Riviste scientifiche

[Perspectives] Ebola: transforming fear into appropriate action

The Lancet - Sa, 15/07/2017 - 00:00
It is interesting that so many of the experts who proffered guidance on outbreak control during the west African Ebola crisis had no previous field experience of Ebola, with some seeming to lack understanding of Ebola epidemiology. They, along with others, seeded and perpetuated fear, with statements that ranged from predicting that this high mortality pathogen could become endemic in humans if not rapidly contained, and declaring the need for a vaccine if the outbreak were to be effectively stopped, through to the prediction that patient numbers would continue to increase exponentially, requiring a huge input of hospital beds and extraordinary measures for burial of those who died.

[Perspectives] Augmenting diagnostic vision with AI

The Lancet - Sa, 15/07/2017 - 00:00
In the span of their professional lives a radiologist will read over 10 million images, a dermatologist will analyse 200 000 skin lesions, and a pathologist will review nearly 100 000 specimens. Now imagine a computer doing this work over days, rather than decades, and learning from and refining its diagnostic acumen with each new image. This is the capability that artificial intelligence (AI) will bring to medical care: the potential to interpret clinical data more accurately and more rapidly than medical specialists.

[Perspectives] Bridges

The Lancet - Sa, 15/07/2017 - 00:00
“Why are you helping me?” he asked. “I'm a doctor”, I replied. I wasn't, technically. I was a medical student, and although I'd finished clinical rotations and matched into surgery, I was not a doctor quite yet. But blood was pouring from the man's face and we were nowhere near a medical facility, so I spoke with the unfounded bravado of a young doctor-to-be.

[Obituary] Osmund Reynolds

The Lancet - Sa, 15/07/2017 - 00:00
Key figure in the foundation of UK neonatology. Born in Brighton, UK, on Feb 3, 1933, he died in London, UK, on April 24, 2017, aged 83 years.

[Correspondence] Response to Offline: Is the NHS in crisis?

The Lancet - Sa, 15/07/2017 - 00:00
The accusation by Richard Horton in The Lancet (May 6, 2017, p 1783)1 that it is “intellectual delusion” to suggest the National Health Service (NHS) is in crisis is surprising considering that this conclusion has been reached by many commentators. Unlike Horton, we are front-line clinicians and see first-hand the human cost of a struggling service, which has been termed a “humanitarian crisis” by the Red Cross,2 and a “burning platform” by Sir Michael Richards of the Care Quality Commission.3

[Correspondence] Crisis in the National Health Service: a call to action

The Lancet - Sa, 15/07/2017 - 00:00
The Lancet's Editor-in-Chief, Richard Horton, criticised National Health Service (NHS) front-liners in his Offline Comment1 (May 6, p 1783) after attending a seminar at the London School of Hygiene & Tropical Medicine. We were disappointed by his interpretation of an “extraordinary inability of health leaders to reflect critically on their own failings, preferring instead to blame others.” 1

[Correspondence] New mercury pollution threats: a global health caution

The Lancet - Sa, 15/07/2017 - 00:00
The Minamata Convention—a global agreement to tackle mercury—will enter into force on Aug 16, 2017, as the required 50th of the 128 signatory countries recently ratified the treaty, marking a long-awaited moment for the advancement of public health. However, while this achievement is celebrated, questions about whether governments are prepared to tackle complex issues surrounding implementation of the Convention remain rife. The Trump Administration has been actively working to revoke a host of environmental and health regulations, including restrictions on mercury discharges from coal-fired power plants, despite legal challenges by civil society groups.

[Correspondence] Crying wolf: the misuse of hospital data

The Lancet - Sa, 15/07/2017 - 00:00
We have received a letter from the Care Quality Commission informing us that our institution, Papworth Hospital, has triggered an Imperial College Dr Foster mortality outlier alert, instigated by an apparent finding of 46 deaths for March, 2015, to February, 2016, compared with the 27·8 expected deaths.

[Correspondence] Intensive speech and language therapy after stroke

The Lancet - Sa, 15/07/2017 - 00:00
Caterina Breitenstein and colleagues (April 15, p 1528)1 reported that 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke. The primary outcome measure was assessed using the Amsterdam-Nijmegen Everyday Language Test (ANELT) A-scale, and the mean difference of the ANELT A-scale score improved 2·61 (SD 4·94) points from baseline to after intensive speech and language therapy, but not from baseline to after treatment deferral.

[Correspondence] Intensive speech and language therapy after stroke – Authors' reply

The Lancet - Sa, 15/07/2017 - 00:00
We thank Ryo Sakamoto and colleagues for their Correspondence regarding our FCET2EC trial on the effectiveness of intensive speech and language therapy in chronic post-stroke aphasia.1 Their point regarding the minimal clinically important difference of the primary outcome measure (Amsterdam-Nijmegen Everyday Language Test [ANELT] A-scale) is of major concern, as already acknowledged in our Article (“To our knowledge, no previously published studies exist on the association of change in ANELT scores with clinical effect.”).

[Correspondence] Science is what we need in the treatment of anxiety disorders

The Lancet - Sa, 15/07/2017 - 00:00
It is very surprising that Michelle Craske and Murray Stein (May 13, p 1883)1 assert that “Given the paucity and quality of studies of PDT [psychodynamic therapy] for anxiety disorders compared with CBT [cognitive behavioural therapy], the weight of the evidence enables us to confidently recommend only CBT at this time for the treatment of anxiety disorders.” In their response, Craske and Stein did not provide any evidence for either the poor or poorer quality of studies of PDT for anxiety, or for superiority of CBT.

[Correspondence] Burnout or depression: both individual and social issue

The Lancet - Sa, 15/07/2017 - 00:00
In view of the profound problems attached to the construct of burnout, we recommended in our Correspondence (April 8, p 1397)1 that occupational health specialists focus on (job-related) depression rather than burnout to help workers more effectively. In a reply to our letter, Ronald Epstein and Michael Privitera (April 8, 1398)2 rejected our recommendation on the grounds that burnout is not a “purely individual syndrome”. The authors further argued that “considering burnout solely as a mental illness of individual workers rather than work-related distress would be disastrous”.

[Department of Error] Department of Error

The Lancet - Sa, 15/07/2017 - 00:00
Avidan MS, Maybrier HR, Abdallah AB, et al. Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Lancet 2017; 390: 267–275—In this Article, the eighth author's name should have read “Hilary P Grocott”. This correction has been made to the online version as of July 13, 2017, and the printed Article is correct.

[Department of Error] Department of Error

The Lancet - Sa, 15/07/2017 - 00:00
Reich K, Papp KA, Blauvelt A, et al. Tildrakizumab versus placebo or etanercept for chronic plaque psoriasis (reSURFACE 1 and reSURFACE 2): results from two randomised controlled, phase 3 trials. Lancet 2017; 390: 276–88– In the findings section in the summary of this Article, the sentence “186 patients (59%) in the 200 mg group, and 168 patients (55%) in the 100 mg group achieved PASI 75, compared with …”, should have read “186 patients (59%) in the 200 mg group, and 168 patients (55%) in the 100 mg group achieved a PGA response, compared with …”.

Leveraging peer-based support to facilitate HIV care in Kenya

PLoS Medicine - Ve, 14/07/2017 - 23:00

by Rakhi Karwa, Mercy Maina, Timothy Mercer, Benson Njuguna, Juddy Wachira, Celia Ngetich, Fatma Some, Beatrice Jakait, Regina K. Owino, Adrian Gardner, Sonak Pastakia

Rakhi Karwa and colleagues discuss a program in which peer navigators support care for people with HIV at a Kenyan hospital.

Asteroids may have been giant mudballs in the early solar system

New Scientist - Ve, 14/07/2017 - 21:00
Asteroids could have started life as sludgy balls of mud instead of tough rocks, which may explain how rocky planets came to be

Galaxy supercluster is one of the biggest things in the universe

New Scientist - Ve, 14/07/2017 - 20:37
The Saraswati supercluster of 400 galaxies could help us understand the physics governing the whole universe

The best way to detect aliens may be by finding their footprints

New Scientist - Ve, 14/07/2017 - 19:14
The first sign of aliens might not be microbes or radio signals but fossilised imprints or excrement left on the solid surfaces of Mars or Titan

Rats can tell when they’ve forgotten something, just like us

New Scientist - Ve, 14/07/2017 - 17:30
Ever walked into a room then realised you can't remember why you're there? Like people, rats know what they know, and can tell when their memory has failed them

Hailing e-Volvos as imminent saviours of the planet is nonsense

New Scientist - Ve, 14/07/2017 - 14:57
High praise was heaped on Volvo when it said it would stop making cars powered only by petrol or diesel. This is no revolution, says Olive Heffernan
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