Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy? [or none of them...]

J BUON. 2015 Mar-Apr;20(2):376-80.

Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy, pleurectomy/decortication or extended pleurectomy?

Hountis P1, Chounti M, Matthaios D, Romanidis K, Moraitis S.

Author information

• 1Department of Thoracic and Cardiovascular Surgery, Athens Naval and Veterans Hospital, Athens, Greece.

Abstract

Malignant pleural mesothelioma (MPM) is an asbestos-related disease with a dismal prognosis. Ethic, social, legal and economic parameters are implicated in its management. It is quite clear that multimodality therapy is necessary to improve long-term results but precise treatment schemes have not yet been equivocally accepted. The extent of surgery is questioned and radical operations are highly debatable. On the other hand, debulking or cyto-reductive surgery have been also proposed within a multimodality approach. However, the role and order of adjuvant or neoadjuvant use of chemotherapy, radiotherapy and surgery has not been established. The aim of this study was to analyze contemporary studies on the impact of different surgical approaches on outcome of patients with MPM.

Curr Stem Cell Res Ther. 2015 May 28. [Epub ahead of print]

An update on human stem cell-based therapy in Parkinson`s disease.

Gonzalez C, Bonilla S, Flores AI, Cano E, Liste I1.

Author information

• 1Unidad de Regeneracion Neural, Unidad Funcional de Investigacion de Enfermedades Cronicas. Instituto de Salud Carlos III (ISCIII) 28220 Majadahonda, Madrid, Spain. iliste@isciii.es.

Abstract

Parkinson `s disease (PD) is the second most common neurodegenerative disorder after Alzheimer`s disease and it is characterized by the progressive loss of dopaminergic neurons of the substantia nigra pars compacta (SNpc). Current pharmacological treatments for PD are only symptomatic and unfortunately there is still no cure for this disorder. Stem cell technology has become an attractive option to investigate and treat PD. Indeed, transplantation of fetal ventral mesencephalic cells into PD brains have provided proof of concept that cell replacement therapy can be beneficial for some patients, greatly improving their motor symptoms. However, ethical and practical aspects of tissue availability limit its widespread clinical use. Hence, the need of alternative cell sources based on the use of different types of stem cells. Stem cell-based therapies can be beneficial by acting through several mechanisms such as cell replacement, trophic actions and modulation of inflammation. Here we review recent and current remarkable clinical studies involving stem cell-based therapy for PD and provide an overview of the different types of stem cells available nowadays, their main properties and how they are developing as a possible therapy for PD treatment.

Inactivity is putting kids as young as 15 at risk of obesity, heart disease and Type 2 diabetes

Inactivity is putting kids as young as 15 at risk of obesity, heart disease and Type 2 diabetes


"The study provided clear evidence that the negative effects of inactivity in childhood are evident well before adulthood, he said."

Clin Teach. 2015 May 28. doi: 10.1111/tct.12378. [Epub ahead of print]

Teaching telehealth consultation skills.

Rienits H1, Teuss G1, Bonney A1.

Author information

• 1Graduate School of Medicine, University of Wollongong, New South Wales, Australia.

Abstract

BACKGROUND:

Although teleconsultations have been used for many years in Australia, there has been a recent increase following new government incentives. There is a paucity of literature on enabling medical students to acquire the relevant skills. With a focus on equipping students for practice in rural and remote areas, our medical school has developed an innovative clinical skills lesson to prepare our students for their rural practice placements.

METHODS:

This lesson was delivered to all students in their third year of training in small groups to enable interactive learning. The objectives of the lesson were to familiarise students with: the various methods of conducting teleconsultations currently in use; the legal and ethical considerations; the technical and procedural issues; and the barriers and benefits for patients and doctors. Students rotated through four different stations over 2 hours and the lesson was evaluated using a student survey.

RESULTS:

Medical students self-reported statistically significant improvements in understanding the issues and procedures, and in confidence in conducting a telehealth consultation.

DISCUSSION:

Analysis of the results and student comments demonstrated that students recognise the value of telemedicine learning, and benefit from formal teaching on all aspects of telemedicine, including technology, ethics and protocols. Interestingly, the students found the opportunity to discuss areas such as the ethics of, and barriers to, the use of teleconsultations to be the most challenging and helpful of all of the stations. There is a paucity of literature on enabling medical students to acquire the relevant [teleconsultation] skills.

Int J Adolesc Youth. 2015 Apr 3;20(2):131-147. Epub 2014 Dec 10.

Teen responses when a younger school-age sibling has been bullied.

Honig AS1, Zdunowski-Sjoblom N2.

Author information

• 1Department of Child and family Studies, Syracuse University , Syracuse , NY , USA.
• 2Horsham Clinic , Philadelphia , PA , USA.

Abstract

The prevalence of bullying among children, and the sometimes tragic consequences as a result, has become a major concern in schools. The larger research for this study reported on in-depth interviews with 28 elementary and middle school-age boys and girls (7-12 years) who had experienced various forms of bullying and relational aggression by their peers, mostly on school grounds, and the responses of their parents and teachers. Responses of the children's teen siblings to the younger child's revelations of being bullied are the focus of this report. In-depth interviews with each teen sibling (n = 28) and with each bullied child revealed how the children viewed the teen siblings' supportive strategies. Almost all the children (89%) reported that their older siblings talked with them and offered advice. The teen siblings shared with the younger ones that they too (71%) had been bullied, or they knew someone who had been bullied (18%). Teens gave the advice to 'bully back' to 11% and advice to 'tell someone' to 32% of the younger children. The children felt quite positive about their older siblings' advice (89%), which did differ depending on the bullied child's gender. Teen siblings gave advice to 'avoid bullies' to 77% of female and to 27% of male younger children.

Dev Psychol. 2015 May 11. [Epub ahead of print]

Classroom Norms of Bullying Alter the Degree to Which Children Defend in Response to Their Affective Empathy and Power.

Peets K, Pöyhönen V, Juvonen J, Salmivalli C.

Abstract

This study examined whether the degree to which bullying is normative in the classroom would moderate associations between intra- (cognitive and affective empathy, self-efficacy beliefs) and interpersonal (popularity) factors and defending behavior. Participants were 6,708 third- to fifth-grade children (49% boys; Mage = 11 years) from 383 classrooms. Multilevel modeling analyses revealed that children were more likely to defend in response to their affective empathy in classrooms with high levels of bullying. In addition, popular students were more likely to support victims in classrooms where bullying was associated with social costs. These findings highlight the importance of considering interactions among individual and contextual influences when trying to understand which factors facilitate versus inhibit children's inclinations to defend others.

Am Psychol. 2015 May-Jun;70(4):311-321.

A relational framework for understanding bullying: Developmental antecedents and outcomes.

Rodkin PC1, Espelage DL1, Hanish LD2.

Author information

• 1Department of Educational Psychology.
• 2T. Denny Sanford School of Social and Family Dynamics, Arizona State University.

Abstract

This article reviews current research on the relational processes involved in peer bullying, considering developmental antecedents and long-term consequences. The following themes are highlighted: (a) aggression can be both adaptive and maladaptive, and this distinction has implications for bullies' functioning within peer social ecologies; (b) developmental antecedents and long-term consequences of bullying have not been well-distinguished from the extant research on aggressive behavior; (c) bullying is aggression that operates within relationships of power and abuse. Power asymmetry and repetition elements of traditional bullying definitions have been hard to operationalize, but without these specifications and more dyadic measurement approaches there may be little rationale for a distinct literature on bullying-separate from aggression. Applications of a relational approach to bullying are provided using gender as an example. Implications for future research are drawn from the study of relationships and interpersonal theories of developmental psychopathology. 

Am Psychol. 2015 May-Jun;70(4):322-332.

Translating research to practice in bullying prevention.

Bradshaw CP1.

Author information

• 1University of Virginia.

Abstract

Bullying continues to be a concern in schools and communities across the United States and worldwide, yet there is uncertainty regarding the most effective approaches for preventing it and addressing its impacts on children and youth. This paper synthesizes findings from a series of studies and meta-analyses examining the efficacy of bullying prevention programs. This paper considers some methodological issues encountered when testing the efficacy and effectiveness of bullying prevention and intervention approaches. It also identifies several areas requiring additional research in order to increase the effectiveness of bullying prevention efforts in real-world settings. Drawing upon a public health perspective and findings from the field of prevention science, this paper aims to inform potential future directions for enhancing the adoption, high quality implementation, and dissemination of evidence-based bullying prevention programs. It is concluded that althoughbullying prevention programs can be effective in reducing bullying and victimization among school-aged youth, there is a great need for more work to increase the acceptability, fidelity, and sustainability of the existing programs in order to improve bullying-related outcomes for youth. The findings from this review are intended to inform both policy and public health practice related to bullying prevention. 

Am Psychol. 2015 May-Jun;70(4):333-343.

Law and policy on the concept of bullying at school.

Cornell D1, Limber SP2.

Author information

• 1Curry School of Education.
• 2Institute on Family & Neighborhood Life, Clemson University.

Abstract

The nationwide effort to reduce bullying in U.S. schools can be regarded as part of larger civil and human rights movements that have provided children with many of the rights afforded to adult citizens, including protection from harm in the workplace. Many bullied children find that their schools are hostile environments, but civil rights protections against harassment apply only to children who fall into protected classes, such as racial and ethnic minorities, students with disabilities, and victims of gender harassment or religious discrimination. This article identifies the conceptual challenges that bullying poses for legal and policy efforts, reviews judicial and legislative efforts to reduce bullying, and makes some recommendations for school policy. Recognition that all children have a right to public education would be one avenue for broadening protection against bullying to all children. 

Am Psychol. 2015 May-Jun;70(4):344-353.

Understanding the psychology of bullying: Moving toward a social-ecological diathesis-stress model.

Swearer SM1, Hymel S2.

Author information

• 1Department of Educational Psychology.
• 2Faculty of Education, Department of Educational and Counselling Psychology and Special Education, University of British Columbia.

Abstract

With growing recognition that bullying is a complex phenomenon, influenced by multiple factors, research findings to date have been understood within a social-ecological framework. Consistent with this model, we review research on the known correlates and contributing factors in bullying/victimization within the individual, family, peer group, school and community. Recognizing the fluid and dynamic nature of involvement in bullying, we then expand on this model and consider research on the consequences of bullying involvement, as either victim or bully or both, and propose a social-ecological, diathesis-stress model for understanding the bullying dynamic and its impact. Specifically, we frame involvement in bullying as a stressful life event for both children who bully and those who are victimized, serving as a catalyst for a diathesis-stress connection between bullying, victimization, and psychosocial difficulties. Against this backdrop, we suggest that effectivebullying prevention and intervention efforts must take into account the complexities of the human experience, addressing both individual characteristics and history of involvement in bullying, risk and protective factors, and the contexts in which bullying occurs, in order to promote healthier social relationships. 

Am Psychol. 2015 May-Jun;70(4):293-299.

Four decades of research on school bullying: An introduction.

Hymel S1, Swearer SM2.

Author information

• 1Faculty of Education, Department of Educational and Counselling Psychology and Special Education.
• 2Faculty of Education, Department of Educational Psychology, University of Nebraska-Lincoln.

Abstract

This article provides an introductory overview of findings from the past 40 years of research on bullying among school-aged children and youth. Research on definitional and assessment issues in studying bullying and victimization is reviewed, and data on prevalence rates, stability, and forms of bullying behavior are summarized, setting the stage for the 5 articles that comprise this American Psychologist special issue on bullying and victimization. These articles address bullying, victimization, psychological sequela and consequences, ethical, legal, and theoretical issues facing educators, researchers, and practitioners, and effective prevention and intervention efforts. The goal of this special issue is to provide psychologists with a comprehensive review that documents our current understanding of the complexity of bullying among school-aged youth and directions for future research and intervention efforts. 

Issue Brief (Commonw Fund). 2015 Mar;6:1-11.

The federal medical loss ratio rule: implications for consumers in year 3.

McCue MJ1, Hall MA.

Author information

• 1Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University. mccue@vcu.edu

Abstract

For the past three years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in medical claims or quality improvement expenses--known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2013 were $325 million, less than one-third the amount paid out in 2011, indicating much greater compliance with the MLR rule. Insurers' spending on quality improvement remained low, at less than 1 percent of premiums. Insurers' administrative and sales costs, such as brokers' fees, and profit margins have reduced slightly but remain fairly steady. In the first three years under this regulation, total consumer benefits related to the medical loss ratio--both rebates and reduced overhead--amounted to over $5 billion. This was achieved without a great exodus of insurers from the market.

Should people considered obese be protected by human rights laws?

Should people considered obese be protected by human rights laws?

"He says the other way of protecting people could be banning “appearance bias” — discrimination based on how someone looks.

The number of severely obese Canadians has skyrocketed over the last few decades, and Bogart argues the law needs to keep up with changes in society. He uses changing attitudes toward same-sex marriage and smoking as examples."

"Stepping aside from its awkward and embarrassing rollout and its politically biased claims and counterclaims, the ACA appears to be achieving many of its goals."

Clin Ther. 2015 Apr 7. pii: S0149-2918(15)00144-7. doi: 10.1016/j.clinthera.2015.03.007. [Epub ahead of print]

The Patient Protection and Affordable Care Act: Politics and Pills.

Shader RI.

"Stepping aside from its awkward and embarrassing rollout and its politically biased claims and counterclaims, the ACA appears to be achieving many of its goals. More people are now covered than in the past, and costs are either coming down or are increasing by smaller increments; the Congressional Budget Office indicates both lower premiums and a meaningful contribution to deficit reduction; and there is evidence of innovation, through the creation of 4350 accountable care organizations nationwide.4,5 Contrary to the Republicans’ warning about lengthy waiting periods, a recent article in the New England Journal of Medicine showed that as a consequence of the ACA there has been “…improved appointment availability for Medicaid enrollees among participating providers without generating longer waiting times.”6"

From NYU: How will the Affordable Care Act affect the use of health care services?

Issue Brief (Commonw Fund). 2015 Feb;4:1-15.

How will the Affordable Care Act affect the use of health care services?

Glied S1, Ma S.

Author information

• 1Robert F. Wagner Graduate School of Public Service, New York University.

Abstract

In January 2014, the Affordable Care Act extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. We project that primary care providers will see, on average, 1.34 additional office visits per week, accounting for a 3.8 percent increase in visits nationally. Hospital outpatient departments will see, on average, 1.2 to 11.0 additional visits per week, or an average increase of about 2.6 percent nationally. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand.

BMC Public Health. 2015 Apr 26;15(1):424. [Epub ahead of print]

Perceptions of risk from nanotechnologies and trust in stakeholders: a cross sectional study of public, academic, government and business attitudes.

Capon A1,2, Gillespie J3, Rolfe M4, Smith W5.

Author information

• 1Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia. acap1921@uni.sydney.edu.au.
• 2Environmental Health Branch, Health Protection NSW, 73 Miller St, North Sydney, Sydney, Australia. acap1921@uni.sydney.edu.au.
• 3Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia. james.gillespie@sydney.edu.au.
• 4University Centre for Rural Health, School of Public Health, University of Sydney, Sydney, Australia. margaret.rolfe@sydney.edu.au.
• 5Environmental Health Branch, Health Protection NSW, 73 Miller St, North Sydney, Sydney, Australia. wayne.smith@doh.health.nsw.gov.au.

Abstract

BACKGROUND:

Policy makers and regulators are constantly required to make decisions despite the existence of substantial uncertainty regarding the outcomes of their proposed decisions. Understanding stakeholder views is an essential part of addressing this uncertainty, which provides insight into the possible social reactions and tolerance of unpredictable risks. In the field of nanotechnology, large uncertainties exist regarding the real and perceived risks this technology may have on society. Better evidence is needed to confront this issue.

METHODS:

We undertook a computer assisted telephone interviewing (CATI) survey of the Australian public and a parallel survey of those involved in nanotechnology from the academic, business and government sectors. Analysis included comparisons of proportions and logistic regression techniques. We explored perceptions of nanotechnology risks both to health and in a range of products. We examined views on four trust actors.

RESULTS:

The general public's perception of risk was significantly higher than that expressed by other stakeholders. The public bestows less trust in certain trust actors than do academics or government officers, giving its greatest trust to scientists. Higher levels of public trust were generally associated with lower perceptions of risk. Nanotechnology in food and cosmetics/sunscreens were considered riskier applications irrespective of stakeholder, while familiarity with nanotechnology was associated with a reduced risk perception.

CONCLUSIONS:

Policy makers should consider the disparities in risk and trust perceptions between the public and influential stakeholders, placing greater emphasis on risk communication and the uncertainties of risk assessment in these areas of higher concern. Scientists being the highest trusted group are well placed to communicate the risks of nanotechnologies to the public.

J Med Screen. 2015 Apr 29. pii: 0969141315579119. [Epub ahead of print]

Lung cancer risk by years since quitting in 30+ pack year smokers.

Pinsky PF1, Zhu CS2, Kramer BS2.

Author information

• 1Division of Cancer Prevention, National Cancer Institute pp4f@nih.gov.
• 2Division of Cancer Prevention, National Cancer Institute.

Abstract

OBJECTIVE:

Current United States recommendations for low-dose computed tomography (LDCT) lung cancer screening limit eligibility to ever-smokers with 30+ pack-years, with former smokers eligible only within 15 years of quitting. The 15 year limit is partly based on perceived decreases in lung cancer risk as years since quitting (YSQ) increase. We examine the relationship between lung cancer risk and YSQ among 30+ pack-year former smokers.

METHODS:

In the Prostate, Lung, Colorectal, and Ovarian trial, participants aged 55-74 were randomized to screening or usual care; screened subjects received annual chest-radiographs for lung cancer screening. Subjects completed a baseline questionnaire; smoking history included average cigarettes per day and age at starting and stopping smoking. Subjects were followed 13 years. Cox proportional hazards models were utilized to estimate hazard ratios (HRs) associated with YSQ, with YSQ treated as a time-varying covariate. The models adjusted for age and sex.

RESULTS:

Of 154899 subjects randomized, 27101 were former smokers with 30+ pack-years, and 69182 were never smokers. HRs relative to never smokers ranged from 30.8 (95% CI:23.4-40.5) for YSQ ≤5 to 6.4 (95% CI:5.1-8.0) for YSQ > 30. For YSQ of >10-15, >15-20, and >20-25, HRs were 14.8 (95% CI:11.9-18.2), 13.5 (95% CI:11.3-16.2), and 9.9 (95% CI: 8.1-12.0), respectively.

CONCLUSIONS:

Lung cancer risk decreases gradually with YSQ in 30+ pack year former smokers. A range of upper limits on YSQ may be supportable for LDCT screening.

Account Res. 2015;22(5):249-266.

An International Study of Research Misconduct Policies.

Resnik DB1, Rasmussen LM, Kissling GE.

Author information

• 1a National Institute of Environmental Health Sciences, National Institutes of Health , Research Triangle Park , North Carolina , USA.

Abstract

Research misconduct is an international concern. Misconduct policies can play a crucial role in preventing and policing research misconduct, and many institutions have developed their own policies. While institutional policies play a key role in preventing and policing misconduct, national policies are also important to ensure consistent promulgation and enforcement of ethical standards. The purpose of this study was to obtain more information about research misconduct policies across the globe. We found that twenty-two of the top forty research and development funding countries (55%) had a national misconduct policy. Four countries (18.2%) are in the process of developing a policy, and four (18.2%) have a national research ethics code but no misconduct policy. All twenty-two countries (100%) with national policies included fabrication, falsification, and plagiarism in the definition of misconduct, but beyond that there was considerable diversity. Unethical authorship was mentioned in 54.6% of the misconduct definitions, followed by unethical publication practices (36.4%), conflict of interest mismanagement (36.4%), unethical peer review (31.8%), misconduct related to misconduct investigations (27.3%), poor record keeping (27.3%), other deception (27.3%), serious deviations (22.7%), violating confidentiality (22.7%), and human or animal research violations (22.7%). Having a national policy was positively associated with research and development funding ranking and intensiveness. To promote integrity in international research collaborations, countries should seek to harmonize and clarify misconduct definitions and develop procedures for adjudicating conflicts when harmonization does not occur.

In case you forgot, its Friday.

In case you forgot, its Friday.