http://www.ncbi.nlm.nih.gov/pubmed/23456142

Sci Eng Ethics. 2013 Mar 1. [Epub ahead of print]

Publication Ethics in Biomedical Journals from Countries in Central and Eastern Europe.

Broga M, Mijaljica G, Waligora M, Keis A, Marusic A.

Source

Department of Ethical Didactics, Lithuanian University of Educational Sciences, Studentų st. 39, LT-08106, Vilnius, Lithuania, mindaugas.broga@vpu.lt.

Abstract

Publication ethics is an important aspect of both the research and publication enterprises. It is particularly important in the field of biomedical science because published data may directly affect human health. In this article, we examine publication ethics policies in biomedical journals published in Central and Eastern Europe. We were interested in possible differences between East European countries that are members of the European Union (Eastern EU) and South-East European countries (South-East Europe) that are not members of the European Union. The most common ethical issues addressed by all journals in the region were redundant publication, peer review process, and copyright or licensing details. Image manipulation, editors' conflicts of interest and registration of clinical trials were the least common ethical policies. Three aspects were significantly more common in journals published outside the EU: statements on the endorsement of international editorial standards, contributorship policy, and image manipulation. On the other hand, copyright or licensing information were more prevalent in journals published in the Eastern EU. The existence of significant differences among biomedical journals' ethical policies calls for further research and active measures to harmonize policies across journals.

From Princeton U: "... Hispanics are more disadvantaged relative to whites under the top 10% admission regime at both UT and TAMU."

http://www.ncbi.nlm.nih.gov/pubmed/23457432

Race Soc Probl. 2012 Apr;4(1):57-67.

HISPANICS IN HIGHER EDUCATION AND THE TEXAS TOP TEN PERCENT LAW.

Harris AL, Tienda M.

Source

Princeton University.

Abstract

This paper examines the consequences of changes in Hispanic college enrollment after affirmative action was banned and replaced by an admission guarantee for students who graduate in the top 10% of their high school class. We use administrative data on applicants, admittees and enrollees from the two most selective public institutions and TEA data about high schools to evaluate whether and how application, admission and enrollment rates changed under the three admission regimes. Despite popular claims that the top 10% law has restored diversity to Texas's public flagships, our analyses that account for secular changes in the size of graduation cohorts show that Hispanics are more disadvantaged relative to whites under the top 10% admission regime at both UT and TAMU. Simulations of Hispanics' gains and losses at each stage of the college pipeline reveal that affirmative action is the most efficient policy to diversify college campuses, even in highly segregated states like Texas.

From Johns Hopkins: On higher ground: ethical reasoning and its relationship with error disclosure

http://www.ncbi.nlm.nih.gov/pubmed/23457359

BMJ Qual Saf. 2013 Mar 1. [Epub ahead of print]

On higher ground: ethical reasoning and its relationship with error disclosure.

Cole AP, Block L, Wu AW.

Source

Johns Hopkins School of Medicine, , Baltimore, Maryland, USA.

Abstract

BACKGROUND:

There is broad consensus that disclosure of harmful medical errors is vital to improve safety and is ethically required. Although most physicians-in-training are taught ethics, there have been no empirical studies on whether ethical reasoning is related to disclosure. We examined whether scores on a test of ethical reasoning were associated with greater willingness to disclose errors.

METHODS:

We conducted a cross-sectional survey of house officers in internal medicine at Johns Hopkins Hospital. Ethical reasoning was assessed using the Defining Issues Test, V.2 (DIT-2). Higher DIT-2 scores are associated with more sophisticated ethical reasoning, and scores tend to improve after formal ethical training. Respondents were then given a medical error scenario with multiple scripted disclosure options. Ethicalreasoning scores were compared for different levels of disclosure.

RESULTS:

A total of 29 out of 127 medicine residents completed the survey (response rate=22.8%). The 41% of residents who would explicitly tell a patient that, 'an error happened' had significantly higher DIT-2 scores than those who would not (51.1 vs 31.6, p<0.01). Higher DIT-2 scores were found in the 62% of residents who would give the most detail about the error (44.8 vs 31.2, p=0.04) and in the 71% of residents who would take personal responsibility (43.5 vs 27.9, p=0.03).

CONCLUSIONS:

Ethical reasoning scores were associated with acknowledging an error, providing more detailed explanations and taking personal responsibility. The low response rate may limit generalisability. Nevertheless, taken together with prior studies showing that ethical reasoning can be taught and measured, our findings suggest that ethical training may help to improve disclosure of medical errors.

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2012-0512-ED

Arch Pathol Lab Med. 2013 Mar;137(3):310-1. doi: 10.5858/arpa.2012-0512-ED.

Second opinions: pathologists' preventive medicine.

Allen TC.

Source

From the Department of Pathology, University of Texas Health Science Center at Tyler.

http://www.ncbi.nlm.nih.gov/pubmed/23447556

Psychol Sci. 2013 Feb 27. [Epub ahead of print]

Rules or Consequences? The Role of Ethical Mind-Sets in Moral Dynamics.

Cornelissen G, Bashshur MR, Rode J, Le Menestrel M.

Source

1Department of Economics and Business, Universitat Pompeu Fabra.

Abstract

Recent research on the dynamics of moral behavior has documented two contrasting phenomena-moral consistency and moral balancing. Moral balancing refers to the phenomenon whereby behaving ethically or unethically decreases the likelihood of engaging in the same type of behavior again later. Moral consistency describes the opposite pattern-engaging in ethical or unethical behavior increases the likelihood of engaging in the same type of behavior later on. The three studies reported here supported the hypothesis that individuals' ethical mind-set (i.e., outcome-based vs. rule-based) moderates the impact of an initial ethical or unethical act on the likelihood of behaving ethically on a subsequent occasion. More specifically, an outcome-based mind-set facilitated moral balancing, and a rule-based mind-set facilitated moral consistency.

"In addition, Mr. Tynan was a superficial thinker who donned ideas as if they were suits."

http://online.wsj.com/article/SB10001424127887324662404578330142990601264.html

The Ungenerous Brilliance of Kenneth Tynan

So far as I know,Kenneth Tynan is the only real-life drama critic to have been portrayed in a stage play under his own name. Tracy Letts played him as an effete, stuttering insult-monger in the 2005 off-Broadway production of Austin Pendleton's "Orson's Shadow," and anyone who ever saw the real man on television would have marveled at the lethal accuracy of Mr. Letts's performance. Mr. Tynan, who died in 1980, covered theater in London and New York from 1952 to 1963, and throughout that time he was known as the most spectacularly savage of critics, a stiletto-toting wit who could coin a telling phrase and make it stick. He's been on my mind of late, for it happens that Mr. Tynan permanently retired from drama criticism exactly 50 years ago. Back then he was famous, but now he is no longer well remembered save by his surviving victims. Indeed, I doubt that many viewers of "Orson's Shadow" under the age of 70 realized that he was anything other than a fictional character—a fitting fate for a critic in whom talent and triviality were always at odds.
.............................

When people talked about his reviews, though, it was usually the ones in which he pulled his knife and started slashing. In the words of John Gielgud, "They're wonderful—when it isn't you." It was Mr. Tynan who described Vivien Leigh's Lady Macbeth as "more niminy-piminy than thundery-blundery…but still quite competent in its small way" and dismissed Orson Welles's overblown Othello as "Citizen Coon." Even his admirers were disturbed by his ungenerous brilliance. One of them, Harold Clurman, wrote that "his cleverness at times stands out on the body of his work as a sort of decorative rash on a young man's face."

In addition, Mr. Tynan was a superficial thinker who donned ideas as if they were suits. Too often he "saw" the show that he expected to see instead of the one on stage. He failed to appreciate Gielgud's refined art, underrated William Inge and Eugène Ionesco, misunderstood Terence Rattigan…the list goes on and on. Many of his biggest blunders were rooted in his political views (though by no means all—he was never fooled, for instance, by Arthur Miller). He was a Veuve Clicquot Marxist who wrote low and lived high. "I believed—and still do—that he was totally sincere in his desire for a more just society, even though most of our talk about revolution took place in high-priced restaurants," one of his friends recalled.

From UTMB: Should high-risk adolescents have Papanicolaou tests?

http://www.ncbi.nlm.nih.gov/pubmed/23450854

Cancer Cytopathol. 2013 Feb 28. doi: 10.1002/cncy.21274. [Epub ahead of print]

Should high-risk adolescents have Papanicolaou tests?

Ma LT, Campbell GA, Richardson G, Schnadig VJ.

Source

Department of Pathology, Division of Cytopathology, University of Texas Medical Branch, Galveston, Texas.

Abstract

BACKGROUND:

The current American College of Obstetricians and Gynecologists guidelines state that cervical cancer screening should begin at age 21 years, regardless of sexual or obstetric history. However, previous studies have demonstrated that there is a small but significant subset of high-risk adolescents with extensive sexual and obstetric history who harbor a significant squamous cervical lesion. The objective of the current study was to use histologic and demographic data from adolescents (aged <21 years) who received Papanicolaou (Pap) tests to determine whether they benefited from early cervical cancer screening.

METHODS:

Adolescent girls who had Pap tests between 2000 and 2010 were included in the study. Demographic data, including obstetric history, number of sexual partners, age of first coitus, age at first pregnancy, menarche, smoking history, and Chlamydia and syphilis infection, were analyzed for associations with levels of cervical dysplasia.

RESULTS:

Of 56,785 adolescent Pap tests, 277 (0.5%) were diagnosed as high-grade squamous HSIL, and 56 of those Pap tests (20%) were from patients who had grade 3 cervical intraepithelial neoplasia (CIN-3) on subsequent biopsy and/or excision. One patient had microinvasive cervical carcinoma identified on loop electrosurgical excision procedure at age 27 years after an HSIL Pap test. Increased parity was associated significantly with higher rates of CIN-3.

CONCLUSIONS:

The study findings indicated that current American College of Obstetricians and Gynecologists guidelines to begin Pap testing at age 21 years are appropriate for the majority of adolescents, because the rate of HSIL is very low, and the risk for invasive carcinoma is minimal. Although higher parity was associated with a significantly increased grade of CIN, the conclusions are questionable because of the significant amount of missing demographic data points. That being said, this study should lead to other similar studies to determine any association of higher grade CIN with adolescent sexual and obstetric history. 

http://www.ncbi.nlm.nih.gov/pubmed/23445249

J Palliat Med. 2013 Feb 27. [Epub ahead of print]

Not Just Little Adults: Palliative Care Physician Attitudes Toward Pediatric Patients.

Rapoport A, Obwanga C, Sirianni G, Librach SL, Husain A.

Source

1 Paediatric Advanced Care Team, Hospital for Sick Children , Toronto, ON, Canada .

Abstract

Abstract Background: Palliative care physicians are increasingly being asked to provide end-of-life (EOL) care for children. Yet very little is known about physicians' level of comfort and willingness to do so. Objectives: This study assessed the attitudes of palliative care physicians toward providing care for pediatric patients and to describe the supports they desire in order to do so. Methods: An online questionnaire was e-mailed to all physicians in the Division of Palliative Care at the University of Toronto. The questionnaire explored perceptions, attitudes, and level of comfort caring for pediatric patients. Results are reported using frequencies, ratios, and other descriptive analyses. Results: Forty-four physicians of the 74 (59%) surveyed responded. On average, physicians cared for fewer than one child per each year of practice. Although the majority of respondents perceived their pediatric training to be inadequate, 70% were willing to provide care to children. Respondents felt at ease applying their knowledge and skills in some aspects of pediatric care (e.g., principles of pain and symptom management, communication about EOL issues) but less so in others (e.g., medication dosing, ethical issues unique to pediatrics). All respondents welcomed opportunities for additional training, but a third felt it was not essential. In particular, the most frequently expressed need was for mentorship by pediatric palliative care specialists. Conclusions: Palliative physicians tend to be willing to care for children, but perceive their level of training to be insufficient. Although additional training is endorsed, physicians favored real-time support and mentorship from a pediatric expert.

Hydraphiles!

http://www.ncbi.nlm.nih.gov/pubmed/23401675

Int J Biomed Imaging. 2013;2013:803579. doi: 10.1155/2013/803579. Epub 2013 Jan 15.

Hydraphiles: a rigorously studied class of synthetic channel compounds with in vivo activity.

Negin S, Smith BA, Unger A, Leevy WM, Gokel GW.

Source

Departments of Chemistry and Biochemistry and Biology, Center for Nanoscience, University of Missouri-St. Louis, St. Louis, MO 63121, USA.

Abstract

Hydraphiles are a class of synthetic ion channels that now have a twenty-year history of analysis and success. In early studies, these compounds were rigorously validated in a wide range of in vitro assays including liposomal ion flow detected by NMR or ion-selective electrodes, as well as biophysical experiments in planar bilayers. During the past decade, biological activity was observed for these compounds including toxicity to bacteria, yeast, and mammalian cells due to stress caused by the disruption of ion homeostasis. The channel mechanism was verified in cells using membrane polarity sensitive dyes, as well as patch clamping studies. This body of work has provided a solid foundation with which hydraphiles have recently demonstrated acute biological toxicity in the muscle tissue of living mice, as measured by whole animal fluorescence imaging and histological studies. Here we review the critical structure-activity relationships in the hydraphile family of compounds and the in vitro and in cellulo experiments that have validated their channel behavior. This report culminates with a description of recently reported efforts in which these molecules have demonstrated activity in living mice.

http://www.ncbi.nlm.nih.gov/pubmed/23451317

J Grad Med Educ. 2012 Mar;4(1):101-5. doi: 10.4300/JGME-D-11-00110.1.

Education in professionalism: results from a survey of pediatric residency program directors.

Kesselheim JC, Sectish TC, Joffe S.

Abstract

BACKGROUND:

The Accreditation Council for Graduate Medical Education (ACGME) requires pediatric residency programs to teach professionalism but does not provide concrete guidance for fulfilling these requirements. Individual programs, therefore, adopt their own methods for teaching and evaluating professionalism, and published research demonstrating how to satisfy the ACGME professionalism requirement is lacking.

METHODS:

We surveyed pediatric residency program directors in 2008 to explore the establishment of expectations for professional conduct, the educational experiences used to foster learning in professionalism, and the evaluation of professionalism.

RESULTS:

Surveys were completed by 96 of 189 program directors (51%). A majority reported that new interns attend a session during which expectations for professionalism are conveyed, either verbally (93%) or in writing (65%). However, most program directors reported that "None or Few" of their residents engaged in multiple educational experiences that could foster learning in professionalism. Despite the identification of professionalism as a core competency, a minority (28%) of programs had a written curriculum in ethics or professionalism. When evaluating professionalism, the most frequently used assessment strategies were rated as "very useful" by only a modest proportion (26%-54%) of respondents.

CONCLUSIONS:

Few programs have written curricula in professionalism, and opportunities for experiential learning in professionalism may be limited. In addition, program directors express only moderate satisfaction with current strategies for evaluating professionalism that were available through 2008.

http://www.ncbi.nlm.nih.gov/pubmed/22943658

BMC Med Res Methodol. 2012 Sep 3;12:134.

Scanning for satisfaction or digging for dismay? Comparing findings from a postal survey with those from a focus group-study.

Carlsen B, Glenton C.

Source

Uni Rokkan Centre, Nygaardsgt 5, N-5015 Bergen, Norway. benedicte.carlsen@uni.no

Abstract

BACKGROUND:

Despite growing support for mixed methods approaches we still have little systematic knowledge about the consequences of combining surveys and focus groups. While the methodological aspects of questionnaire surveys have been researched extensively, the characteristics of focus group methodology are understudied. We suggest and discuss whether the focus group setting, as compared to questionnaire surveys, encourages participants to exaggerate views in a negative direction.

DISCUSSION:

Based on an example from our own research, where we conducted a survey as a follow up of a focus group study, and with reference to theoretical approaches and empirical evidence from the literature concerning survey respondent behaviour and small group dynamics, we discuss the possibility that a discrepancy in findings between the focus groups and the questionnaire reflects characteristics of the two different research methods. In contrast to the survey, the focus group study indicated that doctors were generally negative to clinical guidelines. We were not convinced that this difference in results was due to methodological flaws in either of the studies, and discuss instead how this difference may have been the result of a general methodological phenomenon.

SUMMARY:

Based on studies of how survey questionnaires influence responses, it appears reasonable to claim that surveys are more likely to find exaggerated positive views. Conversely, there are some indications in the literature that focus groups may result in complaints and overly negative attitudes, but this is still an open question. We suggest that while problematic issues tend to be under-communicated in questionnaire surveys, they may be overstated in focus groups.We argue for the importance of increasing our understanding of focus group methodology, for example by reporting interesting discrepancies in mixed methods studies. In addition, more experimental research on focus groups should be conducted to advance the methodology and to test our hypothesis.

http://www.ncbi.nlm.nih.gov/pubmed/23373158

J Med Pract Manage. 2012 Nov-Dec;28(3):187-91.

Time management tips, tricks, and exercises for busy medical practice employees.

Hills L.

Source

Blue Pencil Institute, Fairfax, VA 22030, USA. lhills@bluepencilinstitute.com

Abstract

Working in a busy medical practice requires excellent time management skills and an ability to handle those unanticipated emergencies, urgencies, and monkey-wrenches that can and often do throw a well-planned day out of whack. This article offers busy medical practice employees 50 time management tips to help them manage their time well. It focuses specifically on eliminating time wasters, working more efficiently, and developing personal goals and habits that can increase productivity, reduce stress, and make working in the practice more enjoyable. This article also offers several hands-on time management exercises, including a time management self-assessment quiz, a multitasking exercise, and a time drain exercise. These can be completed individually or collaboratively with other members of the medical practice team. Finally, this article explores 12 popular time management myths and how a medical practice employee can increase his or her productivity by identifying and harnessing his or her productivity "happy hour(s)".

"The New England Journal of Medicine described the fungal meningitis outbreak as “unprecedented.” However, residents of the Fredericksburg area could be forgiven for thinking they’d seen it all before."

http://news.fredericksburg.com/newsdesk/2013/03/02/area-too-had-deadly-link-to-compounding-pharmacy/

March 2nd, 2013, 11:17 pm

Area, too, had deadly link to ‘compounding’ pharmacy

BY JIM HALL

The New England Journal of Medicine described the fungal meningitis outbreak as “unprecedented.” However, residents of the Fredericksburg area could be forgiven for thinking they’d seen it all before.

Fredericksburg and Mary Washington Hospital were the focus of a similar tragedy in 2005. As in Massachusetts, the incident involved a compounding pharmacy, contaminated medicine and patient injuries and death. And again, there were questions and accusations.

.....................

To date, 48 people have been killed by the company’s medicine. More than 700 people have been injured in 20 states.

Move over, Abby Scuito, this is real: An analysis of the alleged skeletal remains of Carin Göring

http://www.ncbi.nlm.nih.gov/pubmed/23284605

PLoS One. 2012;7(12):e44366. doi: 10.1371/journal.pone.0044366. Epub 2012 Dec 19.

An analysis of the alleged skeletal remains of Carin Göring.

Kjellström A, Edlund H, Lembring M, Ahlgren V, Allen M.

Source

Osteoarchaeological Research Laboratory, Department of Archaeology and Classical Studies, Stockholm University, Stockholm, Sweden.

Abstract

In 1991, treasure hunters found skeletal remains in an area close to the destroyed country residence of former Nazi leader Hermann Göring in northeastern Berlin. The remains, which were believed to belong to Carin Göring, who was buried at the site, were examined to determine whether it was possible to make a positive identification. The anthropological analysis showed that the remains come from an adult woman. The DNA analysis of several bone elements showed female sex, and a reference sample from Carin's son revealed mtDNA sequences identical to the remains. The profile has one nucleotide difference from the Cambridge reference sequence (rCRS), the common variant 263G. A database search resulted in a frequency of this mtDNA sequence of about 10% out of more than 7,000 European haplotypes. The mtDNA sequence found in the ulna, the cranium and the reference sample is, thus, very common among Europeans. Therefore, nuclear DNA analysis was attempted. The remains as well as a sample from Carin's son were successfully analysed for the three nuclear markers TH01, D7S820 and D8S1179. The nuclear DNA analysis of the two samples revealed one shared allele for each of the three markers, supporting a mother and son relationship. This genetic information together with anthropological and historical files provides an additional piece of circumstantial evidence in our efforts to identify the remains of Carin Göring.

Time to End Free Drug Samples

http://www.bullhpl.org/resources/Publications/AllenCommentaryBHPL-Prod.pdf

Time to End Free Drug SamplesTimothy Craig Allen, MD, JD. 

Published: 10 January 2013 Cite as: Craig TA. Time To End Free Drug Samples. Bull Health L Policy. 2012;1(2).

Introduction
Pharmaceutical manufacturers are highly regulated, and must meet a plethora of governmental and nongovernmental guidelines and rules, some of which were enacted to address manufacturer improprieties regarding drug sales. Yet pharmaceutical manufacturers continue to use, and indeed increasingly utilize, extreme pharmaceutical marketing tactics that often incorporate deceptive methods or biased information.1 Further, pharmaceutical sales teams are typically an aggressive sort, and have been likened to soldiers going to war, stopping at nothing to prevail.1

Free drug samples are big business. The value of free drug samples dwarfs the value of other pharmaceutical manufacturer gifts to physicians.2 One study found that up to 94% of physicians have some pharmaceutical manufacturer relationship, and between 78-92% receive free drug samples.3 No matter what they are told by pharmaceutical manufacturer sales teams, physicians should clearly understand that “[d]rug samples are gifts from pharmaceutical representatives. Acceptance of the sample establishes an implicit relationship with the gift giver that involves vague but real obligations. Any gift, even those of small monetary value or those that benefit patients, creates a relationship of reciprocity that affects treatment decisions.”3-6 Yet, whereas gifts to physicians have come under increasing scrutiny and control,3 free drug samples have been left relatively unexamined, and only a few academic centers have banned free drug samples altogether.7 

From Harvard: Big Pharma's gifts to med students/residents still coming despite school policies

http://www.ncbi.nlm.nih.gov/pubmed/23444007

J Gen Intern Med. 2013 Feb 27. [Epub ahead of print]

Changing Interactions Between Physician Trainees and the Pharmaceutical Industry: A National Survey.

Austad KE, Avorn J, Franklin JM, Kowal MK, Campbell EG, Kesselheim AS.

Source

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont St., Suite 3030, Boston, MA, 02120, USA.

Abstract

BACKGROUND:

Increasingly, medical school policies limit pharmaceutical representatives' access to students and gifts from drugmakers, but little is known about how these policies affect student attitudes toward industry.

OBJECTIVE:

To assess interactions between trainees and the pharmaceutical industry, and to determine whether learning environment characteristics influence students' practices and attitudes.

DESIGN, PARTICIPANTS:

We conducted a cross-sectional survey with a nationally-representative sample of first- and fourth-year medical students and third-year residents, stratified by medical school, including ≥ 14 randomly selected trainees at each level per school.

MAIN MEASURES:

We measured frequency of industry interactions and attitudes regarding how such interactions affect medical training and the profession. Chi-squared tests assessed bivariate linear trend, and hierarchical logistic regression models were fitted to assess associations between trainees' attitudes and their schools' National Institutes of Health (NIH) funding levels and American Medical Student Association (AMSA) PharmFree Scorecard grades reflecting industry-related conflict of interest policies.

KEY RESULTS:

Among 1,610 student (49.3 % response rate) and 739 resident (43.1 %) respondents, industry-sponsored gifts were common, rising from 33.0 % (first-year students) to 56.8 % (fourth-year students) and 54 % (residents) (p < 0.001). These gifts included meals outside the hospital (reported by 5 % first-year students, 13.4 % fourth-year students, 27.5 % residents (p < 0.001)) and free drug samples (reported by 7.4 % first-year students, 14.1 % fourth-year students, 14.3 % residents (p < 0.001)). The perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased (64.1 % to 67.5 % to 79.8 %, p < 0.001). Students in schools receiving more NIH funding reported industry gifts less often (OR = 0.51, 95 % CI: 0.38-0.68, p < 0.001), but the strength of institutional conflict of interest policies was not associated with this variable.

CONCLUSIONS:

Despite recent policy changes, a substantial number of trainees continue to receive gifts from pharmaceutical representatives. We found no relation between these outcomes and a school's policies concerning interactions with industry.

Zombie allusions: They just keep on coming-ignoring the "Austrian" response

http://www.slate.com/articles/business/project_syndicate/2013/03/quantitative_easing_all_your_questions_answered.html

All of Your Quantitative Easing Questions, Answered

When is it ineffective? When is it justified? And what about unintended consequences?

By Nouriel Roubini

First, while a purely “Austrian” response (that is, austerity) to bursting asset and credit bubbles may lead to a depression, QE policies that postpone the necessary private- and public-sector deleveraging for too long may create an army of zombies: zombie financial institutions, zombie households and firms, and, in the end, zombie governments. So, somewhere between the Austrian and Keynesian extremes, QE needs to be phased out over time.

Second, repeated QE may become ineffective over time as the channels of transmission to real economic activity become clogged. The bond channel doesn’t work when bond yields are already low; and the credit channel doesn’t work when banks hoard liquidity and velocity collapses. Indeed, those who can borrow (high-grade firms and prime households) don’t want or need to, while those who need to—highly leveraged firms and non-prime households—can’t, owing to the credit crunch.

What's wrong with this sentence? "Canadian parents are telling educators to make a concerted effort to find ways of creating a learning environment that reduces sedentary behaviours..."

http://www.thestar.com/opinion/editorialopinion/2013/03/03/physical_and_health_education_is_more_than_just_gym_class.html

Physical and health education is more than just gym class

24 per cent of Canadian adults are now obese and the rate of childhood obesity nearly tripled in 20 years.

The findings that we released on Friday attest to the need Canadians see for better resourcing of physical and health education in our primary, secondary and post-secondary education systems. Canadian parents are telling educators to make a concerted effort to find ways of creating a learning environment that reduces sedentary behaviours and inculcates a lifelong commitment to active, healthy living.