscular Medicine, Western University of Health Sciences, COMP-Northwest, Lebanon, Oregon; Department of Family Practice, Western University of Health Sciences, COMP-Northwest, Lebanon, Oregon; College of Dental Medicine, Pomona, California; Department of Orthopaedics, Samaritan Health Services, Corvallis, Oregon; Department of General Surgery, Samaritan Health Services, Corvallis, Oregon; Department of Oral Maxillofacial Surgery, Oregon Health and Science University, Portland, Oregon; Department of Surgery, Oregon Health and Science University, Portland, Oregon; Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon.

Abstract

This study investigated the integration, implementation, and use of cadaver dissection, hospital radiology modalities, surgical tools, and AV technology during a 12-week contemporary anatomy course suggesting a millennial laboratory. The teaching of anatomy has undergone the greatest fluctuation of any of the basic sciences during the past 100 years in order to make room for the meteoric rise in molecular sciences. Classically, anatomy consisted of a 2-year methodical, horizontal, anatomy course; anatomy has now morphed into a 12-week accelerated course in a vertical curriculum, at most institutions. Surface and radiological anatomy is the language for all clinicians regardless of specialty. The objective of this study was to investigate whether integration of full-body dissection anatomy and modern hospital technology, during the anatomy laboratory, could be accomplished in a 12-week anatomy course. Literature search was conducted on anatomy text, journals, and websites regarding contemporary hospital technology integrating multiple image mediums of 37 embalmed cadavers, surgical suite tools and technology, and audio/visual technology. Surgical and radiology professionals were contracted to teach during the anatomy laboratory. Literature search revealed no contemporary studies integrating full-body dissection with hospital technology and behavior. About 37 cadavers were successfully imaged with roentograms, CT, and MRI scans. Students were in favor of the dynamic laboratory consisting of multiple activity sessions occurring simultaneously. Objectively, examination scores proved to be a positive outcome and, subjectively, feedback from students was overwhelmingly positive. Despite the surging molecular based sciences consuming much of the curricula, full-body dissection anatomy is irreplaceable regarding both surface and architectural, radiological anatomy. Radiology should not be a small adjunct to understand full-body dissection, but rather, full-body dissection aids the understanding of radiology mediums. The millennial anatomy dissection laboratory should consist of, at least, 50% radiology integration during full-body dissection. This pilot study is an example of the most comprehensive integration of full-body dissection, radiology, and hospital technology.

"The real irony of our forecasting boom is that as fortune-tellers proliferate, fortunes become harder to read."

The Dismal Art

Economic forecasting has become much more sophisticated in the decades since its invention. So why are we still so bad at it?

James Surowiecki

"The real issue here is one that the economist Oskar Morgenstern identified back in the late 1920s—namely, that economic predictions actually end up shaping the very outcomes they’re trying to predict. And the more predictions you have, the more complex that Möbius strip becomes. In that sense, for all the challenges they faced, men like Babson and Fisher had it easy, since forecasts were few and far between. The real irony of our forecasting boom is that as fortune-tellers proliferate, fortunes become harder to read." 

Ann Am Thorac Soc. 2014 Mar;11(3):407-16. doi: 10.1513/AnnalsATS.201312-420PS.

Lung disease in a global context. A call for public health action.

Schluger NW1, Koppaka R.

Author information

• 11 World Lung Foundation, New York, New York.

Abstract

As described in a recently released report of the Forum of International Respiratory Societies, four of the leading causes of death in the world are chronic obstructive pulmonary disease, acute respiratory tract infections, lung cancer, and tuberculosis. A fifth, asthma, causes enormous global morbidity. Not enough progress has been made in introducing new therapies and reducing disease burden for these illnesses in the last few decades, despite generous investments and some notable progress in biomedical research. Four external and modifiable drivers are responsible for a substantial percentage of the disease burden represented by the major lung diseases: tobacco, outdoor air pollution, household air pollution, and occupational exposures to lung toxins. Especially in low- and middle-income countries, but in highly developed economies as well, pressures for economic development and lax regulation are contributing to the continued proliferation of these drivers. Public health approaches to the most common lung diseases could have enormous effects on reducing morbidity and mortality. There must be increased advocacy from and mobilization of civil society to bring attention to the drivers of lung diseases in the world. The World Health Organization should negotiate accords similar to the Framework Convention on Tobacco Control to address air pollution and occupational exposures. Large increases in funding by government agencies and nongovernmental organizations around the world are needed to identify technologies that will reduce health risks while allowing populations to enjoy the benefits of economic development. This paradigm, focused more on public health than on individual medical treatment, has the best chance of substantial reduction in the burden of lung disease around the world in the next several years.

Int J Drug Policy. 2014 Feb 11. pii: S0955-3959(14)00024-3. doi: 10.1016/j.drugpo.2014.01.021. [Epub ahead of print]

Do disgusting and fearful anti-smoking advertisements increase or decrease support for tobacco control policies?

Halkjelsvik T.

Author information

• Norwegian Institute for Alcohol and Drug Research, Norway. Electronic address: th@sirus.no.

Abstract

BACKGROUND:

Frightening messages and disgusting pictures are commonly used in anti-smoking media campaigns. How does watching these campaigns affect people's attitudes towards tobacco control policies?

METHODS:

Non-smokers (n=464) and smokers (n=139) recruited through the online labour market Amazon Mechanical Turk watched anti-smoking videos with one of the three types of emotional content (random allocation): fear plus disgust, fear only (i.e., only moderate levels of disgust), or a control condition. Differences between the three conditions on a Tobacco Policy Support Index were tested after advertisement exposure. Potential mediation through ratings of negative emotions was determined with bootstrap tests of indirect effects.

RESULTS:

For non-smokers, videos that induced fear or fear in combination with disgust were associated with higher support for tobacco control policies than the control condition. The effect seemed to be mediated through ratings of fearfulness. Those who perceived the videos as fearful reported higher levels of support. For smokers, there was no overall effect of the videos.

CONCLUSION:

The data suggest that anti-smoking advertisements with strong negative emotional content can produce more support for tobacco control policies among non-smokers.

From U Edinburgh: Habitable worlds with no signs of life

Philos Trans A Math Phys Eng Sci. 2014 Mar 24;372(2014):20130082. doi: 10.1098/rsta.2013.0082. Print 2014.

Habitable worlds with no signs of life.

Cockell CS.

Author information

• UK Centre for Astrobiology, University of Edinburgh, , Edinburgh EH10 4EP, UK.

Abstract

'Most habitable worlds in the cosmos will have no remotely detectable signs of life' is proposed as a biological hypothesis to be tested in the study of exoplanets. Habitable planets could be discovered elsewhere in the Universe, yet there are many hypothetical scenarios whereby the search for life on them could yield negative results. Scenarios for habitable worlds with no remotely detectable signatures of life include: planets that are habitable, but have no biosphere (Uninhabited Habitable Worlds); planets with life, but lacking any detectable surface signatures of that life (laboratory examples are provided); and planets with life, where the concentrations of atmospheric gases produced or removed by biota are impossible to disentangle from abiotic processes because of the lack of detailed knowledge of planetary conditions (the 'problem of exoplanet thermodynamic uncertainty'). A rejection of the hypothesis would require that the origin of life usually occurs on habitable planets, that spectrally detectable pigments and/or metabolisms that produce unequivocal biosignature gases (e.g. oxygenic photosynthesis) usually evolve and that the organisms that harbour them usually achieve a sufficient biomass to produce biosignatures detectable to alien astronomers.

Zombie allusions: They just keep on coming™-"identifying cockroach brains."

PLoS One. 2014 Feb 26;9(2):e89683. doi: 10.1371/journal.pone.0089683. eCollection 2014.

Sensory arsenal on the stinger of the parasitoid jewel wasp and its possible role in identifying cockroach brains.

Gal R1, Kaiser M1, Haspel G2, Libersat F1.

Author information

• 1Department of Life Sciences and the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
• 2Department of Biological Sciences, New Jersey Institute of Technology, Newark, New Jersey, United States of America.

Abstract

The parasitoid jewel wasp uses cockroaches as live food supply for its developing larva. To this end, the adult wasp stings a cockroach and injects venom directly inside its brain, turning the prey into a submissive 'zombie'. Here, we characterize the sensory arsenal on the wasp's stinger that enables the wasp to identify the brain target inside the cockroach's head. An electron microscopy study of the stinger reveals (a) cuticular depressions innervated by a single mechanosensory neuron, which are presumably campaniform sensilla; and (b) dome-shaped structures innervated by a single mechanosensory neuron and 4-5 chemosensory neurons, which are presumably contact-chemoreceptive sensilla. Extracellular electrophysiological recordings from stinger afferents show increased firing rate in response to mechanical stimulation with agarose. This response is direction-selective and depends upon the concentration (density) of the agarose, such that the most robust response is evoked when the stinger is stimulated in the distal-to-proximal direction (concomitant with the penetration during the natural stinging behavior) and penetrating into relatively hard (0.75%-2.5%) agarose pellets. Accordingly, wasps demonstrate a normal stinging behavior when presented with cockroaches in which the brain was replaced with a hard (2.5%) agarose pellet. Conversely, wasps demonstrate a prolonged stinging behavior when the cockroach brain was either removed or replaced by a soft (0.5%) agarose pellet, or when stinger sensory organs were ablated prior to stinging. We conclude that the parasitoid jewel wasp uses at least mechanosensory inputs from its stinger to identify the brain within the head capsule of the cockroach prey.

"Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state..."

Int J Law Psychiatry. 2014 Jan-Feb;37(1):71-81. doi: 10.1016/j.ijlp.2013.09.007. Epub 2013 Oct 12.

Russian and Soviet forensic psychiatry: troubled and troubling.

Healey D.

Author information

• St Antony's College, University of Oxford, 62 Woodstock Rd, Oxford OX2 6JF, United Kingdom. Electronic address: dan.healey@history.ox.ac.uk.

Abstract

Russian forensic psychiatry is defined by its troubled and troubling relationship to an unstable state, a state that was not a continuous entity during the modern era. From the mid-nineteenth century, Russia as a nation-state struggled to reform, collapsed, re-constituted itself in a bloody civil war, metastasized into a violent "totalitarian" regime, reformed and stagnated under "mature socialism" and then embraced capitalism and "managed democracy" at the end of the twentieth century. These upheavals had indelible effects on policing and the administration of justice, and on psychiatry's relationship with them. In Russia, physicians specializing in medicine of the mind had to cope with rapid and radical changes of legal and institutional forms, and sometimes, of the state itself. Despite this challenging environment, psychiatrists showed themselves to be active professionals seeking to guide the transformations that inevitably touched their work. In the second half of the nineteenth century debates about the role of psychiatry in criminal justice took place against a backdrop of increasingly alarming terrorist activity, and call for revolution. While German influence, with its preference for hereditarianism, was strong, Russian psychiatry was inclined toward social and environmental explanations of crime. When revolution came in 1917, the new communist regime quickly institutionalized forensic psychiatry. In the aftermath of revolution, the institutionalization of forensic psychiatry "advanced" with each turn of the state's transformation, with profound consequences for practitioners' independence and ethical probity. The abuses of Soviet psychiatry under Stalin and more intensively after his death in the 1960s-80s remain under-researched and key archives are still classified. The return to democracy since the late 1980s has seen mixed results for fresh attempts to reform both the justice system and forensic psychiatric practice.

Minerva Chir. 2014 Feb;69(1):9-15.

Treatment of diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery and HIPEC.

Robella M1, Vaira M, Mellano A, Marsanic P, Cinquegrana A, Borsano A, Barbera M, Caneparo A, Siatis D, Sottile A, De Simone M.

Author information

• 1Unit of Surgical Oncology, IRCCS (Scientific Institute for Cancer Research and Treatment), Candiolo, Turin, Italy - manuela.robella@hotmail.it.

Abstract

AIM:

Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and locally aggressive tumor with poor prognosis, related in most cases to asbestos exposure. It is increasing in frequency, but currently no standard therapy is available. The biology of this disease is still poorly understood. Several highly specialized centers have recently reported improved survival by means of an innovative local-regional approach. The purpose of this article is to evaluate the survival benefit and the morbidity rate of patients affected by DMPM treated at our institution by cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC).

METHODS:

This study includes 42 patients affected by DMPM treated by an uniform approach consisting of cytoreductive surgery associated with HIPEC using cisplatin and doxorubicin. The primary end point was overall survival and morbidity rate. The secondary end point was evaluation of prognostic variables for overall survival.

RESULTS:

The median follow-up period was 72 months (range 1-235 months). Thirty-five patients (83.3%) presented epithelial tumors and 7 were affected by multicystic mesothelioma. The mean peritoneal cancer index (PCI) was 13. Thirty-eight patients (90.4%) had complete cytoreduction (CC-0/1). The overall morbidity rate was 35.7% associated to a perioperative mortality of 7.1%. Median overall survival rate was 65 months with a 1- and 5-year survival rates of 63% and 44%, respectively.

CONCLUSION:

The treatment of DMPM by CRS+HIPEC in selected patients is a feasible technique that allows to achieve encouraging results in terms of overall survival rate, with an acceptable morbidity rate. Further investigations are needed to clarify the role and the timing of this promising technique.

Jung's evolving views of Nazi Germany

J Anal Psychol. 2014 Apr;59(2):245-62. doi: 10.1111/1468-5922.12072.

Jung's evolving views of Nazi Germany: From 1936 to the end of World War II.

Schoenl W.

Author information

• Michigan, USA.

Abstract

This article first shows Jung's evolving views of Nazi Germany from 1936 to the beginning of World War II. In a lecture at the Tavistock Clinic, London, in October 1936, he made his strongest and most negative statements to that date about Nazi Germany. While in Berlin in September 1937 for lectures to the Jung Gesellschaft, his observations of Hitler at a military parade led him to conclude that should the catastrophe of war come it would be far more and bloodier than he had previously supposed. After the Sudetenland Crisis in Fall 1938, Jung in interviews made stronger comments on Hitler and Nazi Germany. The article shows how strongly anti-Nazi Jung's views were in relation to events during World War II such as Nazi Germany's invasion of Poland, the fall of France, the bombings of Britain, the U.S. entry into the War, and Allied troops advancing into Germany. Schoenl and Peck, 'An Answer to the Question: Was Jung, for a Time, a "Nazi Sympathizer" or Not?' (2012) demonstrated how his views of Nazi Germany changed from 1933 to March 1936. The present article shows how his views evolved from 1936 to the War's end in 1945.

Hist Psychiatry. 2014 Mar;25(1):35-56. doi: 10.1177/0957154X13515153.

Therapeutic Fascism: re-educating Communists in Nazi-occupied Serbia, 1942-44.

Antic A.

Author information

• Birkbeck College, London.

Abstract

This article probes the relationship between psychoanalysis and right-wing authoritarianism, and analyses a unique psychotherapeutic institution established by Serbia's World War II collaborationist regime. The extraordinary Institute for compulsory re-education of high-school and university students affiliated with the Communist resistance movement emerged in the context of a brutal civil war and violent retaliations against Communistactivists, but its openly psychoanalytic orientation was even more astonishing. In order to stem the rapid spread of Communism, the collaborationist state, led by its most extreme fascistic elements, officially embraced psychotherapy, the 'talking cure' and Freudianism, and conjured up its own theory of mental pathology and trauma - one that directly contradicted the Nazi concepts of society and the individual. In the course of the experiment, Serbia's collaborationists moved away from the hitherto prevailing organicist, biomedical model of mental illness, and critiqued traditional psychiatry's therapeutic pessimism.

Are we justified in treating for multidrug-resistant tuberculosis based on positive follow-up smear results? (study says no)

Int J Tuberc Lung Dis. 2014 Apr;18(4):449-53. doi: 10.5588/ijtld.13.0429.

Are we justified in treating for multidrug-resistant tuberculosis based on positive follow-up smear results?

Kumar RS1, Kumar AM2, Claassens M3, Banurekha VV1, Sekar G1, Venkatesan P1, Swaminathan S1.

Author information

Abstract

SETTING:

National Institute for Research in Tuberculosis, India.

OBJECTIVE:

To assess, among new culture-confirmed smear-positive pulmonary tuberculosis (TB) patients, the proportion of follow-up smear-positives that were culture-negative (S+C-) by month of follow-up examination, human immunodeficiency virus (HIV) status, pre-treatment drug susceptibility status and smear grading.

DESIGN:

We extracted follow-up smear (fluorescence microscopy) and culture (Löwenstein-Jensen) results of patients enrolled in clinical trials from January 2000 to August 2012 and treated with the WHO Category I regimen (2EHRZ3/4HR3).

RESULTS:

Of 520 patients, including 176 who were HIV-infected, respectively 199, 81, 47 and 43 were smear-positive at months 2, 4, 5 and 6; of these, respectively 138 (69%), 62 (75%), 32 (68%) and 27 (63%) were culture-negative. The S+C- phenomenon was more pronounced among '1+ positive' patients than in 2+ or 3+ positive patients and in 'pan-susceptible' patients than in those with any resistance, and did not vary by HIV status.

CONCLUSION:

Nearly two thirds of patients with follow-up smears positive at months 5 and 6 were culture-negative. Starting multidrug-resistant TB (MDR-TB) treatment empirically based on smear results, even in resource-limited settings, is incorrect and can have hazardous consequences. There is an urgent need to revisit the WHO recommendation concerning empirical MDR-TB treatment.

Survivors of Self-inflicted Gunshot Wounds to the Head

JAMA Ophthalmol. 2014 Mar 27. doi: 10.1001/jamaophthalmol.2013.8201. [Epub ahead of print]

Survivors of Self-inflicted Gunshot Wounds to the Head: Characterization of Ocular Injuries and Health Care Costs.

Reddy AK1, Baker MS2, Sobel RK2, Whelan DA3, Carter KD4, Allen RC4.

Author information

• 1Carver College of Medicine, University of Iowa, Iowa City.
• 2Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City.
• 3Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City.
• 4Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City4Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City.

Abstract

IMPORTANCE Suicides and attempted suicides are major public health issues in the United States and around the world. Self-inflicted gunshot wounds (SIGSWs) are a common method of attempting suicide, the head being the most commonly injured body region; however, the literature lacks an overview of the orbital and ocular injuries as well as outcomes associated with SIGSWs. 

OBJECTIVES To characterize the ocular and orbital injuries and outcomes of patients presenting with SIGSWs and to examine the cost associated with these injuries. 

DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review was performed of all patients who presented to the University of Iowa Hospitals and Clinics between 2003 to 2013 with the admitting diagnosis of self-inflicted injuries via firearms. Patients with no periorbital or ocular injuries and/or those who did not survive for at least 2 months following the incident were excluded. 

MAIN OUTCOMES AND MEASURES Ocular injuries and outcomes and health care costs and reimbursements, which were generated by a financial report obtained from the hospital finance department that included data from both the hospital billing and cost accounting systems. 

RESULTS All patients in this study (n = 18) were men with a mean age of 47.2 years. Eight patients (44.4%) displayed submental missile entry points, 7 (38.9%) displayed intraoral entry points, and 3 (16.7%) displayed pericranial entry points. Patients with pericranial entries sustained more severe ocular injuries and had poorer ocular outcomes. Seven patients (38.9%) were found at final follow-up to have visual acuity of 20/40 or better in each eye and all showed missile trajectories in the sagittal plane. The mean cost of treatment of these patients totaled $117 338 while the mean reimbursement amount was $124 388. 

CONCLUSIONS AND RELEVANCE Data regarding ocular injuries and outcomes may assist ophthalmologists in the treatment of patients with SIGSWs in the future. Many patients had extremely functional vision at final follow-ups, which highlights the importance of specialists conducting examinations and reconstructive procedures promptly, carefully, and thoroughly. Cost and reimbursement data suggest that while these cases place a large financial burden on society, they may not burden hospital systems in the same way.

From U Geneva: The Swiss national environmental health action plan (NEHAP): why it ended

Health Promot Int. 2014 Mar 27. [Epub ahead of print]

The Swiss NEHAP: why it ended.

Forbat J.

Author information

• Institute of Environmental Sciences, University of Geneva, 7, rte de Drize, Carouge 1227, Switzerland.

Abstract

While European countries tend to increase the importance given to their national environmental health action plan (NEHAP), Switzerland stopped implementing its NEHAP in 2007. This study investigates the reasons for this surprising decision. The results provide an explanation of a relatively unique case and should inform any person interested in understanding common obstacles in the making and implementation of coordinated environmental health policies and programs. Data used in this study have been obtained from interviews conducted among experts of the Swiss environmental health policies and from survey results provided by the WHO Regional Office for Europe. Findings show that financial constraints were only partly responsible for the abandonment of the NEHAP and that many of the shortcomings observed arose from the creation and the functioning of the Environmental and Health Section at the Federal Office of Public Health, which was devoted to the NEHAP. Lack of scientific knowledge and capacity to build intersectoral collaboration, compounded by a limited conception of environmental health, resulted in a lack of political awareness of environmental health issues. In consequence, the study highlights the necessity of a true interdisciplinary and intersectoral approach for environmental health policies. Policy makers should also be concerned with the creation of relevant systems of indicators, since they appear to be fundamental to the success of environmental health policies.

From McGill U: Stem Cell Research Funding Policies and Dynamic Innovation

Stem Cell Rev. 2014 Mar 28. [Epub ahead of print]

Stem Cell Research Funding Policies and Dynamic Innovation: A Survey of Open Access and Commercialization Requirements.

Lévesque M1, Kim JR, Isasi R, Knoppers BM, Plomer A, Joly Y.

Author information

• 1Centre of Genomics and Policy, McGill University, 740 Avenue du Docteur-Penfield, Montreal, Quebec, Canada, H3A 1A5, maroussia.levesque@gmail.com.

Abstract

This article compares and contrasts the pressures of both open access data sharing and commercialization policies in the context of publicly funded embryonic stem cell research (SCR). First, normative guidelines of international SCR organizations were examined. We then examined SCR funding guidelines and the project evaluation criteria of major funding organizations in the EU, the United Kingdom (UK), Spain, Canada and the United States. Our survey of policies revealed subtle pressures to commercialize research that include: increased funding availability for commercialization opportunities, assistance for obtaining intellectual property rights (IPRs) and legislation mandating commercialization. In lieu of open access models, funders are increasingly opting for limited sharing models or "protected commons" models that make the research available to researchers within the same region or those receiving the same funding. Meanwhile, there still is need for funding agencies to clarify and standardize terms such as "non-profit organizations" and "for-profit research," as more universities are pursuing for-profit or commercial opportunities.

Nannystate: From Stanford U: Smokers develop "strategic responses to sin taxes"

Health Econ. 2013 Oct 16. doi: 10.1002/hec.3004. [Epub ahead of print]

SMOKERS' STRATEGIC RESPONSES TO SIN TAXES: EVIDENCE FROM PANEL DATA IN THAILAND.

White JS1, Ross H.

Author information

• 1Stanford University, Stanford, CA, USA.

Abstract

In addition to quitting and cutting consumption, smokers faced with higher cigarette prices may compensate in several ways that mute the health impact of cigarette taxes. This study examines three price avoidance strategies among adult male smokers in Thailand: trading down to a lower-priced brand, buying individual sticks of cigarettes instead of packs, and substituting roll-your-own tobacco for factory-manufactured cigarettes. Using two panels of microlevel data from the International Tobacco Control Southeast Asia Study, collected in 2005 and 2006, we estimate the effects of a substantial excise tax increase implemented throughout Thailand in December 2005. We present estimates of the marginal effects and price elasticities for each of five consumer behaviors. We find that, controlling for baseline smoking characteristics, sociodemographics, and policyvariables, quitting is highly sensitive to changes in cigarette prices, but so are brand choice, stick-buying, and use of roll-your-own tobacco. Neglecting such strategic responses leads to overestimates of a sin tax's health impact, and neglecting product substitution distorts estimates of the price elasticity of cigarette demand. We discuss the implications for consumer welfare and several policies that mitigate the adverse impact of consumer responses.

Nannystate: Legislative 'solutions' to 'unhealthy eating' "...gaining political acceptance in Australia..."

Public Health. 2011 Dec;125(12):896-904. doi: 10.1016/j.puhe.2011.06.004. Epub 2011 Nov 5.

Legislative solutions to unhealthy eating and obesity in Australia.

MacKay S.

Author information

• Obesity Policy Coalition (Cancer Council Victoria, Diabetes Australia - Victoria, VicHealth, WHO Collaborating Centre for Obesity Prevention at Deakin University), 100 Drummond Street, Carlton, VIC 3053, Australia. sarah.mackay@cancervic.org.au

Abstract

This paper discusses legislative interventions that have potential to address factors in the food environment that contribute to unhealthy eating patterns and increasing obesity rates in the Australian population, and political barriers to the implementation of these interventions. The paper devotes particular attention to legislative interventions to require disclosure of nutrition information about food and beverage products, which would help to inform consumer choices, and are, therefore, difficult to object to on personal responsibility or 'nanny state' grounds. It is suggested that these interventions seem to be gaining political acceptance in Australia, and may provide a starting point for incremental progress.