Writing the risk of cancer: Cancer risk in public policy

In this paper we examine how cancer risk is written in cancer policy documents from the English speaking OECD nations. We offer an audit of the multiple ways in which cancer risk is conceptualised and presented in health policy and professional contexts with the long term aim of comparing this with lay conceptualisations. Our study sampled cancer policy documents produced by six nations, the World Health Organization and the International Union for Cancer Control since 2000 and analysed them iteratively through questions and codes. Whilst the documents contained a comprehensive range of concepts and locations for cancer risk, our analysis found two predominant representations: firstly, well established metaphors that depict cancer as uniformly dreadful and life threatening; and secondly, through a concentration on five behavioural risk factors (tobacco smoking, drinking alcohol, inadequate nutrition, sun exposure and physical inactivity) and one bodily state (overweight). We discuss the implications of this dual focus and of other tensions within ideas about cancer risk that we identified for risk communication

Differential expression of skeletal muscle genes following administration of clenbuterol to exercised horses.

BackgroundClenbuterol, a beta2-adrenergic receptor agonist, is used therapeutically to treat respiratory conditions in the horse. However, by virtue of its mechanism of action it has been suggested that clenbuterol may also have repartitioning affects in horses and as such the potential to affect performance. Clenbuterol decreases the percent fat and increases fat-free mass following high dose administration in combination with intense exercise in horses. In the current study, microarray analysis and real-time PCR were used to study the temporal effects of low and high dose chronic clenbuterol administration on differential gene expression of several skeletal muscle myosin heavy chains, genes involved in lipid metabolism and the β2-adrenergic receptor. The effect of clenbuterol administration on differential gene expression has not been previously reported in the horse, therefore the primary objective of the current study was to describe clenbuterol-induced temporal changes in gene expression following chronic oral administration of clenbuterol at both high and low doses.ResultsSteady state clenbuterol concentrations were achieved at approximately 50 h post administration of the first dose for the low dose regimen and at approximately 18-19 days (10 days post administration of 3.2 μg/kg) for the escalating dosing regimen. Following chronic administration of the low dose (0.8 μg/kg BID) of clenbuterol, a total of 114 genes were differentially expressed, however, none of these changes were found to be significant following FDR adjustment of the p-values. A total of 7,093 genes were differentially expressed with 3,623 genes up regulated and 3,470 genes down regulated following chronic high dose administration. Of the genes selected for further study by real-time PCR, down-regulation of genes encoding myosin heavy chains 2 and 7, steroyl CoA desaturase and the β2-adrenergic receptor were noted. For most genes, expression levels returned towards baseline levels following cessation of drug administration.ConclusionThis study showed no evidence of modified gene expression following chronic low dose administration of clenbuterol to horses. However, following chronic administration of high doses of clenbuterol alterations were noted in transcripts encoding various myosin heavy chains, lipid metabolizing enzymes and the β2-adrenergic receptor

Multi-Disciplinary Experts Supporting Graduate Medical Education through Participation in COMPLETE Chart Rounds

Learning Objective: As a result of this presentation, attendees will learn skills that they can use to implement collaborative graduate medical education learning experiences using a community of multi-disciplinary professionals within their own institutions. Background: Inter-professional Chart Rounds were implemented to provide residents an opportunity to review and present patient cases utilizing “COMPLETE” guidelines developed by residency leadership as the result of a “Regional Medicine – Public Health Education Centers” grant. COMPLETE guidelines explicitly direct residents to include consideration of: - Context – Culture of context – who is the patient? - Outside Visitors/Resources – incorporate visitors/experts such as librarians, pharmacists and psychologists and utilize their resources - Mental Health – assess behavioral health aspects of the case - Population Perspective – address prevalence of the condition in the community - Learn From Others – consider specialists, home care, and complementary therapies - Expectations – clear goals set between physician and patient - Time – Start on time, end on time. Respect everyone’s time. - End with “Culture of Continuity” – what are the key lessons? Is there a follow-up plan? Through the attendance of librarians, psychologists, pharmacologists, medical students and other faculty, discussion ensues which leads to continued resident education and support. Methods: Chart Rounds are held daily at each residency practice site. Residents are required to attend along with medical and pharmacy students rotating at the centers. The preceptor leads Chart Rounds and other faculty physicians join as they are able. Residents present cases while maintaining patient confidentiality. The preceptor leads the group discussion of the case. Faculty members discuss clinical and administrative implications, the psychologist addresses potential behavioral aspects of the case, the librarian searches for Evidence-Based information to support decisions and the pharmacologist advises on medication management. The group also discusses how individual patient care reflects the public health needs and profile of the community. Residents (n=32) were invited to complete a survey asking them to evaluate their experience with multi-disciplinary COMPLETE Chart Rounds. Results: Survey results as well as observational analysis will be used to improve the resident’s experience at Chart Rounds with the goal of making this experience an even more rewarding collaborative educational experience. Some sample findings include: - 66% of residents report satisfaction of Chart Rounds challenging the academic aspects of their work - 100% of residents in the early portion of their program report that Chart Rounds assists them in building collaborative relationships with faculty and other providers/experts - Residents report the greatest satisfaction (92% overall) with pharmacist participation in Chart Rounds across all Post Graduate Years - Satisfaction with librarian participation increases through each year (from only 10% in PGY1 to over 60% in PGY3) , possibly due to limited exposure early in the program Although these guidelines were developed for use in a Family Medicine Graduate Medical Education program and fit well into this practice model, the findings can be utilized in other resident training programs. Presented at the Patients and Populations: Public Health in Medical Education conference sponsored by the Association of American Medical Colleges (AAMC) and the Centers for Disease Control and Prevention (CDC), held September 14-15, 2010, in Cleveland, OH

word~river literary review (2009)

wordriver is a literary journal dedicated to the poetry, short fiction and creative nonfiction of adjuncts and part-time instructors teaching in our universities, colleges, and community colleges. Our premier issue was published in Spring 2009. We are always looking for work that demonstrates the creativity and craft of adjunct/part-time instructors in English and other disciplines. We reserve first publication rights and onetime anthology publication rights for all work published. We define adjunct instructors as anyone teaching part-time or full-time under a semester or yearly contract, nationwide and in any discipline. Graduate students teaching under part-time contracts during the summer or who have used up their teaching assistant time and are teaching with adjunct contracts for the remainder of their graduate program also are eligible.https://digitalscholarship.unlv.edu/word_river/1002/thumbnail.jp

Border Insecurity: Reading Transnational Environments in Jim Lynch’s Border Songs

This article applies an eco-critical approach to contemporary American fiction about the Canada-US border, examining Jim Lynch’s portrayal of the British Columbia-Washington borderlands in his 2009 novel Border Songs. It argues that studying transnational environmental actors in border texts—in this case, marijuana, human migrants, and migratory birds—helps illuminate the contingency of political boundaries, problems of scale, and discourses of risk and security in cross-border regions after 9/11. Further, it suggests that widening the analysis of trans-border activity to include environmental phenomena productively troubles concepts of nature and regional belonging in an era of climate change and economic globalization. Cet article propose une lecture écocritique de la fiction étatsunienne contemporaine portant sur la frontière entre le Canada et les États-Unis, en étudiant le portrait donné par Jim Lynch de la région frontalière entre la Colombie-Britannique et Washington dans son roman Border Songs, paru en 2009. L’article soutient que l’étude, dans les textes sur la frontière, des acteurs environnementaux transnationaux – dans ce cas-ci, la marijuana, les migrants humains et les oiseaux migratoires – jette un jour nouveau sur la contingence des limites territoriales politiques, des problèmes d’échelle et des discours sur le risque et la sécurité des régions transfrontalières après les évènements du 11 septembre 2001. Il suggère également qu’en élargissant l’analyse de l’activité transfrontalière pour y inclure les phénomènes environnementaux, on brouille de façon productive les concepts de nature et d’appartenance régionale d’une époque marquée par les changements climatiques et la mondialisation de l’économie

Drivers of reef shark abundance and biomass in the Solomon Islands

Remote island nations face a number of challenges in addressing concerns about shark population status, including access to rigorously collected data and resources to manage fisheries. At present, very little data are available on shark populations in the Solomon Islands and scientific surveys to document shark and ray diversity and distribution have not been completed. We aimed to provide a baseline of the relative abundance and diversity of reef sharks and rays and assess the major drivers of reef shark abundance/biomass in the Western Province of the Solomon Islands using stereo baited remote underwater video. On average reef sharks were more abundant than in surrounding countries such as Fiji and Indonesia, yet below that of remote islands without historical fishing pressure, suggesting populations are relatively healthy but not pristine. We also assessed the influence of location, habitat type/complexity, depth and prey biomass on reef shark abundance and biomass. Location was the most important factor driving reef shark abundance and biomass with two times the abundance and a 43% greater biomass of reef sharks in the more remote locations, suggesting fishing may be impacting sharks in some areas. Our results give a much needed baseline and suggest that reef shark populations are still relatively unexploited, providing an opportunity for improved management of sharks and rays in the Solomon Islands

Patient-centered interventions to improve medication management and adherence: A qualitative review of research findings

Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior

Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine

Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine

Crop pests and predators exhibit inconsistent responses to surrounding landscape composition

The idea that noncrop habitat enhances pest control and represents a win–win opportunity to conserve biodiversity and bolster yields has emerged as an agroecological paradigm. However, while noncrop habitat in landscapes surrounding farms sometimes benefits pest predators, natural enemy responses remain heterogeneous across studies and effects on pests are inconclusive. The observed heterogeneity in species responses to noncrop habitat may be biological in origin or could result from variation in how habitat and biocontrol are measured. Here, we use a pest-control database encompassing 132 studies and 6,759 sites worldwide to model natural enemy and pest abundances, predation rates, and crop damage as a function of landscape composition. Our results showed that although landscape composition explained significant variation within studies, pest and enemy abundances, predation rates, crop damage, and yields each exhibited different responses across studies, sometimes increasing and sometimes decreasing in landscapes with more noncrop habitat but overall showing no consistent trend. Thus, models that used landscape-composition variables to predict pest-control dynamics demonstrated little potential to explain variation across studies, though prediction did improve when comparing studies with similar crop and landscape features. Overall, our work shows that surrounding noncrop habitat does not consistently improve pest management, meaning habitat conservation may bolster production in some systems and depress yields in others. Future efforts to develop tools that inform farmers when habitat conservation truly represents a win–win would benefit from increased understanding of how landscape effects are modulated by local farm management and the biology of pests and their enemies