Arbitration Nation: While Arbitration Grows, Judicial Review of Arbitral Awards May Be Shrinking

In Sands v. Menard, Inc., the Court of Appeals of Wisconsin upheld an arbitration award reinstating a discharged attorney to her position as in-house counsel. On appeal, the court refused to vacate the reinstatement order, notwithstanding the fact that reinstatement was not requested or desired by either party, the effect of reinstatement was likely to violate the ethical rules that bind attorneys, and other remedies were available to compensate the aggrieved party. This note explores the limited but important role that judicial review plays, and will continue to play, in arbitration and how this role affected the outcome of Sands v. Menard

Cancer registry in Iran: A brief overview

Cancer registry is an important tool for any successful cancer control program. The first formal cancer related data from Iran were published in 1956. In 1969, observations documenting a high incidence of esophageal cancer in the Caspian Littoral, urged researchers to set up the first population-based cancer registry in this region. This cancer registry was established jointly by University of Tehran and the International Agency for Research on Cancer (IARC). In 1976, another cancer registry started its activities in Fars Province. In 1984, the Parliament passed a bill mandating the report of all tissues "diagnosed or suspected as cancer tissue" to the Ministry of Health. While only 18% of all estimated cancer cases were reported in first reports, this rate increased to 81% in 2005 In 1998, Tehran Population-Based Cancer Registry started to collect data from cases of cancer referred to the treatment and diagnostic facilities throughout the Tehran metropolis. Digestive Disease Research Center, Tehran University of Medical Sciences, established four new population-based cancer registries in Northern Iran and another in Kerman Province in the south. These five provinces have a total population of about 9.5 million, and constitute about 16% of the total population of Iran. While the pathology-based cancer registration is in place, we hope that the addition of the population-based cancer registries, and establishment of new registries in poorly-covered areas, will improve cancer reporting in the country

Asynchronous web-based learning, a practical method to enhance teaching in emergency medicine

Objective: To compare medical knowledge acquisition among emergency medicine (EM) residents who attend weekly core content lectures with those absent but asynchronously viewing the same lectures in a Web-based electronic platform. Subjects and Methods: During the study period all EM residents attending or absent from weekly educational conferences were given a quiz on the covered material. During Phase 1, absentees were not given supplemental educational content for missed lectures. During Phase 2, absentees were sent a link to an online multimedia module containing an audiovisual recording of the actual missed lecture with presentation slides. Scores between attendees and absentees during both phases were compared using a repeated-measures analysis to evaluate the effect of the supplemental online module on knowledge acquisition. Results:Thirty-nine EM residents (equally distributed in postgraduate years 1–4) were studied during a 15-week period. Overall and after adjusting for sex and postgraduate year level, both lecture attendance (b=27; 95% confidence interval, 22–32;p Conclusions: In an EM residency program, asynchronous Web-based learning may result in medical knowledge acquisition similar to or better than attending traditional core content lectures. The percentage of curriculum delivery by asynchronous learning that may be used to achieve overall terminal learning objectives in medical knowledge acquisition requires further study

Cancer incidence in Golestan province: Report of an ongoing population-based cancer registry in Iran between 2004 and 2008

Background: Golestan Province, at the western end of the Asian esophageal cancer (EC) belt in northeastern Iran, was reported to have one of the highest worldwide rates of EC in the 1970s. We have previously shown a declining incidence of EC in Golestan during the last decades. This study reports additional new results from the Golestan Population-based Cancer Registry (GPCR). Methods: The GPCR collected data from newly diagnosed (incident) cancer cases from all 68 public and private diagnostic and therapeutic centers in Golestan Province. CanReg-4 software was used for data entry and analysis based on the guidelines of the International Agency for Research on Cancer (IARC). Age-standardized incidence rates (ASR) of cancers were calculated using the 2000 world standard population. Results: From 2004 through 2008, 9007 new cancer cases were reported to the GPCR. The mean (SD) age was 55.5 (18.6) years, and 54 were diagnosed in men. The ASRs of all cancers were 175.3 and 141.1 per 100,000 person-years for males and females, respectively. Cancers of the stomach (ASR:30.7), esophagus (24.3), and lung (15.4) were the most common cancers in males. In females, breast cancer (ASR:26.9) was followed by malignancies of the esophagus (19.1) and stomach (12.4). The diagnosis of cancer was based on histopatho- logical reports in 71 and on death certificate only in 9 ofcases. Conclusions: The EC incidence rate continues to decline in Golestan, while the incidence rates of stomach, colorectal, and breast cancers continue to increase

Declining incidence of esophageal cancer in the Turkmen Plain, eastern part of the Caspian Littoral of Iran: A retrospective cancer surveillance

Background: Previous studies have shown that upper gastrointestinal cancers are the most common cancers in Caspian Littoral, and rate of esophageal cancer (EC) in Iranian Turkmens residing in the Eastern part of littoral are among the highest in the world. Our aim was to reassess the rate 30 years later and following socioeconomic changes in the region. Methods: A comprehensive retrospective search was undertaken to find all new cancer cases during the 1996-2000 period. Diagnosis of cancer was based on histopathological reports in 68.2, clinical and/or radiological evidence in 29.7 and death certificate only (DCO) in 2.1 of the cases. Results: A total of 5143 new cancer cases were registered of whom 3063 (59.6) were males. The median (IQR) age was 60 (44-69) years. Age-standardized rates (ASR) for all cancers in males and females were 134.7 and 104.5 per 100,000, respectively. Based on ASR, the top five common cancers in males (excluding skin cancer) were cancers of esophagus (43.4), stomach (27.8), colorectal (10.7), bladder (7.8) and oral cavity (6.3), while in females cancer of esophagus (36.3) was followed by cancers of breast (15.7), stomach (8.3) colorectal (6.6) and cervix (3.6). Conclusion: We conclude that EC incidence rate has decreased to less than half the rate reported 30 years ago, while the incidence rates of colorectal and breast cancers have increased significantly. © 2006 International Society for Preventive Oncology. Published by Elsevier Ltd. All rights reserved

The effect of the timing of umbilical cord clamping on hemoglobin levels, neonatal outcomes and developmental status in infants at 4 months old

Objective:Delayed umbilical cord clamping (DCC) increases blood transfer to newborns. Hence we investigated the effect of the timing of DCC on hemoglobin levels, neonatal outcomes and developmental status in infants at four months old.Materials & Methods:This clinical trial examined infants born to 400 pregnant women immediately upon birth and at the age of four months. The newborns were randomly assigned to either the intervention group with a 90-120-second delay in umbilical cord clamping or the control group with a clamping delay of below 60 seconds, and blood samples were taken from their umbilical cords. The Ages and Stages Questionnaire was used to evaluate the infants’ developmental status.Results:Umbilical cord hemoglobin was found to be significantly higher in the intervention group compared to in the controls (P=0/024). No significant differences were observed between the two groups in terms of neonatal complications except neonatal jaundice was significantly more common in the intervention group (P=0/025), although the need for phototherapy was not different between the groups. Overall, no significant differences were observed between the two groups in terms of developmental status at four months old; however, the infants had better problem-solving skills in the delayed umbilical cord clamping group (P=0/015).Conclusion:The results obtained show that, despite elevating hemoglobin, delayed umbilical cord clamping but has no effects on infant development except in terms of problem-solving skills. Further studies are recommended on the effects of delayed umbilical cord clamping on infant development

HIV infection is an independent risk factor for decreased 6-minute walk test distance.

BackgroundAmbulatory function predicts morbidity and mortality and may be influenced by cardiopulmonary dysfunction. Persons living with HIV (PLWH) suffer from a high prevalence of cardiac and pulmonary comorbidities that may contribute to higher risk of ambulatory dysfunction as measured by 6-minute walk test distance (6-MWD). We investigated the effect of HIV on 6-MWD.MethodsPLWH and HIV-uninfected individuals were enrolled from 2 clinical centers and completed a 6-MWD, spirometry, diffusing capacity for carbon monoxide (DLCO) and St. George's Respiratory Questionnaire (SGRQ). Results of 6-MWD were compared between PLWH and uninfected individuals after adjusting for confounders. Multivariable linear regression analysis was used to determine predictors of 6-MWD.ResultsMean 6-MWD in PLWH was 431 meters versus 462 in 130 HIV-uninfected individuals (p = 0.0001). Older age, lower forced expiratory volume (FEV1)% or lower forced vital capacity (FVC)%, and smoking were significant predictors of decreased 6-MWD in PLWH, but not HIV-uninfected individuals. Lower DLCO% and higher SGRQ were associated with lower 6-MWD in both groups. In a combined model, HIV status remained an independent predictor of decreased 6-MWD (Mean difference = -19.9 meters, p = 0.005).ConclusionsHIV infection was associated with decreased ambulatory function. Airflow limitation and impaired diffusion capacity can partially explain this effect. Subjective assessments of respiratory symptoms may identify individuals at risk for impaired physical function who may benefit from early intervention

The prevalence of hepatitis B surface antigen and anti-hepatitis B core antibody in Iran: A population-based study

Background: Hepatitis B virus infection is a very common cause of chronic liver disease worldwide. It is estimated that 3 of Iranians are chronically infected with hepatitis B virus. Current population-based studies on both rural and urban prevalence of hepatitis B virus infection in Iran are sparse with results that do not always agree. We performed this study to find the prevalence of hepatitis B surface antigen, anti-hepatitis B core antibody, and associated factors in the general population of three provinces of Iran. Methods: We randomly selected 6,583 subjects from three provinces in Iran, namely Tehran, Golestan, and Hormozgan. The subjects were aged between 18 and 65 years. Serum samples were tested for hepatitis B surface antigen and anti-hepatitis B core antibody. Various risk factors were recorded and multivariate analysis was performed. Results: The prevalence of hepatitis B surface antigen and anti-hepatitis B core antibody in Iran was 2.6 and 16.4, respectively. Predictors of hepatitis B surface antigen or anti-hepatitis B core antibody in multivariate analysis included older age, not having high-school diploma, living in a rural area, and liver disease in a family member. We did not find any significant differences between males and females. Conclusion: In spite of nationwide vaccination of newborns against hepatitis B virus since 1992, hepatitis B virus infection remains a very common cause of chronic liver disease in Iran which should be dealt with for at least the next 30-50 years

Increased MACC1 levels in tissues and blood identify colon adenoma patients at high risk

Background Colorectal cancer is a preventable disease if caught at early stages. This disease is highly aggressive and has a higher incidence in African Americans. Several biomarkers and mutations of aggressive tumor behavior have been defined such as metastasis-associated in colon cancer 1 (MACC1) that was associated with metastasis in colorectal cancer patients. Here, we aim to assess colon tissue MACC1 protein and circulating MACC1 transcripts in colon preneoplastic and neoplastic African American patients. Methods Patients’ tissue samples (n = 143) have been arranged on three tissue microarrays for normal (n = 26), adenoma (n = 68) and cancer (n = 49) samples. Immunohistochemistry was used to detect MACC1 expression. Blood samples (n = 93) from normal (n = 45), hyperplastic (n = 15) and tubular adenoma (n = 33) patients were used to assess MACC1 transcripts using qRT-PCR. Distribution of continuous variables was tested between different diagnoses with Kruskal–Wallis test. Categorical variables were tested by Chi square test. We assessed the prognostic ability of IHC staining by calculating area under receiver operating characteristics curve (ROC) for adenoma and cancer separately. Differences between groups in terms of MACC1 transcript levels in plasma were calculated by using non-parametric (exact) Wilcoxon-Mann–Whitney tests. We performed all calculations with SPSS, version 21. Results In patient tissues, there was a statistically significant difference in MACC1 expression in normal vs. adenoma samples (p = 0.004) and normal vs. cancer samples (p < 0.001). There was however no major difference in MACC1 expression between adenoma vs. cancer cases or tubular adenomas vs tubulovillous adenomas. The area under the curve for both normal vs. adenoma and normal vs. cancer cases were 70 and 67 %, respectively. MACC1 expression was not correlated to age, gender or anatomical sample location. In patient plasma, MACC1 transcripts in adenoma patients were significantly higher than in plasma from normal patients (p = 0.014). However, the difference between normal and hyperplastic plasma MACC1 transcripts was not statistically significant. Conclusion Metastasis- associated in colon cancer 1 is expressed at early stages of colorectal oncogenesis within the affected colonic tissue in this patient cohort. The plasma transcripts can be used to stratify African American patients at risk for potential malignant colonic lesions

Subanesthetic ketamine infusions for the treatment of children and adolescents with chronic pain: a longitudinal study

Background Chronic pain is common in children and adolescents and is often associated with severe functional disability and mood disorders. The pharmacological treatment of chronic pain in children and adolescents can be challenging, ineffective, and is mostly based on expert opinions and consensus. Ketamine, an N-methyl-D-aspartate receptor antagonist, has been used as an adjuvant for treatment of adult chronic pain and has been shown, in some instances, to improve pain and decrease opioid-requirement. We examined the effects of subanesthetic ketamine infusions on pain intensity and opioid use in children and adolescents with chronic pain syndromes treated in an outpatient setting. Methods Longitudinal cohort study of consecutive pediatric patients treated with subanesthetic ketamine infusions in a tertiary outpatient center. Outcome measurements included self-reported pain scores (numeric rating scale) and morphine-equivalent intake. Results Over a 15-month period, 63 children and adolescents (median age 15, interquartile range 12–17 years) with chronic pain received 277 ketamine infusions. Intravenous administration of subanesthetic doses of ketamine to children and adolescents on an outpatient basis was safe and not associated with psychotropic effects or hemodynamic perturbations. Overall, ketamine significantly reduced pain intensity (p \u3c0.001) and yielded greater pain reduction in patients with complex regional pain syndrome (CRPS) than in patients with other chronic pain syndromes (p = 0.029). Ketamine-associated reductions in pain scores were the largest in postural orthostatic tachycardia syndrome (POTS) and trauma patients and the smallest in patients with chronic headache (p = 0.007). In 37 % of infusions, patients had a greater than 20 % reduction in pain score. Conversely, ketamine infusions did not change overall morphine-equivalent intake (p = 0.3). Conclusions These data suggest that subanesthetic ketamine infusion is feasible in an outpatient setting and may benefit children and adolescents with chronic pain. Further, patients with CRPS, POTS, and