Prim Prev Insights. 2015;5:1-4.

Obesity Prevention and Treatment in School-aged Children, Adolescents, and Young Adults-Where Do We Go from Here?

Karp SM1, Gesell SB2.

Author information

• 1Schools of Nursing and Medicine (Pediatrics), Vanderbilt University, Nashville, TN, USA.
• 2Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Abstract

The rise in the rate of obesity in school-aged children, adolescents, and young adults in the last 30 years is a clear healthcare crisis that needs to be addressed. Despite recent national reports in the United States highlighting positive downward trends in the rate of obesity in younger children, we are still faced with approximately 12.7 million children struggling with obesity. Given the immediate and long-term health consequences of obesity, much time and effort has been expended to address this epidemic. Yet, despite these efforts, we still only see limited, short-term success from most interventions. Without changes to how we address childhood obesity, we will continue to see inadequate improvements in the health of our children. Clinicians and researchers need to be lobbying for evidence-based policy changes, such as those identified by systems science, in order to improve the nation's health.

"All of the hipsters start to synchronize, and they start to oscillate in unison."

The mathematician who proved why hipsters all look alike

What brain neurons tell us about the 'hipster effect' when all contrarians end up looking the same.

"What Touboul noticed is that if you increase the delay factor past a certain point, something amazing happens. Out of what appears to be random noise, a pattern emerges. All of the hipsters start to synchronize, and they start to oscillate in unison."

HT:RW

Virulence. 2015 Jul 7:1-12. [Epub ahead of print]

Tackling tuberculosis: insights from an international TB Summit in London.

Maitra A1, Danquah CA, Scotti F, Howard TK, Kamil TK, Bhakta S.

Author information

• 1a Mycobacteria Research Laboratory; Institute of Structural and Molecular Biology; Birkbeck; University of London , Malet Street, Bloomsbury, London WC1E 7HX , United Kingdom.

Abstract

Tuberculosis (TB) poses a grave predicament to the world as it is not merely a scientific challenge but a socio-economic burden as well. A prime cause of mortality in human due to an infectious disease; the malady and its cause, Mycobacterium tuberculosis have remained an enigma with many questions that remain unanswered. The ability of the pathogen to survive and switch between varied physiological states necessitates a protracted therapeutic regimen that exerts an excessive strain on low-resource countries. To complicate things further, there has been a significant rise of antimicrobial resistance. Existing control measures, including treatment regimens have remained fairly uniform globally for at least half a century and require reinvention. Overcoming the societal and scientific challenges requires an increase in dialog to identify key regions that need attention and effective partners with whom successful collaborations can be fostered. In this report, we explore the discussions held at the International TB Summit 2015 hosted by EuroSciCon, which served as an excellent platform for researchers to share their recent findings. Ground-breaking results require outreach to affect policy design, governance and control of the disease. Hence, we feel it is important that meetings such as these reach a wider, global audience.

Curr Biol. 2015 Jul 1. pii: S0960-9822(15)00595-3. doi: 10.1016/j.cub.2015.05.021. [Epub ahead of print]

Dissociable Effects of Serotonin and Dopamine on the Valuation of Harm in Moral Decision Making.

Crockett MJ1, Siegel JZ2, Kurth-Nelson Z3, Ousdal OT4, Story G5, Frieband C5, Grosse-Rueskamp JM5, Dayan P6, Dolan RJ3.

Author information

• 1Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford OX1 3UD, UK; Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London WC1N 3BG, UK. Electronic address: molly.crockett@psy.ox.ac.uk.
• 2Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford OX1 3UD, UK.
• 3Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London WC1N 3BG, UK; Max Planck-UCL Centre for Computational Psychiatry and Ageing, University College London, 12 Queen Square, London WC1N 3BG, UK.
• 4Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London WC1N 3BG, UK; Department of Radiology, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway.
• 5Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen Square, London WC1N 3BG, UK.
• 6Gatsby Computational Neuroscience Unit, University College London, Alexandra House, 17 Queen Square, London WC1N 3AR, UK.

Abstract

An aversion to harming others is a core component of human morality and is disturbed in antisocial behavior [1-4]. Deficient harm aversion may underlie instrumental and reactive aggression, which both feature in psychopathy [5]. Past work has highlighted monoaminergic influences on aggression [6-11], but a mechanistic account of how monoamines regulate antisocial motives remains elusive. We previously observed that most people show a greater aversion to inflicting pain on others than themselves [12]. Here, we investigated whether this hyperaltruistic disposition is susceptible to monoaminergic control. We observed dissociable effects of the serotonin reuptake inhibitor citalopram and the dopamine precursor levodopa on decisions to inflict pain on oneself and others for financial gain. Computational models of choice behavior showed that citalopram increased harm aversion for both self and others, while levodopa reduced hyperaltruism. The effects of citalopram were stronger than those of levodopa. Crucially, neither drug influenced the physical perception of pain or other components of choice such as motor impulsivity or loss aversion [13, 14], suggesting a direct and specific influence of serotonin and dopamine on the valuation of harm. We also found evidence for dose dependency of these effects. Finally, the drugs had dissociable effects on response times, with citalopram enhancing behavioral inhibition and levodopa reducing slowing related to being responsible for another's fate. These distinct roles of serotonin and dopamine in modulating moral behavior have implications for potential treatments of social dysfunction that is a common feature as well as a risk factor for many psychiatric disorders.

From U Pittsburgh: An Overview of Sarcopenic Obesity

J Clin Densitom. 2015 Jun 30. pii: S1094-6950(15)00052-9. doi: 10.1016/j.jocd.2015.04.013. [Epub ahead of print]

An Overview of Sarcopenic Obesity.

Cauley JA1.

Author information

• 1Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: jcauley@edc.pitt.edu.

Abstract

Sarcopenic obesity (SO) refers to the copresence of sarcopenia and obesity. In this condition, a disproportion exists between the amount of lean mass relative to fat mass. Research on SO is important because the presence of both sarcopenia and obesity may have important health consequences. However, SO research has been hampered by the disparate number of definitions of SO. Various definitions of sarcopenia include ratios of appendicular mass to height2 or body weight, measures of muscle strength, or physical function. More recent definitions incorporate all 3. Obesity is usually defined by high body mass index, but some studies have relied on percent body fat or visceral fat. Depending on the definition, the prevalence of SO ranges from 0% to 41% in older populations. The loss of lean mass and increase in fat mass with advancing age may share common etiologic pathways. Declines in physical activity can lead to poor muscle strength, lower muscle mass, and increased fat infiltration; all of which could lead to increases in fat mass. The increases in fat mass and accompanying increases in adipokines and inflammation may further adversely affect muscle quality. SO has been related to an increased risk of mobility disability, above and beyond sarcopenia, or obesity alone. Additional research is needed to further our understanding of the pathophysiology of SO and its consequences. Interventions aimed at reducing SO may improve physical function as well as reduce disability and death.

Drug Des Devel Ther. 2015 Jun 24;9:3247-55. doi: 10.2147/DDDT.S75219. eCollection 2015.

Development of biosimilars in an era of oncologic drug shortages.

Li E1, Subramanian J2, Anderson S3, Thomas D4, McKinley J5, Jacobs IA4.

Author information

• 1University of New England College of Pharmacy, Portland, ME, USA.
• 2Hanna Cancer Associates, Knoxville, TN, USA.
• 3Pfizer Inc, La Jolla, CA, USA.
• 4Pfizer Inc, New York, NY, USA.
• 5Pfizer Inc, Groton, CT, USA.

Abstract

Acute and chronic shortages of various pharmaceuticals and particularly of sterile injectable products are being reported on a global scale, prompting evaluation of more effective strategies to manage current shortages and development of new, high-quality pharmaceutical products to mitigate the risk of potential future shortages. Oncology drugs such as liposomal doxorubicin and 5-fluorouracil represent examples of first-choice drugs critically affected by shortages. Survey results indicate that the majority of hospitals and practicing oncologists have experienced drug shortages, which may have compromised patient safety and clinical outcomes, and increased health care costs, due to delays or changes in treatment regimens. Clinical trials evaluating novel agents in combination with standard-of-care drugs are also being affected by drug shortages. Clinical and ethicalconsiderations on treatment objectives, drug indication, and availability of alternative options may help in prioritizing cancer patients involved in active drug shortages. The United States Food and Drug Administration and the European Medicines Agency have identified manufacturing problems, delays in supply, and lack of available active ingredients as the most frequent causes of recent or ongoing drug shortages, and have released specific guidance to monitor, manage, and reduce the risk of shortages. The upcoming loss of exclusivity for a number of anticancer biologics, together with the introduction of an abbreviated approval pathway for biosimilars, raises the question of whether these products will be vulnerable to shortages. Future supply by reliable manufacturers of well characterized biosimilar monoclonal antibodies, developed in compliance with regulatory and manufacturing guidelines and with substantial investments, may contribute to prevent future biologics shortages and ensure access to effective and safe treatment options for patients with cancer. Preclinical and clinical characterization is ongoing for potential biosimilars of trastuzumab, rituximab, and bevacizumab, with promising results.

Transl Res. 2015 Jun 18. pii: S1931-5244(15)00212-1. doi: 10.1016/j.trsl.2015.06.007. [Epub ahead of print]

The role of genetic testing in unexplained sudden death.

Miles CJ1, Behr ER2.

Author information

• 1Division of Clinical Sciences, Cardiovascular Sciences Research Centre, St George's University of London, London, UK.
• 2Division of Clinical Sciences, Cardiovascular Sciences Research Centre, St George's University of London, London, UK. Electronic address: ebehr@sgul.ac.uk.

Abstract

Most sudden deaths are because of a cardiac etiology and are termed sudden cardiac death (SCD). In younger individuals coronary artery disease is less prevalent and cardiac genetic disorders are more common.1 If sudden death is unexplained despite an appropriate autopsy and toxicologic assessment the term sudden arrhythmic death syndrome (SADS) may be used.2 This is an umbrella term and common underlying etiologies are primary arrhythmia syndromes with a familial basis such as Brugada syndrome, long QT syndrome, and subtle forms of cardiomyopathy. The first clinical presentation of these conditions is often SCD, which makes identification, screening, and risk stratification crucial to avert further deaths. This review will focus on genetic testing in the context of family screening. It will address the role of the "molecular autopsy" alongside current postmortem practices in the evaluation of SADS deaths. We describe the current data underlying genetic testing in these conditions, explore the potential for next-generation sequencing, and discuss the inherent diagnostic problems in determination of pathogenicity.

Zombie allusions: They just keep on coming: "filled with stagnant water and breeding lots of mosquitoes."

"Zombie" pool in Kenmore breeding lots of mosquitoes, neighbors worry about West Nile Virus

"KENMORE, N.Y. - "The mosquitoes are bad enough that we can't even enjoy our back yard," said Kenmore resident James Burns who is furious that he living next door to a vacant property with an in-ground pool that is filled with stagnant water and breeding lots of mosquitoes.
Burns said he has complained to Village of Kenmore officials, but because the property is in foreclosure, there is nothing more than they can do.  Adding to Burns concern is the recent discovery that some mosquitoes in Erie County have tested positive for the West Nile Virus.  "I am very, very concerned about that because I have numerous mosquito bites." commented the Washington Avenue resident."  

Oncotarget. 2015 Jun 10. [Epub ahead of print]

Reactive oxygen species a double-edged sword for mesothelioma.

Benedetti S1, Nuvoli B2, Catalani S1, Galati R2.

Author information

• 1Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy.
• 2Molecular Medicine Area, Regina Elena National Cancer Institute, Rome, Italy.

Abstract

It is well known that oxidative stress can lead to chronic inflammation which, in turn, could mediate most chronic diseases including cancer. Oxidants have been implicated in the activity of crocidolite and amosite, the most powerful types of asbestos associated to the occurrence ofmesothelioma. Currently rates of mesothelioma are rising and estimates indicate that the incidence of mesothelioma will peak within the next 10-15 years in the western world, while in Japan the peak is predicted not to occur until 40 years from now. Although the use of asbestos has been banned in many countries around the world, production of and the potentially hazardous exposure to asbestos is still present with locally high incidences ofmesothelioma. Today a new man-made material, carbon nanotubes, has arisen as a concern; carbon nanotubes may display 'asbestos-like' pathogenicity with mesothelioma induction potential. Carbon nanotubes resulted in the greatest reactive oxygen species generation. How oxidative stress activates inflammatory pathways leading to the transformation of a normal cell to a tumor cell, to tumor cell survival, proliferation, invasion, angiogenesis, chemoresistance, and radioresistance, is the aim of this review.

Bon appetit: Beer Calorie Counts Will Hit Restaurant Menus by December

Beer Calorie Counts Will Hit Restaurant Menus by December

"Many are doubtful that the new requirements will actually cause any behavioral changes. Annica Kreider, a spokesperson for pizza chain Mellow Mushroom, tells Draft: "I think beer lovers are like food lovers; they're going to indulge in what's important to them and compensate elsewhere." Studies have also shown that displaying calorie counts may not be the best way to curb consumption. Instead, researchers found listing the amount of exercise required to burn off the menu item was more effective."

J Thorac Oncol. 2015 Jul;10(7):974-84. doi: 10.1097/JTO.0000000000000551.

Non-Small-Cell Lung Cancer: Role of the Immune System and Potential for Immunotherapy.

Carbone DP1, Gandara DR, Antonia SJ, Zielinski C, Paz-Ares L.

Author information

• 1*Ohio State University Medical Center, Columbus, Ohio; †University of California Davis Comprehensive Cancer Center, Sacramento, California; ‡H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; §Comprehensive Cancer Center, Medical University of Vienna General Hospital, Vienna, Austria; and ‖Instituto de Biomedicina de Sevilla, Seville, Spain.

Abstract

As the leading cause of cancer death worldwide, lung cancer continues to impose a major burden on healthcare systems and cause significant challenges for clinicians and patients. Most patients present with advanced disease at the time of diagnosis and have a poor prognosis, with the vast majority surviving less than 5 years. Although new therapies have been introduced in recent years that target molecular disease drivers present in a subset of patients, there is a significant need for treatments able to improve response and extend survival while minimizing effects on quality of life. Recent evidence of clinical efficacy for immunotherapeutic approaches for lung cancer suggests that they will become the next major therapeutic advance for this disease. Non-small-cell lung cancer, which accounts for approximately 85% of lung cancer cases, has historically been considered a nonimmunogenic disease; however, as with several other malignancies, recent data show that much of this lack of immune responsiveness is functional rather than structural (i.e., possible to overcome therapeutically). This review explores the key elements of the immune system involved in non-small-cell lung cancer and briefly examines immunotherapeutic strategies in development to shift the balance of immune activity away from a tumor-induced immune-suppressive state toward an active antitumor immune response.

Pediatr Res. 2015 Jul 7. doi: 10.1038/pr.2015.130. [Epub ahead of print]

Decreased renal function in overweight and obese prepubertal children.

Correia-Costa L1, Caldas Afonso A1, Schaefer F2, Guimarães JT3, Bustorff M4, Guerra A5, Barros H6, Azevedo A6.

Author information

• 11] EPIUnit -Institute of Public Health, University of Porto, Porto, Portugal [2] Division of Pediatric Nephrology, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal.
• 2Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany.
• 31] EPIUnit -Institute of Public Health, University of Porto, Porto, Portugal [2] Department of Clinical Pathology, Centro Hospitalar São João & Department of Biochemistry, Faculty of Medicine, University of Porto, Porto, Portugal.
• 4Department of Nephrology, Centro Hospitalar São João, Porto, Portugal.
• 5Division of Pediatric Nutrition, Integrated Pediatric Hospital, Centro Hospitalar São João, Porto, Portugal.
• 61] EPIUnit -Institute of Public Health, University of Porto, Porto, Portugal [2] Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine of University of Porto, Porto, Portugal.

Abstract

BACKGROUND:

Obesity is a potentially modifiable risk factor for the development and progression of kidney disease, both in adults and children. We aim to study the association of obesity and renal function in children, by comparing estimated glomerular filtration rate (eGFR) in nonoverweight and overweight/obese children. Secondarily, we aim to evaluate the accuracy of equations on eGFR estimation when compared to 24-hour urinary creatinine clearance (CrCl).

METHODS:

Cross-sectional study of 313 children aged 8-9 years, followed in the birth cohort Generation XXI (Portugal). Creatinine and cystatin C, GFR estimated by several formulas and CrCl were compared in 163 nonoverweight and 150 overweight/obese, according to WHO growth reference.

RESULTS:

Overweight/obese children had significantly lower eGFR, estimated by all methods, except for CrCl and revised Schwartz formula. Despite all children having renal function in the normal range, eGFR decreased significantly with BMI z-score (differences ranging from -4.3 to -1.1 mL/min/1.73m2 per standard deviation of BMI). The Zappitelli combined formula presented the closest performance to CrCl, with higher correlation coefficients and higher accuracy values.

CONCLUSION:

Young prepubertal children with overweight/obesity already present significantly lower GFR estimations that likely represent some degree of renal impairment associated with the complex deleterious effects of adiposity.

CDC: Only 1 in 10 Americans Eats Enough Fruits and Vegetables

Only 1 in 10 Americans Eats Enough Fruits and Veggies: CDC

The foods help lower risk of illnesses such as obesity, heart disease and type 2 diabetes, expert says

"Even residents of California, the state with the best consumption rate for these nutritious foods, fell woefully behind. Only close to 18 percent of Californians ate enough fruit every day, and only 13 percent ate enough vegetables."

Disco lives: Music listening as a means of stress reduction in daily life

Psychoneuroendocrinology. 2015 Jun 21;60:82-90. doi: 10.1016/j.psyneuen.2015.06.008. [Epub ahead of print]

Music listening as a means of stress reduction in daily life.

Linnemann A1, Ditzen B2, Strahler J1, Doerr JM1, Nater UM3.

Author information

• 1University of Marburg, Department of Psychology, Marburg, Germany.
• 2Heidelberg University Hospital, Department of Medical Psychology, Heidelberg, Germany.
• 3University of Marburg, Department of Psychology, Marburg, Germany. Electronic address: nater@uni-marburg.de.

Abstract

The relation between music listening and stress is inconsistently reported across studies, with the major part of studies being set in experimental settings. Furthermore, the psychobiological mechanisms for a potential stress-reducing effect remain unclear. We examined the potential stress-reducing effect of music listening in everyday life using both subjective and objective indicators of stress. Fifty-five healthy university students were examined in an ambulatory assessment study, both during a regular term week (five days) and during an examination week (five days). Participants rated their current music-listening behavior and perceived stress levels four times per day, and a sub-sample (n=25) additionally provided saliva samples for the later analysis of cortisol and alpha-amylase on two consecutive days during both weeks. Results revealed that mere music listening was effective in reducing subjective stress levels (p=0.010). The most profound effects were found when 'relaxation' was stated as the reason formusic listening, with subsequent decreases in subjective stress levels (p≤0.001) and lower cortisol concentrations (p≤0.001). Alpha-amylase varied as a function of the arousal of the selected music, with energizing music increasing and relaxing music decreasing alpha-amylase activity (p=0.025). These findings suggest that music listening can be considered a means of stress reduction in daily life, especially if it is listened to for the reason of relaxation. Furthermore, these results shed light on the physiological mechanisms underlying the stress-reducing effect of music, with musiclistening differentially affecting the physiological stress systems.

Pers Soc Psychol Bull. 2015 Jun 19. pii: 0146167215591501. [Epub ahead of print]

The Unifying Moral Dyad: Liberals and Conservatives Share the Same Harm-Based Moral Template.

Schein C1, Gray K2.

Author information

• 1The University of North Carolina at Chapel Hill, USA.
• 2The University of North Carolina at Chapel Hill, USA kurtgray@unc.edu.

Abstract

Do moral disagreements regarding specific issues (e.g., patriotism, chastity) reflect deep cognitive differences (i.e., distinct cognitive mechanisms) between liberals and conservatives? Dyadic morality suggests that the answer is "no." Despite moral diversity, we reveal that moral cognition-in both liberals and conservatives-is rooted in a harm-based template. A dyadic template suggests that harm should be central within moral cognition, an idea tested-and confirmed-through six specific hypotheses. Studies suggest that moral judgment occurs via dyadic comparison, in which counter-normative acts are compared with a prototype of harm. Dyadic comparison explains why harm is the most accessible and important of moral content, why harm organizes-and overlaps with-diverse moral content, and why harm best translates across moral content. Dyadic morality suggests that various moral content (e.g., loyalty, purity) are varieties of perceived harm and that past research has substantially exaggerated moral differences between liberals and conservatives.

Ann Oncol. 2015 Jun 30. pii: mdv283. [Epub ahead of print]

Planning and Reporting of Quality of Life Outcomes in Cancer Trials.

Schandelmaier S1, Conen K2, von Elm E3, You JJ4, Blümle A5, Tomonaga Y6, Amstutz A7, Briel M8, Kasenda B9; DISCO study group.

Collaborators (40)

Author information

• 1Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland.
• 2Department of Oncology, University Hospital of Basel, Switzerland.
• 3Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
• 4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
• 5German Cochrane Centre, Medical Center - University of Freiburg, Freiburg, Germany.
• 6Epidemiology, Biostatistics and Prevention Institute. University of Zurich, Zurich, Switzerland.
• 7Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland.
• 8Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Clinical Research, University of Basel, Switzerland.
• 9Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Switzerland Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland Department of Medical Oncology, Royal Marsden Hospital, London, United Kingdom.

Abstract

BACKGROUND:

Information about the impact of cancer treatments on patients' quality of life (QoL) is of paramount importance to patients and treating oncologists. Cancer trials that do not specify QoL as an outcome or fail to report collected QoL data, omit crucial information for decision making. To estimate the magnitude of these problems, we investigated how frequently QoL outcomes were specified in protocols of cancer trials and subsequently reported.

DESIGN:

Retrospective cohort study of RCT protocols approved by six research ethics committees in Switzerland, Germany, and Canada between 2000 and 2003. We compared protocols to corresponding publications, which were identified through literature searches and investigator surveys.

RESULTS:

Of the 173 cancer trials, 90 (52%) specified QoL outcomes in their protocol, 2 (1%) as primary and 88 (51%) as secondary outcome. Of the 173 trials, 35 (20%) reported QoL outcomes in a corresponding publication (4 modified from the protocol), 18 (10%) were published but failed to report QoL outcomes in the primary or a secondary publication, and 37 (21%) were not published at all. Of the 83 (48%) trials that did not specify QoL outcomes in their protocol, none subsequently reported QoL outcomes. Failure to report pre-specified QoL outcomes was not associated with industry sponsorship (vs. non-industry), sample size, and multi centre (vs. single centre) status but possibly with trial discontinuation.

CONCLUSIONS:

About half of cancer trials specified QoL outcomes in their protocols. However, only 20% reported any quality of life data in associated publications. Highly relevant information for decision-making is often unavailable to patients, oncologists, and health-policy makers.

Neurosurg Focus. 2015 Jul;39(1):E6. doi: 10.3171/2015.4.FOCUS1587.

Woodrow Wilson's hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy.

Menger RP1, Storey CM1, Guthikonda B1, Missios S1, Nanda A1, Cooper JM2.

Author information

• 1Department of Neurosurgery, Louisiana State University of Health Sciences, Shreveport, Louisiana; and.
• 2University of Wisconsin Department of History, Madison, Wisconsin.

Abstract

World War I catapulted the United States from traditional isolationism to international involvement in a major European conflict. Woodrow Wilson envisaged a permanent American imprint on democracy in world affairs through participation in the League of Nations. Amid these defining events, Wilson suffered a major ischemic stroke on October 2, 1919, which left him incapacitated. What was probably his fourth and most devastating stroke was diagnosed and treated by his friend and personal physician, Admiral Cary Grayson. Grayson, who had tremendous personal and professional loyalty to Wilson, kept the severity of the stroke hidden from Congress, the American people, and even the president himself. During a cabinet briefing, Grayson formally refused to sign a document of disability and was reluctant to address the subject of presidential succession. Wilson was essentially incapacitated and hemiplegic, yet he remained an active president and all messages were relayed directly through his wife, Edith. Patient-physician confidentiality superseded national security amid the backdrop of friendship and political power on the eve of a pivotal juncture in the history of American foreign policy. It was in part because of the absence of Woodrow Wilson's vocal and unwavering support that the United States did not join the League of Nations and distanced itself from the international stage. The League of Nations would later prove powerless without American support and was unable to thwart the rise and advance of Adolf Hitler. Only after World War II did the United States assume its global leadership role and realize Wilson's visionary, yet contentious, groundwork for a Pax Americana. The authors describe Woodrow Wilson's stroke, the historical implications of his health decline, and its impact on United States foreign policy.

Kennedy Inst Ethics J. 2015 Jun;25(2):169-2. doi: 10.1353/ken.2015.0007.

Robot Lies in Health Care: When Is Deception Morally Permissible?

Matthias A.

Abstract

Autonomous robots are increasingly interacting with users who have limited knowledge of robotics and are likely to have an erroneous mental model of the robot's workings, capabilities, and internal structure. The robot's real capabilities may diverge from this mental model to the extent that one might accuse the robot's manufacturer of deceiving the user, especially in cases where the user naturally tends to ascribe exaggerated capabilities to the machine (e.g. conversational systems in elder-care contexts, or toy robots in child care). This poses the question, whether misleading or even actively deceiving the user of an autonomous artifact about the capabilities of the machine is morally bad and why. By analyzing trust, autonomy, and the erosion of trust in communicative acts as consequences of deceptive robot behavior, we formulate four criteria that must be fulfilled in order for robot deception to be morally permissible, and in some cases even morally indicated.