Community policing in Providence: combating crime and fear

Now in his second year, the new Chief of Police in Providence, Rhode Island, discusses his community policing philosophy and how it is helping to reduce crime in the city.Crime prevention - Rhode Island

The WISDOM Study: breaking the deadlock in the breast cancer screening debate.

There are few medical issues that have generated as much controversy as screening for breast cancer. In science, controversy often stimulates innovation; however, the intensely divisive debate over mammographic screening has had the opposite effect and has stifled progress. The same two questions-whether it is better to screen annually or bi-annually, and whether women are best served by beginning screening at 40 or some later age-have been debated for 20 years, based on data generated three to four decades ago. The controversy has continued largely because our current approach to screening assumes all women have the same risk for the same type of breast cancer. In fact, we now know that cancers vary tremendously in terms of timing of onset, rate of growth, and probability of metastasis. In an era of personalized medicine, we have the opportunity to investigate tailored screening based on a woman's specific risk for a specific tumor type, generating new data that can inform best practices rather than to continue the rancorous debate. It is time to move from debate to wisdom by asking new questions and generating new knowledge. The WISDOM Study (Women Informed to Screen Depending On Measures of risk) is a pragmatic, adaptive, randomized clinical trial comparing a comprehensive risk-based, or personalized approach to traditional annual breast cancer screening. The multicenter trial will enroll 100,000 women, powered for a primary endpoint of non-inferiority with respect to the number of late stage cancers detected. The trial will determine whether screening based on personalized risk is as safe, less morbid, preferred by women, will facilitate prevention for those most likely to benefit, and adapt as we learn who is at risk for what kind of cancer. Funded by the Patient Centered Outcomes Research Institute, WISDOM is the product of a multi-year stakeholder engagement process that has brought together consumers, advocates, primary care physicians, specialists, policy makers, technology companies and payers to help break the deadlock in this debate and advance towards a new, dynamic approach to breast cancer screening

Development of a Personalized Decision Aid for Breast Cancer Risk Reduction and Management

Background: Breast cancer risk reduction has the potential to decrease the incidence of the disease, yet remains underused. We report on the development a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians. Methods: Under Institutional Review Board approval, we evaluated the decision tool through a patient focus group, usability testing, and provider interviews (including breast specialists, primary care physicians, genetic counselors). This included demonstrations and data collection at two scientific conferences (2009 International Shared Decision Making Conference, 2009 San Antonio Breast Cancer Symposium). Results: Overall, the evaluations were favorable. The patient focus group evaluations and usability testing (N = 34) provided qualitative feedback about format and design; 88% of these participants found the tool useful and 94% found it easy to use. 91% of the providers (N = 23) indicated that they would use the tool in their clinical setting. Conclusion: BreastHealthDecisions.org represents a new approach to breast cancer prevention care and a framework for high quality preventive healthcare. The ability to integrate risk assessment and decision support in real time will allow for informed, value-driven, and patient-centered breast cancer prevention decisions. The tool is being further evaluated in the clinical setting

Toma de decisión en la prevención del cáncer de mama

Breast cancer is one of the most common cancers among women and the leading cause of death in women between the ages of 45-60 in most developed countries. The efficacy of prevention options has been established and includes lifestyle modifications, chemoprevention, and prophylactic surgery. Despite the efficacy of these options, breast cancer prevention remains underused, resulting in avoidable morbidity and mortality. Here, the main barriers to effective use of breast cancer prevention are outlined and a framework to facilitate patient-centered and evidence-based breast cancer prevention decision making is presented. The framework is intended to encourage a shared decision making approach to prevention decisions, within the context of a woman’s overall health. The inclusion of effective lifestyle interventions makes this framework relevant to most women, and is not exclusive to women at increased risk of developing breast cancer.El cáncer de mama es uno de los canceres más comunes y la causa principal de muerte entre las mujeres de las edades de 45 a 60 en la mayoría de los países desarrollados. La eficacia de las opciones preventivas están bien determinadas e incluyen modificaciones en el estilo de vida, quimioprevención y cirugía profiláctica. A pesar de la eficacia de estas opciones, los medios preventivos están infrautilizados, con resultados de morbilidad y mortalidad que podrían evitarse. En el presente trabajo, se exponen las barreras principales del uso efectivo de los medios de prevención del cáncer de mama y se presenta un encuadre para tomar decisiones en la prevención del cáncer de mama centradas en el paciente y basado en datos acerca de su eficacia. Este encuadre se propone para estimular una aproximación a la toma de decisiones compartida en el contexto de la salud global de la mujer. La inclusión de intervenciones efectivas sobre el estilo de vida hace que este encuadre sea relevante para la mayor parte de las mujeres y no sea exclusivo de las que tengan alto riesgo de cáncer de mama

How Well Does the WTO Settle Disputes?

Last fall, a judicial panel of the WorldTrade Organization (WTO) issued a controversial ruling in a high-stakes corporate tax dispute between the United States and the European Union. Paying scant attention to the complexities of the case, the panel authorized Brussels to implement retaliatory sanction of $4 billion - an unprecedented sum - against Washington. Notably, around the same time the United States and its European allies were also making headlines with another fierce legal battle: over the authority of the International Criminal Court to prosecute American soldiers for alleged misdeeds committed abroad

A case report of vanishing bile duct syndrome after exposure to pexidartinib (PLX3397) and paclitaxel.

Pexidartinib (PLX3397) is a small molecule tyrosine kinase and colony-stimulating factor-1 inhibitor with FDA breakthrough therapy designation for tenosynovial giant-cell tumor, and currently under study in several other tumor types, including breast cancer, non-Hodgkin's lymphoma, and glioblastoma. Here, we report a case of severe drug-induced liver injury requiring liver transplantation due to vanishing bile duct syndrome (VBDS) after exposure to pexidartinib in the I-SPY 2 Trial, a phase 2 multicenter randomized neoadjuvant chemotherapy trial in patients with Stage II-III breast cancer. We also review the current literature on this rare, idiosyncratic, and potentially life-threatening entity

Competing risks regression for clustered survival data via the marginal additive subdistribution hazards model

A population-averaged additive subdistribution hazards model is proposed to assess the marginal effects of covariates on the cumulative incidence function and to analyze correlated failure time data subject to competing risks. This approach extends the population-averaged additive hazards model by accommodating potentially dependent censoring due to competing events other than the event of interest. Assuming an independent working correlation structure, an estimating equations approach is outlined to estimate the regression coefficients and a new sandwich variance estimator is proposed. The proposed sandwich variance estimator accounts for both the correlations between failure times and between the censoring times, and is robust to misspecification of the unknown dependency structure within each cluster. We further develop goodness-of-fit tests to assess the adequacy of the additive structure of the subdistribution hazards for the overall model and each covariate. Simulation studies are conducted to investigate the performance of the proposed methods in finite samples. We illustrate our methods using data from the STrategies to Reduce Injuries and Develop confidence in Elders (STRIDE) trial