Conflicts of Interest in Clinical Practice Guidelines

Clinical practice guidelines are used increasingly across medical specialties and settings, making evaluation of their utility and validity a critical public health issue. In this paper, we describe some of the challenges that specialty organizations face as they try to ensure that their guidelines are trustworthy and useful. We examine the practice guidelines for Major Depressive Disorder recently published by the American Psychiatric Association (APA), identify five sources of potential bias that may affect the guideline development process and offer suggestions based on our review. For example, even for mild depression, this guideline privileges pharmacotherapy over other interventions, despite questions about the risk/benefit ratio and the increasing concern over the iatrogenic harms of SSRIs and SNRIs. We compare recommendations from international scientific groups (e.g. NICE) with those produced by specialty societies in an effort to demonstrate some of the ways in which conflicts of interest, both intellectual and financial, may unduly influence guidelines

Theory Building as Integrated Reflection: Understanding Physician Reflection Through Human Communication Research, Medical Education, and Ethics

Grounded in a presupposition that a single explanatory framework cannot fully account for the expansive learning processes that occur during medical residency, the article examines developing physicians’ reflective writing from three disciplinary lenses. The goal is to understand how the multi-dimensional nature of medical residency translates into assembling educational experiences and constructing meaning that cannot be fully explained through a single discipline. An interdisciplinary research team across medical education, communication, and ethics qualitatively analyzed reflective entries (N=756) completed by family medicine residents (N=33) across an academic year. Results provide evidence for moving toward an integrated thematic explanation across disciplines. The authors suggest that the integration of disciplinary explanations allows for comprehensive understanding of reflection as a cornerstone in the broader formation of the physician. Examples provide evidence for an integrated understanding of a fuller human experience by considering the three thematic explanations as co-occurring, reciprocal processes

The American Psychiatric Association’s Guideline for Major Depressive Disorder: A Commentary

The American Psychiatric Association (APA) published a new guideline for Major Depressive Disorder (MDD) which will undoubtedly be used by many practitioners to guide clinical decision-making. In fact, it is non-psychiatrist clinicians who prescribe the majority of antidepressants (AD). We review the APA’s most recent guideline on MDD and report on our observations

Scientific Objectives of Einstein Telescope

The advanced interferometer network will herald a new era in observational astronomy. There is a very strong science case to go beyond the advanced detector network and build detectors that operate in a frequency range from 1 Hz-10 kHz, with sensitivity a factor ten better in amplitude. Such detectors will be able to probe a range of topics in nuclear physics, astronomy, cosmology and fundamental physics, providing insights into many unsolved problems in these areas.Comment: 18 pages, 4 figures, Plenary talk given at Amaldi Meeting, July 201

The Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort study: Assessment of environmental exposures

The Canadian Healthy Infant Longitudinal Development birth cohort was designed to elucidate interactions between environment and genetics underlying development of asthma and allergy. Over 3600 pregnant mothers were recruited from the general population in four provinces with diverse environments. The child is followed to age 5 years, with prospective characterization of diverse exposures during this critical period. Key exposure domains include indoor and outdoor air pollutants, inhalation, ingestion and dermal uptake of chemicals, mold, dampness, biological allergens, pets and pests, housing structure, and living behavior, together with infections, nutrition, psychosocial environment, and medications. Assessments of early life exposures are focused on those linked to inflammatory responses driven by the acquired and innate immune systems. Mothers complete extensive environmental questionnaires including time-activity behavior at recruitment and when the child is 3, 6, 12, 24, 30, 36, 48, and 60 months old. House dust collected during a thorough home assessment at 3–4 months, and biological specimens obtained for multiple exposure-related measurements, are archived for analyses. Geo-locations of homes and daycares and land-use regression for estimating traffic-related air pollution complement time-activity-behavior data to provide comprehensive individual exposure profiles. Several analytical frameworks are proposed to address the many interacting exposure variables and potential issues of co-linearity in this complex data set

Educational interventions to improve handover in health care: an updated systematic review

Effective handovers (handoffs) are vital to patient safety. Educational interventions to improve handovers were previously investigated through a systematic review in 2010.1 The number of publications on handover education has increased substantially in recent years, so an update review was undertaken. Studies involving educational interventions to improve handover amongst undergraduate or postgraduate health professionals in acute care settings were considered. A standardized search of online databases was carried out independently by two authors and consensus reached. Data extraction and quality assessment were also completed independently, after which a content analysis of interventions was conducted and key themes extracted. Eighteen studies met the inclusion criteria, with all but two based in the US. Interventions most commonly used single-patient exercises based on simulation and role-play. Many discussed multi-professional working, but were largely taught in single professional contexts. Analysis of interventions revealed themes in three major areas: facilitating information management, reducing the potential for errors and improving confidence in participating in handovers. The majority of studies assessed Kirkpatrick’s outcomes of knowledge and skill improvement. The strength of conclusions was generally weak. Despite increased interest and publications on handover, the quality of published research remains poor. Inadequate reporting of interventions, especially as it relates to educational theory, pedagogy, curricula, and resource requirements, continues to impede replication. Weaknesses in quality of study, length of follow up and scope of impact evaluation persist. Future work is vital to address these issues, and to consider the role of multi-professional and multi-patient handovers

Nothing Lasts Forever: Environmental Discourses on the Collapse of Past Societies

The study of the collapse of past societies raises many questions for the theory and practice of archaeology. Interest in collapse extends as well into the natural sciences and environmental and sustainability policy. Despite a range of approaches to collapse, the predominant paradigm is environmental collapse, which I argue obscures recognition of the dynamic role of social processes that lie at the heart of human communities. These environmental discourses, together with confusion over terminology and the concepts of collapse, have created widespread aporia about collapse and resulted in the creation of mixed messages about complex historical and social processes

Fundulus as the premier teleost model in environmental biology : opportunities for new insights using genomics

Author Posting. © Elsevier B.V., 2007. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Comparative Biochemistry and Physiology Part D: Genomics and Proteomics 2 (2007): 257-286, doi:10.1016/j.cbd.2007.09.001.A strong foundation of basic and applied research documents that the estuarine fish Fundulus heteroclitus and related species are unique laboratory and field models for understanding how individuals and populations interact with their environment. In this paper we summarize an extensive body of work examining the adaptive responses of Fundulus species to environmental conditions, and describe how this research has contributed importantly to our understanding of physiology, gene regulation, toxicology, and ecological and evolutionary genetics of teleosts and other vertebrates. These explorations have reached a critical juncture at which advancement is hindered by the lack of genomic resources for these species. We suggest that a more complete genomics toolbox for F. heteroclitus and related species will permit researchers to exploit the power of this model organism to rapidly advance our understanding of fundamental biological and pathological mechanisms among vertebrates, as well as ecological strategies and evolutionary processes common to all living organisms.This material is based on work supported by grants from the National Science Foundation DBI-0420504 (LJB), OCE 0308777 (DLC, RNW, BBR), BES-0553523 (AW), IBN 0236494 (BBR), IOB-0519579 (DHE), IOB-0543860 (DWT), FSML-0533189 (SC); National Institute of Health NIEHS P42-ES007381(GVC, MEH), P42-ES10356 (RTD), ES011588 (MFO); and NCRR P20 RR-016463 (DWT); Natural Sciences and Engineering Research Council of Canada Discovery (DLM, TDS, WSM) and Collaborative Research and Development Programs (DLM); NOAA/National Sea Grant NA86RG0052 (LJB), NA16RG2273 (SIK, MEH,GVC, JJS); Environmental Protection Agency U91620701 (WSB), R82902201(SC) and EPA’s Office of Research and Development (DEN)

Love Island and Relationship Education

The rise of reality TV programmes focusing on relationships and the search for “love” has focused media attention on the portrayal of healthy relationships, gender rolesand intimate partner abuse (IPVA). Love Island, a UK reality TV programme, was watched in 2019 by over 3 million viewers, a majority of whom are young women aged 16–34, though a younger teenage demographic also watch. Many of these younger viewers may be learning about what healthy relationships are like, and entering their first romantic relationships. Contestant’s behavior on Love Island prompted Women’s Aid to issue a statement speaking out against unhealthy behaviors in relationships—especially“gaslighting,” a form of emotional abuse that makes someone question their own feelings, memories and version of reality. Based on our experience of running a relationship education program in 24 schools, as part of the Tender national partnership and our research with young people on their perceptions of Love Island, the paper will examine the role reality TV programmes; play in young people’s understandings of healthy relationships. It argues representations of relationships on Love Island are framed within normative heterosexuality and the normalization of emotional abuse. However, we also argue that these programmes can be a catalyst for discussion amongst young people and open up spaces, especially online, to challenge dominant constructions of relationships. It also makes recommendations for education policy and practice around relationship and sex education in schools