Use of CT and PET/CT for Staging of Local Extent in Patients With Malignant Pleural Mesothelioma

J Comput Assist Tomogr. 2014 Oct 28. [Epub ahead of print]

Use of Computed Tomography and Positron Emission Tomography/Computed Tomography for Staging of Local Extent in Patients With Malignant Pleural Mesothelioma.

Frauenfelder T1, Kestenholz P, Hunziker R, Nguyen TD, Fries M, Veit-Haibach P, Husmann L, Stahel R, Weder W, Opitz I.

Author information

• 1From the *Institute of Diagnostic and Interventional Radiology, †Division of Thoracic Surgery, ‡Clinic of Nuclear Medicine, and §Clinic of Oncology, University Hospital of Zurich, Zurich, Switzerland.

Abstract

PURPOSE:

The objective of this study was to determine the diagnostic value of computed tomography (CT) and positron emission tomography (PET)/CT for staging of malignant pleural mesothelioma (MPM) in patients undergoing induction chemotherapy.

METHODS:

Sixty-two patients (median age, 61 years; female: n = 9) with proven MPM underwent CT after induction chemotherapy. Of these, 28 underwent additional PET/CT. Extrapleural pneumonectomy was performed for pathological TNM staging. Clinical TNM stage was assessed by 3 independent readers. Relative and absolute underestimation and overestimation were compared with pathological tumor stage. Sensitivity, specificity, and accuracy for differentiation between stages T2 and T3 were assessed. Interobserver agreement between the readers was analyzed (κ).

RESULTS:

Positron emission tomography/CT and CT underestimated T stage in up to 30% of the cases. Positron emission tomography/CT had a higher accuracy for tumor extent compared with CT (PET/CT: 0.92; CT: 0.84). The accuracy for nodal staging was higher for CT than for PET/CT (PET/CT: 0.78; CT: 0.87). Concerning International Mesothelioma Interest Group classification, PET/CT improved the accuracy of preoperative staging compared with CT (PET/CT: 0.91; CT: 0.82). Interobserver agreement was moderate for CT (0.48-0.62) and good for PET/CT (0.64-0.83) for T staging. For nodal staging, interobserver agreement was fair to moderate for CT and good for PET/CT (CT: 0.37-0.51; PET/CT: 0.73-0.76).

CONCLUSIONS:

Positron emission tomography/CT is more accurate and has a lower interobserver variability for clinical intrathoracic staging of MPM compared with CT. Nevertheless PET/CT underestimated tumor stage in a substantial number of cases, showing the need for a more accurate imaging technology or approach.

Poll: 82 Percent of New Yorkers Support the 21-Day Ebola Quarantine

Poll: 82 Percent of New Yorkers Support the 21-Day Ebola Quarantine

"Roberto Binaschi, 56, from Italy, was arrested at Dublin Airport on Thursday." His crime:

Man fined over Ebola joke on Dublin to Milan Aer Lingus flight

Roberto Binaschi, 56, from Italy, was arrested at Dublin Airport on Thursday.

He had written "Attenzione Ebola" on the lid of a disposable coffee cup as a joke with his daughter while on board the Aer Lingus flight from Milan.

Health Care Manag (Frederick). 2014 Jul-Sep;33(3):254-60. doi: 10.1097/HCM.0000000000000019.

Medicare fraud in the United States: can it ever be stopped?

Hill C1, Hunter A, Johnson L, Coustasse A.

Author information

• 1Author Affiliations: Health Care Administration Program, College of Business, Marshall University Graduate College, South Charleston, West Virginia.

Abstract

The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial impact of Medicare fraud. The methodology for this study was a literature review. Research was conducted using a scholarly online database search and government Web sites. The number of individuals charged with criminal fraud increased from 797 cases in fiscal year 2008 to 1430 cases in fiscal year 2011-an increase of more than 75%. According to 2010 data, of the 7848 subjects investigated for criminal fraud, 25% were medical facilities, and 16% were medical equipment suppliers. In 2009 and 2010, the Health Care Fraud and Abuse Control Program recovered approximately $25.2 million of taxpayers' money. Educating providers about the policies and laws designed to prevent fraud would help them to become partners. Many new programs and partnerships with government agencies have also been developed to combat Medicare fraud. Medicare fraud has been a persistent crime, and laws and policies alone have not been enough to control the problem. With investments in governmental partnerships and new systems, the United States can reduce Medicare fraud but probably will not stop it altogether.

J Pathol. 2014 Oct 9. doi: 10.1002/path.4456. [Epub ahead of print]

Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg Viruses.

Martines RB1, Ng DL, Greer PW, Rollin PE, Zaki SR.

Author information

• 1Infectious Diseases Pathology Branch, Atlanta, GA, 30030.

Abstract

Ebolaviruses and marburgviruses include some of the most virulent and fatal pathogens known to humans. These viruses cause severe haemorrhagic fevers with case fatality rates ranging from 25% to 90%. The diagnosis of filovirus using formalin-fixed tissues from fatal cases poses a significant challenge. The most characteristic histopathological findings are seen in the liver: however findings overlap with many other viral and non-viral haemorrhagic diseases. The need to distinguish filovirus infections from other haemorrhagic fevers, particularly in areas with multiple endemic viral haemorrhagic agents, is of paramount importance. In this review we discuss the current state of knowledge of filovirus infections and their pathogenesis, including histopathological findings, epidemiology, modes of transmission, and filovirus entry and spread within host organisms. The pathogenesis of filovirus infections is complex and involves activation of the mononuclear phagocytic system with release of proinflammatory cytokines, chemokines and growth factors; endothelial dysfunction; alterations of the innate and adaptive immune systems; direct organ and endothelial damage from unrestricted viral replication late in infection; and coagulopathy. Although our understanding of the pathogenesis of filovirus infections has rapidly increased in the past few years, many questions remain unanswered.

Ebola in Sierra Leone: "Clinical and laboratory factors at presentation that were associated with a fatal outcome included fever, weakness, dizziness, diarrhea, and elevated levels of blood urea nitrogen, aspartate aminotransferase, and creatinine."

N Engl J Med. 2014 Oct 29. [Epub ahead of print]

Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone.

Schieffelin JS1, Shaffer JG, Goba A, Gbakie M, Gire SK, Colubri A, Sealfon RS, Kanneh L, Moigboi A, Momoh M, Fullah M, Moses LM, Brown BL, Andersen KG,Winnicki S, Schaffner SF, Park DJ, Yozwiak NL, Jiang PP, Kargbo D, Jalloh S, Fonnie M, Sinnah V, French I, Kovoma A, Kamara FK, Tucker V, Konuwa E, Sellu J, Mustapha I, Foday M, Yillah M, Kanneh F, Saffa S, Massally JL, Boisen ML, Branco LM, Vandi MA, Grant DS, Happi C, Gevao SM, Fletcher TE, Fowler RA,Bausch DG, Sabeti PC, Khan SH, Garry RF; the KGH Lassa Fever Program, the Viral Hemorrhagic Fever Consortium, and the WHO Clinical Response Team.

Author information

Abstract

Background 

Limited clinical and laboratory data are available on patients with Ebola virus disease (EVD). The Kenema Government Hospital in Sierra Leone, which had an existing infrastructure for research regarding viral hemorrhagic fever, has received and cared for patients with EVD since the beginning of the outbreak in Sierra Leone in May 2014. 

Methods 

We reviewed available epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed between May 25 and June 18, 2014. We used quantitative reverse-transcriptase-polymerase-chain-reaction assays to assess the load of Ebola virus (EBOV, Zaire species) in a subgroup of patients. 

Results 

Of 106 patients in whom EVD was diagnosed, 87 had a known outcome, and 44 had detailed clinical information available. The incubation period was estimated to be 6 to 12 days, and the case fatality rate was 74%. Common findings at presentation included fever (in 89% of the patients), headache (in 80%), weakness (in 66%), dizziness (in 60%), diarrhea (in 51%), abdominal pain (in 40%), and vomiting (in 34%). Clinical and laboratory factors at presentation that were associated with a fatal outcome included fever, weakness, dizziness, diarrhea, and elevated levels of blood urea nitrogen, aspartate aminotransferase, and creatinine. Exploratory analyses indicated that patients under the age of 21 years had a lower case fatality rate than those over the age of 45 years (57% vs. 94%, P=0.03), and patients presenting with fewer than 100,000 EBOV copies per milliliter had a lower case fatality rate than those with 10 million EBOV copies per milliliter or more (33% vs. 94%, P=0.003). Bleeding occurred in only 1 patient. 

Conclusions 

The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common.

Being prepared: bioterrorism and mass prophylaxis. Parts 1 and 2

Adv Emerg Nurs J. 2014 Jul-Sep;36(3):226-38; quiz 239-40. doi: 10.1097/TME.0000000000000029.

Being prepared: bioterrorism and mass prophylaxis: part I.

Weant KA1, Bailey AM, Fleishaker EL, Justice SB.

Author information

• 1North Carolina Public Health Preparedness and Response, North Carolina Department of Health and Human Services, Raleigh (Dr Weant); University of Kentucky HealthCare, Departments of Pharmacy Services and Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington (Drs Bailey and Justice and Ms Fleishaker).

Abstract

Bioterrorism presents a real and omnipresent risk to public health throughout the world. More than 30 biological agents have been identified as possessing the potential to be deployed in a bioterrorist attack. Those that have been determined to be of the greatest concern and possess the greatest potential of use in this arena are known as the Category A agents: Bacillus anthracis (anthrax); Variola major (smallpox); Yersinia pestis (plague); Francisella tularensis (tularemia); viral hemorrhagic fevers; and Clostridium botulinum toxin (botulism toxin). Although the Centers for Disease Control and Prevention utilizes surveillance systems to identify illnesses, the weight of diagnosing, effectively treating, and notifying the appropriate public health officials lies squarely on the shoulders of emergency care personnel. Part I of this two-part review will focus on the clinical presentation and treatment of anthrax, plague, and tularemia. The subsequent Part II of this review will discuss smallpox, viral hemorrhagic fevers, botulism toxin, and the provision of mass prophylaxis.

Adv Emerg Nurs J. 2014 October/December;36(4):307-317.

Being Prepared: Bioterrorism and Mass Prophylaxis: Part II.

Weant KA1, Bailey AM, Fleishaker EL, Justice SB.

Author information

• 1KentuckyOne Health, University of Louisville, Louisville, Kentucky (Dr Weant); University of Kentucky HealthCare, Departments of Pharmacy Services and Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington (Drs Bailey, and Fleishaker); and Charleston Area Medical Center, Department of Pharmacy, Charleston, West Virginia (Dr Justice).

Abstract

Although several biological agents have been recognized as presenting a significant threat to public health if used in a bioterrorist attack, those that are of greatest importance are known as the Category A agents: Bacillus anthracis (anthrax); variola major (smallpox); Yersinia pestis (plague); Francisella tularensis (tularemia); ribonucleic acid viruses (hemorrhagic fevers); and Clostridium botulinum (botulism toxin). In the previous issue, Part I of this review focused on the clinical presentation and treatment of anthrax, plague, and tularemia. In this second part of this 2-part review of these agents, the focus is on the clinical presentation and treatment of smallpox, viral hemorrhagic fevers, and botulism toxin. The utilization of mass prophylaxis to limit the morbidity and mortality associated with all these agents is also discussed along with the role emergency care personnel play in its implementation.

From Harvard and Mayo Clinic: Triage Management, Survival, and the Law in the Age of Ebola

Disaster Med Public Health Prep. 2014 Oct 24:1-6. [Epub ahead of print]

Triage Management, Survival, and the Law in the Age of Ebola.

Burkle FM1, Burkle CM2.

Author information

• 11Harvard Humanitarian Initiative,Harvard University,Cambridge,Massachusetts, and Woodrow Wilson International Center for Scholars,Washington,DC. 
• 22Mayo Graduate School of Medicine,Mayo Clinic,Rochester,Minnesota.

Abstract

Liberia, Sierra Leone, and Guinea lack the public health infrastructure, economic stability, and overall governance to stem the spread of Ebola. Even with robust outside assistance, the epidemiological data have not improved. Vital resource management is haphazard and left to the discretion of individual Ebola treatment units. Only recently has the International Health Regulations (IHR) and World Health Organization (WHO) declared Ebola a Public Health Emergency of International Concern, making this crisis their fifth ongoing level 3 emergency. In particular, the WHO has been severely compromised by post-2003 severe acute respiratory syndrome (SARS) staffing, budget cuts, a weakened IHR treaty, and no unambiguous legal mandate. Population-based triage management under a central authority is indicated to control the transmission and ensure fair and decisive resource allocation across all triage categories. The shared responsibilities critical to global health solutions must be realized and the rightful attention, sustained resources, and properly placed legal authority be assured within the WHO, the IHR, and the vulnerable nations. 

Disaster Med Public Health Prep. 2014 Oct 29:1-2. [Epub ahead of print]

Ebola Triage Screening and Public Health: The New "Vital Sign Zero"

Koenig KL.

Author information

• Center for Disaster Medical Sciences,University of California at Irvine,Orange,California.

Abstract

During public health emergencies of international concern such as the 2014 Ebola event, health care leaders need to educate clinicians on the front lines to make uncomfortable, but real triage decisions that focus on optimization of population health outcomes over individual care. Health care workers must consider their own protection first before direct contact with potentially contagious patients. In an era of globalization and emerging infectious disease, routine triage including evaluation of the standard vital signs must shift to include public health considerations with immediate consequences. A new "vital sign zero" should be taken at the time of initial patient evaluation to assess for risk and exposure to potentially contagious infectious diseases.

From U Louisville: The Moral Challenge of Ebola

Am J Public Health. 2014 Oct 29:e1-e3. [Epub ahead of print]

The Moral Challenge of Ebola.

Rothstein MA.

Author information

• Mark A. Rothstein is with the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, Louisville, KY. He is also a Department Editor for the American Journal of Public Health.

Abstract

The Ebola epidemic continues largely unabated in West Africa, and the first few cases have spread to the United States and Europe. Especially in Guinea, Liberia, and Sierra Leone, Ebola poses an existential threat. The dread, despair, and death from Ebola are rampaging in these countries with their grossly inadequate health care and public health systems, precarious economies, and besieged governments. In these developing countries of West Africa, as well as in the developed countries where the infection has spread, Ebola poses a moral challenge to both individuals and societies. Foundational moral considerations should play a key role in public health decision-making to bring Ebola under control in an expeditious and just manner, as well as to prepare for the inevitable infectious disease outbreaks of the future.

Krauthammer questions role of science in Ebola response

Q Rev Biophys. 2014 Sep 16:1-79. [Epub ahead of print]

Frustration in biomolecules.

Ferreiro DU1, Komives EA2, Wolynes PG3.

Author information

• 1Protein Physiology Lab,Dep de Química Biológica,Facultad de Ciencias Exactas y Naturales,UBA-CONICET-IQUIBICEN,Buenos Aires,Argentina.
• 2Department of Chemistry and Biochemistry,University of California San Diego,La Jolla,CA 92093,USA.
• 3Department of Physics,Department of Chemistry, andCenter for Theoretical Biological Physics, Rice University,Houston,TX 77005,USA.

Abstract

Biomolecules are the prime information processing elements of living matter. Most of these inanimate systems are polymers that compute their own structures and dynamics using as input seemingly random character strings of their sequence, following which they coalesce and perform integrated cellular functions. In large computational systems with finite interaction-codes, the appearance of conflicting goals is inevitable. Simple conflicting forces can lead to quite complex structures and behaviors, leading to the concept of frustration in condensed matter. We present here some basic ideas about frustration in biomolecules and how the frustration concept leads to a better appreciation of many aspects of the architecture of biomolecules, and especially how biomolecular structure connects to function by means of localized frustration. These ideas are simultaneously both seductively simple and perilously subtle to grasp completely. The energy landscape theory of protein folding provides a framework for quantifyingfrustration in large systems and has been implemented at many levels of description. We first review the notion of frustration from the areas of abstract logic and its uses in simple condensed matter systems. We discuss then how the frustration concept applies specifically to heteropolymers, testing folding landscape theory in computer simulations of protein models and in experimentally accessible systems. Studying the aspects offrustration averaged over many proteins provides ways to infer energy functions useful for reliable structure prediction. We discuss how frustrationaffects folding mechanisms. We review here how the biological functions of proteins are related to subtle local physical frustration effects and howfrustration influences the appearance of metastable states, the nature of binding processes, catalysis and allosteric transitions. In this review, we also emphasize that frustration, far from being always a bad thing, is an essential feature of biomolecules that allows dynamics to be harnessed for function. In this way, we hope to illustrate how Frustration is a fundamental concept in molecular biology.

"Unlike Payne, Kromah continues to struggle to be accepted in his community and does not know when the stigmatization will end."

This Man Lost 35 Relatives to Ebola and His Community Wants Him Gone

He lost his wife, his son, and his daughter in a Liberian Ebola ward—along with 31 other family members—and now even his neighbors have turned against him.

From MD Anderson: Stress and Morale of Academic Biomedical Scientists

Acad Med. 2014 Oct 21. [Epub ahead of print]

Stress and Morale of Academic Biomedical Scientists.

Holleman WL1, Cofta-Woerpel LM, Gritz ER.

Author information

• 1Dr. Holleman is professor, Department of Behavioral Science, and director, Faculty Health & Well-Being Program, University of Texas MD Anderson Cancer Center, Houston, Texas. Dr. Cofta-Woerpel is assistant professor, Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas. Dr. Gritz is professor and chair, Department of Behavioral Science, and Olla S. Stribling Distinguished Chair for Cancer Research, University of Texas MD Anderson Cancer Center, Houston, Texas.

Abstract

Extensive research has shown high rates of burnout among physicians, including those who work in academic health centers. Little is known, however, about stress, burnout, and morale of academic biomedical scientists. The authors interviewed department chairs at one U.S. institution and were told that morale has plummeted in the past five years. Chairs identified three major sources of stress: fear of not maintaining sufficient funding to keep their positions and sustain a career; frustration over the amount of time spent doing paperwork and administrative duties; and distrust due to an increasingly adversarial relationship with the executive leadership.In this Commentary, the authors explore whether declining morale and concerns about funding, bureaucracy, and faculty-administration conflict are part of a larger national pattern. The authors also suggest ways that the federal government, research sponsors, and academic institutions can address these concerns and thereby reduce stress and burnout, increase productivity, and improve overall morale of academic biomedical scientists.

From Wash U: Clinical next-generation sequencing in patients with non-small cell lung cancer

Cancer. 2014 Oct 24. doi: 10.1002/cncr.29089. [Epub ahead of print]

Clinical next-generation sequencing in patients with non-small cell lung cancer.

Hagemann IS1, Devarakonda S, Lockwood CM, Spencer DH, Guebert K, Bredemeyer AJ, Al-Kateb H, Nguyen TT, Duncavage EJ, Cottrell CE, Kulkarni S,Nagarajan R, Seibert K, Baggstrom M, Waqar SN, Pfeifer JD, Morgensztern D, Govindan R.

Author information

• 1Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University, St. Louis, Missouri.

Abstract

BACKGROUND:

A clinical assay was implemented to perform next-generation sequencing (NGS) of genes commonly mutated in multiple cancertypes. This report describes the feasibility and diagnostic yield of this assay in 381 consecutive patients with non-small cell lung cancer (NSCLC).

METHODS:

Clinical targeted sequencing of 23 genes was performed with DNA from formalin-fixed, paraffin-embedded (FFPE) tumor tissue. The assay used Agilent SureSelect hybrid capture followed by Illumina HiSeq 2000, MiSeq, or HiSeq 2500 sequencing in a College of American Pathologists-accredited, Clinical Laboratory Improvement Amendments-certified laboratory. Single-nucleotide variants and insertion/deletion events were reported. This assay was performed before methods were developed to detect rearrangements by NGS.

RESULTS:

Two hundred nine of all requisitioned samples (55%) were successfully sequenced. The most common reason for not performing the sequencing was an insufficient quantity of tissue available in the blocks (29%). Excisional, endoscopic, and core biopsy specimens were sufficient for testing in 95%, 66%, and 40% of the cases, respectively. The median turnaround time (TAT) in the pathology laboratory was 21 days, and there was a trend of an improved TAT with more rapid sequencing platforms. Sequencing yielded a mean coverage of 1318×. Potentially actionable mutations (ie, predictive or prognostic) were identified in 46% of 209 samples and were most commonly found in KRAS (28%), epidermal growth factor receptor (14%), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (4%), phosphatase and tensin homolog (1%), and BRAF (1%). Five percent of the samples had multiple actionable mutations. A targeted therapy was instituted on the basis of NGS in 11% of the sequenced patients or in 6% of all patients.

CONCLUSIONS:

NGS-based diagnostics are feasible in NSCLC and provide clinically relevant information from readily available FFPE tissue. The sample type is associated with the probability of successful testing. 

Front Oncol. 2014 Oct 13;4:229. doi: 10.3389/fonc.2014.00229. eCollection 2014.

Role of radiotherapy in metastatic non-small cell lung cancer.

Faria SL.

Author information

• Department of Radiation Oncology, McGill University Health Centre, Montreal General Hospital , Montreal, QC , Canada.

Abstract

Radiotherapy has had important role in the palliation of NSCLC. Randomized trials tend to suggest that, in general, short regimens give similar palliation and toxicity compared to longer regimens. The benefit of combining chemotherapy to radiosensitize the palliative radiation treatment is an open question, but so far it has not been proved to be very useful in NSCLC. The addition of molecular targeted drugs to radiotherapy outside of approved regimens or clinical trials warrants careful consideration for every single case and probably should not be used as a routine management. Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) are modern techniques being used each time more frequently in the treatment of single or oligometastases. In general, they offer good tumor control with little toxicity (with a more expensive cost) compared to the traditionally fractionated radiotherapy regimens.

PLoS One. 2014 Oct 16;9(10):e110851. doi: 10.1371/journal.pone.0110851. eCollection 2014.

Triclosan potentiates epithelial-to-mesenchymal transition in anoikis-resistant human lung cancer cells.

Winitthana T1, Lawanprasert S1, Chanvorachote P2.

Author information

• 1Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.
• 2Department of Pharmacology and Physiology, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand; Cell-Based Drug and Health Product Development Research Unit, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.

Abstract

Alteration of cancer cell toward mesenchymal phenotype has been shown to potentiate tumor aggressiveness by increasing cancer cell metastasis. Herein, we report the effect of triclosan, a widely used antibacterial agent found in many daily products, in enhancing the epithelial-to-mesenchymal transition (EMT) in aggressive anoikis resistant human H460 lung cancer cells. EMT has been long known to increase abilities of the cells to increase migration, invasion, and survival in circulating system. The present study reveals that treatment of the cancer cells with triclosan at the physiologically related concentrations significantly increased the colony number of the cancer cells assessed by tumor formation assay. Also, the mesenchymal-like morphology and decrease in cell-to-cell adhesion were observed in triclosan-treated cells. Importantly, western blot analysis revealed that triclosan-treated cells exhibited decreased E-cadherin, while the levels of EMT markers, namely N-cadherin, vimentin, snail and slug were found to be significantly up-regulated. Furthermore, EMT induced by triclosan treatment was accompanied by the activation of focal adhesion kinase/ATP dependent tyrosine kinase (FAK/Akt) and Ras-related C3 botulinum toxin substrate 1 (Rac1), which enhanced the ability of the cells to migrate and invade. In conclusion, we demonstrated for the first time that triclosan may potentiate cancer cells survival in detached condition and motility via the process of EMT. As mentioned capabilities are required for success in metastasis, the present study provides the novel toxicological information and encourages the awareness of triclosan use in cancer patients.

J Genet Couns. 2014 Oct 29. [Epub ahead of print]

Ethical Considerations in Biobanks: How a Public Health Ethics Perspective Sheds New Light on Old Controversies.

Virani AH1, Longstaff H.

Author information

• 1Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6T 1Z2, Canada, alice.virani@cw.bc.ca.

Abstract

Biobanks, collections of biospecimens with or without linked medical data, have increased dramatically in number in the last two decades. Their potential power to identify the underlying mechanisms of both rare and common disease has catalyzed their proliferation in the academic, medical, and private sectors. Despite demonstrated public support of biobanks, some within the academic, governmental, and public realms have also expressed cautions associated with the ethical, legal, and social (ELSI) implications of biobanks. These issues include concerns related to the privacy and confidentiality of data; return of results and incidental findings to participants; data sharing and secondary use of samples; informed consent mechanisms; ownership of specimens; and benefit sharing (i.e., the distribution of financial or other assets that result from the research). Such apprehensions become amplified as more researchers seek to pursue national and cross-border collaborations between biobanks. This paper provides an overview of two of the most contentious topics in biobank literature -informed consent and return of individual research results or incidental findings - and explores how a public health ethics lens may help to shed new light on how these issues may be best approached and managed. Doing so also demonstrates the important role that genetic counselors can play in the ongoing discussion of ethically appropriate biobank recruitment and management strategies, as well as identifies important areas of ongoing empirical research on these unresolved topics.

"I Can't Eat if I Don't Plass"

HEC Forum. 2014 Oct 28. [Epub ahead of print]

"I Can't Eat if I Don't Plass": Impoverished Plasma Donors, Alternatives, and Autonomy.

Weimer S.

Author information

• Department of English and Philosophy, Arkansas State University, P.O. Box 1890, Jonesboro, AR, 72467, USA, sweimer@astate.edu.

Abstract

One of the central considerations to be taken into account in evaluating the ethics of compensation for donated plasma is respect for donor autonomy. And one of the main arguments against compensated donation systems is that many donors do or would come from circumstances of poverty that restrict their alternatives in a way that compromises those donors' autonomy. In this paper, I develop and defend a novel version of this "compromised autonomy argument" which improves upon extant versions by employing a more nuanced account of the relationship between alternatives and autonomy. According to the version of that argument I offer, donors lack autonomy with respect to the sale of their plasma if their economic circumstances leave them with no choice but to sell their plasma (i.e., "plass") on the basis of a desire they have had no choice but to hold. After explicating the key terms of this argument, I examine its policy implications. I argue that, given several reasonable empirical assumptions, my argument implies that a majority of individuals whose income falls below a specified threshold would indeed lack autonomy with respect to the sale of their plasma. Most individuals whose income falls above that threshold, on the other hand, would be able to autonomously sell their plasma. I argue that respect for donor autonomy therefore speaks in favor of an income-restricted system of compensated donation which permits collection centers to purchase plasma from those whose income falls above the relevant threshold, but not those below it.