Monday, February 20, 2017

CEDAR CREEK, TEXAS

Pecan Pie Vending Machine

A 24-hour vending machine restocked daily with homemade full-sized pecan pies.

Thursday, February 16, 2017

Sunday, February 12, 2017

"...metalloproteinase-9 released by second hand smoke-activated leukocytes may propagate pro-atherogenic alterations in endothelial cells."

2017 Feb 6;12(2):e0171427. doi: 10.1371/journal.pone.0171427. eCollection 2017.

Metalloproteinase-9 contributes to endothelial dysfunction in atherosclerosis via protease activated receptor-1.

Florence JM1, Krupa A1,2, Booshehri LM1, Allen TC3, Kurdowska AK1.

Author information

1Department of Cellular and Molecular Biology, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America.
2Institute of Medical Biology, Polish Academy of Sciences, Lodz, Poland.
3Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America.

Abstract

The atherosclerotic process begins when vascular endothelial cells undergo pro-inflammatory changes such as aberrant activation to dysfunctional phenotypes and apoptosis, leading to loss of vascular integrity. Our laboratory has demonstrated that exposure of mice to second hand smoke triggers an increase in expression of metalloproteinase-9. Further, metalloproteinase-9 released by second hand smoke-activated leukocytes may propagate pro-atherogenic alterations in endothelial cells. We have shown that levels of metalloproteinase-9 were increased in the plasma from apolipoprotein E deficient (ApoE-/-) mice exposed to second hand smoke relative to non-exposed controls. Moreover, we have collected data from two different, but complementary, treatments of second hand smoke exposed atherosclerotic mice. Animals received either cell specific metalloproteinase-9 directed siRNA to minimize metalloproteinase-9 expression in neutrophils and endothelial cells, or a pharmacological inhibitor of Bruton's tyrosine kinase which indirectly limits metalloproteinase-9 production in neutrophils. These treatments reduced atherosclerotic changes in mice and improved overall vascular health. We also demonstrated that metalloproteinase-9 could activate endothelial cells and induce their apoptosis via cleavage of protease activated receptor-1. In summary, better understanding of metalloproteinase-9's pathogenic capabilities as well as novel signaling pathways involved may lead to development of treatments which may provide additional benefits to atherosclerosis patients with a history of second hand smoke exposure.

Saturday, February 11, 2017

"As prenatal screening evolves, so should informed consent and the resources available to women making decisions."

2016 Jul-Sep;2(3):334-342. doi: 10.1016/j.jemep.2016.07.006.

"I think we've got too many tests!": Prenatal providers' reflections on ethical and clinical challenges in the practice integration of cell-free DNA screening.

Gammon BL1, Kraft SA2, Michie M3, Allyse M1.

Author information

1Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
2Stanford University Center for Biomedical Ethics, 1215 Welch Road, Modular A, Stanford, CA 94305, USA.
3UCSF School of Nursing, 3333 Calif. Street, Laurel Heights, San Francisco, CA 94118, USA.

Abstract

in English, Spanish

BACKGROUND:

The recent introduction of cell-free DNA-based non-invasive prenatal screening (cfDNA screening) into clinical practice was expected to revolutionize prenatal testing. cfDNA screening for fetal aneuploidy has demonstrated higher test sensitivity and specificity for some conditions than conventional serum screening and can be conducted early in the pregnancy. However, it is not clear whether and how clinical practices are assimilating this new type of testing into their informed consent and counselling processes. Since the introduction of cfDNA screening into practice in 2011, the uptake and scope have increased dramatically. Prenatal care providers are under pressure to stay up to date with rapidly changing cfDNA screening panels, manage increasing patient demands, and keep up with changing test costs, all while attempting to use the technology responsibly and ethically. While clinical literature on cfDNA screening has shown benefits for specific patient populations, it has also identified significant misunderstandings among providers and patients alike about the power of the technology. The unique features of cfDNA screening, in comparison to established prenatal testing technologies, have implications for informed decision-making and genetic counselling that must be addressed to ensure ethical practice.

OBJECTIVES:

This study explored the experiences of prenatal care providers at the forefront of non-invasive genetic screening in the United States to understand how this testing changes the practice of prenatal medicine. We aimed to learn how the experience of providing and offering this testing differs from established prenatal testing methodologies. These differences may necessitate changes to patient education and consent procedures to maintain ethical practice.

METHODS:

We used the online American Congress of Obstetricians and Gynecologists Physician Directory to identify a systematic sample of five prenatal care providers in each U.S. state and the District of Columbia. Beginning with the lowest zip code in each state, we took every fifth name from the directory, excluding providers who were retired, did not currently practice in the state in which they were listed, or were not involved in a prenatal specialty. After repeating this step twice and sending a total of 461 invitations, 37 providers expressed interest in participating, and we completed telephone interviews with 21 providers (4.6%). We developed a semi-structured interview guide including questions about providers' use of and attitudes toward cfDNA screening. A single interviewer conducted and audio-recorded all interviews by telephone, and the interviews lasted approximately 30 minutes each. We collaboratively developed a codebook through an iterative process of transcript review and code application, and a primary coder coded all transcripts.

RESULTS:

Prenatal care providers have varying perspectives on the advantages of cfDNA screening and express a range of concerns regarding the implementation of cfDNA screening in practice. While providers agreed on several advantages of cfDNA, including increased accuracy, earlier return of results, and decreased risk of complications, many expressed concern that there is not enough time to adequately counsel and educate patients on their prenatal screening and testing options. Providers also agreed that demand for cfDNA screening has increased and expressed a desire for more information from professional societies, labs, and publications. Providers disagreed about the healthcare implications and future of cfDNA screening. Some providers anticipated that cfDNA screening would decrease healthcare costs when implemented widely and expressed optimism for expanded cfDNA screening panels. Others were concerned that cfDNA screening would increase costs over time and questioned whether the expansion to include microdeletions could be done ethically.

CONCLUSIONS:

The perspectives and experiences of the providers in this study allow insight into the clinical benefit, burden on prenatal practice, and potential future of cfDNA screening in clinical practice. Given the likelihood that the scope and uptake of cfDNA screening will continue to increase, it is essential to consider how these changes will affect frontline prenatal care providers and, in turn, patients. Providers' requests for additional guidance and data as well as their concerns with the lack of time available to explain screening and testing options indicate significant potential issues with patient care. It is important to ensure that the clinical integration of cfDNA screening is managed responsibly and ethically before it expands further, exacerbating pre-existing issues. As prenatal screening evolves, so should informed consent and the resources available to women making decisions. The field must take steps to maximize the advantages of cfDNA screening and responsibly manage its ethical issues.

Marty Robbin's beautiful El Paso

Obesity And The But-For Test Under The ADAAA

Weighty Issues: Obesity And The But-For Test Under The ADAAA

"Noting that “there is no controlling Ninth Circuit precedent on whether morbid obesity is a recognized disability,” the court considered, and ultimately followed, case law from the Eighth, Sixth, and Second Circuits holding that obesity can only be considered a disability under the ADAAA when it is both outside the normal range and occurs as the result of a physiological disorder."

"...despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive."

The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.

Editors

National Academies of Sciences, Engineering, and Medicine (US); Health and Medicine Division (US); Board on Population Health and Public Health Practice (US); Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda (US).

Source

Washington (DC): National Academies Press (US); 2017.
The National Academies Collection: Reports funded by National Institutes of Health.

Excerpt

Significant changes have taken place in the policy landscape surrounding cannabis legalization, production, and use. During the past 20 years, 25 states and the District of Columbia have legalized cannabis and/or cannabidiol (a component of cannabis) for medical conditions or retail sales at the state level and 4 states have legalized both the medical and recreational use of cannabis. These landmark changes in policy have impacted cannabis use patterns and perceived levels of risk. However, despite this changing landscape, evidence regarding the short- and long-term health effects of cannabis use remains elusive. While a myriad of studies have examined cannabis use in all its various forms, often these research conclusions are not appropriately synthesized, translated for, or communicated to policy makers, health care providers, state health officials, or other stakeholders who have been charged with influencing and enacting policies, procedures, and laws related to cannabis use. Unlike other controlled substances such as alcohol or tobacco, no accepted standards for safe use or appropriate dose are available to help guide individuals as they make choices regarding the issues of if, when, where, and how to use cannabis safely and, in regard to therapeutic uses, effectively. Shifting public sentiment, conflicting and impeded scientific research, and legislative battles have fueled the debate about what, if any, harms or benefits can be attributed to the use of cannabis or its derivatives, and this lack of aggregated knowledge has broad public health implications. The Health Effects of Cannabis and Cannabinoids provides a comprehensive review of scientific evidence related to the health effects and potential therapeutic benefits of cannabis. This report provides a research agenda—outlining gaps in current knowledge and opportunities for providing additional insight into these issues—that summarizes and prioritizes pressing research needs.

Friday, February 10, 2017

Metalloproteinase-9 contributes to endothelial dysfunction in atherosclerosis via protease activated receptor-1

2017 Feb 6;12(2):e0171427. doi: 10.1371/journal.pone.0171427. eCollection 2017.

Metalloproteinase-9 contributes to endothelial dysfunction in atherosclerosis via protease activated receptor-1.

Florence JM1, Krupa A1,2, Booshehri LM1, Allen TC3, Kurdowska AK1.

Author information

1Department of Cellular and Molecular Biology, University of Texas Health Science Center at Tyler, Tyler, Texas, United States of America.
2Institute of Medical Biology, Polish Academy of Sciences, Lodz, Poland.
3Department of Pathology, University of Texas Medical Branch, Galveston, Texas, United States of America.

Abstract

Monday, February 6, 2017

"Chocolate slice": the new smoking?

MOM IS SHAMED BY PRESCHOOL FOR PACKING “UNHEALTHY” LUNCH

KAREN JOHNSON

"This school’s note seems to be a couple steps beyond that line. Yet, despite the negative reactions that the school went too far, this incident is not unique. In 2015, a mom in Colorado was shamed from sending a package of Oreos in her child’s lunch. Another report says a child’s Goldfish crackers were taken away as they were deemed an unhealthy choice for school.

I do understand that kids need proper nutrition in order to learn every day, but maybe not so extreme. And while school districts usually have food guidelines and restrictions established, they should do their best to ensure that parents know the rules before the school year starts so they aren’t caught unaware. This way, parents like me will know to save our kids’ fruit snacks for after school so we all don’t get an angry note sent home in a lunchbox."

"It does also appear that it is possible to be 'too nice'."

Why always being nice WON'T make you happy: Researchers warn it can leave people overburdened - and say simply not getting angry is better

Being altruistic been linked to higher satisfaction with life and happiness
There are also positive relationships between altruism and physical health
But the story doesn't end here, it also appears that it is possible to be 'too nice'
This is clearest when people become overburdened with caring for others
This situation can lead to stress, burnout and poor mental health

By Cecile Borkhataria For Dailymail.com

PUBLISHED: 12:14 EST, 6 February 2017

This suggests that the costs of being nice are ultimately outweighed by its numerous advantages.

The story doesn't end there, however.

It does also appear that it is possible to be 'too nice'.

This is clearest in instances where people become overburdened with the need to care for or provide for others.

This situation can lead to stress, burnout and poor mental health.

It is commonly observed in people who help others for a living, such as healthcare professionals and hospice caregivers, but it can be seen among those who spend a lot of time helping others in their personal lives too.

Striking a balance between helping others and looking after your personal well-being is important, although not always easy.

"A study from Queen's University Belfast has found that common herbal supplements may be doing more harm than good."

New study shows hidden dangers in supplements

Researchers have discovered hidden, illegal ingredients in herbal supplements that could cause serious health risks.

By Amy Wallace | Feb. 6, 2017

Feb. 6 (UPI) -- A study from Queen's University Belfast has found that common herbal supplements may be doing more harm than good.

Researchers found that over-the-counter herbal supplements used to treat obesity and erectile dysfunction are labeled fully herbal but may include dangerous pharmaceutical ingredients not listed on the label.

Epistemic Authority and Genuine Ethical Controversies

2017 Feb 3. doi: 10.1111/bioe.12341. [Epub ahead of print]

Epistemic Authority and Genuine Ethical Controversies.

Roberts AJ.

Abstract

In 'Professional Hubris and its Consequences', Eric Vogelstein claims that 'that there are no good arguments in favor of professional organizations taking genuinely controversial positions on issues of professional ethics'. In this response, I defend two arguments in favour of organisations taking such positions: that their stance-taking may lead to better public policy, and that it may lead to better practice by medical professionals. If either of those defences succeeds, then Vogelstein's easy path to his conclusion - that professional organisations should not take such stances - is blocked. He or others must instead look to establish that the reasons against stance-taking on genuine ethical controversies are more compelling than those for it: plausibly a more challenging task.

Saturday, February 4, 2017

Imaging of Glial Cell Activation and White Matter Integrity in Brains of Active and Recently Retired National Football League Players

2017 Jan 1;74(1):67-74. doi: 10.1001/jamaneurol.2016.3764.

Imaging of Glial Cell Activation and White Matter Integrity in Brains of Active and Recently Retired National Football League Players.

Coughlin JM1, Wang Y2, Minn I2, Bienko N3, Ambinder EB2, Xu X2, Peters ME3, Dougherty JW3, Vranesic M2, Koo SM2, Ahn HH2, Lee M2, Cottrell C3, Sair HI2, Sawa A3, Munro CA4, Nowinski CJ5, Dannals RF2, Lyketsos CG3, Kassiou M6, Smith G3, Caffo B7, Mori S2, Guilarte TR8, Pomper MG1.

Author information

1Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland2Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland.
2Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland.
3Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
4Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland3Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
5Concussion Legacy Foundation, Waltham, Massachusetts5Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, Massachusetts.
6School of Chemistry, University of Sydney, New South Wales, Australia7Discipline of Medical Radiation Sciences, University of Sydney, Sydney, New South Wales, Australia.
7Department of Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland.
8Department of Environmental and Occupational Health, Florida International University, Miami10Program in Cognitive Neuroscience and Imaging, Florida International University, Miami.

Abstract

IMPORTANCE:

Microglia, the resident immune cells of the central nervous system, play an important role in the brain's response to injury and neurodegenerative processes. It has been proposed that prolonged microglial activation occurs after single and repeated traumatic brain injury, possibly through sports-related concussive and subconcussive injuries. Limited in vivo brain imaging studies months to years after individuals experience a single moderate to severe traumatic brain injury suggest widespread persistent microglial activation, but there has been little study of persistent glial cell activity in brains of athletes with sports-related traumatic brain injury.

OBJECTIVE:

To measure translocator protein 18 kDa (TSPO), a marker of activated glial cell response, in a cohort of National Football League (NFL) players and control participants, and to report measures of white matter integrity.

DESIGN, SETTING, AND PARTICIPANTS:

This cross-sectional, case-control study included young active (n = 4) or former (n = 10) NFL players recruited from across the United States, and 16 age-, sex-, highest educational level-, and body mass index-matched control participants. This study was conducted at an academic research institution in Baltimore, Maryland, from January 29, 2015, to February 18, 2016.

MAIN OUTCOMES AND MEASURES:

Positron emission tomography-based regional measures of TSPO using [11C]DPA-713, diffusion tensor imaging measures of regional white matter integrity, regional volumes on structural magnetic resonance imaging, and neuropsychological performance.

RESULTS:

The mean (SD) ages of the 14 NFL participants and 16 control participants were 31.3 (6.1) years and 27.6 (4.9) years, respectively. Players reported a mean (SD) of 7.0 (6.4) years (range, 1-21 years) since the last self-reported concussion. Using [11C]DPA-713 positron emission tomographic data from 12 active or former NFL players and 11 matched control participants, the NFL players showed higher total distribution volume in 8 of the 12 brain regions examined (P < .004). We also observed limited change in white matter fractional anisotropy and mean diffusivity in 13 players compared with 15 control participants. In contrast, these young players did not differ from control participants in regional brain volumes or in neuropsychological performance.

CONCLUSIONS AND RELEVANCE:

The results suggest that localized brain injury and repair, indicated by higher TSPO signal and white matter changes, may be associated with NFL play. Further study is needed to confirm these findings and to determine whether TSPO signal and white matter changes in young NFL athletes are related to later onset of neuropsychiatric symptoms.

Chic - Good Times

San Antonio Rose - Bob Wills and His Texas Playboys

Judge Accepts Medicare’s Plan to Remedy Misunderstanding on Therapy Coverage

"A federal judge has accepted Medicare’s plans to try once more to correct a commonly held misconception that beneficiaries’ are eligible for coverage for physical and occupational therapy and other skilled care only if their health is improving."

"The cornerstone to both prevention and treatment of obesity is, of course, lifestyle."

New Guidelines Update MDs on Childhood Obesity Management

As was true for earlier guidelines, task-force members place considerable emphasis on the prevention of obesity, arguing that "achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult."

The cornerstone to both prevention and treatment of obesity is, of course, lifestyle.

Thursday, February 2, 2017

"Liza Bernstein survived breast cancer three times. But it took all she had. She lost her home..."

Beating Cancer Shouldn't Force Patients Into Bankruptcy

By Kenneth Thorpe & Patricia Goldsmith
February 01, 2017

"Liza Bernstein survived breast cancer three times. But it took all she had. She lost her home and savings to the costs of tests and treatments. She's not technically bankrupt -- but that's only because she "couldn't afford the fees" to file the claim.

------------------------------

First, providers and health insurance companies need to stop surprising patients with unexpected costs. Nearly 3 in 4 Americans recently said it's very important to have more transparency when it comes to costs at the hospitals. Yet, only half of cancer patients felt they understood what their insurance plans would cover.

Requiring insurers to be transparent regarding the out-of-pocket costs for hospital and physician visits and medications would empower patients and their doctors to build a treatment plan that meets their needs and budgets."

Mohamed Khalil, Anna Kurdowska, and me: Acute Respiratory Distress Syndrome: A Review Article

Acute Respiratory Distress Syndrome: A Review Article

Khalil, Mohamed MD; Allen, Timothy Craig MD, JD; Kurdowska, Anna MS, PhD

AJSP: Reviews and Reports:

January/February 2017 - Volume 22 - Issue 1 - p 3–7

doi: 10.1097/PCR.0000000000000178

Reviews

"The lack of coverage of Derek Parfit’s death tells us more about the state of the press than it does about philosophy.”

Whatever happened to the public intellectual?

Philosophy used to be a staple of television and the newspapers. Not any longer. So where did all the philosophers go?

What about newspapers? Again, Monk is pessimistic. “There is something seriously wrong with the press. The lack of coverage of Derek Parfit’s death tells us more about the state of the press than it does about philosophy.” In the increasingly desperate search for advertisers, articles about academic philosophy don’t pay their way.

Wednesday, February 1, 2017

"...defensive medicine likely contributes substantial additional costs to Medicare."

2017 Jan 26. doi: 10.1111/1475-6773.12660. [Epub ahead of print]

Malpractice Claim Fears and the Costs of Treating Medicare Patients: A New Approach to Estimating the Costs of Defensive Medicine.

Reschovsky JD1, Saiontz-Martinez CB2.

Author information

1Mathematica Policy Research, Washington, DC.
2Social and Scientific Systems, Inc, Silver Spring, MD.

Abstract

OBJECTIVE:

To estimate the cost of defensive medicine among elderly Medicare patients.

DATA SOURCES:

We use a 2008 national physician survey linked to respondents' elderly Medicare patients' claims data.

STUDY DESIGN:

Using a sample of survey respondent/beneficiary dyads stratified by physician specialty, we estimated cross-sectional regressions of annual costs on patient covariates and a medical malpractice fear index formed from five validated physician survey questions. Defensive medicine costs were calculated as the difference between observed patient costs and those under hypothetical alternative levels of malpractice concern, and then aggregated to estimate average defensive medicine costs per beneficiary.

DATA COLLECTION METHODS:

The physician survey was conducted by mail. Patient claims were linked to survey respondents and reweighted to approximate the elderly Medicare beneficiary population.

PRINCIPAL FINDINGS:

Higher levels of the malpractice fear index were associated with higher patient spending. Based on the measured associations, we estimated that defensive medicine accounted for 8 to 20 percent of total costs under alternative scenarios. The highest estimate is associated with a counterfactual of no malpractice concerns, which is unlikely to be socially optimal as some extrinsic incentives to avoid medical errors are desirable. Among specialty groups, primary care physicians contributed the most to defensive medicine spending. Higher costs resulted mostly from more hospital admissions and greater postacute care.

CONCLUSIONS:

Although results are based on measured associations between malpractice fears and spending, and may not reflect the true causal effects, they suggest defensive medicine likely contributes substantial additional costs to Medicare.

What you don't know about cancer can kill you

Highlights of the survey findings include:

Fewer than 40 percent of Americans know that alcohol affects cancer risk.
Only 40 percent know that processed meats are also associated with cancer risk.
Fifty percent of Americans are aware that being overweight spurs cancer risk, up from 35 percent in 2001.

Nearly one-third of common cancers in the United States could be prevented through diet, weight management and physical activity. That increases to half when factors such as not smoking and avoiding sun damage are added, according to the institute.