Search

Clinical ethics consultation services (CECS) can be particularly complex in oncology, and widespread misconceptions exist about their nature. As a result, visibility and accessibility of information regarding CECS is critical. We investigated the availability and content of information regarding CECS on websites of NCI-designated comprehensive cancer centers and cancer centers (CCs). Each website was reviewed for information on CECS and reviewed for benchmarks partially derived from the American Society of Bioethics and Humanities recommendations for CECS. Our analysis revealed that of 70 NCI-designated center websites, 38 had information on CECS, and 17 were found directly on these sites. When CECS information was available, most websites provided a mission statement (71%) and an explanation of what constitutes an ethics consult (74%). Few provided a description of the consult process (45%) or service membership (39%). Our findings reveal a significant gap in CECS visibility on the websites of NCI-designated CCs. [ABSTRACT FROM AUTHOR]

The development of treatment-related adverse events (trAE) correlates favorably with clinical outcomes in multiple studies of patients receiving immune checkpoint inhibitors (ICI); however, this relationship is undefined in patients with hepatocellular carcinoma (HCC). We derived a cohort of 406 patients with unresectable/advanced HCC receiving ICI therapy as part of international clinical trials submitted to the US Food and Drug Administration (FDA) in support of marketing applications. We tested whether the development of clinically significant trAE (i.e. graded ≥2, trAE2) predicted improved overall survival (OS), progression-free survival (PFS), and objective response rates (ORR) following ICI. We established an international consortium of 10 tertiary-care referral centres located in Europe (n = 67), United States (US, n = 248) and Asia (n = 42) to validate this association. In the FDA dataset of 406 patients, 325 (80%) with Barcelona Clinic Liver Cancer (BCLC) stage C HCC mostly treated with ICI monotherapy (n = 258, 64%), trAE2 were reported in 228 patients (56.1%). Development of trAE2 was associated with longer OS (16.7 versus 11.2 months) and PFS (5.5 versus 2.2 months) and persisted as an independent predictor of outcome after adjusting for viral aetiology, gender, Child-Pugh class, BCLC stage, AFP levels, ECOG-PS, ICI regimen (mono/combination therapy) and receipt of corticosteroid therapy. In a multi-institutional cohort of 357 patients with similar characteristics mostly treated with ICI monotherapy (n = 304, 85%), the development of trAE2 was associated with longer OS (23.3 versus 12.1 months) and PFS (9.6 versus 3.9 months). TrAE2 were confirmed predictors of improved OS (HR 0.43; 95% CI:0.25–0.75) and PFS (HR 0.48; 95% CI: 0.31–0.75), with multivariable analyses confirming their association with outcome independent of clinicopathologic features of interest. Additional time-varying multivariable analyses also indicated that trAEs were associated with a decreased risk of progression (HR 0.56, 95% CI: 0.46–0.67) in the FDA dataset and death (HR 0.55; 95% CI: 0.32–0.95) in the multi-institutional dataset. Development of trAE2 correlates with improved outcomes in patients with HCC receiving ICI in clinical trials and in routine practice. Prospective studies aimed at understanding the underlying immunologic foundations of such relationships are warranted to identify predictive biomarkers of toxicity and response. • Treatment-related adverse events (trAEs) may affect immunotherapy outcomes in HCC. • We correlated trAEs with response and survival in independent datasets. • trAEs predict for better response and survival in trials and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Incident disability rates enable the comparison of risk across populations. Understanding these by age, sex, and race is important for planning for the care of older adults and targeting prevention.Methods: We calculated incident disability rates among older adults in the Cardiovascular Health Study, a study of 5,888 older adults aged ≥ 65 years over 6 years of follow-up. Disability was defined in the following two ways: (i) self-report of disability (severe difficulty or inability) in any of six Activities of Daily Living (ADL), and (ii) mobility difficulty (any difficulty walking half a mile or climbing 10 steps). Incident disability rates were calculated as events per 100 person years for age, gender, and race groups.Results: The incidence of ADL disability, and mobility difficulty were 2.7 (2.5-2.8), and 9.8 (9.4-10.3) events per 100 person years. Women, older participants, and blacks had higher rates in both domains.Conclusion: Incidence rates are considerably different based on the domain examined as well as age, race, and gender composition of the population. Prevention efforts should focus on high risk populations and attempt to ameliorate factors that increase risk in these groups. [ABSTRACT FROM AUTHOR]

The article offers updates about journalism education in the U.S. as of 2013. Topics discussed include the emergence of a debate on the need to use drones in journalism, the 2013 Global Editors Network (GEN) News Summer in Paris, France, and the International Association for Media and Communication Research's conference in Dublin, Ireland. Also provided is information regarding the mass communication courses and massive open online courses (MOOCs) offered by several universities in the country.

The benefits of whole-grade acceleration for the highest achieving students in K-12 education are widely acknowledged. However, much less is known about which personal, family, and school factors are correlated with student acceleration. Which children are grade accelerated in K-7 education? Have factors associated with grade acceleration changed over time? We analyze data from the NELS (students from 1988-1992) and the ELS (students from 2002-2004) nationally representative and longitudinal databases to answer these questions. other things being equal, females, Asian Americans, and students living on the U.S. east or west coast were more likely to be grade accelerated. For example, females had odds of being accelerated that were 1.3 times higher than the odds of males being accelerated. Students from the northeastern region of the U.S. had odds of acceleration that were nearly twice (1.9 times) as high as Midwest students' odds of acceleration. When accelerated students were compared to older classmates of similar achievement who were not accelerated, the accelerated students showed greater gains in achievement than nonaccelerated classmates in and throughout high school. In other words, accelerated students do not just keep up with their older classmates, they actually perform better. [ABSTRACT FROM AUTHOR]

The article discusses importance of understanding emerging technology in journalism and First Amendment in the U.S. Topics discussed include best practices in virtual reality, integration of virtual reality with web and social media, and education about First Amendment freedoms in journalism campuses.

This article examines the recent development of identity theft as a crime within the United States, specifically the appropriation of personal information for the fraudulent adoption of consumer credit accounts. It is demonstrated that identity theft, conceptualized within a discourse of risk, has a realist dimension as an unintended consequence of the deployment of information technologies in the securitization of consumer identities. However, the risk of identity theft is also operationalized in specific ways by an array of authorities who seek to govern the activities of consumers. This occurs through providing tactical advice to victims in coping with the indirect costs and uncertainties of the crime, and educating consumers on the need to adopt prudent risk minimizing and harm-reduction practices. [ABSTRACT FROM AUTHOR]

This paper examines how statistical credit-scoring technologies, sanctioned by the state in the interests of promoting equality, became applied by lenders to the problem of controlling levels of default within American consumer credit. However, these technologies, constituting consumers as ‘risks’, are themselves seen to be problematic, subject to their own conceived sets of methodological, procedural and temporal risks. Nevertheless, as this article will show, such technologies have increasingly been applied to other areas of consumer lending, thus interpreting a wider array of operational contingencies in terms of risk. Finally, it is argued that, since the 1980s, the constitution of credit consumers as risks has been deployed to new ends through technologies of ‘profit scoring’ and new practices of ‘risk pricing’. [ABSTRACT FROM AUTHOR]

Examines the effects of developments in environmental law on Indiana citizens. Features of insurance policies that make them distinct from other types of contracts; Response of state courts to environmental liability claims; Issues examined by the Indiana Court of Appeals in the case PSI Energy Inc. v. The Home Insurance Co.

Focuses on promoting racial equality through equal education opportunity in the U.S. Introduction to the concept of progressive school choice; Significance of adequate education for students; Implication of unequal distribution of adequate education; Barriers to choice-based education reform.

The article analyzes the establishment clause and also focuses on the use of government neutrality principles in the electoral process. Religion has been the means by which the ruling body centralizes authority in the secular government and increases their power over and allegiance from the people. This anticompetitive manipulation of election laws has created a state of political segregation-granting electoral privileges to a favored class of "major parties" and relegating outsiders to second-class electoral status as "minor parties" and independent. The Establishment Clause's traditional enforcement of values such as equality and neutrality in the context of religion creates a useful paradigm for enforcing these same values in the electoral process. The fairness and integrity of the electoral system is the final line of defense between the people and the misuse of power feared by the founders. Disestablishment theory is a useful tool to protect the liberties of the people and limit the power of government. The right to vote is arguably the most important of the fundamental rights recognized by the Supreme Court's interpretation of the Constitution.

Investigates the systematic educational reform plan involving school choice in the United States. Essence of education on the development of a child; Inequality of education provided by the government; Need of a broad structural reform of the public education process.

We use information reported by ten utilities about their electricity conservation programs to calculate the life-cycle cost per kWh saved -- the cost of a "negawatt" -- associated with these programs. These computations indicate that the cost associated with utilities "purchasing" negawatthours is substantially higher than implied by standard sources such as Amory Lovins (Rocky Mountain Institute) and EPRI. The costs calculated for residential programs, in particular, are much higher than conservation advocates have suggested. However, 80% of the expected savings from these programs are attributed to commercial and industrial customers rather than residential customers. We find substantial variation in costs between utilities for similar programs as well as significant intra-utility variation in the cost associated with various sub-programs. We proceed to examine whether or not there are any systematic biases in the reporting of costs and energy savings by the utilities in our sample. In many cases, utilities fail to report all relevant costs, rely on engineering projections of savings rather than applying methods to measure savings based on actual experience, and fail to make appropriate adjustments for free riders. Further biases may result from adopting measure lives that are too long. As a result, on average the cost of a negawatthour computed from utility reports significantly underestimates the true societal cost of conservation achieved this way. While it is difficult to compute the underestimate with any precision, the evidence that we have suggests that computations based on utility expectations could be underestimating the actual societal cost by a factor of two or more on average. Better utility cost accounting procedures and the application of more sophisticated methods to estimate actual energy savings achieved are clearly necessary before large sums of money can be expended wisely on these programs. [ABSTRACT FROM AUTHOR]

In this article the author comments on the contribution made by the economist Otto Eckstein in the area of economics. Eckstein's optimism, his enthusiasm for learning, his accumulated knowledge and objectivity were a gift for those who came into contact with him. And most of all Eckstein's new successes did not alter his old values, his allegiance to Harvard University, his desire to teach, his interest in scholarship and his concern for the U.S. Eckstein's great success story never changed his principles. It just enhanced his effectiveness as it raised the effectiveness of those who were fortunate to work with him. Optimism was present in every aspect of Eckstein's life. He was optimistic about people, about places, about the times and about goals, and he supported his optimism with energy and high principles. Throughout struggles of a new business, Otto always emphasized the future, not the past, the benefits, not the problems and the opportunities, not the hazards. The author describes briefly the Data Resources Inc. story because it was the adventure that brought Eckstein and him so close together.

Background: In the setting of America's opioid epidemic, judicious postoperative opioid prescribing is important. Gynecologists lack standard guidelines about postoperative opioid prescriptions.Objectives: The objectives of the study were to describe opioid prescribing practices by a group of minimally invasive gynecologic surgeons, to measure postoperative opioid use after minimally invasive hysterectomy, and to identify preoperative factors that could predict whether a patient will be a low or high postoperative opioid user.Study Design: This was a prospective survey-based study including 125 women undergoing laparoscopic hysterectomy for benign indications at 2 community teaching hospitals. Patients were preoperatively surveyed about demographics, past medical history, and current and expected pain scores and were screened for anxiety, depression, and pain catastrophizing. At 1 and 2 weeks after surgery, patients were surveyed about their pain and pain medication use.Results: Ninety-eight percent of patients were prescribed an opioid for acute postoperative pain. The median opioid prescription was for 150 morphine milligram equivalents, equivalent to 20 tablets of oxycodone 5 mg, while median patient postoperative use was 37.5 morphine milligram equivalents, equivalent to 5 tablets of oxycodone 5 mg. Ninety percent of patients had leftover opioids at 2 weeks after surgery, and most leftover opioids were stored in an unsecure location. Preoperative factors that were most strongly correlated with postoperative opioid use included a history of chronic pelvic pain or endometriosis, preoperative opioid use, anxiety, depression, pain catastrophizing, preoperative pain score, anticipated postoperative pain score, and anticipated postoperative pain medication needs. A predictive calculator was developed based on these factors to help identify patients who are likely to be a high opioid user (defined as taking greater than 112.5 morphine milligram equivalents) or a low opioid user (defined as taking 37.5 morphine milligram equivalents or less).Conclusion: On average, surgeons prescribed 4 times the amount of opioids than was needed for patients undergoing laparoscopic hysterectomy for acute postoperative pain control. Individualizing patients' opioid prescriptions based on preoperative risk factors could help reduce excess prescription opioids. [ABSTRACT FROM AUTHOR]

The article focuses on the issues confronting journalism and mass communications education units in the U.S. as the 2015-2016 academic year begins. Topics discussed include the budget issues confronting faculties and administrators and matters of accreditation, curriculum revision, mentoring, and innovation. The emergence of mobile journalism is also mentioned.

Taxes on gasoline and diesel are the primary sources of transportation funding at the state and federal level. Due to inflation and improved fuel efficiency, these taxes are increasingly inadequate to maintain the transportation system. In most states and at the federal level, the real fuel tax rates decrease because they are fixed at a cents-per-gallon amount rather than indexed to inflation. In this paper, we provide a forecast on state and federal tax revenue based on different fuel taxation policies such as indexing to inflation, imposing a sales tax on gasoline and diesel, or using a mileage fee on vehicles. We compare how those taxation policies perform compared to the policies states use currently under different macroeconomic conditions relating to the price of oil, economic growth, and vehicle miles traveled. The baselines projections indicate that between 2015 and 2040, fuel tax revenue will decrease 42.9–50.5% in states that do neither index taxes to inflation nor impose a sales tax. Revenue will decrease 10.3–33.4% that currently impose a sales tax but do not index to inflation. The decrease for states that index to inflation is 3.4–16%. For all states, the median increase in revenue in 2040 compared to 2015 is 62% from switching to a mileage fee. Indexing fuel taxes to inflation in addition to imposing a states' sales tax increases revenue significantly but suffers from a continuous decline in the long-run due to increased fuel efficiency. Our results indicate that although a mileage fee is politically and technologically difficult to achieve, it avoids a declining tax revenue in the long-run. [ABSTRACT FROM AUTHOR]

IMbrave150 has established the superiority of atezolizumab plus bevacizumab over sorafenib in patients with unresectable hepatocellular carcinoma (HCC). We generated a prospectively maintained database including patients treated with atezolizumab plus bevacizumab for unresectable HCC across Europe, Asia and USA. Clinico-pathologic characteristics were assessed for their prognostic influence on overall survival (OS) and progression-free survival (PFS) in univariable and multivariate analyses. Overall response rate by RECIST v1.1 and treatment-related adverse events (TRAEs) per CTCAE v.5.0 were reported. Out of 433 patients, 296 Child-Pugh A and ECOG performance status01 patients received atezolizumab plus bevacizumab in first line and were included. Patients were mostly male (82.7%), cirrhotic (75%) with history of viral hepatitis (65.9%). Overall, 68.9% had Barcelona Clinic Liver Cancer C-stage HCC with portal vein tumour thrombosis (PVTT, 35%) and extrahepatic spread (EHS, 51.7%). After a median follow-up of 10.0 months (95% confidence interval (CI): 9.4–10.4), median OS and PFS were 15.7 (95% CI: 14.5-NE) and 6.9 months (95% CI: 6.1–8.3), respectively. In the response-evaluable patients (n = 273), overall response rate was 30.8%. Overall, 221 patients (74.6%) developed TRAEs, with 70 (23.6%) reporting grade 3 or higher TRAEs; 25 (8.4%) patients had bleeding events. OS was independently associated with baseline Albumin-bilirubin (ALBI) grade and PVTT. Shorter PFS was associated with AFP≥ 400 ng/ml, worse ALBI and presence of EHS. This global observational study confirms the reproducible safety and efficacy of atezolizumab plus bevacizumab in routine clinical practice. Within Child-Pugh-A criteria, the presence of PVTT and higher ALBI grade identify patients with poorer survival. • Atezolizumab plus bevacizumab (A + B) is the standard of care for patients with unresectable hepatocellular carcinoma. • We report data from a large cohort of patients treated with A + B in real-life. • Effectiveness and safety of the combination is reproducible in daily practice. • Liver function and macro-vascular invasion is with overall survival. • Radiological response predicts better outcomes. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of death and disability in the United States. Most strokes are ischemic, resulting in both cognitive and motor impairments. Animal models of ischemic stroke such as the distal middle cerebral artery occlusion (dMCAO) and photothrombotic stroke (PTS) procedures have become invaluable tools, with their own advantages and disadvantages. The dMCAO model is clinically relevant as it occludes the artery most affected in humans, but yields variability in the infarct location as well as the behavioral and cognitive phenotypes disrupted. The PTS model has the advantage of allowing for targeted location of infarct, but is less clinically relevant. The present study evaluates phenotype disruption over time in mice subjected to either dMCAO, PTS, or a sham surgery. Post-surgery, animals were tested over 28 days on standard motor tasks (grid walk, cylinder, tapered beam, and rotating beam), as well as a novel odor-based operant task; the 5:1 Odor Discrimination Task (ODT). Results demonstrate a significantly greater disturbance of motor control with PTS as compared with Sham and dMCAO. Disruption of the PTS group was detected up to 28 days post-stroke on the grid walk, and up to 7 days on the rotating and tapered beam tasks. PTS also led to significant short-term disruption of ODT performance (1-day post-surgery), exclusively in males, which appeared to be driven by motoric disruption of the lick response. Together, this data provides critical insights into the selection and optimization of animal models for ischemic stroke research. Notably, the PTS procedure was best suited for producing disruptions of motor behavior that can be detected with common behavioral assays and are relatively enduring, as is observed in human stroke. [ABSTRACT FROM AUTHOR]

Objective Leisure-time physical activity in the United States is lower rural areas and the South and has been linked to socioeconomic and environmental aspects of where people live. The purpose of this study is to assess the built environment and policies for physical activity in rural communities. Methods Eight rural communities in Alabama and Mississippi were assessed in 2011 using the Rural Active Living Assessment (RALA) street segment (SSA), town-wide (TWA), and town program and policies (PPA) assessment tools. Community Health Advisors Trained as Research Partners (CHARPS) and local staff conducted the assessments. The TWA and PPA were scored by domain and total scores. Data were analyzed using descriptive and nonparametric statistics. Results 117 segments were assessed in 22 towns in 8 counties. Built environmental barriers existed in all communities. Sidewalks were available in only 10-40% of the segments. TWA identified parks and playgrounds as the most available community feature. PPA scores indicated few policies for physical activity outside of school settings with mean scores higher in Mississippi compared to Alabama (61 vs. 49, respectively). Conclusions Multiple components of rural communities can be successfully assessed by CHARPs using RALA tools, providing information about resources and barriers for physical activity. [ABSTRACT FROM AUTHOR]