"...alchemists were still frequently portrayed as credulous dupes who begged God’s favour as they wishfully tossed arbitrary heaps of plants and metals into their fires."

No nearer the Philosopher’s Stone

NICHOLAS POPPER

Lawrence M. Principe
THE SECRETS OF ALCHEMY
296pp. University of Chicago Press. Paperback, £10.50 (US $15).
978 0 226 10379 2

"Alchemy’s significance has altered radically in the three centuries since this heyday, Principe argues, after professionalizing Enlightenment scholars rejected the suitability of Decknamen, pseudonyms and dreams of transmutation to a properly rigorous, public science. Denied knowledge of their physical references, Victorian occultists and Jungian psychologists mythologized the arcana of alchemical texts as autonomous allegories, as symbols for occult forces or a psychological manifestation of the collective unconscious. Meanwhile, historians of science dismissed its practitioners as gullible fools. Many recognized that the quest for the Stone involved work at the forge, but alchemists were still frequently portrayed as credulous dupes who begged God’s favour as they wishfully tossed arbitrary heaps of plants and metals into their fires."

From Kathmandu Medical College: Enteric fever: Diagnostic value of clinical features

Kathmandu Univ Med J (KUMJ). 2006 Jul-Sep;4(15):307-315.

Enteric fever: Diagnostic value of clinical features.

Neopane A, Poudel M, Pradhan B, Dhakal R, Karki DB.

Source

Department of Medicine Kathmandu Medical College, Sinamangal.

Abstract

Objectives: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical diagnostic criterion. 

Design: Prospective observational study Setting: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal Materials and methods: febrile patients with clinical diagnosis of enteric fever were included in the study with the aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of various clinical signs and symptoms. 

Results: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom and sign. 

Conclusion: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the important abdominal symptoms and signs of enteric fever. Key words: enteric fever, clinical features, diagnostic criteria.

Arch Iran Med. 2013 Oct;16(10):590-593.

The Islamic Revolution of Iran and Migration of Physicians to the United States.

Ronaghy HA, Shajari A.

Source

1)Department of Medical Education, Shiraz University of Medical Sciences, Shiraz, Iran. 2)Department of Medicine, University of California, San Diego (UCSD), USA.Ronaghy@yahoo.com.

Abstract

Following the Islamic Revolution of 1979 in Iran, the trend of migration of physicians from the country continued. The total number of Iranian physicians migrated to the United States (US) increased from 1625 before revolution in 1974, to 5045 in 2010, thirty years post-revolution. The percentage of medical graduates migrating to the US, in the same period dropped from 15% to 5%. The reasons for this drop were restrictions imposed, along with creation of good postgraduate residency and fellowship programs in Iran. Following the revolution, the number of medical schools increased from 13 to 48. Despite all the restrictions and impediments for post-revolution medical graduates, over 500 medical graduates from newly established medical schools found their ways into the healthcare system of the US.     In spite of all hardships of eight years of imposed war, and 30 years of the US sanctions, Iran has been able to maintain good progress in its healthcare, education, and research in medicine and other branches of science and technology.

Mol Reprod Dev. 2013 Aug;80(8):691-7. doi: 10.1002/mrd.22196. Epub 2013 Jun 17.

The egg. The inside story of a cell.

Monti M, Redi C.

Source

Research Center for Regenerative Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. m.monti@smatteo.pv.it

Abstract

The egg, a fantastic little laboratory of molecular biology, has played a crucial role in redefining modern biology by moving it from the description of living things to the synthesis of living things (synthetic biology). Over the centuries, many hypotheses have been advanced concerning the egg's role in reproduction-from the preformation theory until von Baer's discovery to the present, with the 2012 Nobel Prize for Physiology or Medicine celebrating the egg as a totipotent stem cell able to reprogram fully differentiated somatic nuclei. The molecular dissection of its cytoplasmic components makes the egg an ideal bioreactor for several biotechnological applications, including pharmacological and food production sciences. In addition to its ubiquitous contribution to the worldwide diet, the egg, a powerful symbol, pervades philosophy, art, religion, and idiomatic expressions.

Gerontologist. 2013 Oct 4. [Epub ahead of print]

Pathways to Late-Life Problematic Gambling in Seniors: A Grounded Theory Approach.

Tira C, Jackson AC, Tomnay JE.

Source

*Address correspondence to Connie Tira, Problem Gambling Research & Treatment Centre, Melbourne Graduate School of Education, University of Melbourne, Level 5, 100 Leicester Street, Carlton, Victoria 3010, Australia. E-mail: connietira@gmail.com.

Abstract

Purpose of the Study: To develop a grounded theory on how older adults, who may not have previously experienced gambling issues, come to develop gambling problems in later life.

DESIGN AND METHODS:

Through semistructured in-depth interviews with 31 adults aged 56-85, routes that led the current sample of older adults to develop late-life gambling problems were identified and mapped into coherent pathways using a constructivist grounded theory methodology.

RESULTS:

Three main pathways to late-life problematic gambling were identified, all linked with a common theme of isolation: a grief pathway associated with unresolved losses; a habit pathway associated with habituation to gambling; and a dormant pathway marked by preexisting behavioral excess or impulsivity. Overall, unresolved losses and/or mismanagement of life's stresses were found to be the most significant predictors of late-life problematic gambling.

IMPLICATIONS:

As late-life problem gambling appears to predominantly signify late-life emotional distress and an attempt to deal with this distress using gambling as an escape, it is crucial for problem gambling prevention programs to raise awareness about the processes of loss and grief and provide ideas about constructive loss management. In addition, community-level recreational and social opportunities to combat isolation are identified.

Med J Aust. 2013 Oct 8;199(7):471-473.

The economic evaluation of personalised oncology medicines: ethical challenges.

Lewis JR, Lipworth WL, Kerridge IH, Day RO.

Source

Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, NSW, Australia. jlewis@med.usyd.edu.au.

Abstract

Insights into the molecular drivers of cancer are providing opportunities for the development of new targeted treatments and more personalised approaches to cancer management. Drugs targeting mutant epidermal growth factor receptors, such as erlotinib and gefitinib, may provide more effective, safer and better tolerated treatment options compared with chemotherapy among appropriately selected patients with advanced non-small cell lung cancer (NSCLC). First-line access to these newer treatments remains unfunded after several considerations by the Pharmaceutical Benefits Advisory Committee and their assessment that these are not cost-effective treatments. We suggest that there may be evidentiary and ethical challenges associated with the assessment of the cost-effectiveness of personalised oncology medicines in Australia, and that a new approach is needed to determine the value and cost-effectiveness of personalised medicine.

"... the exercise is a damning indictment of the way peer review works (or doesn't) at many online journals."

Some Online Journals Will Publish Fake Science, For A Fee

by RICHARD KNOX

October 03, 2013

Early Online Release

Recommendations for Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Update

Antonio C. Wolff *, M. Elizabeth H. Hammond *, David G. Hicks *, Mitch Dowsett *, Lisa M. McShane *, Kimberly H. Allison, Donald C. Allred, John M.S. Bartlett, Michael Bilous, Patrick Fitzgibbons, Wedad Hanna, Robert B. Jenkins, Pamela B. Mangu,Soonmyung Paik, Edith A. Perez, Michael F. Press, Patricia A. Spears, Gail H. Vance, Giuseppe Viale, and Daniel F. Hayes *

Antonio C. Wolff, Johns Hopkins Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth H. Hammond, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, UT; David G. Hicks, University of Rochester Medical Center, Rochester, NY; Mitch Dowsett, Royal Marsden Hospital, London, United Kingdom; Kimberly H. Allison, Stanford University Medical Center, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Donald C. Allred, Washington University School of Medicine, St Louis, MO; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada; Michael Bilous, University of Western Sydney and Healthscope Pathology, Sydney, New South Wales, Australia; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; Soonmyung Paik, National Surgical Adjuvant Breast and Bowel Project, Pitsburgh, PA; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Patricia A. Spears, North Carolina State University, Raleigh, NC; Gail H. Vance, Indiana University Medical Center, Indianapolis, IN; Giuseppe Viale, University of Milan, European Institute of Oncology, Milan, Italy; and Daniel F. Hayes, University of Michigan Comprehensive Cancer Care Center, Ann Arbor, MI.

Purpose. To update the American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guideline recommendations for human epidermal growth factor receptor 2 (HER2) testing in breast cancer to improve the accuracy of HER2 testing and its utility as a predictive marker in invasive breast cancer.

Methods. ASCO/CAP convened an Update Committee that included coauthors of the 2007 guideline to conduct a systematic literature review and update recommendations for optimal HER2 testing.

Results. The Update Committee identified criteria and areas requiring clarification to improve the accuracy of HER2 testing by immunohistochemistry (IHC) or in situ hybridization (ISH). The guideline was reviewed and approved by both organizations.

Recommendations. The Update Committee recommends that HER2 status (HER2 negative or positive) be determined in all patients with invasive (early stage or recurrence) breast cancer on the basis of one or more HER2 test results (negative, equivocal, or positive). Testing criteria define HER2-positive status when (on observing within an area of tumor that amounts to >10% of contiguous and homogeneous tumor cells) there is evidence of protein overexpression (IHC) or gene amplification (HER2 copy number or HER2/CEP17 ratio by ISH based on counting at least 20 cells within the area). If results are equivocal (revised criteria), reflex testing should be performed using an alternative assay (IHC or ISH). Repeat testing should be considered if results seem discordant with other histopathologic findings. Laboratories should demonstrate high concordance with a validated HER2 test on a sufficiently large and representative set of specimens. Testing must be performed in a laboratory accredited by CAP or another accrediting entity. The Update Committee urges providers and health systems to cooperate to ensure the highest quality testing.

"If they called, I went after them.”

Texas A&M To Add Medal Of Honor Recipient To Hall Of Honor In November

COLLEGE STATION COLLEGE STATION, Oct. 8, 2013 – Clarence E. Sasser, who was presented the Medal of Honor in 1969 for his service in Vietnam and subsequently attended Texas A&M University on a scholarship offered by then President James Earl Rudder, will have his name and likeness added to the university’s Medal of Honor Hall of Honor.A recognition ceremony is planned for Nov. 7 in the Bethancourt Ballroom in the Memorial Student Center. The program is scheduled to include remarks by Sasser and several other notable speakers, including Judge Willie E.B. Blackmon, a 1973 Texas A&M graduate and recipient of the university’s distinguished alumnus award. Blackmon and Lt. Gen. Joe Weber USMC (Ret.), the university’s vice president for student affairs, spearheaded the effort to honor Sasser, with the full support of University President R. Bowen Loftin.

Best Pract Res Clin Gastroenterol. 2013 Aug;27(4):577-596. doi: 10.1016/j.bpg.2013.08.001. Epub 2013 Aug 22.

Liver abnormalities in drug and substance abusers.

Pateria P, de Boer B, Macquillan G.

Source

Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia 6009, Australia. Electronic address: Puraskar.Pateria@health.wa.gov.au.

Abstract

Drug and substance abuse remains a major medical problem. Alcohol use, abuse and dependence are highly prevalent conditions. Alcohol related liver disease can present as simple steatosis, steatohepatitis, alcoholic hepatitis or liver cirrhosis. Paracetamol hepatotoxicity secondary to accidental or deliberate overdose is another common problem. While the adverse cardiovascular, neurological, renal and psychiatric consequences of various illicit substance abuses are widely studied and publicized, less attention has been directed towards possible hepatotoxic effects. Illicit drug abuse can cause a range of liver abnormalities ranging from asymptomatic derangement of liver function tests to fulminant hepatic failure. This article reviews the epidemiology, risk factors, clinical manifestations, pathogenesis, investigations, management and prognostic factors of alcohol related liver disease and paracetamol hepatotoxicity as well as the current knowledge pertaining to hepatotoxicity of the more commonly used illicit substances including cannabis, amphetamine type stimulants, cocaine, khat chewing and complementary and alternate medicine.

Need another reason to work out? "...significant delay in frailty and dependency..."

Curr Pharm Des. 2013 Sep 27. [Epub ahead of print]

Pharmacological Properties of Physical Exercise in The Elderly.

Viña J, Borras C, Sanchis-Gomar F, Martinez-Bello VE, Olaso-Gonzalez G, Gambini J, Ingles M, Gomez-Cabrera MC.

Source

Department of Physiology. Faculty of Medicine. University of Valencia. Av. Blasco Ibañez, 15, Valencia E46010 Spain. jose.vina@uv.es.

Abstract

Scientific evidence links physical activity to several benefits. Recently, we proposed the idea that exercise can be regarded as a drug. As with many drugs, dosage is of great importance. However, to issue a public recommendation of physical activity in aging is not an easy task. Exercise in the elderly needs to be carefully tailored and individualized with the specific objectives of the person or group in mind. The beneficial effects of exercise in two of the main age-related diseases, sarcopenia and Alzheimer's Disease, are dealt with at the beginning of this report. Subsequently, dosage of exercise and the molecular signaling pathways involved in its adaptations are discussed. Exercise and aging are associated with oxidative stress so the paradox arises, and is discussed, as to whether exercise would be advisable for the aged population from an oxidative stress point of view. Two of the main redox-sensitive signaling pathways altered in old skeletal muscle during exercise, NF-B and PGC-1α, are also reviewed. The last section of the manuscript is devoted to the age-associated diseases in which exercise is contraindicated. Finally, we address the option of applying exercise mimetics as an alternative for disabled old people. The overall denouement is that exercise is so beneficial that it should be deemed a drug both for young and old populations. If old adults adopted a more active lifestyle, there would be a significant delay in frailty and dependency with clear benefits to individual well-being and to the public's health.

Orphanet J Rare Dis. 2013 Sep 8;8(1):137. [Epub ahead of print]

Erdheim-Chester Disease: a comprehensive review of the literature.

Mazor RD, Manevich-Mazor M, Shoenfeld Y.

Abstract

Erdheim-Chester Disease (ECD) is a rare form of non Langerhans' cell histiocytosis. Individuals affected by this disease are typically adults between their 5th and 7th decades of life. Males and females are almost equally affected. The multi systemic form of ECD is associated with significant morbidity, which may arise due to histiocytic infiltration of critical organ systems. Among the more common sites of involvement are the skeleton, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum) and skin. The most common presenting symptom of ECD is bone pain. The etiology of ECD is unknown yet thought to be associated with an intense TH1 immune response. It may also be associated with the V600E BRAF mutation, as described in as many as half of the patients in recent studies. Bilateral symmetric increased tracer uptake on 99mTc bone scintigraphy affecting the periarticular regions of the long bones is highly suggestive of ECD. However, definite diagnosis of ECD is established only once CD68(+), CD1a(-) histiocytes are identified within a biopsy specimen. At present, this obscure ailment embodies numerous challenges to medical science. Given its rarity, it is diagnostically elusive and requires a high level of clinical suspicion. Therapeutically, it is of limited alternatives. Currently, interferon-alpha is the most extensively studied agent in the treatment of ECD and serves as the first line of treatment. Treatment with other agents is based on anecdotal case reports and on the basis of biological rationale. Nevertheless, cladribine (2CDA), anakinra and vemurafenib are currently advocated as promising second line treatments for patients whose response to interferon alpha is unsatisfactory. Overall, the 5 year survival of ECD is 68%. Herein, the authors mustered and brought about a panoramic consolidation of all the relevant facts regarding ECD. This work highlights the different clinical, radiological and pathological manifestations associated with ECD, the differential diagnoses, the various treatment options and the acknowledged science explaining the disease.

BMC Med Inform Decis Mak. 2013 Oct 4;13(1):113. [Epub ahead of print]

The value of usability testing for Internet-based adolescent self-management interventions: "Managing Hemophilia Online"

Breakey VR, Warias AV, Ignas DM, White M, Blanchette VS, Stinson JN.

Abstract

BACKGROUND:

As adolescents with hemophilia approach adulthood, they are expected to assume responsibility for their disease management. A bilingual (English and French) Internet-based self-management program, "Teens Taking Charge: Managing Hemophilia Online," was developed to support adolescents with hemophilia in this transition. This study explored the usability of the website and resulted in refinement of the prototype.

METHODS:

A purposive sample (n=18; age 13--18; mean age 15.5 years) was recruited from two tertiary care centers to assess the usability of the program in English and French. Qualitative observations using a "think aloud" usability testing method and semi-structured interviews were conducted in four iterative cycles, with changes to the prototype made as necessary following each cycle. This study was approved by research ethics boards at each site.

RESULTS:

Teens responded positively to the content and appearance of the website and felt that it was easy to navigate and understand. The multimedia components (videos, animations, quizzes) were felt to enrich the experience. Changes to the presentation of content and the website user-interface were made after the first, second and third cycles of testing in English. Cycle four did not result in any further changes.

CONCLUSIONS:

Overall, teens found the website to be easy to use. Usability testing identified end-user concerns that informed improvements to the program. Usability testing is a crucial step in the development of Internet-based self-management programs to ensure information is delivered in a manner that is accessible and understood by users.

Michael Misialek: What role do pathologists play in patient care?

What role do pathologists play in patient care?

N Engl J Med. 2013 Oct 2. [Epub ahead of print]

The ACA and High-Deductible Insurance - Strategies for Sharpening a Blunt Instrument.

Wharam JF, Ross-Degnan D, Rosenthal MB.

Source

From the Department of Population Medicine, Harvard Medical School (J.F.W., D.R.-D.), the Harvard Pilgrim Health Care Institute (J.F.W., D.R.-D.), and the Department of Health Policy and Management, Harvard School of Public Health (M.B.R.) - all in Boston.

Abstract

The Affordable Care Act (ACA) will cause a major expansion of high-deductible health insurance, a fact that has received little attention but has substantial implications for patients, health care providers, and employers. High-deductible health plans (HDHPs), often considered "blunt instruments" that indiscriminately reduce utilization of both appropriate and discretionary care, require annual out-of-pocket payments of $1,000 to $10,000 for many services before more comprehensive coverage begins.¹ Unfortunately, large gaps remain in our understanding of HDHPs' effects on vulnerable populations, life-saving services, and health outcomes.²,³ In the ACA, Congress chose market-based cost controls over measures that are common internationally, such . . .

Curr Pharm Des. 2013 Sep 27. [Epub ahead of print]

Pharmaceutical Interventions For Frailty And Sarcopenia.

Laosa O, Alonso C, Castro M, Rodríguez-Mañas L.

Source

Sº de Geriatría Hospital Universitario de Getafe Ctra. de Toledo, Km. 12,5 28905-GETAFE Spain. lrodriguez.hugf@salud.madrid.org.

Abstract

Frailty has emerged as one of the most relevant clinical syndromes in older patients. This term relates to the loss of functional reserve that can occur in some older people following exposure to one or more low-intensity stressors placing them at high risk for developing a number of adverse outcomes such as disability, falls, hospitalization and death. Frailty is the outcome of two combined effects: the ageing process and other superimposed injuries like chronic disease or, indeed, psychological and social stressors. The mechanisms leading to frailty typically involve several systems: mainly hormones, oxidative stress, inflammation, immunity, and vascular system. One of the most outstanding pillars of the frailty syndrome is the loss of muscle quantity and function, referred to as sarcopenia. The main bulk of experimental pharmacological interventions addressing the clinical problem of frailty have been focused on the use of hormones, as replacement therapy in subjects with low or normal circulating basal levels of the hormone. Results have been disappointing, except for the case of testosterone that have shown some benefits. The effectiveness of other potential therapeutic interventions (antioxidants, anti-inflammatory agents, nutritional supplements) appears to be limited or has not been explored in detail until now. In conclusion, there is an available path to prevent the development of disability in older people through the treatment of frailty, its main risk factor. Aditional research and further experimental testing will help to identify new targets and help to make this journey successful.

Science. 2013 Oct 4;342(6154):127-132.

Quantifying Long-Term Scientific Impact.

Wang D, Song C, Barabási AL.

Source

Center for Complex Network Research, Department of Physics, Department of Biology, and Department of Computer Science, Northeastern University, Boston, MA 02115, USA.

Abstract

The lack of predictability of citation-based measures frequently used to gauge impact, from impact factors to short-term citations, raises a fundamental question: Is there long-term predictability in citation patterns? Here, we derive a mechanistic model for the citation dynamics of individual papers, allowing us to collapse the citation histories of papers from different journals and disciplines into a single curve, indicating that all papers tend to follow the same universal temporal pattern. The observed patterns not only help us uncover basic mechanisms that govern scientific impact but also offer reliable measures of influence that may have potential policy implications.

From Harvard: The Ethics of Pharmaceutical Research Funding

J Law Med Ethics. 2013 Sep;41(3):629-634. doi: 10.1111/jlme.12072.

The Ethics of Pharmaceutical Research Funding: A Social Organization Approach.

Gray GC.

Source

Lab Fellow at the Edmond J. Safra Center for Ethics at Harvard University.

Abstract

This paper advances a social organization approach to examining unethical behavior. While unethical behaviors may stem in part from failures in individual morality or psychological blind spots, they are both generated and performed through social interactions among individuals and groups. To illustrate the value of a social organization approach, a case study of a medical school professor's first experience with pharmaceutical-company-sponsored research is provided in order to examine how funding arrangements can constrain research integrity. The case illustrates three significant ways that institutional corruption can occur in the research process. First, conflicts of norms between pharmaceutical companies, universities, and affiliated teaching hospitals can result in compromises and self-censorship. Second, normal behavior is shaped through routine interactions. Unethical behaviors can be (or can become) normal behaviors when they are produced and reproduced through a network of social interactions. Third, funding arrangements can create networks of dependency that structurally distort the independence of the academic researcher in favor of the funder's interests. More broadly, the case study demonstrates how the social organization approach deepens our understanding of the practice of ethics.

From U Ottawa: "the killing of patients was part of a biopolitical programme and not a relapse into barbarism"

Nurs Philos. 2013 Oct;14(4):284-94. doi: 10.1111/nup.12013.

Understanding 'caring' through biopolitics: the case of nurses under the Nazi regime.

Foth T.

Source

Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.

Abstract

These days, discussions of what might be the 'essence' or the 'core' of nursing and nursing practice sooner or later end in a discussion about the concept of care. Most of the 'newer' nursing theories use this concept as a theoretical core concept. Even though these theoretical approaches use the concept of care with very different philosophical foundations and theoretical consistency, they concur in defining care as the essence of nursing and thereby glorify goodness as the decisive characteristic of nursing. These theoretical approaches neglect the fact that nursing is above all a profession with a societal task and is characterized by an asymmetrical power relation between nurses and their patients. Based on the results of a research project that analysed the role nurses played in the killing of psychiatric patients in Germany during the Nazi regime, I demonstrate that an approach based on the concept of care is not able to explain how nurses were able to commit crimes of such atrocity. These crimes were bound to an emotional investment that sustained the production of 'life unworthy of living'. In the case of nurses under the Nazi regime, certainly a kind of sadism was at issue that can only be explained if we recognize that the social bond is characterized by a certain tension; 'goodness' that caring theories assign to the social bond always coexists with the capacity for destruction. Using the Foucauldian theoretical framework of biopower and biopolitics enables one to analyse violence and power as integral parts of nurses' practice. Seen from this perspective, the killing of patients was part of a biopolitical programme and not a relapse into barbarism. The concept of care obscures the political agenda of nursing and does not provide a critical and political framework to analysing nursing practice.

From Howard Brody and Franklin Miller: "one need not reject the research-treatment distinction in order to promote learning health systems"

Hastings Cent Rep. 2013 Sep;43(5):41-47. doi: 10.1002/hast.199.

The Research-Clinical Practice Distinction, Learning Health Systems, and Relationships.

Brody H, Miller FG.

Abstract

A special report of The Hastings Center and the Association of American Medical Colleges addressed the ethical oversight of learning health systems, which seek to combine high-quality patient care with routine data collection aimed at improving patient outcomes. The report contained two position papers, authored by a number of distinguished bioethicists, and several commentaries. The position papers urged two changes. First, they urged a rethinking of our approach to the regulation of human subjects research, so as to make it easier in the future for learning health systems to function well. Second, they argued that the rethinking required dispensing with a strict distinction between research and therapy, which has been a major tenet of bioethics since the Belmont Report, which explicated basic ethical principles governing human subjects research. We fully support the objectives of the authors, and we agree that the learning health system is an important advance that serves patients well. Unnecessary regulatory burden ought not impede this progress. We disagree, however, that the best way to bring about these needed changes in the regulatory environment is to reject the basic distinction between research and treatment. Unfortunately, we find the arguments in favor of that strategy to be, in places, reminiscent of what we take to be basic conceptual errors that hampered the ethical understanding of human subjects research prior to adoption of the Belmont Report. To see why one need not reject the research-treatment distinction in order to promote learning health systems, we first investigate in some detail the arguments offered for eliminating the distinction. We next turn to an issue not addressed by those authors, namely, the relationship between the physician or investigator and the patient or subject, to illustrate why the distinction is important and what is lost if it is jettisoned.

"Two Americans and a German won the 2013 Nobel medicine prize..."

Work on cell 'ferrying' system and disease triggers wins Nobel prize

 (Reuters) - Two Americans and a German won the 2013 Nobel medicine prize on Monday for their work on how hormones and enzymes are transported within and outside cells, giving insight into diseases such as diabetes and Alzheimer's.

James Rothman, Randy Schekman and Germany's Thomas Suedhof mapped out one of the body's critical networks that uses tiny bubbles known as vesicles to ferry chemicals such as insulin within cells. The system is so critical and sensitive that errors in the machinery can lead to death.

"Without this wonderfully precise organization, the cell would lapse into chaos," the Nobel Assembly at Sweden's Karolinska Institute said in a statement when awarding the prize of 8 million crowns ($1.2 million).

 

Hastings Cent Rep. 2013 Sep;43(5):39-40. doi: 10.1002/hast.210.

Does Quality Attestation Come in Only One Size?

Postema DC.

Abstract

The American Society for Bioethics and Humanities is now proposing a process whereby the role and authority of clinical ethics consultants can be legitimated. Without regulation and oversight, the field lacks validity and accountability. ASBH has sought to remedy the lack of uniform standards and accreditation by publishing Core Competencies in Health Care Ethics Consultation and an education guide, and now by proposing a "quality attestation process," situated between national certification processes and local credentialing practices, to "attest to the skills and ability of properly trained and competent clinical ethicists." If the process is successful, a cadre of certified clinical ethics consultants will emerge. Before the dawn of this new era, it is worth pausing to consider the adequacy of the quality attestation process itself and how it will affect the current world of clinicalethics consultants. Ethics consultations are often done by a multidisciplinary team, and the consult note is a compilation or synthesis of the work of the team. If the evidence required to attest to one's quality as an ethics consultant is to bear on one's ability to work with a team and present an integrated consult note, then these notes are relevant. If, however, the evidence is to bear on the quality of one's own work, then the evidence is inconclusive at best, fraudulent at worst. The quality attestation process seems to be predicated on the individual ethics consultant model, which may not jibe with the realities of ethics consultation. There may be more than one way to demonstrate one's competence, and there may be more than one competency to demonstrate.

The last battle of World War II

"The National Park Service, which according to former interior secretary Gale Norton “has a long history of dramatizing budget issues by inconveniencing the public,” but it outdid itself last week, blocking public access to places it doesn’t run."

John Wright, a 91-year-old WWII veteran: “This belongs to us, not them”

John Wright, a 91-year-old WWII veteran: “This belongs to us, not them”



Read more: http://www.politico.com/story/2013/10/government-shutdown-wwii-memorial-97875.html#ixzz2gt1TaakC

"Our freedoms come from and always will and always have from the individuals that raise their hand and say I will defend this country"

"Our freedoms come from and always will and always have from the individuals that raise their hand and say I will defend this country"

“It’s a cheap way to deal with the situation”

“It’s a cheap way to deal with the situation,” an angry Park Service ranger in Washington says of the harassment. “We’ve been told to make life as difficult for people as we can. It’s disgusting.”

Causes of death of prisoners of war during the Korean War

Yonsei Med J. 2013 Mar 1;54(2):480-8. doi: 10.3349/ymj.2013.54.2.480.

Causes of death of prisoners of war during the Korean War (1950-1953).

Lee MS, Kang MJ, Huh S.

Source

Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.

Abstract

PURPOSE:

This study aimed at analyzing the causes of death of prisoners of war (POWs) during the Korean War (1950-1953) who fought for theCommunist side (North Korea and the People's Republic of China). In 1998, the United States Department of Defense released new information about the prisoners including, 7,614 deaths of the POW during the Korean War. The data on the causes of death of the POWs during the Korean War provides valuable information on the both the public health and history of the conflict.

MATERIALS AND METHODS:

To analyze the causes of death of the POWs, we classified the clinical diagnosis and findings on 7,614 deaths into 22 chapters, as outlined in the International Statistical Classification of Diseases and Related Health Problems-10th Revision (ICD-10). Second, we traced changes in the monthly death totals of POWs as well as deaths caused by common infectious diseases and external causes of death including injury over time from August 1950 to September 1953.

RESULTS:

The most common category of causes of deaths of POWs was infectious disease, 5,013 (65.8%) out of 7,614 deaths, followed by external causes including injury, 817 (10.7%). Overall, tuberculosis and dysentery/diarrhea were the most common causes of death. Deaths caused by acute and chronic infection, or external causes showed different patterns of increases and decline over time during the Korean War.

CONCLUSION:

The information and data on POWs' deaths during the Korean War reflects the critical impact of the POWs' living conditions and the effect of public health measures implemented in POW camps during the war.

Vietnam army general Giap dies at 102

Legendary general Vo Nguyen Giap was known for scripting Vietnam's victory in wars against France and US. "The so-called ''red Napoleon'' stood out as the leader of rebels who wore sandals made of car tires and lugged their artillery piece by piece over mountains to encircle and crush French forces at Dien Bien Phu in 1954. The unlikely victory, which is still studied at military schools, led to Vietnam's independence and hastened the collapse of colonialism across Indochina and beyond. Giap went on to defeat the US-backed South Vietnam government in April 1975, reuniting a country that had been split into Communist and non-Communist states. He regularly accepted heavy combat losses to achieve his goals."