Are Patents Impeding Medical Care and Innovation?

This month's debate examines whether the current patent system is crucial for stimulating health research or whether it is stifling biomedical research and impeding medical care. Background to the debate: Pharmaceutical and medical device manufacturers argue that the current patent system is crucial for stimulating research and development (R&D), leading to new products that improve medical care. The financial return on their investments that is afforded by patent protection, they claim, is an incentive toward innovation and reinvestment into further R&D. But this view has been challenged in recent years. Many commentators argue that patents are stifling biomedical research, for example by preventing researchers from accessing patented materials or methods they need for their studies. Patents have also been blamed for impeding medical care by raising prices of essential medicines, such as antiretroviral drugs, in poor countries. This debate examines whether and how patents are impeding health care and innovation

Impaired contextual modulation of memories in PTSD: an fMRI and psychophysiological study of extinction retention and fear renewal

Post-traumatic stress disorder (PTSD) patients display pervasive fear memories, expressed indiscriminately. Proposed mechanisms include enhanced fear learning and impaired extinction or extinction recall. Documented extinction recall deficits and failure to use safety signals could result from general failure to use contextual information, a hippocampus-dependent process. This can be probed by adding a renewal phase to standard conditioning and extinction paradigms. Human subjects with PTSD and combat controls were conditioned (skin conductance response), extinguished, and tested for extinction retention and renewal in a scanner (fMRI). Fear conditioning (light paired with shock) occurred in one context, followed by extinction in another, to create danger and safety contexts. The next day, the extinguished conditioned stimulus (CS+E) was re-presented to assess extinction recall (safety context) and fear renewal (danger context). PTSD patients showed impaired extinction recall, with increased skin conductance and heightened amygdala activity to the extinguished CS+ in the safety context. However, they also showed impaired fear renewal; in the danger context, they had less skin conductance response to CS+E and lower activity in amygdala and ventral-medial prefrontal cortex compared with combat controls. Control subjects displayed appropriate contextual modulation of memory recall, with extinction (safety) memory prevailing in the safety context, and fear memory prevailing in the danger context. PTSD patients could not use safety context to sustain suppression of extinguished fear memory, but they also less effectively used danger context to enhance fear. They did not display globally enhanced fear expression, but rather showed a globally diminished capacity to use contextual information to modulate fear expression

Telemedicine and Primary Care Obesity Management in Rural Areas– Innovative Approach for Older Adults?

Background: The growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity. Discussion: We describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models. Conclusions: Recommendations to extend the benefit’s coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity

Right ventricular dysfunction after resuscitation predicts poor outcomes in cardiac arrest patients independent of left ventricular function.

OBJECTIVE: Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction. METHODS: A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012. PATIENTS: 291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous circulation (ROSC) and post-arrest echocardiograms. MEASUREMENTS AND MAIN RESULTS: Of the 291 patients, 57% were male, with a mean age of 59 ± 16 years. 179 (63%) patients had LV dysfunction, 173 (59%) had RV dysfunction, and 124 (44%) had biventricular dysfunction on the initial post-arrest echocardiogram. Independent of LV function, RV dysfunction was predictive of worse survival (mild or moderate: OR 0.51, CI 0.26-0.99, p CONCLUSIONS: Echocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in post-arrest patients after accounting for LV dysfunction. Post-arrest RV dysfunction may be useful for risk stratification and management in this high-mortality population

Response of winter climate and extreme weather to projected Arctic sea-ice loss in very large-ensemble climate model simulations

Very large (~2000 members) initial-condition ensemble simulations have been performed to advance understanding of mean climate and extreme weather responses to projected Arctic sea-ice loss under 2 °C global warming above preindustrial levels. These simulations better sample internal atmospheric variability and extremes for each model compared to those from the Polar Amplification Model Intercomparison Project (PAMIP). The mean climate response is mostly consistent with that from the PAMIP multi-model ensemble, including tropospheric warming, reduced midlatitude westerlies and storm track activity, an equatorward shift of the eddy-driven jet and increased mid-to-high latitude blocking. Two resolutions of the same model exhibit significant differences in the stratospheric circulation response; however, these differences only weakly modulate the tropospheric response. The response of temperature and precipitation extremes largely follows the seasonal-mean response. Sub-sampling confirms that large ensembles (e.g. ≥400) are needed to robustly estimate the seasonal-mean large-scale circulation response, and very large ensembles (e.g. ≥1000) for regional climate and extremes

Radiocarbon Date List X: Baffin Bay, Baffin Island, Iceland, Labrador Sea, and the Northern North Atlantic

Date List X contains an annotated listing of 213 radiocarbon dates determined on samples from marine and terrestrial environments. The marine samples were collected from the East Greenland, Iceland, Spitzbergen, and Norwegian margins, Baffin Bay, and Labrador Sea. The terrestrial samples were collected from Vestfirdir, Iceland and Baffin Island. The samples were submitted by INSTAAR and researchers affiliated with INSTAAR\u27s Micropaleontology Laboratory under the direction of Dr.’s John T. Andrews and Anne E. Jennings. All of the dates from marine sediment cores were determined from either shells or foraminifera (both benthic and planktic). All dates were obtained by the Accelerator Mass Spectrometry (AMS) method. Regions of concentrated marine research include: Baffin Bay, Baffin Island, Labrador Sea, East Greenland fjords, shelf and slope, Denmark Strait, the southwestern and northwestern Iceland shelves, and Vestfirdir, Iceland. The non-marine radiocarbon dates are from peat, wood, plant microfossils, and mollusc. The radiocarbon dates have been used to address a variety of research objectives such as: 1. determining the timing of northern hemisphere high latitude environmental changes including glacier advance and retreat, and 2. assessing the accuracy of a fluctuating reservoir correction. Thus, most of the dates constrain the timing, rate, and interaction of late Quaternary paleoenvironmental fluctuations in sea level, glacier extent, sediment input, and changes in ocean circulation patterns. Where significant, stratigraphic and sample contexts are presented for each core to document the basis for interpretations