Malpractice Suits and Physician Apologies in Cancer Care

Conside the following case: The patient is a 44-year-old woman who presents for radiation treatment of an isolated locoregional recurrence of breat cancer in her chest wall, 3 years after undergoing masectomy. At the time of diagnosis, she had T2N2M0 disease, with four of 15 lymph nodes involved with tumor. She received a masectomy with negative margins and appropriate chemotherapy, but none of her physicians talked to her about postmasectomy radiation therapy, which would clearly have been indicated to reduce her risk of locoregional failure and would have been expected to improve her likelihood of survival. She asks the radiation oncologist who sees her whether this recurrence could have been prevented, and she notes that when she was diagnosed with the recurrence, a nurse asked her why she had not received radiation before. She states that she is thinking of retaining an attorney. The radiation oncologist says, Dwelling on what could have been isn\u27t productive - let\u27s just focus on how we can fight this cancer now. This case reveals some of the dilemmas oncologists face when treating patients who have suffered from substandard medical care. It also highlights some of the shortcomings of the existing tort systm, both in addressing the legitimate claims of the patient who has been harmed by negligent care and in promoting quality improvement. In this article, we survey the US medical malpractice system and assess the effectiveness of tort law at achieving its goals. We then consider how physicians and health care organizations could better assist negligently harmed patients and simultaneously reduce future mistakes. Specifically, we describe how the hypothetical case presented might have been handled if if had occurred at our own institution, which has adopted a noevl approach to promote transparency and remedy through disclosure and apology by negligent providers to injured patients. This program was designed to compensate patients swiftly and fairly when there is evidence of harm caused by unreasonable care, as well as to decrease future errors through continuous quality improvement and an open exchange with injured patients about medical mistakes

Synthesis and bioactivity of a conjugate composed of green tea catechins and hyaluronic acid

(-)-Epigallocatechin-3-gallate (EGCG) is a green tea polyphenol that has several biological activities, including anti-cancer activity and anti-inflammation. Hyaluronic acid (HA) is a naturally-occurring polysaccharide that is widely used as a biomaterial for drug delivery and tissue engineering due to its viscoelastic, biocompatible and biodegradable properties. By conjugating HA with EGCG, the resulting HA-EGCG conjugate is expected to exhibit not only the inherent properties of HA but also the bioactivities of EGCG. Toward this end, we report the synthesis of an amine-functionalized EGCG as an intermediate compound for conjugation to HA. EGCG was reacted with 2,2-diethoxyethylamine (DA) under acidic conditions, forming ethylamine-bridged EGCG dimers. The EGCG dimers were composed of four isomers, which were characterized by HPLC, high-resolution mass spectrometry and NMR spectroscopy. The amine-functionalized EGCG dimers were conjugated to hyaluronic acid (HA) through the formation of amide bonds. HA-EGCG conjugates demonstrated several bioactivities which were not present in unmodified HA, including resistance to hyaluronidase-mediated degradation, inhibition of cell growth and scavenging of radicals. The potential applications of HA-EGCG conjugates are discussed

Visible Sector Supersymmetry Breaking Revisited

We revisit the possibility of "visible sector" SUSY models: models which are straightforward renormalizable extensions of the Minimal Supersymmetric Standard Model (MSSM), where SUSY is broken at tree level. Models of this type were abandoned twenty years ago due to phenomenological problems, which we review. We then demonstrate that it is possible to construct simple phenomenologically viable visible sector SUSY models. Such models are indeed very constrained, and have some inelegant features. They also have interesting and distinctive phenomenology. Our models predict light gauginos and very heavy squarks and sleptons. The squarks and sleptons may not be observable at the LHC. The LSP is a stable very light gravitino with a significant Higgsino admixture. The NLSP is mostly Bino. The Higgs boson is naturally heavy. Proton decay is sufficently and naturally suppressed, even for a cutoff scale as low as 10^8 GeV. The lightest particle of the O'Raifeartaigh sector (the LOP) is stable, and is an interesting cold dark matter candidate.Comment: 23 pages, 3 figures, LaTe

κ−(BEDT−TTF)2X\kappa-(BEDT-TTF)_2X organic crystals: superconducting versus antiferromagnetic instabilities in an anisotropic triangular lattice Hubbard model

A Hubbard model at half-filling on an anisotropic triangular lattice has been proposed as the minimal model to describe conducting layers of $\kappa-(BEDT-TTF)_2X$ organic materials. The model interpolates between the square lattice and decoupled chains. The $\kappa-(BEDT-TTF)_2X$ materials present many similarities with cuprates, such as the presence of unconventional metallic properties and the close proximity of superconducting and antiferromagnetic phases. As in the cuprates, spin fluctuations are expected to play a crucial role in the onset of superconductivity. We perform a weak-coupling renormalization-group analysis to show that a superconducting instability occurs. Frustration in the antiferromagnetic couplings, which arises from the underlying geometrical arrangement of the lattice, breaks the perfect nesting of the square lattice at half-filling. The spin-wave instability is suppressed and a superconducting instability predominates. For the isotropic triangular lattice, there are again signs of long-range magnetic order, in agreement with studies at strong-coupling.Comment: 4 pages, 5 eps figs, to appear in Can. J. Phys. (proceedings of the Highly Frustrated Magnetism (HFM-2000) conference, Waterloo, Canada, June 2000

On the harmonic measure of stable processes

Using three hypergeometric identities, we evaluate the harmonic measure of a finite interval and of its complementary for a strictly stable real L{\'e}vy process. This gives a simple and unified proof of several results in the literature, old and recent. We also provide a full description of the corresponding Green functions. As a by-product, we compute the hitting probabilities of points and describe the non-negative harmonic functions for the stable process killed outside a finite interval

Effects of inhomogeneities on apparent cosmological observables: "fake" evolving dark energy

Using the exact Lemaitre-Bondi-Tolman solution with a non-vanishing cosmological constant $\Lambda$, we investigate how the presence of a local spherically-symmetric inhomogeneity can affect apparent cosmological observables, such as the deceleration parameter or the effective equation of state of dark energy (DE), derived from the luminosity distance under the assumption that the real space-time is exactly homogeneous and isotropic. The presence of a local underdensity is found to produce apparent phantom behavior of DE, while a locally overdense region leads to apparent quintessence behavior. We consider relatively small large scale inhomogeneities which today are not linear and could be seeded by primordial curvature perturbations compatible with CMB bounds. Our study shows how observations in an inhomogeneous $\Lambda$CDM universe with initial conditions compatible with the inflationary beginning, if interpreted under the wrong assumption of homogeneity, can lead to the wrong conclusion about the presence of "fake" evolving dark energy instead of $\Lambda$.Comment: 22 pages, 19 figures,Final version to appear in European Physical Journal

Crohn's and Colitis Foundation of America Partners Patient-Powered Research Network

Background: To build a Patient-Powered Research Networks (PPRN) that prioritizes the needs of its members who have inflammatory bowel diseases (IBD), we sought to better understand patients' preferences for what are the essential features that will facilitate and sustain engagement. Methods: We conducted a two-phase qualitative study. Seven focus groups involving 62 participants with IBD were conducted (phase 1). Focus group results informed the phase 2 cognitive interviews, which included 13 phone interviews. Topics included experiences with IBD and research, PPRN engagement, patient-generated health data, and resources/tools to facilitate self-management. All focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed in ATLAS.ti 7.5. Thematic categories were derived from the data, and codes were grouped into emergent themes and relationships. Results: Four major themes emerged through inductive coding: (1) the impact of knowing; (2) participation barriers and challenges; (3) engagement and collaboration; and (4) customizable patient portal features/functionalities. Participants were motivated to participate in the PPRN because the knowledge gained from research studies would benefit both society and the individual. Main concerns included credibility of online resources, pharmaceutical industry profiting from their data, data security, and participation expectations. Participants wanted a true and equal partnership in every phase of building a PPRN. Participants felt it was important to have access to personal health records and be able to track health status and symptoms. Conclusion: Partnering with participants throughout PPRN development was critical to understanding the needs and preferences of patients with IBDs and for shaping engagement strategies and the portal's design

Dirac gaugino as leptophilic dark matter

We investigate the leptophilic properties of Dirac gauginos in an R--symmetric N=2 supersymmetric model with extended gauge and Higgs sectors. The annihilation of Dirac gauginos to leptons requires no chirality flip in the final states so that it is not suppressed as in the Majorana case. This implies that it can be sizable enough to explain the positron excess observed by the PAMELA experiment with moderate or no boost factors. When squark masses are heavy, the annihilation of Dirac gauginos to hadrons is controlled by their Higgsino fraction and is driven by the $hZ$ and $W^+W^-$ final states. Moreover, at variance with the Majorana case, Dirac gauginos with a non-vanishing higgsino fraction can also have a vector coupling with the $Z$ gauge boson leading to a sizable spin--independent scattering cross section off nuclei. Saturating the current antiproton limit, we show that Dirac gauginos can leave a signal in direct detection experiments at the level of the sensitivity of dark matter searches at present and in the near future.Comment: 24 pages, 10 figures, typos corrected, final version published on JCA

Racial differences in user experiences and perceived value of electronic symptom monitoring in a cohort of black and white bladder and prostate cancer patients

Purpose: Electronic patient-reported outcomes (ePROs) are increasingly being used for symptom monitoring during routine cancer care, but have rarely been evaluated in diverse patient populations. We assessed ePRO user experiences and perceived value among Black and White cancer patients. Methods: We recruited 30 Black and 49 White bladder and prostate cancer patients from a single institution. Participants reported symptoms using either a web-based or automated telephone interface over 3 months and completed satisfaction surveys and qualitative interviews focused on user experiences and value. Using a narrative mixed methods approach, we evaluated overall and race-specific differences in ePRO user experiences and perceived value. Results: Most participants selected the web-based system, but Blacks were more likely to use the automated telephone-based system than Whites. In satisfaction surveys, Whites more commonly reported ease in understanding and reporting symptoms compared with Blacks. Blacks more often reported that the ePRO system was helpful in facilitating symptom-related discussions with clinicians. During interviews, Blacks described how the ePRO helped them recognize symptoms, while Whites found value in better understanding and tracking symptoms longitudinally. Blacks also expressed preferences for paper-based ePRO options due to perceived ease in better understanding of symptom items. Conclusion: Electronic patient-reported outcomes are perceived as valuable for variable reasons by Black and White cancer populations, with greater perceived value for communicating with clinicians reported among Blacks. To optimize equitable uptake of ePROs, oncology practices should offer several ePRO options (e.g., web-based, phone-based), as well as paper-based options, and consider the e-health literacy needs of patients during implementation

Direct Instantons in QCD Nucleon Sum Rules

We study the role of direct (i.e. small-scale) instantons in QCD correlation functions for the nucleon. They generate sizeable, nonperturbative corrections to the conventional operator product expansion, which improve the quality of both QCD nucleon sum rules and cure the long-standing stability problem, in particular, of the chirally odd sum-rule.Comment: 10 pages, UMD PP#93-17