Childbearing

Is There a Role for Herpes Zoster Vaccine in Chronic Pain Management?

About the Authors

With the death of Theodore L. Sourkes on Jan. 17, 2015, at age 95, the CCNP, Canada and the international research community lost one of the pioneers of a research discipline: the study of the biochemistry of the brain in relation to mental and neurological disorders. Ted was born in Montréal, Que

Part One provides a first look from the supply side at the reaction of the political risk insurance market to September 11, 2001, the Argentine economic crisis, and other recent corporate upheavals. This section starts off with the public provider's perspective, provided by Vivian Brown, Chief Executive of the U.K.'s Export Credits Guarantee Department (ECGD) and President of the Berne Union. Part Two explores the reactions of investors and lenders to the recent upheavals in the global economy. It pays particular attention to the problems confronting large infrastructure projects, in which purchase agreements are guaranteed by the host country, and revenues are denominated in local currency. It examines how political risk insurance can help lenders to return to financing infrastructure development in emerging markets, and asks to what extent investors and lenders need new products or new kinds of coverage to deal with currency crises. Part Three brings together Felton Mac Johnston, President, FMJ International Risk; Charles Berry, Chairman, Berry, Palmer & Lyle Limited; and Witold Henisz and Bennet Zelner, Assistant Professors at Wharton and Georgetown University respectively. Additional commentary is provided by David Bailey, Vice President, Sovereign Risk Insurance Ltd. and Edith Quintrell, Manager, Insurance, at the Overseas Private Investment Corporation, who provide perspectives on how the political risk insurance industry might evolve to meet the needs of insurers and reinsurers, on the one hand, and investors and lenders, on the other.

Under the Shrinking U.S. Security Umbrella: India's End Game in Afghanistan?

Dr. Buek is Assistant Professor, Department of Obstetrics and Gynecology, Georgetown University, and Residency Program Director, Washington Hospital Services, and Dr. Wilson is Resident, Department of Obstetrics and Gynecology, Women and Infant Services, Room 5B63, Washington Hospital Services, 110 Irving Street, NW, Washington, DC 20010; E-mail: [email protected]. The authors have disclosed that they have no significant relationships with or financial interests in any commercial organizations pertaining to this educational activity. All staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity. Lippincott CME Institute, Inc., has identified and resolved all faculty and staff conflicts of interest in any commercial organizations pertaining to this educational activity.

Jay Michael Sullivan was a gentleman and a scholar. These have been the words used by so many who knew this scientist, teacher, superb clinician, husband, father, and friend when learning of his untimely death. Jay Sullivan died on February 22, 1999, at only 62 years of age, less than two months after experiencing the first manifestations of carcinoma of the pancreas. Jay Sullivan was born in Brockton, Massachusetts, and grew up in Miami, Florida. He received his bachelor and medical degrees from Georgetown University, where he was valedictorian of his medical school class, graduating in 1962. He then went to Boston, near his birthplace, and spent 12 years at Harvard Medical School and Peter Bent Brigham Hospital, where he did his internship and residency in medicine and was Chief Resident in Medicine and a Cardiology fellow. He also had a two-year preceptorship in biological chemistry. In 1970, he joined the Harvard faculty for four years as an Assistant Professor of Medicine. During this time, he was also Director of the Hypertension Unit at the Peter Bent Brigham Hospital, and in 1973–74, he was Director of Medical Services at the Boston Hospital …

Current Opinion in Endocrinology and Diabetes was launched in 1994, with Obesity added to the title in 2007. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of endocrinology and diabetes are divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce one of the Journal's Editor in Chief and the Section Editors for this issue. EDITOR IN CHIEF Lewis E. BravermanLewis E. BravermanLewis E. Braverman, MD is currently a Professor of Medicine in the Section of Endocrinology, Diabetes and Nutrition in the Department of Medicine at Boston University School of Medicine, USA. Dr Braverman earned his undergraduate degree from Harvard University, USA, and received his MD from Johns Hopkins University School of Medicine, USA. He also received an honorary doctorate in medicine from the University of Parma, Parma, Italy. Internal medicine residency and an endocrinology fellowship, under the direction of the late Sidney H. Ingbar, MD, were completed on the II-IV Medical Services (Harvard) and Thorndike Memorial Laboratory (Harvard), Boston City Hospital, USA. He has been the recipient of many national and international awards, including those from the American Thyroid Association, The Endocrine Society, The German Endocrine Society, The Technion University School of Medicine (Haifa, Israel), the Thai American Physicians Foundation and the American Association of Clinical Endocrinologists (AACE). Dr Braverman has served the ATA as its Secretary and President. He has served the research community on many NIH study sections and advisory committees and has been a Principal Investigator on several key clinical and research studies. As an author and co-author, Dr Braverman's work has been published in many leading clinical and research medical journals. He is co-editor of the leading thyroid textbook, has served as Editor-in-Chief of the Journal of Clinical Endocrinology and Metabolism and Endocrine Practice, and currently as the Editor-in-Chief of Current Opinion in Endocrinology, Diabetes & Obesity. He serves on many journal editorial boards, and is a member of many national and international research and clinical organizations. SECTION EDITORS H. Christian WeberH. Christian WeberDr H. Christian Weber is a graduate of Hamburg University Medical School, Hamburg, Germany. He received his internal medicine training at the University of Mainz, Germany, and in Framingham, Massachusetts, at the MetroWest Medical Center, USA. He was trained in gastroenterology at Georgetown University in Washington DC, USA, and at the National Institutes of Health in Bethesda, Maryland, USA. He has been a staff gastroenterologist at Boston University Medical Center, USA, and at the Veteran Administration (VA) Boston Healthcare System, USA, since 1997. He holds academic appointments as Assistant Professor of Medicine and Pathology and Laboratory Medicine at Boston University School of Medicine. Dr Weber was appointed Associate Chief and Clinical Director of Gastroenterology at the VA Boston Healthcare System in 2007. His research interests in neuroendocrinology span laboratory studies regarding molecular mechanisms of mammalian bombesin receptor regulation in cancer and obesity, and clinical investigations concerning acid secretory disorders and functional bowel disorders. Lynne L. LevitskyLynne L. LevitskyLynne L. Levitsky is a graduate of Bryn Mawr College and Yale Medical School, USA. She received her pediatric training at the Albert Einstein College of Medicine in New York, USA, and at the Children's Hospital of Philadelphia, USA. She was trained in pediatric endocrinology at the University of Maryland in Baltimore, USA. She was a pediatric endocrinologist at the Pritzker School of Medicine, University of Chicago, USA, until 1990. She then came to Massachusetts General Hospital, USA, as Chief of the Pediatric Endocrine Unit and Associate Professor of Pediatrics at Harvard Medical School. Her research interests in carbohydrate metabolism span laboratory studies of transcriptional control of beta cell function, and a role as an investigator in the NIH-sponsored TODAY treatment study of type 2 diabetes in the young. She is a past President of the Pediatric Endocrine Society and is the head of the Education Council for that organization.

The chirality of a supramolecular system that incorporates rigid oligomers flip-flops rhythmically as a chiral ligand is added. This novel phenomenon was discovered by the group of Stefan Matile, assistant professor of chemistry at Georgetown University, Washington, D.C. The behavior is unusual because it is due to ligand-receptor binding only. Normally, you have to break and reassemble chemical bonds to flip one enantiomer to the other, says Matile, who by June will have moved to the University of Geneva, Switzerland, as an associate professor of chemistry. In this case, just adding something flips the whole apparent stereochemistry. The complex system displaying this unique property consists of stiff oligomers embedded in a bilayer composed of egg yolk phosphatidylcholine. The oligomer spans the length of the bilayer and terminates in a ligand-binding group. This group, an iminodiacetate, sits on one surface of the bilayer, alongside the phosphatidylcholine heads. When added, copper ions bind to t...

Back to table of contents Previous article Next article Professional NewsFull AccessIndustry Influence Can Be Mediated by Understanding Theory Behind ItAaron LevinAaron LevinSearch for more papers by this authorPublished Online:10 Sep 2013https://doi.org/10.1176/appi.pn.2013.9b15AbstractIf doctors can approach the food, flattery, and friendship that underlie pharmaceutical marketing with sufficient skepticism, its biasing effects may decrease.New norms within the medical profession that keep industry at arm’s length might lessen conflict of interest, said Adriane Fugh-Berman, M.D., of Georgetown University Medical Center.Aaron LevinSocial science research can help understand the marketing practices of pharmaceutical and medical device manufacturers, but might also plausibly be used to help doctors form independent judgments about therapies and diagnostic tools, according to two Georgetown University physicians.However, doctors must first understand the techniques used to influence their choices.“Industry uses principles of social psychology to manipulate prescribing behavior; physicians unaware of such subtle influences will not try to avoid the resulting conflicts of interest,” wrote Sunita Sah, M.D., M.B.A., Ph.D., an assistant professor of business ethics at Georgetown and a research fellow at the Ethics Center at Harvard University; and Adriane Fugh-Berman, M.D., an assistant professor of pharmacology and physiology and of family medicine at the Georgetown University Medical Center. Their article appears in the August issue of the Journal of Law, Medicine, and Ethics.Earlier studies showed that physicians believe they are not personally influenced by industry but their colleagues are. “Physicians think they are making their own independent choice of therapeutics for their patients and don’t realize the extent to which they are affected by drug reps,” said Fugh-Berman in an interview. She is also director of PharmedOut, a Georgetown University Medical Center project that advocates evidence-based prescribing and educates health care professionals about pharmaceutical marketing practices. “Overconfidence and naivetȳ are a dangerous combination.”One understanding of the industry’s techniques may lie in the principles of influence and persuasion set out by social psychologists like Robert Cialdini, Ph.D., a professor emeritus of psychology and marketing at Arizona State University, as cited by Sah and Fugh-Berman.For a start, reciprocity might be the tenet most familiar to medical professionals. That pizza or fancy dinner provided by the drug rep sets up an implicit obligation to return the favor.Commitment to even a small goal (like prescribing that new drug to just a few patients) is amplified by a desire later to justify that choice with future consistency.Conformity (or “social proof”) is doing what others do, especially those with more prestige or authority. Industry’s use of “high-status, respected, academic physicians” to act as “key opinion leaders” is such a time-tested tactic.“The effect on trainees of observing trusted mentors accepting hospitality and funds from industry may be more powerful than the influence of institutional policies or formal curricula,” said Sah and Fugh-Berman.However, Fugh-Berman said she has noticed a change in the last five years as attitudes toward speakers with heavy industry support have become less favorable, especially among medical students.Finally, there’s simple likeability. Drug reps are hired at least as much for their social skills as for their scientific knowledge. And flattery, whether it’s a pleasant conversation over that archetypal pizza or an invitation to speak at a prestigious meeting, gets them everywhere.“Some of that social science thinking might be turned around to help medical students and trainees think the way they have already learned to read the peer-reviewed literature,” said former APA President Carolyn Robinowitz, M.D., special associate provost for health science at George Washington University in Washington, D.C. “They could learn to recognize marketing techniques and begin to question more critically drug reps or speakers at those dinner meetings.”Like Sah and Fugh-Berman, Robinowitz believes that educating physicians, trainees, and medical students is the best way to minimize any biases in marketing messages.“We need to look to our leadership to help us learn this approach and help doctors make decisions based on the best evidence,” said Robinowitz.However, like it or not, the reality is that corporations exist to produce profits as well as products, she added. “Drug companies perform a useful function, and they must make money or they won’t invest in our field.”Somewhere out there between the bathwater and the babies lies a place where industry can make medicines and equipment while health professionals can find unbiased information about them.“Educational interventions have been able to move the needle on whether other physicians are affected by industry influence,” said Fugh-Berman. If enough physicians can learn to avoid the social obligations that industry cultivates and if academic medicine maintains its distance from industry, she said, “a new social norm may emerge that rejects transactions fraught with conflicts of interest.” ■An abstract of “Physicians Under the Influence: Social Psychology and Industry Marketing Strategies” is posted at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1748-720X. Adriane Fugh-Berman’s PharmedOut site can be found at http://www.pharmedout.org/. ISSUES NewArchived

Nutrition Education in Health Professions Programs: A Survey of Dental, Physician Assistant, Nurse Practitioner, and Nurse Midwifery Programs

OLADAPO A. KOLAWOLE, M.S., PHARM.D., is Assistant Director, Department of Pharmacy, Georgetown University Hospital, Washington, DC; at the time of this study he was Pharmacy Practice Resident, The Ohio State University Medical Center (OSUMC), Columbus, and a graduate student, College of Pharmacy, The Ohio State University (OSU), Columbus. CRAIG A. PEDERSEN, PH.D., is Assistant Professor, College of Pharmacy, OSU. PHILIP J. SCHNEIDER, M.S., is Clinical Professor and Director, Latiolais Leadership Program, College of Pharmacy, OSU. DAVID A. Perspectives on the attributes and characteristics of pharmacy executives

The use of histone deacetylase (HDAC) inhibitors to sensitize patients to cancer therapies, particularly patients with hormonally positive breast cancer with resistance to drugs like tamoxifen, were among the advances discussed in November at the Molecular Targets and Cancer Therapeutics Conference, sponsored by the American Association for Cancer Research (AACR). In a randomized controlled phase 2 study of metastatic breast cancer patients, for instance, postmenopausal women with positive disease achieved double the progression-free survival with use of entinostat combined with exemestane versus exemestane alone, Researchers examined blood samples in a subset analysis of 49 patients to evaluate whether changes in circulating blood cells reflected the activity of the HDAC inhibitor and found that biological activity of the drug, which could be associated with clinical benefit, was apparent as soon as 8 days after administration. Entinostat is the first drug for metastatic breast cancer to show that clinical outcome can be predicted shortly after administration.1 More than 750 abstracts in oral and poster sessions were presented at the AACR Molecular Targets meeting. Abstracts delved into subjects such as the molecular drivers of metastasis, immunotherapy, cancer stem cells, tumor metabolism and epigenetics, and drug development for targeted therapies. In one of the most highlighted studies of the meeting, researchers reported that amplification of anaplastic lymphoma kinase (ALK), which has been reported in other cancers such as non-small cell lung cancers, may be a primary driver of the rapid metastasis experienced by patients with inflammatory breast cancer. If validated, the use of anaplastic lymphoma kinase (ALK) inhibitors may be a new treatment approach for patients with this lethal form of breast cancer, says Kenneth Anderson, MD, co-chair of the meeting and editor-in-chief of Clinical Cancer Research.2 Other studies explored the subject of antifolate resistance in non-small cell lung cancer and how best to predict such resistance. In one study, researchers treated human NSCLC cell lines (KRAS wild type, KRAS mutant nonamplified, and KRAS mutant amplified) with the antifolates methotrexate or pemetrexed. Results showed that KRAS wild-type and KRAS mutant amplified cells were relatively resistant to antifolate treatment. In contrast, antifolates inhibited growth in KRAS mutant nonamplified cell lines. The researchers also reported dramatic and prolonged responses to pemetrexed therapy in patients with KRAS mutant NSCLC. Thus, it's important for oncologists to test for KRAS mutation as well as KRAS amplification in order to assess the potential efficacy of antifolates, the researchers concluded.3 “Many of the studies presented here show the power of mechanistic-based science to elucidate new diagnostic biomarkers or targeted treatment options with either a single agent or combined therapy,” says Dr. Anderson. The U.S. Food and Drug Administration (FDA) is funding centers at the University of Maryland and Georgetown University aimed at improved review of the safety and efficacy of drugs and medical products. The Centers of Excellence in Regulatory Science and Innovation (CERSI) were each funded with a $1 million grant and may receive more funds over the next 3 years. It currently costs $1 billion and takes about 10 years to develop a new drug, according to James Polli, PhD, the Shangraw/Noxell Endowed Chair in pharmaceutical sciences at the University of Maryland and co-principal investigator for the University of Maryland CERSI. “We plan to sponsor educational lectures and daylong events that will feature the best academic scientists and provide FDA reviewers with a broad exposure to current research,” he says. According to Dr. Polli, FDA reviewers need improved training in preclinical science. “When regulators can ensure that the science is better for products such as predictive tests, there will be less need for oversight and more opportunities for accurate risk evaluation,” he says. Instructors at the University of Maryland will train FDA reviewers in how to use clinical data to assess the possible side effects of new drugs and drug-drug interactions. “The problem the FDA faces is that it's often hard for reviewers to get additional training in new research since their time is limited and so are the resources of the FDA,” Dr. Pollli says. The Georgetown CERSI will be working on one project to assess ways to use bioinformatics to enhance medical product development and another to examine data sharing. “The FDA has access to vast amounts of data that can be mined to answer important biomedical and public health questions but it's important to determine how data can best be utilized while protecting the intellectual property rights of pharmaceutical companies and stakeholders such as researchers, universities, and the public,” says Ira Shoulson, MD, professor of neurology, pharmacology, and human science at Georgetown and the university's CERSI principal investigator and director. The U.S. Department of Defense has awarded Boston University Medical School a $13.6 million grant to lead 2 multi-site studies aimed at finding ways to detect lung cancer noninvasively and to distinguish those smokers at highest risk for developing lung tumors. Although the National Lung Screening Trial showed that there were fewer fatalities among smokers and former smokers screened with low dose helical CT, using such screening for all smokers is cost-prohibitive, says Avrum Spira, MD, a pulmonary and critical care physician at Boston University Medical Center, who is leading the Department of Defense lung cancer research effort. Only 10 to 20% of smokers and former smokers actually develop lung cancer, leading researchers to ask which smokers and former smokers should receive imaging tests, particularly expensive ones, such as CT scans. To help answer this question, Boston University researchers will collaborate with military hospitals and Veteran's Affairs medical centers to investigate lung cancer risk among a large number of patients. The consortium for the lung cancer studies, called the Detecting Early Lung Cancer Among Military Personnel (DECAMP) Consortium, is the largest consortium of researchers in the U.S. dedicated to identifying noninvasive ways to detect early-stage lung cancer. Lung cancer is of special concern to the Department of Defense because military and military veterans have higher rates of smoking than the national average. They're also exposed to toxins during military action that can put them at elevated risk for lung cancer, Dr. Spira says. Researchers will investigate ways that molecular biomarkers, both genomic and proteomic, could be used to predict risk of lung cancer and to distinguish between smokers and former smokers with benign nodules in the lung versus patients with cancerous ones. In the first study, 500 military personnel with suspect lung nodules will undergo blood tests and bronchoscopy for samples that might yield molecular clues to the presence of cancer in the lungs versus those that might indicate benign nodules, and then will be followed until biopsy is completed. “One of the exciting aspects of this research is that although the cells we'll be collecting are far away from the lung, they are all bathed in the toxins in cigarette smoke that eventually cause genetic and genomic alterations as well as lung cancer,” Dr. Spira says. “Epithelial cells derived from bronchoscopy might act like a canary in a cold mine, telling you about the presence of lung cancer,” Dr. Spira said. In a second study, researchers will follow 1,000 smokers and former smokers at high risk for development of lung cancer because of the amount of cigarettes they smoked or the duration of their smoking habit. Presence of lung nodules or lung cancer will be assessed over a 5-year period. “If we can find molecular markers that cause smokers to be at elevated risk for lung cancer, then we can follow them more closely with imaging studies, and find cancer at an earlier stage. And we could potentially offer them treatment that might prevent lung cancer,” Dr. Spira said. A number of compounds to prevent lung cancer are now being tested in early clinical trials, including the prostacyclin, iloprost. Research advances in sequencing technologies that make it possible to scan entire human genomes more cost-effectively are fueling a research initiative by the National Institute of Neurological Disorders and Stroke (NINDS). Duke's Center for Human Genome Variation won the first grant in the NINDS initiative, called the Center Without Walls on Human Genetics. The Center will be using the $25 million grant, awarded over the course of 5 years, to sequence and analyze the entire genomes of 4,000 epilepsy patients. “Improved understanding of the genetic basis of epilepsy will shed light on the underlying pathophysiology that leads to epilepsy disorders,” says Erin Heinzen, PhD, co-principal investigator and assistant professor in Duke's Center for Human Genome Variation. “This knowledge will likely lead to the development of medications or treatments that can specifically treat the cause of seizures in patients,” Dr. Heinzen says. Although Duke will be leading the effort, investigators from other universities in the United States, Canada, and Australia will be contributing genomic and detailed clinical information on patients with epilepsy. Genetic studies of epilepsy indicate that many different genes are disrupted in order to cause the condition. “This high level of heterogeneity means that we will likely need very large sample sizes to identify epilepsy susceptibility genes, which can only be obtained by collaborating with other institutions studying epilepsy,” Dr. Heinzen says. When exactly might this research work affect treatment?“The timing of how long it may take for gene discoveries to be translated into clinically useful information or drug therapies is uncertain,” Dr. Heinzen says. “But it's clear that gene discovery will improve our understanding of epilepsy and over time this will improve patient care.” CTS

*cardiovascular nursing clinical specialist. St. Paul Hospital. Dallas. Texas. †an instructor in the nurse midwifery program, University of Mississippi, Jackson.

In Memoriam: Dr. Clive L. Dym (1942–2016)