Schwannoma of the cervical vagus nerve: A rare benign neurogenic tumor

A schwannoma, also known as an acoustic neuroma, is a benign nerve sheath tumor composed of schwann cells, which normally produce the insulating myelin sheath covering the peripheral nerves. Schwannoma, originating from the cervical vagus nerve, is an extremely rare neoplasm that usually occurs in men between the 3rd and 6th decades of life. The most common presentation is a painless, slow-growing, lateral neck mass;this appears in a large proportion of cases. Complete surgical resection with care to protect the nerve of origin is the recommended treatment of choice. Here, we report a case of cervical vagal schwannoma in a 55-year-old male who admitted with the complaint of a firm and painless mass lesion on the right side of the neck. The management of the case is discussed along with the relevant literature.Keywords: Neurilemmoma; Neoplasms; Vagus nerve; Treatment

Evaluating Patient Preferences of Maintenance Therapy for the Treatment of Chronic Obstructive Pulmonary Disease: A Discrete Choice Experiment in the UK, USA and Germany.

Introduction: With increasing availability of different treatments for chronic obstructive pulmonary disease (COPD), we sought to understand patient preferences for COPD treatment in the UK, USA, and Germany using a discrete choice experiment (DCE). Methods: Qualitative research identified six attributes associated with COPD maintenance treatments: ease of inhaler use, exacerbation frequency, frequency of inhaler use, number of different inhalers used, side effect frequency, and out-of-pocket costs. A DCE using these attributes, with three levels each, was designed and tested through cognitive interviews and piloting. It comprised 18 choice sets, selected using a D-efficient experimental design. Demographics and disease history were collected and the final DCE survey was completed online by participants recruited from panels in the UK, USA and Germany. Responses were analyzed using mixed logit models, with results expressed as odds ratios (ORs). Results: Overall, 450 participants (150 per country) completed the DCE; most (UK and Germany, 97.3%; USA, 98.0%) were included in the final analysis. Based on relative attribute importance, avoidance of side effects was found to be most important (UK: OR 11.65; USA: OR 7.17; Germany: OR 11.45; all p<0.0001), followed by the likelihood of fewer exacerbations (UK: OR 2.22; USA: OR 1.63; Germany: OR 2.54; all p<0.0001) and increased ease of use (UK: OR 1.84; USA: OR 1.84; Germany: OR 1.60; all p<0.0001). Number of inhalers, out-of-pocket costs, and frequency of inhaler use were found to be less important. Preferences were relatively consistent across the three countries. All participants required a reduction in exacerbations to accept more frequent inhaler use or use of more inhalers. Conclusion: When selecting COPD treatment, individuals assigned the highest value to the avoidance of side effects, experiencing fewer exacerbations, and ease of inhaler use. Ensuring that patients' preferences are considered may encourage treatment compliance

A cross-cultural comparison of responses to true accusations and the role of honor values

In honor cultures (e.g., Turkey, Southern US), self-worth depends on one’s own perception and on other people’s opinions about oneself, and reputation is very important. In dignity cultures (Northern US, Western Europe), self-worth mainly depends on the individual and cannot be taken away by others. In this work, I investigated how people from an honor culture, Turkey, and from a dignity culture, northern US, emotionally and behaviorally responded to two types of conflict: A true accusation of a transgression and negative performance feedback. Honor has three facets common to these two cultures: Social respect (being respectable in society), moral behavior (being honest), and self-respect (feeling proud of oneself). I proposed that true accusations of a transgression would be a complete honor threat because they threatened all three facets, whereas private negative performance feedback would only be a self-respect threat. I conducted an online survey (Experiment 1) and a laboratory study (Experiment 2) to compare the two cultures. In Experiment 1, participants read conflict scenarios and imagined themselves as the target of the scenario. They indicated how they would feel and behaviorally respond to the conflict source (e.g., the accuser). In Experiment 2, participants were actually accused by an experimenter for cheating on a task or received negative performance feedback. Their emotional and behavioral responses were measured with multiple methods. Results revealed that for people from Turkey (an honor culture), being rightfully accused of a transgression was more humiliating and anger-provoking than receiving poor performance feedback. Moreover, Turkish people became more defensive in response to rightful accusations compared to negative performance feedback. I also found that northern Americans (a dignity culture), perceived rightful accusations and negative performance feedback similarly humiliating and anger-provoking, and they became similarly defensive in response to these two threats. These results are in line with the importance and centrality of reputation and social respect in honor cultures and the emphasis on achievements and positive self-esteem in individualistic dignity cultures. The findings of this work may have implications for many contexts such as politics, work relations, and romantic relationships

Need for approval from others and face concerns as predictors of interpersonal conflict outcome in 29 cultural groups

The extent to which culture moderates the effects of need for approval from others on a person\u27s handling of interpersonal conflict was investigated. Students from 24 nations rated how they handled a recent interpersonal conflict, using measures derived from face-negotiation theory. Samples varied in the extent to which they were perceived as characterised by the cultural logics of dignity, honour, or face. It was hypothesised that the emphasis on harmony within face cultures would reduce the relevance of need for approval from others to face-negotiation concerns. Respondents rated their need for approval from others and how much they sought to preserve their own face and the face of the other party during the conflict. Need for approval was associated with concerns for both self-face and other-face. However, as predicted, the association between need for approval from others and concern for self-face was weaker where face logic was prevalent. Favourable conflict outcome was positively related to other-face and negatively related to self-face and to need for approval from others, but there were no significant interactions related to prevailing cultural logics. The results illustrate how particular face-threatening factors can moderate the distinctive face-concerns earlier found to characterise individualistic and collectivistic cultural groups

A price to pay: Turkish and American retaliation for threats to personal and family honor

Two studies investigated retaliatory responses to actual honor threats among members of an honor culture (Turkey) and a dignity culture (northern U.S.). The honor threat in these studies was based on previous research which has shown that honesty is a key element of the conception of honor and that accusations of dishonesty are threatening to one’s honor. In both studies, participants wrote an essay describing the role of honesty in their lives and received feedback on their essay accusing them of being dishonest (vs. neutral feedback). Turkish participants retaliated more strongly than did northern U.S. participants against the person who challenged their honesty by assigning him/her to solve more difficult tangrams over easy ones (Study 1) and by choosing sensory tasks of a higher level of intensity to complete (Study 2). Study 2 added a relational honor condition, in which participants wrote about honesty in their parents’ lives and examined the role of individual differences in honor values in retaliation. Endorsement of honor values predicted retaliation among Turkish participants in both the personal and relational honor conditions, but not among northern U.S. participants

Modelling the overdiagnosis of breast cancer due to mammography screening in women aged 40 to 49 in the United Kingdom

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited

Overdiagnosis in breast imaging

The main harm of overdiagnosis is overtreatment. However a form of overdiagnosis also occurs when foci of cancer are found by imaging in addition to the symptomatic lesion when this leads to additional treatment which does not benefit the patient. Even if overtreatment is avoided, knowledge of the diagnosis can still cause psychological harm. Overdiagnosis is an inevitable effect of mammographic screening as the benefit comes from diagnosing breast cancer prior to clinical detectability. Estimates of the rate of overdiagnosis at screening are around 10%. DCIS represents 20% of cancers detected by screening and is the main focus in the overdiagnosis debate. Detection and treatment of low grade DCIS and invasive tubular cancer would appear to represent overdiagnosis in most cases. Supplementary screening with tomosynthesis or US are both likely to increase overdiagnosis as both modalities detect predominantly low grade invasive cancers. MRI causes overdiagnosis because it is so sensitive that it detects real tumour foci which after radiotherapy and systemic therapy do not, in many cases go on and cause local recurrence if the women had had no MRI and undergone breast conservation and adjuvant therapy with these small foci left in situ.</p

Cultures of honor

Cultures of honor developed in contexts in which a person’s livelihood was easily stolen (such as a herd of animals) and the rule of law was weak. In such contexts, men were required to develop a reputation for toughness and willingness to retaliate quickly and aggressively when threatened, so that others would not consider stealing their property. Consequently, cultures of honor have developed ideologies, norms, and practices that reinforce the importance of maintaining social respect through aggressive means if necessary. In this chapter, we first briefly review the initial work by anthropologists, sociologists and historians that described cultures of honor in the Mediterranean region and southern US states. This early work formed the foundation of research by Nisbett, Cohen, and their colleagues, who carefully articulated a psychological theory of how concerns for honor may explain higher rates of aggression and violence in southern US states compared to northern states. We then summarize research on components of honor, behavioral and psychological consequences of honor, and socialization practices that maintain cultures of honor. We finish by discussing possible future directions and methodological considerations in research on cultures of honor. This research has extended the scope of cultural psychology by going beyond the more common east-west comparisons; it has the potential to help explain behavior of groups that have not been widely studied by social psychologists

The role of culture in appraisals, emotions, and helplessness in response to threats

In honour cultures such as Turkey, reputation management is emphasized, whereas in dignity cultures such as northern US, self-respect and personal achievements are central. Turkey is also a collectivistic culture, where relationship harmony is as important as reputation management. When Turkish people’s reputation is threatened, they may experience an internal conflict between these two motives and display helplessness. In this study, we predicted and found that Turkish participants anticipated stronger anger, shame, and helplessness in response to reputation threat than self-respect threat situations, whereas these differences were non-existent or smaller in northern US. Moreover, shame was a mediator between appraisal and helplessness for reputation threats in Turkey (shame positively predicted helplessness), whereas anger was a mediator between appraisal and helplessness for self-respect threats in northern US (anger negatively predicted helplessness). These results are novel in their inclusion of helplessness and appraisal theory of emotions when examining honour and dignity cultures

Long-term cost and utility consequences of short-term clinically important deterioration in patients with chronic obstructive pulmonary disease: results from the TORCH study.

Purpose: Clinically important deterioration (CID) in chronic obstructive pulmonary disease (COPD) is a novel composite endpoint that assesses disease stability. The association between short-term CID and future economic and quality of life (QoL) outcomes has not been previously assessed. This analysis considers 3-year data from the TOwards a Revolution in COPD Health (TORCH) study, to examine this question. Patients and methods: This post hoc analysis of TORCH (NCT00268216) compared costs and utilities at 3 years among patients without CID (CID-) and with CID (CID+) at 24 weeks. A positive CID status was defined as either: a deterioration in forced expiratory volume in 1 second (FEV1) of ≥100 mL from baseline; or a ≥4-unit increase from baseline in St George's Respiratory Questionnaire (SGRQ) total score; or the incidence of a moderate/severe exacerbation. Patients from all treatment arms were included. Utility change was based on the EQ-5D utility index. Costs were based on healthcare resource utilization from 24 weeks to end of follow-up combined with unit costs for the UK (2016 GBP), and reported as per patient per year (PPPY). Adjusted estimates were generated controlling for baseline characteristics, treatment assignment, and number of CID criteria met. Results: Overall, 3,769 patients completed the study and were included in the analysis (stable CID- patients, n=1,832; unstable CID+ patients, n=1,937). At the end of follow-up, CID- patients had higher mean (95% confidence interval [CI]) utility scores than CID+ patients (0.752 [0.738, 0.765] vs 0.697 [0.685, 0.71]; difference +0.054; P<0.001), and lower costs PPPY (£538 vs £916; difference: £378 [95% CI: £244, £521]; P<0.001). The cost differential was primarily driven by the difference in general hospital ward days (P=0.003). Conclusion: This study demonstrated that achieving early stability in COPD by preventing short-term CID is associated with better preservation of future QoL alongside reduced healthcare service costs