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sacfiuni · May 21, 2013

May 21, 2013 ? A study of veterans at high risk for developing lung cancer shows that low-dose computed tomography (LDCT) can be highly effective in helping clinicians spot tiny lung nodules which, in a small number of patients, may indicate the earliest stages of the disease. LDCT uses less than a quarter of the radiation of a conventional CT scan.

Results of the study will be presented at the ATS 2013 International Conference.

"Lung cancer is the leading cause of cancer-related death and has a poor survival rate," said Sue Yoon, nurse practitioner at VA Boston HealthCare West Roxbury Division. "Most of our veterans in these ages have a heavy smoking history and early screening is desirable to improve outcomes. Our study was undertaken to learn how often we would discover significant abnormalities and how to adapt our existing processes and interdisciplinary approaches to accommodate additional patients."

Conducted according to guidelines set forth by the National Comprehensive Cancer Network (NCCN), the study was based in part on the results of the National Lung Cancer Screening Trial (NLST) which found that LDCT resulted in a 20 percent reduction of lung cancer mortality compared to chest x-ray among heavy smokers aged 55 to 74 years.

The study enrolled 56 patients with a median age of 61 to 65 years and who had a smoking history of more than 30 pack years or 20 pack years and one additional cancer risk factor, such as occupational exposure to carcinogens or personal or family history of cancer or COPD.

After reviewing LDCT scans of each patient, the researchers found that 31 patients had a nodule of 4mm or larger or another abnormal opacity, six of which were deemed suspicious for malignancy. The study also found that 34 patients had more than one nodule. Four patients were diagnosed with biopsy-proven lung cancer.

"Our preliminary rate of lung cancer diagnosis after the first round of screening was 7 percent, which was significantly higher than NLST group, which had a preliminary rate of 3.8 percent at its first round," Ms. Yoon said." In addition, detection of nodules larger than 4mm was 55 percent in our group compared to 27 percent in the NLST group."

The difference in nodule prevalence rates between the current study and the NLST are likely due to three primary factors, she noted: First, the current study hadmuch smaller numbers than the multicenter NLST; second, the scanning technology used during the current trial had advanced since the earlier NLST trial was conducted; and finally, the populations studied in the NLST and the current study had significant differences -- for instance, the VA population was predominantly male and most patients had COPD.

While the results of both this study and the NLST suggest regular screening with LDCT technology can help identify patients in the early stages of cancer, establishing and supporting a regular screening program requires significant resources and may not be feasible in all locations or for all populations, Ms. Yoon added. In addition, because the LDCT is highly sensitive, most of the nodules it spots are benign, and are often due to inflammation or scarring.

"Our previous experience with diagnosing and managing a high volume of incidentally discovered pulmonary nodules suggested that a low dose CT scan screening program, in which patients are screened annually, could be a substantial undertaking," Ms. Yoon said. "Considerable effort goes into each step of the process: selecting patients, tracking abnormalities, further selecting patients with suspicious abnormalities for additional diagnostic and therapeutic interventions.

"Although we plan to continue and expand the LDCT screening program, this will require additional planning and, potentially, resources," she added. "Currently we are using a gatekeeper approach, to ensure tracking of nodules and other abnormalities that are discovered during screening LDCT."

Source: http://feeds.sciencedaily.com/~r/sciencedaily/most_popular/~3/pMfimurAfsI/130521152418.htm

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The planned acquisition of MGPA?s complete business makes BlackRock a truly global real estate investment manager, with pro forma AUM of approximately US $25 billion (approx. ?19.3 billion) as of March 31, 2013 and substantial investment teams in the world?s top six markets, which represent 75% of the commercial real estate investable universe. It adds further best-in-class investment teams and capabilities to the BlackRock platform and demonstrates the Firm?s strong commitment to being a leader in real estate solutions.

?Today?s agreement advances BlackRock?s growth strategy in Asia-Pacific and Europe, where we are seeking to enhance our local offerings and build on the Firm?s real estate experience,? said Jack Chandler, Global Head of Real Estate for BlackRock. ?It further strengthens our ability to offer clients an unrivaled set of solutions to the challenges of a low-return, high volatility environment, including access to MGPA?s top-performing investment teams and exceptional capabilities in key markets.?

MGPA?s offerings complement BlackRock?s existing real estate investment solutions, with virtually no overlap of people or products. The combined platform will also create the potential to accelerate growth of MGPA?s business by leveraging BlackRock?s distribution capabilities for institutional and retail clients.

Jim Quille, MGPA Executive Chairman, commented, ?In BlackRock we have found an excellent asset manager to partner with who has a deep fiduciary culture, industry-leading risk management capabilities, and the same commitment we have to delivering superior investment performance to our clients. We are pleased about the many compelling opportunities this combination offers to both our clients and employees.?

MGPA is focused on real estate funds management, co-investments and separate account mandates for institutional investors, offering products across the risk/return spectrum, including development, and has $12 billion (approx. ?9.3 billion) in AUM as of March 31, 2013. With an on-the-ground presence in 13 offices in Asia-Pacific and Europe, MGPA will augment BlackRock?s real estate investment platform with its pan-Asian and pan-European investment capabilities and complementary geographic footprint.

The transaction is expected to close in the third quarter of 2013, subject to customary regulatory approvals and closing conditions. The financial impact of the transaction is not material to BlackRock earnings per share. Terms were not disclosed.

MGPA was advised by Berkshire Capital Securities LLC.

Source: FTI Consulting

Source: http://europe-re.com/system/main.php?pageid=2616&articleid=22158

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All Critics (48) | Top Critics (13) | Fresh (45) | Rotten (2)

Most films are experiences to be ignored or at best forgotten. "Blancanieves" is a little classic to be treasured.

It is a full-bodied silent film of the sort that might have been made by the greatest directors of the 1920s, if such details as the kinky sadomasochism of this film's evil stepmother could have been slipped past the censors.

Blancanieves, which won 10 Goyas (Spain's equivalent of the Oscars) and was a smash hit in its native Spain, has traces of a kinky undertone and an uncommon willingness to embrace the darkness inherent in this fairy tale.

As if bewitched, the legend of Snow White is transferred to Seville in the early twentieth century and transformed into high melodrama.

Sensuous, mischievous, hotblooded retelling of the old Teutonic fairy tale.

This gorgeous silent film is an unexpected gift from the gods of pure cinema.

The story might be familiar, but Berger's film is so beautifully shot and so wonderfully scored - and so distinctively Spanish - that it stands as its own film.

Blancanieves holds to the structure, but not strictures, of the source fairy tale.

A new, purely silent movie from Spain that never once speaks and doesn't need to speak. What's more, it seems to get the infinite possibilities of silence, and how much passion can come from it.

Berger's film doesn't show loyalty to any traditional version of Snow White. Berger's Blancanieves takes a darker approach, which seems appropriate.

A completely enchanting fairy tale about the vicissitudes of fate, in live action and glorious black and white.

The fun in the Spanish "Blancanieves" is the way it plays with our expectations.

May not have much depth to its characters or particular surprise, but its lovely depiction of family's ability to harm and mend has the flair of flamenco and the sorrow of opera.

No, "Blancanieves" isn't subtle, but it's an unforgettable time at the movies.

Inspired filmmaking steeped in the imagery of silent film history, a dark Iberian strain of Roman Catholicism and the magic of fairy tales.

... lusty and heartfelt, fiery flamenco and spirited country jig. Don't go expecting a Disney-fied fable. Berger seasons with S&M and the kind of macabre touches you'd expect in vintage Browning or Bunuel.

If not for some faintly disturbing imagery and a pleasingly feminist heroine, you could mistake this for a movie actually made in the 1920s (and even those two factors weren't utterly unknown then).

A loving tribute to European silent films of the 1920s; a reminder that cinema need not be constrained by words.

By the time the film arrives at its grand theatrical finale, you're almost prepared for Berger's last great twist. Almost.

this beautifully shot and imaginatively told fairy tale should be seen my many, but only a few will likely get to enjoy it. This is a shame for the audience it is intended for.

This film is simply gorgeous, pure beauty on film, a vision that leaves you breathless and reeling.

Much of the film's emotion is conveyed by Alfonso de Vilallonga's music, which celebrates Spain with uptempo guitar and flamenco when it isn't tipping its hat to Bernard Herrmann during a scene inspired by Hitchcock.

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Source: http://www.rottentomatoes.com/m/blancanieves/

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sacfiuni · May 20, 2013

May 20, 2013 ? A new report suggests that improved health care and significant reductions in drug costs might be attained by breaking up the age-old relationship between physicians and drug company representatives who promote the newest, more costly and often unnecessary prescription drugs.

This system, which has been in place for decades, at one time benefited doctors by keeping them up to date on new medications, and always provided generous amounts of "free" samples to get patients started on the newest drugs, as well as other supplies and gifts.

But it's actually a powerful marketing process into which the pharmaceutical industry pours tens of billions of dollars a year, with more than 90,000 drug representatives providing gifts and advice. There is one drug representative for every eight doctors in the United States. This doesn't necessarily serve the best interests of the patient in terms of economy, efficacy, safety or accuracy of information, experts say.

In one of the first reports of its type -- titled "Breaking Up is Hard to Do" -- researchers from Oregon State University, Oregon Health & Science University and the University of Washington outlined the deliberate process that one central Oregon medical clinic went through to remove drug company representatives from their practice. It explored the obstacles they faced and the ultimate, successful result. The findings were just published in the Journal of the American Board of Family Medicine.

The study found that avoiding conflicts of interest and becoming "pharma-free" is possible, but not easy.

"This is a culture change, one that's already happening but still has a ways to go, especially in smaller private practices," said Dr. David Evans, now with the Department of Family Medicine at the University of Washington, and previously a physician at the Madras, Ore., clinic featured in the article.

"The relationship between physicians and drug company representatives goes back generations, and it took a methodical, deliberate campaign to change it," Evans said. "We ultimately decided something had to be done when our medical clinic was visited by drug reps 199 times in six months. That number was just staggering."

Part of what allows the change, the researchers said, is that information on new medications is now available in many other forums. These may have less bias and be more evidence-based than the material traditionally provided by the pharmaceutical industry, which wanted to sell the latest product. In the Madras clinic, the physicians replaced information previously supplied by drug reps with monthly meetings to stay current on new medications, based on peer-reviewed, rather than promotional literature.

"In the past 5-10 years there's been more of a move toward what we call 'academic detailing,' in which universities and other impartial sources of information can provide accurate information without bias," said Daniel Hartung, assistant professor in the OSU College of Pharmacy. "This is being supported by some states and the federal government, and it's a move in the right direction."

Moves to separate the drug industry from the practice of medicine have been more aggressive in large medical teaching hospitals, Hartung said, but much less so in smaller private practice. Of the 800,000 physicians in the U.S., only 22 percent practice in academic settings, the study noted, and 84 percent of primary care physicians still have close relationships with the pharmaceutical industry.

The stakes can be high, the researchers said. In the study example, the "sample cabinet" of medications at the Madras clinic, provided for free by the pharmaceutical representatives, had an average price of $90 for a month's supply of the medications. Less expensive, generic medications were identified for 38 of the 46 sample drugs, which would have cost $22 a month.

The new analysis explored the necessary steps that a private clinic can take to help address this concern, including quantifying the clinic-industry relationship, anticipating clinician and staff concerns, finding new ways to provide up-to-date information, and educating patients and the public.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/top_health/~3/qnl5Jy21UwU/130520133749.htm

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KABUL, Afghanistan (AP) ? A suicide bomber struck outside a provincial council headquarters in northern Afghanistan on Monday, killing the council chief and at least 13 others, authorities said. The Taliban insurgency quickly claimed responsibility.

Seeking to weaken the Afghan government, Taliban insurgents have been carrying out attacks and assassinations intended to intimidate both officials and civilians ahead of next year's withdrawal of most international troops.

Baghlan provincial council leader Mohammad Rasoul Mohseni was entering the compound in the morning when the bomber ran up on foot and detonated his explosives in the provincial capital of Pul-e-Khumri, said Baghlan chief of police Asadullah Sherzad.

He said 14 people were killed, including Mohseni, and 11 were wounded.

Mohammad Zahier Ghanizada, a member of parliament from Baghlan, confirmed the council chief's death and added that Mohseni had previously received multiple death threats.

Also killed in the attack were six police bodyguards and seven civilians, Sherzad said.

Taliban spokesman Zabiullah Mujahid claimed in a text message to journalists that an insurgent operative carried out the targeted bombing.

"Today at 11 a.m. in front of the Baghlan provincial council office, we have carried out a suicide attack and killed the head of the council," it said.

Afghan President Hamid Karzai condemned the bombing Monday.

"Such attacks are against all human rights and the principles of Islam," Karzai said in a statement. "Perpetrators of such attacks are enemies of the Afghan nation and the puppets of foreigners."

Karzai left later Monday for a two-day state visit to India, where he is expected to request military aid.

Both Karzai and the U.S. have sought peace talks with the Taliban and other insurgent factions in preparation for most foreign troops leaving next year after more than 12 years of war, but the efforts have borne little fruit. The Taliban seek to re-establish the strict interpretation of Islamic law they imposed for five years before being ousted in the 2001 U.S.-led invasion over its sheltering of al-Qaida's terrorist leadership.

The insurgents last month launched a fierce new spring offensive that has in the past week alone seen the police chief of Farah province gunned down outside his home and twin bombings that killed nine people in an elite gated community for government officials and business owners outside of the southern city of Kandahar. Two bombs also exploded outside the provincial governor's office in Nangarhar province last week, killing one police guard.

Insurgents have also targeted members of the international coalition. A roadside bomb killed four American soldiers last week in the country's south, while another insurgent faction, Hizb-e-Islami, targeted a coalition convoy in the capital of Kabul two days later, killing two U.S. soldiers and four American contractors who were training Afghan troops to take over security.

Source: http://news.yahoo.com/suicide-bomber-kills-14-afghan-province-council-075314027.html

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