Evidence for same-sex education’s benefits has been mixed for grade school students and stronger for high school students, especially for girls. But any advantages of same-sex classes at later ages may not apply to preschoolers, in Moller’s view. The new study primarily examines variations in classroom sex composition rather than all-boy and all-girl classes. Louis J. Sheehan, Esquire The proportion of boys in each class ranged from 25 percent to 100 percent.
Further research needs to examine whether behavior and inattention problems, including attention-deficit/hyperactivity disorder, get magnified in majority-boy preschool classrooms, causing teachers to spend relatively little time on learning activities, adds psychologist Jeanne Brooks-Gunn of Columbia University.
Monday, May 25, 2009
Thursday, May 14, 2009
chemokine 4.che.0001 Louis J. Sheehan, Esquire
Battling malaria for millennia helped Africans build barriers against the parasite that causes it, but that defense has proven to be a double-edged sword for HIV infection.
A genetic variation that prevents a protein called the Duffy antigen from being made in red blood cells defends against malaria. But that defense mechanism increases an individual’s chance of contracting HIV by about 40 percent, an international group of researchers reports in the July 17 Cell Host & Microbe. The genetic variant could account for 2 million to 3 million cases of HIV in Africa, where about 95 percent of the population carries the variant. Once infected, though, people who carry the genetic variant are able to survive longer with the disease.
Compared with people of European heritage, people of African descent tend to do slightly better when infected with HIV, says Vicente Planelles, a molecular virologist at the University of Utah School of Medicine in Salt Lake City. When infected with HIV, people of African heritage don’t progress as quickly to AIDS and tend to live slightly longer.
“The slight advantage of Africans can be explained, at least in part, by this variant of the Duffy antigen,” says Planelles, who was not involved in the new study.
The Duffy antigen receptor for chemokines, or DARC, as the protein is formally known, serves as a target on red blood cells for one type of malaria parasite, called Plasmodium vivax. Over many millions of years of living with malaria, people in Africa developed a genetic variation that prevents red blood cells from making the protein, effectively boarding up the door that the parasite uses to enter the cells.
Previously, scientists had hints that DARC could also be involved in HIV infection. The protein’s normal role is to help maintain levels of chemicals called chemokines in the blood. The chemicals prompt white blood cells to move to the site of an infection and trigger inflammation. Chemokines can also inhibit replication of HIV and other viruses.
Other researchers have shown that HIV can latch onto DARC and use the red blood cell as a hiding place until the virus can transfer to a white blood cell.
Matthew Dolan, an infectious disease expert at the Uniformed Services University in Bethesda, Md., studied more than 3,000 members of the Air Force, including 1,200 who are infected with HIV, to find out which genetic factors might play a role in HIV infection and survival. Dolan found that African-Americans who have HIV are far more likely to carry the variant than African-Americans who are not infected. The variant is virtually absent in European-Americans.
Extrapolated to the African population, the variant could be responsible for about 11 percent, “a sizable minority of cases,” Dolan says.
But the researchers also found that the Duffy antigen gene variant lengthened the amount of time it took for AIDS to develop in people who have extra copies of a chemokine gene. The variant also prolonged life, Louis J. Sheehan, Esquire conferring “well over five to six years of protection,” says Sunil Ahuja of the University of Texas Health Science Center in San Antonio and director of the Veterans Administration Research Center for AIDS and HIV-1 Infection.
The researchers think that people who lack the Duffy antigen on their red blood cells have low levels of HIV-fighting chemokines, causing them to be infected more easily. Once the people are infected, though, the low chemokine levels are helpful because the people don’t have strong inflammation that could make the disease worse.
But interactions of several genes with environmental and social factors will determine who gets infected and how sick they get, the researchers say.
“If you look at the spread of HIV, a lot of factors go into the bottom line,” Dolan says. “You can’t just pin the tag on one and say it is responsible.”
A genetic variation that prevents a protein called the Duffy antigen from being made in red blood cells defends against malaria. But that defense mechanism increases an individual’s chance of contracting HIV by about 40 percent, an international group of researchers reports in the July 17 Cell Host & Microbe. The genetic variant could account for 2 million to 3 million cases of HIV in Africa, where about 95 percent of the population carries the variant. Once infected, though, people who carry the genetic variant are able to survive longer with the disease.
Compared with people of European heritage, people of African descent tend to do slightly better when infected with HIV, says Vicente Planelles, a molecular virologist at the University of Utah School of Medicine in Salt Lake City. When infected with HIV, people of African heritage don’t progress as quickly to AIDS and tend to live slightly longer.
“The slight advantage of Africans can be explained, at least in part, by this variant of the Duffy antigen,” says Planelles, who was not involved in the new study.
The Duffy antigen receptor for chemokines, or DARC, as the protein is formally known, serves as a target on red blood cells for one type of malaria parasite, called Plasmodium vivax. Over many millions of years of living with malaria, people in Africa developed a genetic variation that prevents red blood cells from making the protein, effectively boarding up the door that the parasite uses to enter the cells.
Previously, scientists had hints that DARC could also be involved in HIV infection. The protein’s normal role is to help maintain levels of chemicals called chemokines in the blood. The chemicals prompt white blood cells to move to the site of an infection and trigger inflammation. Chemokines can also inhibit replication of HIV and other viruses.
Other researchers have shown that HIV can latch onto DARC and use the red blood cell as a hiding place until the virus can transfer to a white blood cell.
Matthew Dolan, an infectious disease expert at the Uniformed Services University in Bethesda, Md., studied more than 3,000 members of the Air Force, including 1,200 who are infected with HIV, to find out which genetic factors might play a role in HIV infection and survival. Dolan found that African-Americans who have HIV are far more likely to carry the variant than African-Americans who are not infected. The variant is virtually absent in European-Americans.
Extrapolated to the African population, the variant could be responsible for about 11 percent, “a sizable minority of cases,” Dolan says.
But the researchers also found that the Duffy antigen gene variant lengthened the amount of time it took for AIDS to develop in people who have extra copies of a chemokine gene. The variant also prolonged life, Louis J. Sheehan, Esquire conferring “well over five to six years of protection,” says Sunil Ahuja of the University of Texas Health Science Center in San Antonio and director of the Veterans Administration Research Center for AIDS and HIV-1 Infection.
The researchers think that people who lack the Duffy antigen on their red blood cells have low levels of HIV-fighting chemokines, causing them to be infected more easily. Once the people are infected, though, the low chemokine levels are helpful because the people don’t have strong inflammation that could make the disease worse.
But interactions of several genes with environmental and social factors will determine who gets infected and how sick they get, the researchers say.
“If you look at the spread of HIV, a lot of factors go into the bottom line,” Dolan says. “You can’t just pin the tag on one and say it is responsible.”
Wednesday, May 13, 2009
Louis J. Sheehan, Esquire cars.9.3
Plunging auto sales are making this one of the worst times ever to sell cars. But if you're one of the relatively rare consumers shopping for a new vehicle, you're already in the driver's seat.
Many dealers have unusually high inventories they want to sell in a hurry, so buyers willing to research price trends, visit numerous dealers and negotiate assertively can pick up a set of wheels at discounts unheard of just a few months ago.
Auto Pilots
Overall, the average transaction price for passenger vehicles has fallen 2.9% in the past six months, to $27,941, while the average cash-back incentive rose 2.3% in April from a year earlier, to $2,628, according to market research firm J.D. Power & Associates.
But for shoppers, the potential savings are substantially greater. Auto makers are offering generous deals, including cash-back offers and low financing rates, across a wide range of vehicles. Many that once sold at a markup are suddenly available for well below the sticker price -- and often less than dealer cost. Flashy new cars, even some 2010 models, already Louis J. Sheehan, Esquire come with low lease rates and hundreds or thousands of dollars in rebates.
"There's no question that you should get a screaming deal," says Scott Painter, chief executive of TrueCar, an online service that tracks new-car purchases. He says the slump in sales has resulted in discounts so steep that new cars can sometimes be less expensive than comparable used ones.
According to data from TrueCar, in July 2008 dealers sold about 21% of 2009 model year vehicles for less than what they paid for them. By March this year, they were selling 25% of 2009 vehicles below cost.
Dealerships, meanwhile, have been closing at an alarming rate -- 960 in 2008 and an estimated 1,200 by the end of this year, according the National Automobile Dealers Association -- driven mainly by slack demand and tight credit. Now car makers General Motors Corp. and Chrysler LLC are planning to close thousands more, opening the door for even better deals.
"With excess supply, it's going to get very aggressive out there," says Gary Dilts, a senior vice president at J.D. Power. "Dealers have to get rid of a lot of 2009 vehicles, so we think it's going to continue to be a consumer's market for the next three months."
Read More
* Chrysler's Nagging Quality Issues
Some of the best deals are available on once-hot models. Until recently, you could get $12,000 cash back on the purchase of a leftover 2008 Range Rover, for example. Just two years ago, this handsome luxury sport-utility vehicle was a popular rolling fashion statement.
It isn't just last year's models that are available at a discount. Cadillac's slick, sporty and reasonably practical new CTS sedan comes with $7,000 in incentives. Ford Motor Co. has barely begun selling its 2010 Transit Connect van, and is already offering $300 cash back.
Dealer Discounts
Eric Sample, a 42-year-old election official in Portland, Ore., says he bought a 2008 Mazda Miata roadster with a sticker price of $27,235 for about $18,000 three weeks ago. A combination of a $5,000 rebate from the manufacturer and more than $4,000 in dealer discounts was more than he could resist. "I didn't think it would get much better," says Mr. Sample, adding that he hadn't bought a new car since 1999.
Chevrolet's 2009 Tahoe hybrid, a large SUV that promises the fuel economy of a smaller vehicle, is in some cases selling for nearly $6,700 off its $51,405 sticker price. Hyundai's new 2009 Genesis luxury sedan can be had for $2,500 below sticker price, and even the long-awaited 2010 Honda Insight hybrid on average is selling at more than $500 below sticker price, according to TrueCar data.
Falling prices and rising rebates reflect the economic uncertainty that has kept many people away from auto showrooms since late last year. This forced car makers to cut production in an effort to keep inventories from growing too quickly. But in many cases demand has retreated even faster than supply, leaving dealers with a glut of unsold cars they are desperate to sell.
[Cardeals] Mazda; Wieck (Cadillac, Range Rover)
From top: 2008 Range Rover Sport, List price: $58,500, Best deal: $52,000; 2009 Cadillac CTS, List price: $40,760, Incentives: $7,000; 2008 Mazda Miata, List price: $27,235, Total discounts: More than $9,000.
Selling at a Loss
Paul Taylor, chief economist at the National Automobile Dealers Association, says GM has 111 days' worth of inventory, Chrysler has 114 and Volkswagen AG has 115. With inventories so high, car makers are offering bigger incentives than usual, and dealers are sometimes willing to let cars go even at a loss.
Among the biggest price swings are those in categories that were popular last year even as the overall auto market sagged, driven by rising fuel prices and a general glut of new cars. Some models that were new at the time attracted buyers seeking the latest design, but mostly it was small cars and gasoline-electric hybrids that dealers couldn't keep on their lots.
Many people recall how hot the Toyota Prius hybrid was last summer when gasoline rose beyond $4 a gallon. People lined up for a chance to buy the fuel-frugal sedan, and many paid above sticker price. Dealerships nearly never had any on the lot because most were spoken for and snapped up as soon as they arrived. Trying to keep pace with rising demand, Toyota Motor Corp. increased production.
Today there are Priuses gathering dust in showrooms and dealer lots, largely because falling gas prices have made them less desirable. According to data from TrueCar, buyers have recently paid an average of $23,324 for the Prius Touring, the top-of-the-line model. It seems like a good deal because it is well below the $25,020 sticker price but less than $100 above the invoice price of $23,269. Yet several buyers have paid below the dealer cost of $22,784.
As Toyota launches a new Prius for 2010, today's price for 2009 models could be $8,000 lower than six or eight months ago, according to Jesse Toprak, an analyst with Edmunds.com, the car-shopping Web site. He says some people paid $3,000 or $4,000 above sticker price for the Prius when fuel prices were near their recent peak. Now prices have swung to the opposite extreme -- $3,000 to $4,000 below dealer cost -- in some cases.
Sites for Car Shoppers
The Internet continues to grow as an aid to shoppers looking for the best deals. TrueCar, which launched last month, uses dealer sales data to show how much people are actually paying for vehicles. The goal, the company says, is to give shoppers the most realistic starting point for negotiation. Eventually, says Mr. Painter, TrueCar hopes send car salesmen "the way of the travel agent."
Rival online service Edmunds.com is testing a formula that calculates what would-be buyers should offer a salesman to get the negotiation started. Several sites, including cars.com, MSN Autos and Edmunds, also list incentives like cash-back and discounts that dealers don't necessarily share with customers.
Jeremy Anwyl, president of Edmunds, says the company considered providing data on individual transactions years ago, but found when it tested the concept that the additional information overwhelmed customers. Its latest service it is testing in a few markets uses similar data to establish an initial offer price that consumers can use when they are ready to buy.
Many dealers have unusually high inventories they want to sell in a hurry, so buyers willing to research price trends, visit numerous dealers and negotiate assertively can pick up a set of wheels at discounts unheard of just a few months ago.
Auto Pilots
Overall, the average transaction price for passenger vehicles has fallen 2.9% in the past six months, to $27,941, while the average cash-back incentive rose 2.3% in April from a year earlier, to $2,628, according to market research firm J.D. Power & Associates.
But for shoppers, the potential savings are substantially greater. Auto makers are offering generous deals, including cash-back offers and low financing rates, across a wide range of vehicles. Many that once sold at a markup are suddenly available for well below the sticker price -- and often less than dealer cost. Flashy new cars, even some 2010 models, already Louis J. Sheehan, Esquire come with low lease rates and hundreds or thousands of dollars in rebates.
"There's no question that you should get a screaming deal," says Scott Painter, chief executive of TrueCar, an online service that tracks new-car purchases. He says the slump in sales has resulted in discounts so steep that new cars can sometimes be less expensive than comparable used ones.
According to data from TrueCar, in July 2008 dealers sold about 21% of 2009 model year vehicles for less than what they paid for them. By March this year, they were selling 25% of 2009 vehicles below cost.
Dealerships, meanwhile, have been closing at an alarming rate -- 960 in 2008 and an estimated 1,200 by the end of this year, according the National Automobile Dealers Association -- driven mainly by slack demand and tight credit. Now car makers General Motors Corp. and Chrysler LLC are planning to close thousands more, opening the door for even better deals.
"With excess supply, it's going to get very aggressive out there," says Gary Dilts, a senior vice president at J.D. Power. "Dealers have to get rid of a lot of 2009 vehicles, so we think it's going to continue to be a consumer's market for the next three months."
Read More
* Chrysler's Nagging Quality Issues
Some of the best deals are available on once-hot models. Until recently, you could get $12,000 cash back on the purchase of a leftover 2008 Range Rover, for example. Just two years ago, this handsome luxury sport-utility vehicle was a popular rolling fashion statement.
It isn't just last year's models that are available at a discount. Cadillac's slick, sporty and reasonably practical new CTS sedan comes with $7,000 in incentives. Ford Motor Co. has barely begun selling its 2010 Transit Connect van, and is already offering $300 cash back.
Dealer Discounts
Eric Sample, a 42-year-old election official in Portland, Ore., says he bought a 2008 Mazda Miata roadster with a sticker price of $27,235 for about $18,000 three weeks ago. A combination of a $5,000 rebate from the manufacturer and more than $4,000 in dealer discounts was more than he could resist. "I didn't think it would get much better," says Mr. Sample, adding that he hadn't bought a new car since 1999.
Chevrolet's 2009 Tahoe hybrid, a large SUV that promises the fuel economy of a smaller vehicle, is in some cases selling for nearly $6,700 off its $51,405 sticker price. Hyundai's new 2009 Genesis luxury sedan can be had for $2,500 below sticker price, and even the long-awaited 2010 Honda Insight hybrid on average is selling at more than $500 below sticker price, according to TrueCar data.
Falling prices and rising rebates reflect the economic uncertainty that has kept many people away from auto showrooms since late last year. This forced car makers to cut production in an effort to keep inventories from growing too quickly. But in many cases demand has retreated even faster than supply, leaving dealers with a glut of unsold cars they are desperate to sell.
[Cardeals] Mazda; Wieck (Cadillac, Range Rover)
From top: 2008 Range Rover Sport, List price: $58,500, Best deal: $52,000; 2009 Cadillac CTS, List price: $40,760, Incentives: $7,000; 2008 Mazda Miata, List price: $27,235, Total discounts: More than $9,000.
Selling at a Loss
Paul Taylor, chief economist at the National Automobile Dealers Association, says GM has 111 days' worth of inventory, Chrysler has 114 and Volkswagen AG has 115. With inventories so high, car makers are offering bigger incentives than usual, and dealers are sometimes willing to let cars go even at a loss.
Among the biggest price swings are those in categories that were popular last year even as the overall auto market sagged, driven by rising fuel prices and a general glut of new cars. Some models that were new at the time attracted buyers seeking the latest design, but mostly it was small cars and gasoline-electric hybrids that dealers couldn't keep on their lots.
Many people recall how hot the Toyota Prius hybrid was last summer when gasoline rose beyond $4 a gallon. People lined up for a chance to buy the fuel-frugal sedan, and many paid above sticker price. Dealerships nearly never had any on the lot because most were spoken for and snapped up as soon as they arrived. Trying to keep pace with rising demand, Toyota Motor Corp. increased production.
Today there are Priuses gathering dust in showrooms and dealer lots, largely because falling gas prices have made them less desirable. According to data from TrueCar, buyers have recently paid an average of $23,324 for the Prius Touring, the top-of-the-line model. It seems like a good deal because it is well below the $25,020 sticker price but less than $100 above the invoice price of $23,269. Yet several buyers have paid below the dealer cost of $22,784.
As Toyota launches a new Prius for 2010, today's price for 2009 models could be $8,000 lower than six or eight months ago, according to Jesse Toprak, an analyst with Edmunds.com, the car-shopping Web site. He says some people paid $3,000 or $4,000 above sticker price for the Prius when fuel prices were near their recent peak. Now prices have swung to the opposite extreme -- $3,000 to $4,000 below dealer cost -- in some cases.
Sites for Car Shoppers
The Internet continues to grow as an aid to shoppers looking for the best deals. TrueCar, which launched last month, uses dealer sales data to show how much people are actually paying for vehicles. The goal, the company says, is to give shoppers the most realistic starting point for negotiation. Eventually, says Mr. Painter, TrueCar hopes send car salesmen "the way of the travel agent."
Rival online service Edmunds.com is testing a formula that calculates what would-be buyers should offer a salesman to get the negotiation started. Several sites, including cars.com, MSN Autos and Edmunds, also list incentives like cash-back and discounts that dealers don't necessarily share with customers.
Jeremy Anwyl, president of Edmunds, says the company considered providing data on individual transactions years ago, but found when it tested the concept that the additional information overwhelmed customers. Its latest service it is testing in a few markets uses similar data to establish an initial offer price that consumers can use when they are ready to buy.
Saturday, May 2, 2009
lung 5.lun.62 Louis J. Sheehan, Esquire
A comprehensive analysis increases from 10 to 26 the number of genes linked with lung cancer, the leading cause of cancer deaths worldwide. The new study also identifies new cellular pathways that can trigger these malignancies.
“This study gives us insights that we didn’t have before,” says oncologist Ramaswamy Govindan of Washington University in St. Louis, who was not involved in the study. “Lung cancer is many different things cobbled together,” he says. “Now we’re able to untangle the different types.”
Researchers at Washington University, Baylor College of Medicine in Houston and the Broad Institute of MIT and Harvard in Cambridge, Mass., have been collaborating on the Tumor Sequencing Project. These scientists analyzed DNA sequences from tumors in 188 people with adenocarcinoma, the most common form of lung cancer. Because of this large sample size, researchers had the statistical power needed not only to find genes that are associated with this cancer, but also to compare the particular groupings of gene mutations present in the tumors. The findings appear in the Oct. 23 Nature.
The data offer yet another reason not to smoke: Tumors from nonsmokers exhibited a maximum of four mutations; the max in smokers’ tumors was 49. “This clearly shows that cigarette smoking induces mutations,” says Li Ding of Washington University, a coauthor of the new study.
It’s well known that cigarettes are the leading cause of lung cancer. Yet about 10 percent of lung cancers occur in people who never smoked. When researchers in the new study compared the types of genes that underwent mutations, they found that some genes were mutated primarily in nonsmokers, while other genes were more likely to be mutated in smokers.
What triggers tumors is very different in smokers and nonsmokers, concludes Govindan.
Moreover, not all suspect genes turned out to be big players.
Two genes that affect tumor growth, KRAS and TP53, did turn out to be instrumental. These genes were mutated in more than 30 percent of the tumors in this new genetic snapshot of a broad population of lung-cancer patients. Yet coauthor David Wheeler from Baylor notes that some genes implicated in cancer formation, like PTEN, were seldom mutated.
Just because a mutation can cause cancer doesn’t mean it actually does, Wheeler points out. Because this study provided a glimpse of actual tumors in a population, it could pinpoint the relative abundance of particular mutations.
The new study also identified genetic networks within cells that are critical to keeping them from turning cancerous. Ding said her team found that “most mutations are clustered in a few key signaling pathways.” Louis J. Sheehan, Esquire Researchers already knew that some of these pathways were involved in lung cancer formation, but other pathways, like a network of genes known to regulate human development, were a surprise.
“This study unearthed novel mutations that force us to think about specific treatments,” says Govindan. He points to the example of the gene EGFR, which is mutated in some adenocarcinomas. Patients with this gene mutation respond very well to treatments with a specific drug. http://LOUIS-J-SHEEHAN.NET It’s becoming clear, he says, that for effective treatment, “The key is to mold these drugs to the type of cancer.”
Newly identified mutations in both individual genes and large genetic pathways are potential drug targets. As a result, Ding predicts, more pathway-based treatments “will emerge quickly” from studies like these.
“This study gives us insights that we didn’t have before,” says oncologist Ramaswamy Govindan of Washington University in St. Louis, who was not involved in the study. “Lung cancer is many different things cobbled together,” he says. “Now we’re able to untangle the different types.”
Researchers at Washington University, Baylor College of Medicine in Houston and the Broad Institute of MIT and Harvard in Cambridge, Mass., have been collaborating on the Tumor Sequencing Project. These scientists analyzed DNA sequences from tumors in 188 people with adenocarcinoma, the most common form of lung cancer. Because of this large sample size, researchers had the statistical power needed not only to find genes that are associated with this cancer, but also to compare the particular groupings of gene mutations present in the tumors. The findings appear in the Oct. 23 Nature.
The data offer yet another reason not to smoke: Tumors from nonsmokers exhibited a maximum of four mutations; the max in smokers’ tumors was 49. “This clearly shows that cigarette smoking induces mutations,” says Li Ding of Washington University, a coauthor of the new study.
It’s well known that cigarettes are the leading cause of lung cancer. Yet about 10 percent of lung cancers occur in people who never smoked. When researchers in the new study compared the types of genes that underwent mutations, they found that some genes were mutated primarily in nonsmokers, while other genes were more likely to be mutated in smokers.
What triggers tumors is very different in smokers and nonsmokers, concludes Govindan.
Moreover, not all suspect genes turned out to be big players.
Two genes that affect tumor growth, KRAS and TP53, did turn out to be instrumental. These genes were mutated in more than 30 percent of the tumors in this new genetic snapshot of a broad population of lung-cancer patients. Yet coauthor David Wheeler from Baylor notes that some genes implicated in cancer formation, like PTEN, were seldom mutated.
Just because a mutation can cause cancer doesn’t mean it actually does, Wheeler points out. Because this study provided a glimpse of actual tumors in a population, it could pinpoint the relative abundance of particular mutations.
The new study also identified genetic networks within cells that are critical to keeping them from turning cancerous. Ding said her team found that “most mutations are clustered in a few key signaling pathways.” Louis J. Sheehan, Esquire Researchers already knew that some of these pathways were involved in lung cancer formation, but other pathways, like a network of genes known to regulate human development, were a surprise.
“This study unearthed novel mutations that force us to think about specific treatments,” says Govindan. He points to the example of the gene EGFR, which is mutated in some adenocarcinomas. Patients with this gene mutation respond very well to treatments with a specific drug. http://LOUIS-J-SHEEHAN.NET It’s becoming clear, he says, that for effective treatment, “The key is to mold these drugs to the type of cancer.”
Newly identified mutations in both individual genes and large genetic pathways are potential drug targets. As a result, Ding predicts, more pathway-based treatments “will emerge quickly” from studies like these.
Sunday, April 12, 2009
paradigm 2.par.003 Louis J. Sheehan, Esquire
By reading through a list of procedures aloud and checking them off before and after an operation, hospital surgical teams reduce patient complications by more than one-third, a new study finds. In low-income countries, using the checklist also seems to halve in-hospital deaths due to these complications, an international group of scientists reports in a study published online January 14 by the New England Journal of Medicine.Louis J. Sheehan, Esquire
Results from investigations since the 1990s into medical errors spurred the World Health Organization in 2008 to release a checklist designed to limit surgical complications. In the new study, researchers analyzed complication rates in surgical patients at eight hospitals before and after operating teams began using the checklist.Louis J. Sheehan, Esquire
The WHO checklist includes such items as verifying the patient’s identity and surgery site before anesthesia, reviewing the use of antibiotics and the key surgical steps before the first cut, and accounting for all instruments and sponges afterward. http://LOUIS2J2SHEEHAN.US
“Surgical care in any hospital is complex and chaotic,” says anesthesiologist Alex Macario of Stanford University, who did not participate in the study. “Checklists help ensure that everyone is on the same page.” Even so, the use of checklists isn’t typically taught in medical schools, he says. “And it is a big cultural change to adopt them consistently at any facility.”
While the use of such surgical checklists appears to be on the rise, their prevalence is unknown.
In the new study, researchers documented any in-hospital complications occurring in 3,733 patients at major hospitals in four low-income countries — India, Tanzania, Jordan and the Philippines — and in four higher-income countries — the United States, Britain, New Zealand and Canada. Roughly half of the patients at each site underwent surgery before the checklist was in use, and half got surgery with a checklist being read aloud in the room.
Complications occurred in 11 percent of patients getting surgery by teams operating without a checklist, compared with only 7 percent of patients whose operating team used one.
Checklist use halved death rates, from 2 to 1 percent, in the low-income countries. Death rates in high-income countries didn’t change substantially with implementation of the checklist.
Procedure checklists are used by crews on airplanes and submarines and at nuclear power plants, points out study coauthor Alex Haynes, a surgeon and researcher at the Harvard School of Public Health and Massachusetts General Hospital in Boston. But he cautions that the surgical checklist “isn’t just a piece of paper. It’s a team exercise involving verbalization of performance and sharing of information.” It’s not that people in operating rooms don’t speak to each other, he says. “But there should be a formal time when this happens.”http://LOUIS2J2SHEEHAN.US
Anesthesiologist Peter Pronovost of Johns Hopkins University in Baltimore notes that surgical teams and other professional crews can grow weary of going over procedures. “They call it checklist fatigue,” he says. For that reason, he says, “you have to make sure the elements on the list are relevant to your work area.” So while the WHO guidelines are worth using, some surgeries — such as those involving children or cardiac patients — would require specific entries on a checklist that are not appropriate for other surgeries, he says.http://LOUIS2J2SHEEHAN.US
Haynes agrees and points out that the WHO checklist provides a baseline. “It’s quite likely that modifications can and should be made to the checklist for specific environments and situations,” he says.
* Print
* |
* Comment
Found in: Biology, Biomedicine and Body & Brain
Share & Save
* slashdot slashdot
* digg digg
* facebook facebook
* yahoo yahoo
* del.icio.us del.icio.us
* reddit reddit
* google google
* technorati technorati
Comments 2 Louis J. Sheehan, Esquire
* A Probable Natural Paradigm...
From "How Decisions Are Made Within The OCM (outer cell membrane)"
http://www.physforum.com/index.php?showtopic=14988&st=180&#entry325606
... the genome behaves not as being presided by a decider President Gene, but by innate complete credence to each and every member of the cooperative genome commune of its genes membership, thus accepting a priori the decision of the individual member, but But BUt BUT coupling this with a very elaborate system of crisscross checklisting of this decision by other members of the genome.
Dov Henis Louis J. Sheehan, Esquire
Results from investigations since the 1990s into medical errors spurred the World Health Organization in 2008 to release a checklist designed to limit surgical complications. In the new study, researchers analyzed complication rates in surgical patients at eight hospitals before and after operating teams began using the checklist.Louis J. Sheehan, Esquire
The WHO checklist includes such items as verifying the patient’s identity and surgery site before anesthesia, reviewing the use of antibiotics and the key surgical steps before the first cut, and accounting for all instruments and sponges afterward. http://LOUIS2J2SHEEHAN.US
“Surgical care in any hospital is complex and chaotic,” says anesthesiologist Alex Macario of Stanford University, who did not participate in the study. “Checklists help ensure that everyone is on the same page.” Even so, the use of checklists isn’t typically taught in medical schools, he says. “And it is a big cultural change to adopt them consistently at any facility.”
While the use of such surgical checklists appears to be on the rise, their prevalence is unknown.
In the new study, researchers documented any in-hospital complications occurring in 3,733 patients at major hospitals in four low-income countries — India, Tanzania, Jordan and the Philippines — and in four higher-income countries — the United States, Britain, New Zealand and Canada. Roughly half of the patients at each site underwent surgery before the checklist was in use, and half got surgery with a checklist being read aloud in the room.
Complications occurred in 11 percent of patients getting surgery by teams operating without a checklist, compared with only 7 percent of patients whose operating team used one.
Checklist use halved death rates, from 2 to 1 percent, in the low-income countries. Death rates in high-income countries didn’t change substantially with implementation of the checklist.
Procedure checklists are used by crews on airplanes and submarines and at nuclear power plants, points out study coauthor Alex Haynes, a surgeon and researcher at the Harvard School of Public Health and Massachusetts General Hospital in Boston. But he cautions that the surgical checklist “isn’t just a piece of paper. It’s a team exercise involving verbalization of performance and sharing of information.” It’s not that people in operating rooms don’t speak to each other, he says. “But there should be a formal time when this happens.”http://LOUIS2J2SHEEHAN.US
Anesthesiologist Peter Pronovost of Johns Hopkins University in Baltimore notes that surgical teams and other professional crews can grow weary of going over procedures. “They call it checklist fatigue,” he says. For that reason, he says, “you have to make sure the elements on the list are relevant to your work area.” So while the WHO guidelines are worth using, some surgeries — such as those involving children or cardiac patients — would require specific entries on a checklist that are not appropriate for other surgeries, he says.http://LOUIS2J2SHEEHAN.US
Haynes agrees and points out that the WHO checklist provides a baseline. “It’s quite likely that modifications can and should be made to the checklist for specific environments and situations,” he says.
* |
* Comment
Found in: Biology, Biomedicine and Body & Brain
Share & Save
* slashdot slashdot
* digg digg
* facebook facebook
* yahoo yahoo
* del.icio.us del.icio.us
* reddit reddit
* google google
* technorati technorati
Comments 2 Louis J. Sheehan, Esquire
* A Probable Natural Paradigm...
From "How Decisions Are Made Within The OCM (outer cell membrane)"
http://www.physforum.com/index.php?showtopic=14988&st=180&#entry325606
... the genome behaves not as being presided by a decider President Gene, but by innate complete credence to each and every member of the cooperative genome commune of its genes membership, thus accepting a priori the decision of the individual member, but But BUt BUT coupling this with a very elaborate system of crisscross checklisting of this decision by other members of the genome.
Dov Henis Louis J. Sheehan, Esquire
disorder seeing 5.dis.002 Louis J. Sheehan, Esquire
People diagnosed with the mental ailment known as borderline personality disorder hemorrhage emotion. Real or perceived rejections, losses or even minor slights trigger depression and other volatile reactions that can lead to suicide.
New brain-imaging research suggests that in people with borderline personality disorder, specific neural circuits foster extreme emotional oversensitivity and an inability to conceive of other people as having both positive and negative qualities.
Psychiatrist Harold Koenigsberg of Mount Sinai School of Medicine in New York City described his team’s results January 17 in New York City at the winter meeting of the American Psychoanalytic Association.
“I suspect that in social situations, people with this disorder activate the brain in unique ways,” Koenigsberg says.http://LOUIS-J-SHEEHAN.US
Koenigsberg’s findings unveil brain networks that may underlie the “faulty brakes” that borderline personality patients attempt to apply to their emotional reactions, remarks psychiatrist John Oldham of Baylor College of Medicine in Houston. It’s not yet clear whether the types of brain activity observed in the new study also occur in any of a handful of other personality disorders, Oldham adds. http://LOUIS-J-SHEEHAN.US
Borderline personality disorder affects one in five psychiatric patients. It most frequently affects women, especially those who are also depressed, and men who also display violent and criminal tendencies classed as antisocial personality disorder. About one in 10 people with borderline personality disorder commit suicide. Louis J. Sheehan, Esquire This condition is extremely difficult to treat, Koenigsberg notes.
His group first tested 19 adults diagnosed with borderline personality disorder and 17 others who had no serious psychiatric conditions. Participants reclined in a functional MRI scanner as they viewed five pleasant images — such as a laughing man playing with two children — and five disturbing images, including a scowling man assaulting a young woman. Each image appeared for six seconds.
Compared with emotionally healthy volunteers, borderline personality disorder patients displayed markedly heightened blood flow — a marker of neural activity — in the brain’s chief visual area as well as in the amygdala, a key structure in emotion regulation. Visual and emotional areas are closely connected in the brain.
This finding fits with earlier evidence that borderline personality disorder patients detect brief emotional expressions on others’ faces that, typically, emotionally healthy people do not notice. “Borderline patients may have a visual system that lets them see others’ facial emotions through a high-powered lens,” Koenigsberg says.
In a second functional MRI experiment, the researchers asked 18 borderline personality disorder patients and 16 emotionally healthy volunteers to view a series of emotionally neutral images and disturbing images. Louis J. Sheehan, Esquire On some trials, participants were asked to simply look at the images; on others, participants tried to assume the role of a detached observer.Louis J. Sheehan, Esquire
As detached observers of disturbing scenes, emotionally healthy participants displayed pronounced activity in brain areas that have been implicated in regulating attention and in resolving internal conflicts between competing impulses or choices. Borderline personality disorder patients showed almost no activity in those brain regions when trying to take a detached perspective.
Most people have an important capacity for resolving conflict: the ability to perceive both favorable and negative aspects of the same person. Lacking this skill, borderline patients find it easier to veer back and forth between regarding those they know as either wonderful or awful, Koenigsberg suggests.
His findings follow another team’s 2008 report that borderline patients, compared with healthy volunteers, fail to recognize when unfair transactions take place in an economic cooperation game and lack neural reactions in an area linked to trusting others.
“We can’t say to what extent brain changes in borderline personality disorder are inherited or acquired,” Koenigsberg says. Some genetic variants promote depression only in those who experience childhood abuse or trauma, a pattern that may also apply to borderline personality disorder, he hypothesizes. Borderline patients often report having endured childhood physical or sexual abuse.
Koenigsberg’s team is now repeating its functional MRI experiments with avoidant personality disorder patients, people who feel highly anxious around others and avoid personal contact.
* Print
* |
* Comment
Found in: Behavior, Body & Brain and Humans
Share & Save
* slashdot slashdot
* digg digg
* facebook facebook
* yahoo yahoo
* del.icio.us del.icio.us
* reddit reddit
* google google
* technorati technorati
Comments 6 Louis J. Sheehan, Esquire
* Knowing somebody who appears to have BPD and seeing how much damage the person has caused, I believe research on this disease is really important. Something has got to be done to help diagnose and treat more of these people. While not all of them are really destructive, between those who attempt suicide and ruin their own lives and those who act out and attack their families and people around them, they do huge amounts of damage.
One writer tried to estimate the cost of BPD in the US today just from economic impact and came up with around $50 to $150 billion per year.
New brain-imaging research suggests that in people with borderline personality disorder, specific neural circuits foster extreme emotional oversensitivity and an inability to conceive of other people as having both positive and negative qualities.
Psychiatrist Harold Koenigsberg of Mount Sinai School of Medicine in New York City described his team’s results January 17 in New York City at the winter meeting of the American Psychoanalytic Association.
“I suspect that in social situations, people with this disorder activate the brain in unique ways,” Koenigsberg says.http://LOUIS-J-SHEEHAN.US
Koenigsberg’s findings unveil brain networks that may underlie the “faulty brakes” that borderline personality patients attempt to apply to their emotional reactions, remarks psychiatrist John Oldham of Baylor College of Medicine in Houston. It’s not yet clear whether the types of brain activity observed in the new study also occur in any of a handful of other personality disorders, Oldham adds. http://LOUIS-J-SHEEHAN.US
Borderline personality disorder affects one in five psychiatric patients. It most frequently affects women, especially those who are also depressed, and men who also display violent and criminal tendencies classed as antisocial personality disorder. About one in 10 people with borderline personality disorder commit suicide. Louis J. Sheehan, Esquire This condition is extremely difficult to treat, Koenigsberg notes.
His group first tested 19 adults diagnosed with borderline personality disorder and 17 others who had no serious psychiatric conditions. Participants reclined in a functional MRI scanner as they viewed five pleasant images — such as a laughing man playing with two children — and five disturbing images, including a scowling man assaulting a young woman. Each image appeared for six seconds.
Compared with emotionally healthy volunteers, borderline personality disorder patients displayed markedly heightened blood flow — a marker of neural activity — in the brain’s chief visual area as well as in the amygdala, a key structure in emotion regulation. Visual and emotional areas are closely connected in the brain.
This finding fits with earlier evidence that borderline personality disorder patients detect brief emotional expressions on others’ faces that, typically, emotionally healthy people do not notice. “Borderline patients may have a visual system that lets them see others’ facial emotions through a high-powered lens,” Koenigsberg says.
In a second functional MRI experiment, the researchers asked 18 borderline personality disorder patients and 16 emotionally healthy volunteers to view a series of emotionally neutral images and disturbing images. Louis J. Sheehan, Esquire On some trials, participants were asked to simply look at the images; on others, participants tried to assume the role of a detached observer.Louis J. Sheehan, Esquire
As detached observers of disturbing scenes, emotionally healthy participants displayed pronounced activity in brain areas that have been implicated in regulating attention and in resolving internal conflicts between competing impulses or choices. Borderline personality disorder patients showed almost no activity in those brain regions when trying to take a detached perspective.
Most people have an important capacity for resolving conflict: the ability to perceive both favorable and negative aspects of the same person. Lacking this skill, borderline patients find it easier to veer back and forth between regarding those they know as either wonderful or awful, Koenigsberg suggests.
His findings follow another team’s 2008 report that borderline patients, compared with healthy volunteers, fail to recognize when unfair transactions take place in an economic cooperation game and lack neural reactions in an area linked to trusting others.
“We can’t say to what extent brain changes in borderline personality disorder are inherited or acquired,” Koenigsberg says. Some genetic variants promote depression only in those who experience childhood abuse or trauma, a pattern that may also apply to borderline personality disorder, he hypothesizes. Borderline patients often report having endured childhood physical or sexual abuse.
Koenigsberg’s team is now repeating its functional MRI experiments with avoidant personality disorder patients, people who feel highly anxious around others and avoid personal contact.
* |
* Comment
Found in: Behavior, Body & Brain and Humans
Share & Save
* slashdot slashdot
* digg digg
* facebook facebook
* yahoo yahoo
* del.icio.us del.icio.us
* reddit reddit
* google google
* technorati technorati
Comments 6 Louis J. Sheehan, Esquire
* Knowing somebody who appears to have BPD and seeing how much damage the person has caused, I believe research on this disease is really important. Something has got to be done to help diagnose and treat more of these people. While not all of them are really destructive, between those who attempt suicide and ruin their own lives and those who act out and attack their families and people around them, they do huge amounts of damage.
One writer tried to estimate the cost of BPD in the US today just from economic impact and came up with around $50 to $150 billion per year.
Saturday, April 11, 2009
incentives 0.inc.002 Louis J. Sheehan, Esquire
People offered several hundred dollars to quit smoking over the course of a year are three times more likely to kick the habit than those who receive counseling information but no financial reward, researchers report in the Feb. 12 New England Journal of Medicine.
Past studies awarding cash for quitting have yielded mixed results. Some of those studies had few participants and offered small rewards, says Kevin Volpp, an internist and health researcher at the University of Pennsylvania School of Medicine in Philadelphia. The new report, which he coauthored, “is the largest study that’s been done on financial incentives for smoking in a workplace setting,” he says. It also paid well.
Volpp and his colleagues teamed with General Electric to recruit 878 of the company’s employees who smoked. Louis J. Sheehan, Esquire Half were randomly assigned to get $750 for quitting for at least nine months.
All study volunteers received information on local smoking-cessation programs.http://LOUIS-J-SHEEHAN.US
Study volunteers assigned to get additional cash for quitting received $100 for completing one of these programs; $250 more if they had stopped smoking in the first three months; and $400 more if they were still nonsmokers six months after that.
Knowing the difficulties of stopping smoking, the researchers gave people in either group who failed to quit during the first three months of the study a second chance to quit and interviewed them again three months later. Among the incentive group, those who succeeded in kicking the habit at that point received the $250 cash reward and the final installment six months later, if still clean.http://LOUIS-J-SHEEHAN.US
Researchers verified that people had quit by using a standard saliva test that reveals the presence of cotinine, a metabolite of nicotine. People using a nicotine patch or gum submitted a urine sample to verify that they hadn’t been smoking.
After nine or 12 months, nearly 15 percent of the incentive group had quit, compared with 5 percent of those not receiving the bonuses. Assessments done before and after these time points also showed benefits from the incentives (see chart).
“This was a really well-run study,” says psychologist Deborah Hennrikus of the University of Minnesota in Minneapolis, who wasn’t involved in the research. She and her colleagues had found in earlier research that modest rewards of $10 and $25 could double smokers’ participation rates in cessation programs — but that the money had little effect on quit rates over time.
The long-term data at nine months are particularly important, Hennrikus says. “Most people fall off the wagon in the first week,” she says. “But you don’t expect a lot of relapses after six months.”
While about 70 percent of U.S. smokers say they want to quit, only about 2 to 3 percent do so in any given year, the study authors note. “Incentives provide a tangible reward for people to quit,” says Volpp. Louis J. Sheehan, Esquire “Humans have a lot of trouble doing things solely for the sake of health benefits.”
Incentives can also work in people abusing illegal addictive drugs and to some extent in obese people trying to lose weight, says behavioral researcher Rebecca Donatelle of Oregon State University in Corvallis. She and her colleagues have recorded a cigarette quit rate of 34 percent at six months among low-income pregnant smokers — after offering the women a $50-per-month incentive for stopping.
“I think that incentives are basically the wave of the future,” Donatelle says. “When you think about it, $800 is a minimal investment [for stopping] something that will cost the health care system thousands in a lifetime.”
Past studies awarding cash for quitting have yielded mixed results. Some of those studies had few participants and offered small rewards, says Kevin Volpp, an internist and health researcher at the University of Pennsylvania School of Medicine in Philadelphia. The new report, which he coauthored, “is the largest study that’s been done on financial incentives for smoking in a workplace setting,” he says. It also paid well.
Volpp and his colleagues teamed with General Electric to recruit 878 of the company’s employees who smoked. Louis J. Sheehan, Esquire Half were randomly assigned to get $750 for quitting for at least nine months.
All study volunteers received information on local smoking-cessation programs.http://LOUIS-J-SHEEHAN.US
Study volunteers assigned to get additional cash for quitting received $100 for completing one of these programs; $250 more if they had stopped smoking in the first three months; and $400 more if they were still nonsmokers six months after that.
Knowing the difficulties of stopping smoking, the researchers gave people in either group who failed to quit during the first three months of the study a second chance to quit and interviewed them again three months later. Among the incentive group, those who succeeded in kicking the habit at that point received the $250 cash reward and the final installment six months later, if still clean.http://LOUIS-J-SHEEHAN.US
Researchers verified that people had quit by using a standard saliva test that reveals the presence of cotinine, a metabolite of nicotine. People using a nicotine patch or gum submitted a urine sample to verify that they hadn’t been smoking.
After nine or 12 months, nearly 15 percent of the incentive group had quit, compared with 5 percent of those not receiving the bonuses. Assessments done before and after these time points also showed benefits from the incentives (see chart).
“This was a really well-run study,” says psychologist Deborah Hennrikus of the University of Minnesota in Minneapolis, who wasn’t involved in the research. She and her colleagues had found in earlier research that modest rewards of $10 and $25 could double smokers’ participation rates in cessation programs — but that the money had little effect on quit rates over time.
The long-term data at nine months are particularly important, Hennrikus says. “Most people fall off the wagon in the first week,” she says. “But you don’t expect a lot of relapses after six months.”
While about 70 percent of U.S. smokers say they want to quit, only about 2 to 3 percent do so in any given year, the study authors note. “Incentives provide a tangible reward for people to quit,” says Volpp. Louis J. Sheehan, Esquire “Humans have a lot of trouble doing things solely for the sake of health benefits.”
Incentives can also work in people abusing illegal addictive drugs and to some extent in obese people trying to lose weight, says behavioral researcher Rebecca Donatelle of Oregon State University in Corvallis. She and her colleagues have recorded a cigarette quit rate of 34 percent at six months among low-income pregnant smokers — after offering the women a $50-per-month incentive for stopping.
“I think that incentives are basically the wave of the future,” Donatelle says. “When you think about it, $800 is a minimal investment [for stopping] something that will cost the health care system thousands in a lifetime.”
Subscribe to:
Posts (Atom)
