Information needed to decide about cardiovascular treatment in primary care.

There is growing consensus that treatment of cardiovascular risks should be based on multiple rather than single factors and on absolute rather than relative risks. Thresholds for treatment should reflect the level of absolute risk at which the benefits and hazards of treating outweigh the benefits and hazards of not treating. Once a decision has been made to initiate a treatment programme, clinicians need to know the patient''s absolute risk. At this level of risk do the benefits of treatment outweigh the hazards? Given this information, which treatment option does the patient prefer? Using cardiovascular disease as an example, I review some measures that assist decision making in primary care. Practice guidelines should routinely include accessible presentation of treatment outcomes on benefit, hazard, and costs for a range of absolute risks. These measures enable patients and their doctors to weigh the pros and cons of treatment in their particular circumstances.     

Identification of Risks in the Life Cycle of Nanotechnology‐Based Products

In order to realize the projected market potential of nanotechnology, the environmental, health, and safety (EHS) uncertainties posed by a nano‐product (i.e., a nanotechnology‐enabled product) need to be characterized through the identification of risks and opportunities in early stages of product development. We present a methodology to identify risks from nano‐products using a scenario analysis approach that allows for expert elicitation on a set of preidentified use and disposal scenarios and what we have labeled “risk triggers” to obtain scores on their likelihood of occurrence and severity. Use and disposal scenarios describe product life‐cycle stages that could result in risk attributed to the nano‐product, whereas risk triggers are particular to nanoparticle properties. These are potential risks, as the risk assessment community is currently debating the specific risks attributed to nanotechnology. Through such a framework, our goal is to identify which products pose greater risks, where these risks occur in the product life cycle, and the impacts of these environmental risks on society. The comparison of risk triggers across nano‐products allows relative risk ranking on axes of exposure‐ and hazard‐related risk triggers. For the specific case of air fresheners, areas of acute risks resulted from bioavailability of nanoparticles in air release and water entrainment exposure scenarios; catalytic activity of nanoparticles in inhalation and air release exposure scenarios; the harmful effects due to the antibacterial property on useful bacteria particularly in susceptible populations; and, finally, risks from the lack of nanoparticle coating stability in air release scenarios.     

"Bioplutonism" and the evolutionary implications of beneficial genes from another biosphere

Could exogenous genes from another biosphere have aided the evolution of life on Earth's surface over the last half-billion years? That possibility was considered by Thomas Gold in 1992, when he hypothesized that a “deep hot biosphere” (DHB) resides independently well below its cooler surface counterpart. And he suggested that “… in the long term … there may occasionally be beneficial exchanges of genetic material between microbial life at depth and the surface life.” Thus, the question: what evidence is there to support Gold's notion that exogenous genes from the DHB – let us call them “bioplutons” – ever bestowed benefits on the evolution of surface life? In pursuit of this question I drafted a null hypothesis: “Nothing beyond our own biosphere, as we know it today, renders any kind of genetic benefits to biological evolution.” After objectively analyzing the evidence and arguments pro and con I failed to reject the null hypothesis, given what we know today, especially the fact that no genetic imprint from the DHB has been identified in eukaryotic genomes. But my conclusion is regarded as tentative, because the fundamentals of Gold's argument, collectively referred to herein as “bioplutonism,” might be confirmed eventually with successful probes into the DHB, and with the sampling of its alleged genetic material.     

What Explains Wildlife Value Orientations? A Study among Central African Forest Dwellers

This study of values placed on wildlife by Bantu and Yaka Pygmy forest dwellers (n = 200) in Northern Congo identified and analyzed two wildlife value orientations - “anthropocentric” and “biocentric.” The former, strongly displayed across all segments of both societies, was likely motivated by heavy reliance on bushmeat and human–wildlife conflicts, and was linked to attitudes approving the killing of animals for human benefit. The “biocentric” orientation was more common among formally educated male respondents who do not hunt and positively linked to attitudes favoring conservation. Wildlife management strategies should consider including 1) sustainable local wildlife exploitation, 2) livelihood projects that provide a real alternative to hunting, and 3) human–wildlife conflict mitigation.     

Participants' perceptions of research benefits in an African genetic epidemiology study

Background: Both the Council for International Organization of Medical Sciences and the Helsinki Declaration emphasize that the potential benefits of research should outweigh potential harms; consequently, some work has been conducted on participants' perception of benefits in therapeutic research. However, there appears to be very little work conducted with participants who have joined non‐therapeutic research. This work was done to evaluate participants' perception of benefits in a genetic epidemiological study by examining their perception of the potential benefits of enrollment. Methods: In‐depth interviews lasting between 45 and 60 minutes were conducted with a convenient sample of 25 ill patients and 25 healthy accompanying relatives enrolled in a genetic epidemiological study of tuberculosis. Recorded interviews were transcribed and analyzed using content analysis. Results: Participants perceived that research was beneficial and some of the benefits included the generation of new knowledge, finding the cause of diseases, as well as the control, eradication and prevention of disease. Some thought that research was risky whilst others thought that the benefits outweighed the risks. Conclusion: Participants perceived research to be beneficial and most of them thought that, though it was risky, the benefits outweighed the risks. It is our view that researchers need to give serious consideration to participant's perception of benefits in designing their consent forms, to see to the fulfillment of achievable goals.     

Science‐Based Carbon Targets for the Corporate World: The Ultimate Sustainability Commitment,or a Costly Distraction?

Dr. Alice Stewart conclusively demonstrated, in 1958, that pediatric X‐rays doubled the risk of childhood leukemia. Nevertheless, doctors continued X‐raying mothers‐to‐be until 1980. Margaret Heffernan's (2011) book, Willful Blindness: Why We Ignore the Obvious at Our Peril, documents this and numerous other examples of our skill at ignoring information that points to something we don't want to know. Specifically, on the topic of climate change, Heffernan notes: “[I]n failing to confront the greatest challenge of our age – climate change – all the forces of willful blindness come together, like synchronized swimmers in a spectacular water ballet.” When it comes to corporate sustainability, we're seeing some recent efforts to get past willful blindness. In 2013, we saw examples such as Auden Schendler (co‐author of this piece) and Michael Toffel's (2013) publication in Grist, Corporate Sustainability is Not Sustainable, which itself built upon Professor Robin Craig's (2012) article provocatively entitled “Climate Change Means the Death of Sustainability.” More recently, in Lima, Unilever's Paul Polman said that “.. most CEOs…know that their companies cannot prosper in a world with runaway climate change.” Perhaps, after years of corporate sustainability flag waving, it is no longer possible to ignore the fact that much of what companies classify as “sustainability” is, at best, green fluff that is fundamentally out of touch with the realities of anticipated climate change. Significantly, chief executive officers (CEOs) themselves are questioning the historic focus on corporate sustainability policies and targets. As summarized in the CEO Study on Sustainability, jointly published by the United Nations (UN) Global Compact and Accenture (2013): “Business leaders [now] believe that only with greater government intervention — at global, national and local levels — can sustainability move from sporadic incremental advances to a collective and transformative impact.”     

“Solution-Focused Risk Assessment”: A Proposal for the Fusion of Environmental Analysis and Action

For 30 years, more attention and resources have been expended on dissecting problems (risk assessment) than on evaluating actual solutions that reduce risks. The basic dogma holds that risk assessment must precede risk management. But there is an opposite and perhaps better way: the opening question should not be “How bad is the problem?” but “How good are the solutions we might apply to the problem?” Rethinking risk assessment in this context offers three classes of benefits over the status quo. First, it can help break the endless cycle of analysis: when the goal is to know enough to decide, rather than to know everything, natural stopping points emerge. Second, it can lead to more decisions that actually achieve risk reduction, rather than pronouncements about how much risk reduction would be optimal. Third, it can highlight ways to resolve multiple risks simultaneously, avoid needless and tragic risk-risk tradeoffs, and involve affected stakeholders in debating what should be done. Arguably, the longer the disembodied analysis of risk information is allowed to proceed, the more likely it is that the “problem” will be defined in a way that blunts the free-wheeling discussion of solutions, to the detriment of human health, the environment, and the economy.     

Review of quantitative and qualitative studies on U.S. public perceptions of synthetic biology

How are public perceptions towards synthetic biology likely to evolve? Which factors will impact the framing of this emerging technology, its benefits and risks? The objective of this article is not to draw exhaustive conclusions about public perceptions of synthetic biology, but rather to provide readers with a review of integrated findings from the first quantitative and qualitative research ever conducted on this subject in the United States. Synthetic biology survey research shows two clear findings. The first is that most people know little or nothing about synthetic biology. Second, notwithstanding this lack of knowledge, respondents are likely to venture some remark about what they think synthetic biology is and the tradeoff between potential benefits and potential risks. Finding only some support for the “familiarity argument”—according to which support for emerging technologies will likely increase as awareness of them develops—this article suggests that analogs to cloning, genetic engineering and stem cell research appear to be recurrent in the framing process of synthetic biology. The domain of application seems to be another decisive factor in the framing of synthetic biology. Finally, acceptance of the risk-benefit tradeoff of synthetic biology seems to depend on having an oversight structure that would prove able to manage unknowns, human and environmental concerns, and long-term effects. The most important conclusion of this study is the need for additional investigation of factors that will shape public perceptions about synthetic biology, its potential benefits, and its potential risks.     

Analysis of Determining Factors of the Public's Risk Acceptance Level in China

This work will characterize risk acceptance in China, based on the psychometric paradigm, and explore the determining factors that influence the risk acceptable level to the Chinese public. For this purpose, a survey was conducted including 12 hazards, 10 risk attributes (including risk acceptance), and demographic variables. First, the research attempted to explore Nanjing citizens’ average risk acceptable level for 12 hazards in China. Second, intercorrelation analysis and factor analysis of nine risk attributes were performed to obtain the suitable risk perception factors as independent variables. Three risk perception models of acceptance were constructed, which were named “Environmental risk model,” “Daily risk model,” and “Technical risk model,” that explained 59.0–69.6% of variance separately. In general, the variables of Knowledge, Benefit, and Trust were found to be significant in all models, implying that these variables are the main determining factors. However, in the environmental risk model, the variable of effect was also significant, which means the determining factors would change for different types of hazards. These results could help the Chinese government to improve the communication of risks with the public and make effective mitigation policies to improve people's rational judgment on the acceptability of risks.     

Avoiding risk at what cost? Putting use of medicines for breastfeeding women into perspective

Breastfeeding women often need to take medicines, and therefore health professionals need to consider the effects of medication on lactation and the breastfed infant, and any associated risks. This commentary discusses the tragic case of a young woman with a history of mental illness who committed suicide in the postpartum period. She was determined to be a 'good mother' and breastfeed, and to avoid any potential adverse effects of medication on her breastfed infant. The final outcome was fatal for both mother and child. We argue that if women require medication during lactation, all risks need to be considered ?C the risk of not treating the maternal medical condition may greatly outweigh the potential risk to the breastfed infant.     

Patients, their doctors, nonsteroidal anti-inflammatory drugs and the perception of risk

This article is about risk. Risk is probably the most misunderstood component in determining therapeutic intervention; however, it is probably the most relevant issue to consider in the context of expected benefit. The rarity of quantitative risk–benefit assessment and the lack of comparative risk–benefit when alternative therapies exist for a given condition leads to inadequate decisions. Without some quantitation of the risks associated with specific therapies, doctors and patients cannot make optimal risk–benefit calculations. Patients may abandon effective therapies for which benefits may still outweigh risks, or opt for therapies with less well-publicized potential adverse events of even greater frequency or severity. When only small incremental benefits accrue to patients from the use of a given therapy, on the other hand, even very rare serious events may play a role in decision-making by patients, by their health care providers and by regulatory authorities.     

Application of a Multi-Criteria Decision-Making Approach for Ranking Environmental Risks Caused by Petrochemical Industries: A Case Study of a Sodium Carbonate Production Unit

The occurrence of accidents in petrochemical industries that cause environmental catastrophes has persuaded experts to use risk-oriented approaches. The approach is to rank the key elements of risk assessment by which the priority of each risk is specified compared to the other ones. The present study was performed to test the applicability of a multi-criteria decision-making approach for prioritizing environmental risks of a petrochemical complex in southwestern Iran. Accordingly, all risky activities of the Sodium Carbonate Production Unit (SCPU) were identified initially. Afterward, the relevant environmental components affected by the risky activities were specified. According to the specification, the most significant risks were shortlisted using experts’ judgment based on three criteria: “impact intensity,” “occurrence probability,” and the “extent of contamination dispersion in the environment.” The shortlisted environmental risks were then prioritized by the Method “Elimination et Choice Translating Reality (Elimination and Choice Expressing Reality)” abbreviated as ELECTRE. Based on the obtained results, “decreased air quality” and “manpower health threatening” are the top-priority risks while “poor quality of groundwater” was identified as the least priority risk. In a general conclusion, a multi-criteria decision-making approach is quite useful for assessing environmental risks of petrochemical industries.     

Melanoma literacy among the general population of three western US states

Melanoma is a significant cause of cancer death, despite being detectable without specialized or invasive technologies. Understanding barriers to preventive behaviors such as skin self-examination (SSE) could help to define interventions for increasing the frequency of early detection. To determine melanoma knowledge and beliefs across three high-incidence US states, 15,000 surveys were sent to a population-representative sample. We aimed to assess (1) melanoma literacy (i.e., knowledge about melanoma risks, attitudes, and preventive behaviors) and (2) self-reported SSE and its association with melanoma literacy, self-efficacy, and belief in the benefits of SSE. Of 2326 respondents, only 21.2% provided responses indicating high knowledge of melanoma, and 62.8% reported performing an SSE at any time in their lives. Only 38.3% and 7.3% reported being “fairly” or “very” confident about doing SSE, respectively. SSE performance among respondents was most strongly associated with higher melanoma knowledge, higher self-efficacy, and personal history of melanoma. Melanoma literacy among survey respondents was modest, with greater literacy associated with a higher likelihood of reported preventive behavior. This assessment establishes a baseline and provides guidance for public health campaigns designed to increase prevention and early detection of this lethal cancer.     

Knowledge,Attitudes, and Acceptability of Pre-Exposure Prophylaxis among Individuals Living with HIV in an Urban HIV Clinic

Introduction

Pre-exposure prophylaxis (PrEP) is an effective tool to reduce HIV transmission. The primary objective of this study was to assess awareness of PrEP by individuals living with HIV (HIV+) and acceptance of its use for their HIV negative (HIV-) partners.

Methods

A cross sectional survey was conducted among individuals living with HIV who received care at an urban HIV clinic between January 2013 and June 2013. The survey examined knowledge, attitudes, and acceptability of PrEP, and perception of transmission risk of HIV. Chi-Square test and Fisher''s Exact test were used to compare proportions.

Results

Among 206 subjects living with HIV, 15.3% (32) had heard of PrEP. Men who have sex with men (MSM) were more likely to be aware of PrEP than all others (p = 0.003). Once educated about PrEP those who believed PrEP would reduce their partner’s risk for HIV were more likely to recommend PrEP to their partner (p<0.001). 92% of all respondents said they would be “extremely likely/likely” to discuss PrEP use with their provider. Of 159 subjects whose main partner was HIV-, MSM (p = 0.007), male participants (p = 0.044), and those who were consistently taking meds (p = 0.049) were more likely to be aware of PrEP. Those who perceived they were at risk of transmitting HIV (p<0.001) and those who were consistently taking meds (0.049) were more likely to agree that PrEP could reduce the risk of HIV to their partners.

Conclusion

This study illustrates a low awareness of PrEP but once educated the willingness of a cohort of individuals living with HIV to recommend PrEP to their partners. Our findings demonstrate the importance of providers informing their patients living with HIV about PrEP, as these persons are an underutilized link to support the uptake of PrEP by their HIV- partners.     

Elimination of tumor by CD47/PD-L1 dual-targeting fusion protein that engages innate and adaptive immune responses

The host immune system generally serves as a barrier against tumor formation. Programmed death-ligand 1 (PD-L1) is a critical “don't find me” signal to the adaptive immune system, whereas CD47 transmits an anti-phagocytic signal, known as the “don't eat me” signal, to the innate immune system. These and similar immune checkpoints are often overexpressed on human tumors. Thus, dual targeting both innate and adaptive immune checkpoints would likely maximize anti-tumor therapeutic effect and elicit more durable responses. Herein, based on the variable region of atezolizumab and consensus variant 1 (CV1) monomer, we constructed a dual-targeting fusion protein targeting both CD47 and PD-L1 using “Knobs-into-holes” technology, denoted as IAB. It was effective in inducing phagocytosis of tumor cells, stimulating T-cell activation and mediating antibody-dependent cell-mediated cytotoxicity in vitro. No obvious sign of hematological toxicity was observed in mice administered IAB at a dose of 100 mg/kg, and IAB exhibited potent antitumor activity in an immune-competent mouse model of MC38. Additionally, the anti-tumor effect of IAB was impaired by anti-CD8 antibody or clodronate liposomes, which implied that both CD8+ T cells and macrophages were required for the anti-tumor efficacy of IAB and IAB plays an essential role in the engagement of innate and adaptive immune responses. Collectively, these results demonstrate the capacity of an elicited endogenous immune response against tumors and elucidate essential characteristics of synergistic innate and adaptive immune response, and indicate dual blockade of CD47 and PD-L1 by IAB may be a synergistic therapy that activates both innate and adaptive immune response against tumors.     

Do the Japanese feel more suspicious about cancer registration than the British?

Background: Cancer registration is indispensable, providing useful statistical measures for the appropriate evaluation of cancer control programs and medical treatment or screening. Methods: Following the British national survey on attitudes toward cancer registration, we conducted an investigation to correctly evaluate the general opinion of the Japanese population in this regard. We randomly recruited 3000 men and women aged 20–69 years from a research database. Results: Only 4% of all respondents had heard about the cancer registry system before the investigation. However, 77% of respondents thought that cancer registration was useful. Forty-three percent of respondents answered, regardless of the strictness of the data protection, that privacy had been violated if the registration occurred without an individual explanation. Compared with the British survey results, Japanese people seemed to be more suspicious about the largely unknown system of cancer registry. Nonetheless, it is noteworthy that Japanese respondents did not show active opposition to cancer registration; they tended to choose “I don’t know” instead of “no” to questions asking if they supported the registry system. Multivariate analysis showed that male sex, older age, and living in the southern region were the factors significantly associated with support for cancer registration. Conclusions: We can seek society's understanding toward cancer registration by actively utilizing information from cancer registries, by using examples of how data are actually used that have wide appeal, and by educating the public on how the data are treated under the complete privacy policy.     

Influenza vaccination in the elderly: 1. Determinants of acceptance.

In the autumn of 1982 routine annual influenza vaccination was offered, by reminder letters and follow-up telephone calls, to 273 independent elderly individuals registered at a community health clinic in Hamilton, Ont. The demographic and geographic characteristics and the health beliefs of those who either accepted or did not accept the vaccine were compared. Among those who received reminder letters there were no significant differences in the rates of vaccine acceptance according to age, sex, household composition or ease of access to the clinic. The patients who reported having previously experienced side effects from the vaccine and perceived a lack of efficacy of the vaccine were more likely not to accept it this time. Both a lack of effort by health care providers (to promote vaccination) and patient behaviour appeared to contribute to pre-existing low levels of influenza vaccination coverage. Although physicians'' efforts to inform patients about the vaccination clinics resulted in a tripling of the overall rate of acceptance of the vaccine, there remained a "hard core" of almost half the patients who were unwilling to receive the vaccine, apparently because they perceived its risks to outweigh its benefits.     

Environmental and Health Implications of Nanotechnology—Have Innovators Learned the Lessons from Past Experiences?

Nanotechnology (NT) is expected to bring about novel technological designs and materials resulting in a wide spectrum of applications. Experience gained from past innovations shows that new technologies are often accompanied by undesired side-effects. If such side-effects are neglected or underestimated, they may result in damage. In this article we examine whether innovators, the pioneers of technological advance in nanotechnology, are aware of the lessons that can be learned from adverse effects that have occurred in connection with several past innovations. Based on the results of a survey taken among innovators we discuss what consequences the innovators draw for the present innovation process and which priorities they set when dealing with environmental and health risks of nanotechnology. Results suggest that innovators may be not very sensitive to early scientific warnings regarding risks of nanotechnology. The innovators are confident that risks are assessable and manageable on a “business as usual” basis. They consider lacking public acceptance as a potential hurdle for innovation and many innovators are afraid of a backlash. Nevertheless, they seldom engage in risk communication or stakeholder dialogue. Picking up recommendations voiced by the innovators interviewed, we sketch some possible approaches as to how innovators could tackle the potential risks of nanotechnology in a proactive manner.     

WEIGHTING HEALTH STATES AND STRONG EVALUATION*

The problem of public consultation over the allocation of health care resources is addressed by considering the role that quality of life measures, such as QALYs and the Nottingham Health Profile, could play. Such measures are typically grounded in social surveys, and as such may reflect public preferences for health care priorities. Using Charles Taylor's concepts of “weak” and “strong” evaluation, it is suggested that current quality of life measures are inadequate, insofar as they typically presuppose that survey respondents are mere “weak evaluators”, who express only inarticulate preferences. Respondents may, conversely, be understood as strong evaluators, with deeper visions of human nature and the good life informing their health preferences. Space is then created for such respondents to be asked to defend their preferences, and so be encouraged to reflect critically and publicly on the beliefs and prejudices that ground their view of health care priorities.