Public Health Rep. 2014 Jul;129(4):361-8.

What predicts dissemination efforts among public health researchers in the United States?

Tabak RG1, Stamatakis KA2, Jacobs JA1, Brownson RC3.

Author information

• 1Washington University in St. Louis, Prevention Research Center in St. Louis, Brown School, St. Louis, MO.
• 2Saint Louis University College for Public Health and Social Justice, Departments of Epidemiology and Behavioral Science and Health Education, St. Louis, MO.
• 3Washington University in St. Louis, Prevention Research Center in St. Louis, Brown School, St. Louis, MO ; Washington University in St. Louis, School of Medicine, Division of Public Health Sciences and Alvin J. Siteman Cancer Center, St. Louis, MO.

Abstract

OBJECTIVES:

We identified factors related to dissemination efforts by researchers to non-research audiences to reduce the gap between research generation and uptake in public health practice.

METHODS:

We conducted a cross-sectional study of 266 researchers at universities, the National Institutes of Health (NIH), and CDC. We identified scientists using a search of public health journals and lists from government-sponsored research. The scientists completed a 35-item online survey in 2012. Using multivariable logistic regression, we compared self-rated effort to disseminate findings to non-research audiences (excellent/good vs. poor) across predictor variables in three categories: perceptions or reasons to disseminate, perceived expectation by employer/funders, and professional training and experience.

RESULTS:

One-third of researchers rated their dissemination efforts as poor. Many factors were significantly related to whether a researcher rated him/herself as excellent/good, including obligation to disseminate findings (odds ratio [OR] = 2.7, 95% confidence interval [CI] 1.1, 6.8), dissemination important for their department (OR=2.3, 95% CI 1.2, 4.5), dissemination expected by employer (OR=2.0, 95% CI 1.2, 3.2) or by funder (OR=2.1, 95% CI 1.3, 3.2), previous work in a practice/policy setting (OR=4.4, 95% CI 2.1, 9.3), and university researchers with Prevention Research Center affiliation vs. NIH researchers (OR=4.7, 95% CI 1.4, 15.7). With all variables in the model, dissemination expected by funder (OR=2.0, 95% CI 1.2, 3.1) and previous work in a practice/policy setting (OR=3.5, OR 1.7, 7.1) remained significant.

CONCLUSIONS:

These findings support the need for structural changes to the system, including funding agency priorities and participation of researchers in practice- and policy-based experiences, which may enhance efforts to disseminate by researchers.

Int Health. 2014 Jun 26. pii: ihu037. [Epub ahead of print]

Neglected tropical diseases: now more than just 'other diseases'-the post-2015 agenda.

Molyneux DH.

Author information

• Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK david.molyneux@liv.ac.uk.

Abstract

Neglected tropical diseases (NTDs) have become recognised as important health problems facing at least a billion people in the low-income countries and the poorest communities in middle-income countries. WHO plays a leading role in developing strategies to address these diseases, pharmaceutical companies provide drug donations to treat or control the NTDs and many partners from different constituencies have become increasingly committed to their control or elimination. This review looks to the post-2015 agenda and emphasises that despite the progress made over recent years, if the targets established are to be achieved, then not only will additional financial resources be required to up-scale treatments and increase access, but increased applied and operational research will be necessary to address problems and human capacity in NTD skills will need to be strengthened. Continuing advocacy for the relevance of control or elimination of NTDs must be placed in the context of universal health coverage and access to donated essential medicines for the poor as a right. The evidence that investment in NTD interventions are cost-effective and impact not only on health, but also to enhance socio-economic development, must be refined and promulgated. The global burden of disease attributable to NTDs requires reassessment to appropriately define the true burden, while the potential for unexpected events, political, climatic, environmental as well as biological, have the potential to reduce future progress towards the agreed post-2015 targets. NTD progress towards the WHO Roadmap targets and the fulfilment of the World Health Assembly Resolution 66.12 of 2013 demand continued commitment from all partner constituencies when challenges emerge.

Liz Wagar: "Professional society–based clinical practice guidelines can be used to inform and influence hospital guidelines to promote best practices."

Elizabeth A. Wagar (2014) Credibility. Archives of Pathology & Laboratory Medicine: July 2014, Vol. 138, No. 7, pp. 873-875.

EDITORIALS

Credibility

Elizabeth A. Wagar, MD

From the Department of Laboratory Medicine, University of Texas, MD Anderson Cancer Center, Houston, Texas.

"Professional society–based clinical practice guidelines can be used to inform and influence hospital guidelines to promote best practices. They also provide evidence to challenge payors' decisions regarding reimbursement decisions. The transparent and structured process is a direct means for quality improvement and can play a role in pay-for-performance reimbursement. They additionally provide pathology exposure to the larger community. For example, the recent Her2/neu update reached many national and regional media outlets, informing millions of individuals about our progress. It is important that CAP and the CAP Center be among our frontline advocates for our credibility in answering these challenges."

From Stephen Sarewitz: Subspecialization in Community Pathology Practice

Stephen J. Sarewitz (2014) Subspecialization in Community Pathology Practice. Archives of Pathology & Laboratory Medicine: July 2014, Vol. 138, No. 7, pp. 871-872.

EDITORIALS

Subspecialization in Community Pathology Practice

Stephen J. Sarewitz, MD"More and more of the clinicians we serve are subspecialists, and if they are going to continue to turn to us for diagnostic and consultative services, we must possess corresponding subspecialty expertise in pathology and laboratory medicine. The breast surgeon needs a breast pathologist; the endocrinologist needs a pathologist with deep knowledge of clinical chemistry; the infectious disease specialist needs a microbiologist; and so forth. A generalist pathologist simply cannot command a sufficient depth of subspecialty knowledge to adequately serve these clinicians. Primary care physicians and physician extenders will also expect subspecialty expertise from their pathology group, just as they expect it from their clinical subspecialty consultants."

Texas A&M, Houston Methodist announce degree partnership

Texas A&M, Houston Methodist announce degree partnership

By Lora Hines

July 1, 2014

"Beginning with the 2015 fall semester, two dozen Texas A&M medical students annually will get a shot at completing their degrees in clinical training and graduate research at Houston Methodist's flagship hospital and research institute in the Texas Medical Center."

Accreditor Puts Baylor College of Medicine on Probation

Accreditor Puts Baylor College of Medicine on Probation

June 30, 2014 by Lawrence Biemiller

"The Liaison Committee on Medical Education said on Friday that it was putting Baylor College of Medicine on probation after an accreditation review found deficiencies in 14 administrative areas, the Associated Press reported."

Acad Med. 2014 Jun 20. [Epub ahead of print]

Honoring Those Who Have Served: How Can Health Professionals Provide Optimal Care for Members of the Military, Veterans, and Their Families?

Lee J1, Sanders KM, Cox M.

Author information

• 1Dr. Lee is deputy secretary of health and human resources, Commonwealth of Virginia, Richmond, Virginia, and was director, Office of Community Engagement, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, at the time this was written. Dr. Sanders is acting chief academic affiliations officer, Office of Academic Affiliations, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, and was deputy chief, Office of Academic Affiliations, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, at the time this was written. Dr. Cox is adjunct professor of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, and was chief academic affiliations officer, Office of Academic Affiliations, Veterans Health Administration, U.S. Department of Veterans Affairs, Washington, DC, at the time this was written.

Abstract

With over one million service members separating from the military over the next several years, it seems prudent to ask whether U.S. health care professionals and systems of care are prepared to evaluate and treat the obvious and more subtle injuries ascribed to military deployment and combat. The authors suggest that several systemic interventions-adding military health history sections to electronic health records, history and physical diagnosis textbooks, and licensing exams while also ensuring that this content is adequately covered in undergraduate and graduate health professional training-will enable all health care professionals to provide service members and veterans with the high-quality care that they deserve. The authors also highlight the U.S. Department of Veterans Affairs' recent innovations in education and care delivery, which are enhancing the education of thousands of students and residents, who will be better prepared to care for veterans after receiving this training.

SMOKE IT!

Harm Reduct J. 2014 Jun 27;11(1):18. [Epub ahead of print]

SMOKE IT! Promoting a change of opiate consumption pattern - from injecting to inhaling.

Stöver HJ, Schäffer D.

Abstract

BACKGROUND:

Intravenous drug use has been predominantly practised since illegal heroin use became known in Germany in the early 1970s. The available data suggest that the risk of accidental overdose when smoking heroin is substantially reduced compared to injecting a substance of unknown purity and quality. Moreover, the risk of transmitting HIV, Hepatitis B or C via blood contact is considerably reduced when smoking heroin rather than when injecting it intravenously. In spite of the significant strain on the lungs and the respiratory tract caused by smoking, it can be concluded that inhalative use - measured by the indicators 'overdose' and 'viral infections' is considerably less dangerous than intravenous use. Despite these harm-reducing effects of inhalative use, there is only very limited scientific survey on this subject. The project 'SMOKE IT!' studied to what extent a change of the consumption method can be supported by making new equipment for drug use available.

METHOD:

'SMOKE IT!' was carried out as a multi-centre survey in drug consumption rooms (DCRs) in five German cities. Participants received 'SMOKE-IT!' packs that contained new heroin smoking foils, as well as information about inhalative drug use. The quantitative data collection was aided by a written questionnaire filled out at three different stages in 2012.

RESULTS:

The vast majority of the 165 respondents favoured using the foils from the 'SMOKE-IT!' packs (82.5%). The survey shows that two-thirds of the sample used the SMOKE-IT foils for inhaling instead of injecting. Almost six out of ten said that smoking was healthier than injecting. Thirty-five percent of the participants named the reduced risk of a hepatitis or HIV infection as a particularly important factor. A third of the respondents used the smoking foils to avoid the danger of an overdose.

CONCLUSIONS:

Targeted media and personal intervention in association with the dispensation of attractive drug use equipment can motivate opiate users to change their method of drug use. The main reason for inhalative use is that it is significantly less dangerous, measured by the indicators 'overdose' and 'viral infections'. All drop-in centres should expand their syringe-exchange services to include the dispensation of smoking foils.

From the CDC: Geographic Variation of Reproductive Health Indicators and Outcomes in the United States: Place Matters

Am J Obstet Gynecol. 2014 Jun 20. pii: S0002-9378(14)00623-1. doi: 10.1016/j.ajog.2014.06.043. [Epub ahead of print]

Geographic Variation of Reproductive Health Indicators and Outcomes in the United States: Place Matters.

Callaghan WM.

Author information

• Division of Reproductive Health, Centers for Disease Control and Prevention. Electronic address: wgc0@cdc.gov.

Abstract

The social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics. Reproductive health indicators and conditions germane to obstetricians and gynecologists vary across states and regions in the United States as well as within regions and states. The aim of this paper is to illustrate this variation using examples of gynecologic malignancies, sexually transmitted infections, teen birth rates, preterm birth rates and infant mortality. Using the example of infant mortality, the difficulties in "unpacking" the construct of place will be discussed and a special emphasis is placed on the interaction of race, place and disparities in shaping perinatal outcomes. Finally, readily-available and easy to use online data resources will be provided so that obstetricians and gynecologists will be able to assess geographic variation in health indicators and outcomes in their own localities.

Behav Brain Sci. 2014 Jun;37(3):297-307. doi: 10.1017/S0140525X13001192.

Differences in negativity bias underlie variations in political ideology.

Hibbing JR1, Smith KB2, Alford JR3.

Author information

• 1Department of Political Science,University of Nebraska-Lincoln,Lincoln,NE 68588.jhibbing@unl.eduwww.unl.edu/polphyslab.
• 2Department of Political Science,University of Nebraska-Lincoln,Lincoln,NE 68588.ksmith1@unl.eduwww.unl.edu/polphyslab.
• 3Department of Political Science,Rice University,Houston,TX 77005.jra@rice.eduhttp://politicalscience.rice.edu/

Abstract

Disputes between those holding differing political views are ubiquitous and deep-seated, and they often follow common, recognizable lines. The supporters of tradition and stability, sometimes referred to as conservatives, do battle with the supporters of innovation and reform, sometimes referred to as liberals. Understanding the correlates of those distinct political orientations is probably a prerequisite for managing political disputes, which are a source of social conflict that can lead to frustration and even bloodshed. A rapidly growing body of empirical evidence documents a multitude of ways in which liberals and conservatives differ from each other in purviews of life with little direct connection to politics, from tastes in art to desire for closure and from disgust sensitivity to the tendency to pursue new information, but the central theme of the differences is a matter of debate. In this article, we argue that one organizing element of the many differences between liberals and conservatives is the nature of their physiological and psychological responses to features of the environment that are negative. Compared with liberals, conservatives tend to register greater physiological responses to such stimuli and also to devote more psychological resources to them. Operating from this point of departure, we suggest approaches for refining understanding of the broad relationship between political views and response to the negative. We conclude with a discussion of normative implications, stressing that identifying differences across ideological groups is not tantamount to declaring one ideology superior to another.

Behav Brain Sci. 2014 Jun;37(3):315-6. doi: 10.1017/S0140525X13002598.

Disgust, politics, and responses to threat.

Inbar Y1, Pizarro D2.

Author information

• 1Department of Social Psychology,Tilburg University,NL-5000 LE Tilburg,The Netherlands.yinbar@uvt.nlhttp://yoelinbar.net.
• 2Department of Psychology,Cornell University,Ithaca,NY 14853.dap54@cornell.eduhttp://peezer.net.

Abstract

We address two questions regarding the relationship between political ideology and responses to threatening or aversive stimuli. The first concerns the reason for the connection between disgust and specific political and moral attitudes; the second concerns the observation that some responses to threat (i.e., neuroticism/anxiety) are associated with a more left-wing political orientation.

Pers Soc Psychol Bull. 2014 Jun 27. pii: 0146167214537834. [Epub ahead of print]

"Ditto Heads": Do Conservatives Perceive Greater Consensus Within Their Ranks Than Liberals?

Stern C1, West TV2, Jost JT2, Rule NO3.

Author information

• 1New York University, New York, USA cds330@nyu.edu.
• 2New York University, New York, USA.
• 3University of Toronto, Ontario, Canada.

Abstract

In three studies, we examined (a) whether conservatives possess a stronger desire to share reality than liberals and are therefore more likely to perceive consensus with politically like-minded others even for non-political judgments and, if so, (b) whether motivated perceptions of consensus would give conservatives an edge in progressing toward collective goals. In Study 1, participants estimated ingroup consensus on non-political judgments. Conservatives perceived more ingroup consensus than liberals, regardless of the amount of actual consensus. The desire to share reality mediated the relationship between ideology and perceived ingroup consensus. Study 2 replicated these results and demonstrated that perceiving ingroup consensus predicted a sense of collective efficacy in politics. In Study 3, experimental manipulations of affiliative motives eliminated ideological differences in the desire to share reality. A sense of collective efficacy predicted intentions to vote in a major election. Implications for the attainment of shared goals are discussed.

"...the non-involvement of a doctor in the process of making an advance directive must be seen as potentially problematic..."

BMC Med Ethics. 2014 Jun 30;15(1):52. [Epub ahead of print]

To what extent are the wishes of a signatory reflected in their advance directive: a qualitative analysis.

Nauck F, Becker M, King C, Radbruch L, Voltz R, Jaspers B.

Abstract

BACKGROUND:

Advance directives (ADs) are assumed to reflect the patients' preferences, even if these are not clearly expressed. Research into whether this assumption is correct has been lacking. This study explores to what extent ADs reflect the true wishes of the signatories.

METHODS:

Semi-structured interviews (INT), pretest. Transcribed INT and the contents of ADs were inductively categorised (Mayring) and triangulated. Software: MAXQDA 2007. Participants: Patients receiving palliative care (PPC), healthy (H) and chronically ill (CI) individuals with an AD completed >=3 months prior to recruitment.

RESULTS:

Between 08/2008 and 07/2009, 53 individuals (20 H, 17 CI, 16 PPC) were interviewed (mean age 63.2 years (55-70 years)), 34% male). Most important (in)consistencies between preferences as expressed in INT compared to ADs included preconditions for termination/rejection of life-sustaining measures, refusal of/demand for medical interventions and the nomination of proxies. Standardized AD forms were rarely tailored to the individual. We found a high tendency to use set phrases, such as want to die with dignity or do not want to suffer/vegetate. Likely events in the course of an existing progressive disease were not covered, even in ADs of PPC close to death.

CONCLUSIONS:

Only some of the incongruities between verbally expressed preferences and the contents of the AD can be put down to use of standardized forms or lack of medical knowledge. Nevertheless, the non-involvement of a doctor in the process of making an AD must be seen as potentially problematic and seeking medical advice should be promoted by politics and physicians. Standardised forms should encourage amendments and present space for free text entries for all aspects covered. Set phrases need to be defined by the individual to enable them to be translated into a specific course of action.

Pediatrics. 2014 Jun 30. pii: peds.2013-1911. [Epub ahead of print]

Translational Research in Pediatrics III: Bronchoalveolar Lavage.

Radhakrishnan D1, Yamashita C2, Gillio-Meina C3, Fraser DD4.

Author information

• 1Departments of Pediatrics,Children's Health Research Institute, London, Ontario, Canada;
• 2Medicine,Centre for Critical Illness Research, Western University, London, Ontario, Canada; andPhysiology and Pharmacology, and.
• 3Clinical Neurologic Sciences, Western University, London, Ontario, Canada;
• 4Departments of Pediatrics,Children's Health Research Institute, London, Ontario, Canada;Centre for Critical Illness Research, Western University, London, Ontario, Canada; andPhysiology and Pharmacology, andClinical Neurologic Sciences, Western University, London, Ontario, Canada;Translational Research Centre, London, Ontario, Canada douglas.fraser@lhsc.on.ca.

Abstract

The role of flexible bronchoscopy and bronchoalveolar lavage (BAL) for the care of children with airway and pulmonary diseases is well established, with collected BAL fluid most often used clinically for microbiologic pathogen identification and cellular analyses. More recently, powerful analytic research methods have been used to investigate BAL samples to better understand the pathophysiological basis of pediatric respiratory disease. Investigations have focused on the cellular components contained in BAL fluid, such as macrophages, lymphocytes, neutrophils, eosinophils, and mast cells, as well as the noncellular components such as serum molecules, inflammatory proteins, and surfactant. Molecular techniques are frequently used to investigate BAL fluid for the presence of infectious pathologies and for cellular gene expression. Recent advances in proteomics allow identification of multiple protein expression patterns linked to specific respiratory diseases, whereas newer analytic techniques allow for investigations on surfactant quantification and function. These translational research studies on BAL fluid have aided our understanding of pulmonary inflammation and the injury/repair responses in children. We review the ethics and practices for the execution of BAL in children for translational research purposes, with an emphasis on the optimal handling and processing of BAL samples.

Acad Med. 2014 Jun 20. [Epub ahead of print]

The Rashomon Effect: Another View of Medicine, Religion, and the American Medical Association.

Crigger BJ.

Author information

• Dr. Crigger is director of ethics policy, American Medical Association, Chicago, Illinois.

Abstract

What is the story of medicine and religion at the American Medical Association (AMA)? Where did the Department of Medicine and Religion originate? What did the program accomplish? Why was it all but completely discontinued after scarcely a decade? The surviving records support more than one interpretation. Exploring the broader organizational context helps tell a richer story.In this issue of Academic Medicine, Daniel Kim and colleagues open a window on a fascinating bit of history: that of the AMA's formal experience with religion and medicine during the 1960s and early 1970s; however, reconstructing the story of a program from documentary records is always something of an uncertain proposition. Equally important is taking account of such factors as the role of the AMA's House of Delegates in policy making, of state and county medical societies in carrying out program activities, and of the influence of charismatic individuals on decisions regarding programs and activities. Before the medical community decides what lesson(s) to draw from the story of the AMA's Department of Medicine and Religion, it should try to understand that story as completely as possible.As Kim et al note, the available materials leave out much that historians might wish to know. Records preserve the substance of decisions taken, but are largely silent about the reasoning behind those decisions. Relevant information is scattered through multiple record systems, making it difficult to find. Inevitably, historians have to read between the lines.

From Tim Mackey, Bryan Liang, and colleagues: Call to action: promoting domestic and global tobacco control by ratifying the framework convention on tobacco control in the United States

PLoS Med. 2014 May 6;11(5):e1001639. doi: 10.1371/journal.pmed.1001639. eCollection 2014.

Call to action: promoting domestic and global tobacco control by ratifying the framework convention on tobacco control in the United States.

Mackey TK1, Liang BA2, Pierce JP3, Huber L4, Bostic C5.

Author information

• 1Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, California, United States of America; Global Health Policy Institute, San Diego, California, United States of America; Joint Masters Program on Health Policy and Law, University of California, San Diego-California Western School of Law, San Diego, California, United States of America.
• 2Department of Anesthesiology, University of California San Diego School of Medicine, San Diego, California, United States of America; Global Health Policy Institute, San Diego, California, United States of America.
• 3Department of Family and Preventative Medicine, University of California San Diego School of Medicine, San Diego, California, United States of America.
• 4Action on Smoking and Health, Washington, DC, United States of America; The Framework Convention Alliance for Tobacco Control, Washington, DC, United States of America.
• 5Action on Smoking and Health, Washington, DC, United States of America.

"Current legal ambiguity has resulted in renewed efforts by the FDA to create new defensible tobacco health warnings. However, even with new warnings, a tobacco industry challenge on constitutional grounds is inevitable and could lead to a future SCOTUS hearing on the issue that poses risks for both domestic and global tobacco control efforts. This is a critical concern given the prominence of the United States in the political economy of the tobacco industry and the need for international support of state-based FCTC implementation in response to strategic and widespread industry legal challenges [10]. In response, the US, consistent with its history of progressive tobacco control policy, including the first health warnings on tobacco packages globally in 1966, should immediately and actively pursue FCTC ratification to protect and promote tobacco control measures being pursued locally and globally."

From Howard Brody: Chauncey Leake and the development of bioethics in America

Kennedy Inst Ethics J. 2014 Mar;24(1):73-95.

Chauncey Leake and the development of bioethics in America.

Brody H.

Abstract

Chauncey D. Leake (1896-1978) occupies a unique place in the history of American bioethics. A pharmacologist, he was largely an autodidact in both history and philosophy, and believed that ethics should ideally be taught to medical students by those with philosophical training. After pioneering work on medical ethics during the 1920s, he helped to lay the groundwork for important centers for bioethics and medical humanities at two institutions where he worked, the University of California-San Francisco and the University of Texas Medical Branch-Galveston. Understanding Leake's role in American bioethics requires navigating a number of paradoxes--why he was described respectfully in his time but largely forgotten today; how in the 1920s he could write forward-looking pieces that anticipated many of the themes taken up by bioethics a half-century later, yet played largely a reactionary role when the new bioethics actually arrived; and why he advocated turning to philosophy and philosophers for a proper understanding of ethics, yet appeared often to misunderstand philosophical ethics.

From Yale and Johns Hopkins: Why We Need Community Engagement in Medical Research

J Investig Med. 2014 Jun 20. [Epub ahead of print]

Why We Need Community Engagement in Medical Research.

Holzer JK1, Ellis L, Merritt MW.

Author information

• 1From the *Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT; and †Department of HealthPolicy and Management, ‡Berman Institute of Bioethics, and §Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.

Abstract

BACKGROUND:

The medical research enterprise depends on public recognition of its societal value. In light of evidence indicating public mistrust, especially among minorities, inadequate enrollment as well as diversity of research participants, and poor uptake of findings, medical research seems to fall short of sufficient public regard. Community engagement in medical research, with special attention to minority communities, may help to remedy this shortfall by demonstrating respect for the communities in practical ways.

APPROACH:

We provided 3 case examples that illustrate how specific approaches to community-engaged research can build trust between researchers and communities, encourage participation among underrepresented groups, and enhance the relevance as well as the uptake of research findings.

DISCUSSION:

A common attribute of the specific approaches discussed here is that they enable the researchers to demonstrate respect by recognizing community values and interests. The demonstration of respect for the communities has intrinsic ethical importance.

CONCLUSIONS:

The 2 potential outgrowths of demonstrating respect specifically through community engagement are (1) the production of research that is more relevant to the community and (2) the mitigation of asymmetry in the researcher-community relationship. We summarized practical resources available to researchers who seek to incorporate community engagement in their research.

"...living in chaotic family environments places youth who may be vulnerable based on socioeconomic factors at a potentially higher risk for inflammation-related diseases."

Psychosom Med. 2014 Jun 20. [Epub ahead of print]

Family Chaos and Adolescent Inflammatory Profiles: The Moderating Role of Socioeconomic Status.

Schreier HM1, Roy LB, Frimer LT, Chen E.

Author information

• 1From the Department of Pediatrics (H.M.C.S.), Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychology (L.B.R.), University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry (L.T.F.), St Paul's Hospital, Vancouver, BC, Canada; and Department of Psychology and Cells to Society (C2S) (E.C.), The Center on Social Disparities and Health, Institute for Policy Research, Northwestern University, Evanston, Illinois.

Abstract

OBJECTIVE:

To test whether family chaos influences adolescents' inflammatory profiles and whether adolescents from low socioeconomic status (SES) environments are at higher risk for experiencing adverse inflammatory profiles from living in chaotic family environments.

METHODS:

A total of 244 families with an adolescent aged 13 to 16 years participated. Parents completed measures of family SES and family chaos. Both systemic inflammation and stimulated proinflammatory cytokine production in response to bacterial challenge were assessed in adolescents.

RESULTS:

Our results suggest that SES moderates the detrimental effect of family chaos on systemic inflammation and interleukin-6 (B = -0.010, standard error [SE] = 0.004, p = .026), but not C-reactive protein (B = 0.009, SE = 0.006, p = .11), and on stimulated proinflammatory cytokine production (B = -0.098, SE = 0.044, p = .026) in adolescents, such that a chaotic family environment is positively associated with greater systemic inflammation and greater stimulated proinflammatory cytokine production in adolescents as family SES declines.

CONCLUSIONS:

These findings indicate that living in chaotic family environments places youth who may be vulnerable based on socioeconomic factors at a potentially higher risk for inflammation-related diseases.

Curr Opin Crit Care. 2014 Jun 28. [Epub ahead of print]

Pulmonary complications in patients receiving a solid-organ transplant.

De Gasperi A1, Feltracco P, Ceravola E, Mazza E.

Author information

• 1a2° Service Anesthesia CCM, Ospedale Niguarda Ca Granda, Milan bDepartment of Medicine, Anesthesia and Intensive Care Unit, Padova University Hospital, Padova, Italy.

Abstract

PURPOSE OF REVIEW:

Major improvements in perioperative care and immunobiology have not abated the risk for severe pulmonary complications after solid-organ transplantation. The aim of this study is to update information on infectious and noninfectious pulmonary complications after solid-organ transplantation, addressing epidemiology, risk factors, diagnostic workup, and management.

RECENT FINDINGS:

Infectious and noninfectious postoperative pulmonary complications depend on the grafted organ and the anatomical site of transplantation. Kidney transplants have the lowest incidence of pulmonary complications, the highest being reported for heart, lung, and liver recipients. Respiratory tract infections, ranking first in heart and lung transplants and second in liver recipients, are a common cause of mortality. Risk factors include end-stage organ disease, comorbidities, perioperative procedures, and graft function. Factors specific for infections are timeline, state of immunosuppression, and graft dysfunction. Nosocomial multi-drug resistant pathogens are frequently responsible for the most severe infections. Aggressive diagnostic workup, early and broad empiric antiinfective therapy, and deescalation policy are the mainstays of their management. The role of intraoperative protective ventilation is under scrutiny.

SUMMARY:

Pulmonary complications after solid-organ transplantation, and particularly infections, are able to compromise the extremely good results of the transplant procedures. Solid-organ transplantation recipients challenge the ICU physician with unique aspects of their post-transplant course, adding, in an already critical patient, the immunosuppressed state and the quality of the functional recovery of the graft.