"Despite the problems associated with requiring disclosure of list prices, the sentiment behind the proposed rule — that patients should know how much drugs will cost before they fill their prescriptions — is sensible."

N Engl J Med. 2018 Nov 14. doi: 10.1056/NEJMp1814065. [Epub ahead of print]

Disclosing Prescription-Drug Prices in Advertisements - Legal and Public Health Issues.

Dusetzina SB1, Mello MM1.

Author information

1

From the Department of Health Policy, Vanderbilt University School of Medicine, Nashville (S.B.D.); and Stanford Law School and the Department of Health Research and Policy, Stanford University School of Medicine - both in Stanford, CA (M.M.M.).

"Despite the problems associated with requiring disclosure of list prices, the sentiment behind the proposed rule — that patients should know how much drugs will cost before they fill their prescriptions — is sensible. The question is how best to achieve that outcome. Just before the CMS rule was announced, the main trade organization of the pharmaceutical industry, PhRMA, released its own guidelines for voluntary disclosure of the costs of advertised medicines. It proposes that advertisements direct patients to a website where the company provides information about list price as well as “average, estimated, or typical patient out-of-pocket costs.” This information is more useful than the WAC alone, but 'typical' out-of-pocket costs don’t convey the variation in what patients pay."

Weightlifting better than walking and cycling for heart: Study #PumpIron

Weightlifting better than walking and cycling for heart: Study

“Both strength training and aerobic activity appeared to be heart healthy, even in small amounts, at the population level,” said Maia P. Smith, Assistant Professor at St. George’s University in Grenada.

“However, static activity appeared more beneficial than dynamic,” Smith added.

From @CassSunstein - Congress Can Agree on This: Cut Federal Paperwork (HT:AP)

Congress Can Agree on This: Cut Federal Paperwork

Republicans and Democrats have a common enemy called “sludge.”

Cass Sunstein

November 13, 2018, 9:00 AM CST Updated on November 13, 2018, 1:28 PM CST

"As it now stands, the law requires OIRA to scrutinize every information collection from the federal government — to 'minimize' its burden and 'maximize [its] practical utility of and public benefit.' That’s good.

But what happens if the office fails to do that? Under the Paperwork Reduction Act, the answer is: Nothing at all. Here’s a better answer: Americans should be given a right to go to court to challenge a mandatory information collection as excessive and unjustified — in the technical jargon of administrative law, as 'arbitrary or capricious.'

When a federal agency issues a regulation, people who are adversely affected usually have the right to make that challenge in court. At least when a paperwork burden exceeds a certain threshold, people should be allowed to require the government to justify it — or to get it struck down in court."

HT:AP

Int J Sports Physiol Perform. 2018 Nov 14:1-22. doi: 10.1123/ijspp.2017-0131. [Epub ahead of print]

A 12-Year Cohort Study of Doc-Stoppage Professional Mixed Martial Arts.

Miarka B1, Dal Bello F2, Brito JC3, Del Vecchio FB2, Amtmann J3, Chamari K4.

Author information

1

1 Department of Fights, School of Physical Education and Sport, Federal University of Rio de Janeiro, Brazil.

2

2 Head of Physical Activity and Sports Science Master Program, Universidad Santo Tomás, Santiago, Chile.

3

3 Physical Education Department, Federal University of Juiz de Fora, Brazil.

4

4 Safety, Health and Industrial Hygiene Department, Montana Tech of the University of Montana, USA.

Abstract

PURPOSES::

This research sought to determine actions during bouts which generate serious enough injury to stop the bout, verifying the injury incidence, types, and prevalence of doctor stoppages (doc-stoppage), and identify potential risk factors by analyzing technical-tactical profiles for injury in sanctioned mixed martial arts (MMA) bouts taking place over a 12-year period.

METHODS::

The research analyzed 440 paired MMA matches separated by doc-stoppage (n=220) and no doc-stoppage (n=220) from 2002-2014. Technical-knockouts for doc-stoppage were diagnosed and managed by attending ringside doctors and the time-motion variables were categorized into total combat time separated by low- or high-intensity activity per round, stand-up or groundwork actions, p≤0.05.

RESULTS::

The main cause of injuries in doc-stoppage situations were due to facial injuries (>90%), with 87.1% occurring after striking actions during the second round. Lacerations were the leading type of injury, which occurred with 80% frequency. The results showed differences between doc-stoppage and no doc-stoppage for standing combat with low-intensity actions (130.6±8.5s vs. 83.3±6.9s for first round; 115.7±10.5s vs. 100.1±9.6s for second round and 121.5±19.5s vs. 106.3±11.7s for third round) and total strike attempts (34.5, 23.0-51.8 vs. 25.0, 12.0-40.8); in standing combat, head strike attempts (21, 10-33 vs. 11, 4-21) and body strikes (2.5, 1.0-5.8 vs. 1.0-2); and in groundwork combat, head strikes landed (0.0-3.0 vs. 0.0-5.0).

CONCLUSIONS::

Our research showed higher values of strike attempts with two main orientations, namely the head (on the ground and in stand-up actions) and body (in stand-up actions), and may provide important information regarding the technical knockout (TKO) and when it can be called by officials supervising MMA bouts.

Low-Carbohydrate Diets May Increase Energy Expenditure

UPDATED November 16, 2018 // NASHVILLE, Tennessee — Lowering dietary carbohydrate intake could help in maintaining weight loss, new research suggests. However, some experts say the trial methodology makes drawing conclusions difficult.

Acad Med. 2018 Nov 13. doi: 10.1097/ACM.0000000000002529. [Epub ahead of print]

Swimming Against the Tide: Challenges in Pursuing Health Equity Today.

Braveman PA1.

Author information

1

P.A. Braveman is director, Center on Social Disparities in Health, and professor of family and community medicine, University of California, San Francisco, San Francisco, California.

Abstract

The term "health equity" has moved from obscurity to the mainstream, creating new possibilities for those who aspire to a world in which everyone has a fair and just opportunity to be healthy. One can now talk explicitly about health equity. The newfound acceptance, however, carries a risk: loss of meaning. Recognizing the need for a common understanding of the core concepts, the Robert Wood Johnson Foundation has promoted a definition that prioritizes being sufficiently concrete to guide action. Lack of conceptual clarity is, unfortunately, not the only challenge in pursuing health equity. Another challenge is the lack of respect for fundamental ethical and human rights principles-cornerstones of health equity-displayed almost daily by those in positions of power, including the president; this lack of commitment to fundamental values has an insidiously toxic effect because many people assume that presidential views must be legitimate. Yet another challenge is lack of imagination. Pursuing health equity inevitably requires swimming against the tide of prevailing forces that exclude, marginalize, or otherwise disadvantage groups of people based on their skin color, wealth, gender, disabilities, sexual orientation, gender identity, religion, or other characteristics tightly linked with social advantage. To persist in swimming against the tide, the end goal and the reason for pursuing it must be very strong and very clear. Academic medicine can play an important role as a powerful force in setting norms and shaping the values and attitudes of medical students, attending physicians, and research faculty.

Obesity stigma

Health (London). 2018 Nov 14:1363459318812007. doi: 10.1177/1363459318812007. [Epub ahead of print]

Obesity, stigma and reflexive embodiment: Feeling the 'weight' of expectation.

Williams O1, Annandale E2.

Author information

1

University of Leicester, UK.

2

University of York, UK.

Abstract

The dominant obesity discourse which emphasises individual moral responsibility and lifestyle modification encourages weight-based stigma. Existing research overwhelmingly demonstrates that obesity stigma is an ineffective means by which to reduce the incidence of obesity and that it promotes weight-gain. However, the sensate experiences associated with the subjective experience of obesity stigma as a reflexively embodied phenomenon have been largely unexamined. This article addresses this knowledge gap by providing a phenomenological account. Data are derived from 11 months of ethnographic participant observation and semi-structured interviews with three single-sex weight-loss groups in England. Group members were predominantly overweight/obese and of low-socio-economic status. The analysis triangulates these two data sources to investigate what/how obesity stigma made group members feel. We find that obesity stigma confused participant's objective and subjective experiences of their bodies. This was primarily evident on occasions when group members felt heavier after engaging in behaviours associated with weight-gain but this 'weight' did not register on the weighing scales. We conceptualise this as the weight of expectation which is taken as illustrative of the perpetual uncertainty and morality that characterises weight-management. In addition, we show that respondents ascribed their sensate experiences of physiological responses to exercise with moral and social significance. These carnal cues provided a sense of certainty and played an important role in attempts to negotiate obesity stigma. These findings deepen the understanding of how and why obesity stigma is an inappropriate and ineffective means of promoting weight-loss.

"Poetry shares something with science fiction and fantasy that much literary fiction tends to reject: a willingness, even an eagerness, to inhabit the non-human other."

Always Beginning

Ursula K. Le Guin’s poetry reveals a writer humbled by the craft.

BY DAVID NAIMON

"Poetry shares something with science fiction and fantasy that much literary fiction tends to reject: a willingness, even an eagerness, to inhabit the non-human other. From Francis Ponge’s poetry of objects to the animal poems of Lucille Clifton, from Tolkien’s ancient tree-like Ents to China Miéville’s double-mouthed Ariekans who cannot lie, point of view is not reserved for human beings in these genres. In fact, the way Merlyn educates the future king, Arthur, in T.H. White’s Sword in the Stone (1938), a book Le Guin considered marvelous and important, is by turning him into various creatures and objects. It is this fellow feeling, this seeing from the perspective of otherness, that one grows from. So Far So Good tells us that regardless of whether we learn that lesson during our lives, we will enact it in our deaths. Like every other creature, our bodies will return to the elements, and our souls will return to the mystery. Le Guin’s emotions run the gamut in this collection—from nostalgia to fear to humor—but one feels most of all her desire to welcome, to embrace, to participate in the cycle of life and death, as in these lines from 'Come to Dust':

Come down to earth as leaves in autumn

to lie in the patient rot of winter.

Rise again in spring’s green fountains.

Drift in sunlight with the sacred pollen

to fall in blessing.

                                      All earth’s dust

has been life, held soul, is holy."

Study links social isolation to higher risk of death

"They found overall, race seemed to be a stronger predictor of social isolation than sex; white men and white women were more likely to be in the least isolated category than black men and women. In the full sample, a statistically significant, positive dose-response relationship was found between social isolation and all-cause mortality risk over the 30-year follow-up period. However, associations were significantly stronger in the first 15 years of follow up."

Chic - Good Times #DiscoLives

Chic  -  Good Times

J R Soc Med. 2018 Nov;111(11):407-413. doi: 10.1177/0141076818803452.

Euthanasia and assisted dying: what is the current position and what are the key arguments informing the debate?

Fontalis A1, Prousali E2, Kulkarni K3.

Author information

1

1 St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.

2

2 Aristotle University of Thessaloniki, 54124 Thessaloniki Greece.

3

3 University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK.

Abstract

Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship, which is fundamentally based on trust, mutual respect and the premise of 'first do no harm'. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.

"With Nietzsche’s life we are again left to ponder the tribute genius must pay to insanity."

I Am Dynamite! A Life of Friedrich Nietzsche review: A gripping read

Prideaux’s Nietzsche is one who is invested with all the hopes and aspirations of a family that has lost a father at a young age, and who is perceived, within that intimate circle, as something approaching a god. He more than fulfilled that destiny, but ultimately not in the way either his mother, a devout Christian, nor his sister would have wished. And for it he paid the highest price. With Nietzsche’s life we are again left to ponder the tribute genius must pay to insanity.

Doctors now seeing more stroke patients under the age of 35

“Many of the causes that we see of stroke have evolved over time,” he said. Those causes include rises in obesity and stress, as well the growing epidemic of drug abuse, specifically drugs like cocaine, fentanyl[,] and carfentanyl. 

Does depression cause obesity or does obesity cause depression? ("...the psychological impact of being obese is likely to cause depression.")

Does depression cause obesity or does obesity cause depression?

In their analysis, they accounted for a range of variables that could influence the results, including socioeconomic position, alcohol consumption, smoking, and physical activity.

They found that individuals with a favorable metabolic profile were just as likely to develop depression as individuals with obesity that carried genes predisposing them to develop metabolic conditions. This effect was most pronounced in women.

"To double-check their findings, they also took data from the Psychiatric Genomics Consortium. And their second analysis returned similar results, adding further weight to their conclusions.

'Our robust genetic analysis concludes that the psychological impact of being obese is likely to cause depression.'

Dr. Jess Tyrrell

These results provide vital insight, as Dr. Tyrrell explains, 'This is important to help target efforts to reduce depression, which makes it much harder for people to adopt [healthful] lifestyle habits.'"

"...motivational SMS text messages could provide an acceptable way to raise awareness of risky alcohol consumption for future fathers."

Int J Ment Health Addict. 2018;16(5):1125-1139. doi: 10.1007/s11469-017-9835-y. Epub 2017 Nov 28.

Alcohol Text Messages: A Developmental Study.

Robinson M1,2, Wilkinson RB3, Fletcher R4, Bruno R5, Baker AL1, Maher L6, Wroe J4, Dunlop AJ1,7,8,9.

Author information

1

1School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales Australia.

2

12 Alfred Street, Newcastle East, New South Wales 2300 Australia.

3

3School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales Australia.

4

4Family Action Centre, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales Australia.

5

5School of Medicine, University of Tasmania, Hobart, Australia.

6

6The Kirby Institute, University of New South Wales, Sydney, New South Wales Australia.

7

Drug and Alcohol Clinical Services, Hunter New England Local Health District, New Lambton, New South Wales Australia.

8

8Centre for Brain and Mental Health, University of Newcastle, Callaghan, New South Wales Australia.

9

9Hunter Medical Research Institute, New Lambton Heights, New South Wales Australia.

Abstract

Risky paternal alcohol use is associated with maternal alcohol use during pregnancy, poor fetal and infant outcomes, domestic violence and depression. This study developed 30 SMS text messages about alcohol for fathers who drink at risky levels. The text messages were developed using two motivational styles: messages presented in a second person voice and the same messages presented in a child's voice. Fifty-one fathers were recruited through social media to complete an online survey rating the SMS text messages for message importance and likelihood of seeking further information and measuring risky alcohol use and psychosocial distress. Seventeen participants then participated in a semi-structured qualitative interview. Fathers rated the text messages presented in the child's voice as more important than messages presented in the second person. Qualitative data supported survey results that motivational SMS text messages could provide an acceptable way to raise awareness of risky alcohol consumption for future fathers.

#ReadyPlayerOne

TOO MUCH SCREEN TIME IS SHORT – SIGHTEDNESS, OBESITY AND CANCER. A NEW STUDY

Over the past 40 years the proportion of children with myopia in Britain has more than doubled: from 7.2% to 16.4%.

This effect scientists call “digital myopia”: every hour spent by a child in front of a screen increases the risk of visual impairment 3%.

Arch Pathol Lab Med. 2018 Aug 22. doi: 10.5858/arpa.2018-0313-SA. [Epub ahead of print]

Keep Calm and Tweet On: Legal and Ethical Considerations for Pathologists Using Social Media.

Gardner JM, Allen TC1.

Author information

1

From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock (Dr Gardner); and Department of Pathology, University of Mississippi Medical Center, Jackson (Dr Allen).

Abstract

Recent privacy breaches by a major social media company have again raised questions from some pathologists regarding the legality and ethics of sharing pathology images on social media. The authors examined ethical principles as well as historic and legal precedents relevant to pathology medical photography. Taking and sharing photographs of pathology specimens is embedded into the culture of the specialty of pathology and has been for more than a century. In general, the pathologist who takes the photograph of a gross or microscopic specimen owns the copyright to that photograph. Patient consent is not legally or ethically required to take or use deidentified photographs of pathology specimens. Current US privacy laws (Health Insurance Portability and Accountability Act [HIPAA] of 1996) permit public sharing of deidentified pathology photographs without specific patient consent, even on social media. There is no case law of action taken against pathologists for sharing deidentified pathology images on social media or elsewhere. If there is any legal risk for pathologists or risk of patient harm in sharing pathology photographs, it is very small. The benefits of professional social media use for pathologists, patients, and society are numerous and well documented in the literature.

From @lijjoseph @ALBoothMD @subatomicdoc @DrMisialek and me: “Please Help Me See the Dragon I Am Slaying”: Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience #Patients First #WhyPathologistsMatter

Adam L. Booth, Matthew S. Katz, Michael J. Misialek, Timothy Craig Allen, and Lija Joseph (2018) “Please Help Me See the Dragon I Am Slaying”: Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience. Archives of Pathology & Laboratory Medicine In-Press.

Early Online Release

“Please Help Me See the Dragon I Am Slaying”: Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience

Adam L. Booth, MD; Matthew S. Katz, MD; Michael J. Misialek, MD; Timothy Craig Allen, MD, JD; Lija Joseph, MD

From the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Booth); the Departments of Pathology and Laboratory Medicine (Dr Joseph) and Radiation Medicine (Dr Katz), Lowell General Hospital, Lowell, Massachusetts; the Department of Pathology, Newton-Wellesley Hospital, Newton, Massachusetts (Dr Misialek); and the Department of Pathology, University of Mississippi Medical School, University of Mississippi Medical Center, Jackson (Dr Allen).

The authors have no relevant financial interest in the products or companies described in this article.

Corresponding author: Lija Joseph, MD, Department of Pathology and Laboratory Medicine, Lowell General Hospital, 295 Varnum Ave, Lowell, MA 01854 (email: Lija.Joseph@lowellgeneral.org).

Context.— Pathologists evaluate human disease and teach medical students, residents, and clinicians. Historically recognized as the “doctor's doctor,” pathologists are well suited to be a direct patient resource of individualized, accurate information.

Objective.— To develop and implement a pathology consultation service whereby patients review their tissue slides directly with the pathologists.

Design.— A pathologist conducted patient consultations, reviewing biopsy or surgery findings on a multiheaded microscope or computer screen. The pathologist evaluated patients' understanding of their disease and invited patients to ask specific questions. We recorded patient demographic data and assessed utilization with a short patient satisfaction survey using 6 questions with a 5-point Likert scale and 2 questions for open response.

Results.— A total of 31 patients came for consultation; 39% (12 of 31) were accompanied by a friend or family member. Patients' median age was 59 years, with a strong female predominance (90%; 28 of 31). The majority of patients had breast cancer (58%; 18 of 31) or hematologic malignancy (19%; 6 of 31). Of the 31 patients, the survey response rate was 58% (18 of 31). Top-box scoring demonstrated program support, with 89% (16 of 18) of respondents strongly recommending the experience to another patient. Additionally, 78% (14 of 18) strongly agreed that they felt more empowered after seeing their disease. Mean scores for Likert-based questions all were higher than 4.0.

Conclusions.— To our knowledge, this study is the first report of direct patient-pathologist consultation. Early data suggest that the program may provide effective patient-specific education. The high response rate and favorable assessment of the program suggest that it may be a valuable resource for some patients.

Michelle Mello and colleagues: Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs. (Bottom line: "...transparency, apology, and proactive compensation can be pursued without adverse financial consequences.")

Health Aff (Millwood). 2018 Nov;37(11):1836-1844. doi: 10.1377/hlthaff.2018.0720.

Effects Of A Communication-And-Resolution Program On Hospitals' Malpractice Claims And Costs.

Kachalia A1, Sands K2, Niel MV3, Dodson S4, Roche S5, Novack V6, Yitshak-Sade M7, Folcarelli P8, Benjamin EM9, Woodward AC10, Mello MM11.

Author information

1

Allen Kachalia ( akachalia@bwh.harvard.edu ) is chief quality officer at Brigham Health, in Boston, Massachusetts.

2

Kenneth Sands is chief epidemiologist and chief patient safety officer at HCA Healthcare, in Nashville, Tennessee.

3

Melinda Van Niel is a project manager at Beth Israel Deaconess Medical Center for the Massachusetts Alliance for Communication and Resolution following Medical Injury, in Boston.

4

Suzanne Dodson, now retired, was project manager at Baystate Health, in Springfield, Massachusetts.

5

Stephanie Roche is a health care quality research analyst at Beth Israel Deaconess Medical Center.

6

Victor Novack is head of the Clinical Research Center at Soroka University Medical Center and a professor of medicine at the Faculty of Health Sciences, Ben-Gurion University of the Negev, in Beer Sheva, Israel.

7

Maayan Yitshak-Sade is a postdoctoral research fellow at the Harvard T. H. Chan School of Public Health, in Boston.

8

Patricia Folcarelli is vice president of health care quality at Beth Israel Deaconess Medical Center.

9

Evan M. Benjamin is chief medical officer of Ariadne Labs, Harvard T. H. Chan School of Public Health and Brigham and Women's Hospital.

10

Alan C. Woodward, an emergency medicine physician in Concord, Massachusetts, is past president and former chair of the Committee on Professional Liability of the Massachusetts Medical Society.

11

Michelle M. Mello is a professor of law at Stanford Law School and a professor of health research and policy at Stanford University School of Medicine, in California.

Abstract

To promote communication with patients after medical injuries and improve patient safety, numerous hospitals have implemented communication-and-resolution programs (CRPs). Through these programs, hospitals communicate transparently with patients after adverse events; investigate what happened and offer an explanation; and, when warranted, apologize, take responsibility, and proactively offer compensation. Despite growing consensus that CRPs are the right thing to do, concerns over liability risks remain. We evaluated the liability effects of CRP implementation at four Massachusetts hospitals by examining before-and-after trends in claims volume, cost, and time to resolution and comparing them to trends among nonimplementing peer institutions. CRP implementation was associated with improved trends in the rate of new claims and legal defense costs at some hospitals, but it did not significantly alter trends in other outcomes. None of the hospitals experienced worsening liability trends after CRP implementation, which suggests that transparency, apology, and proactive compensation can be pursued without adverse financial consequences.

What is obesity and what causes it?

A BMI between 25 and 29.9 indicates that a person is carrying excess weight. A BMI of 30 or over suggests that a person may have obesity.

"Although radicalisation is invoked to explain how people become terrorists, there is little empirical evidence."

Nord J Psychiatry. 2018 Nov 1:1-4. doi: 10.1080/08039488.2018.1525640. [Epub ahead of print]

Radicalisation and mental health.

Bhui K1,2.

Author information

1

a Professor of Cultural Psychiatry & Epidemiology, Barts & The London School of Medicine and Dentistry , Wolfson Institute of Preventive Medicine, Queen Mary University of London , London , UK.

2

b Hon. Consultant Psychiatry, East London NHS Foundation Trust , London , UK.

Abstract

BACKGROUND:

Although radicalisation is invoked to explain how people become terrorists, there is little empirical evidence.

AIMS:

To set out the approaches to understand radicalisation, ethical and definitional issues, and how public health approaches may help.

METHODS:

A non-systematic narrative review.

RESULTS:

Radicalisation is proposed to explain how people become terrorists. Factors such as social connections, political engagement, group belonging, mental illnesses and other social and cultural influence show a complex interplay that we are still trying to understand. Common mental illnesses appear to be a risk factor at a population level for developing extremist beliefs, and psychoses and autism are reported as more common amongst some terrorist offenders. The activation of stereotypical and reactive fears and fantasies may distort our understanding of how to prevent radicalisation and terrorism.

CONCLUSIONS:

A public health framework offers a societal, inclusive, and positive approach to preventing radicalisation, alongside criminal justice actions.

"Achieving population-based shifts in health outcomes for low-income communities requires moving far beyond text message reminders..."

Social Determinants Of Health: Holy Grail Or Dead-End Road?

"Achieving population-based shifts in health outcomes for low-income communities requires moving far beyond text message reminders, Uber rides to clinic visits and vouchers for farmer’s markets and food pantries. These shifts demand bold and transformative steps to address poverty by providing education, economic opportunity and a pathway to lifelong economic stability. Congressman Bill Cassidy also said, 'Prosperity is the key to improving health outcomes'. As we develop interventions for the social determinants of health, unless we begin to heed this message, in the years ahead rather than finding the Holy Grail, we will instead certainly find ourselves on the path to a dead-end road."

"It should be easy to award a lifetime achievement award in literature."

No Nobel Prize for Literature? Thank Goodness.

"It should be easy to award a lifetime achievement award in literature. Writers have long working lives, and there is plenty of time for reasonable opinion to coalesce. The vast majority of the great writers of the last century were amply feted well before their deaths. The prize originated in 1901 when Leo Tolstoy was almost universally regarded as the greatest living writer. And so the first Nobel Prize in literature went to Sully Prudhomme, a poet not even the most ardent Francophile knows as anything other than the first writer to win the Nobel. Tolstoy didn’t die until 1910, but the academy never saw its way to giving him the prize before he got pneumonia at the Astapovo rail station. Chekhov, Ibsen, Zola, Hardy, James, and Twain were all alive and acclaimed in the first decade of the 20th century. None won the prize, and the course of the literary Nobel was set."