Difference in breast cancer survival between black and white ...

In an analysis of 5-year survival rates among black and white women diagnosed with breast cancer between 1991 and 2005, black women continued to have a lower rate of survival, with most of the difference related to factors including poorer health of black patients at diagnosis and more advanced disease, rather than treatment differences, according to a study in the July 24/31 issue of JAMA.

"For 20 years health care investigators in the United States have been keenly aware of racial disparities in survival among women with breast cancer. Numerous reports have not only identified and documented worse outcomes in black patients with breast cancer but have suggested potential reasons for the disparities based on differences in screening, presentation, comorbid conditions on presentation, tumor biology, stage, treatment, and socioeconomic status," according to background information in the article.

Jeffrey H. Silber, M.D., Ph.D., of the Children's Hospital of Philadelphia, and colleagues examined the extent of the racial differences in breast cancer survival in the Medicare population and the reasons the disparity exists. The study compared 7,375 black women 65 years and older diagnosed between 1991 to 2005 and 3 sets of 7,375 matched white control patients selected from 99,898 white potential control patients, using data from 16 U.S. Surveillance, Epidemiology and End Results (SEER) sites in the SEER-Medicare database. All patients received follow-up through December 2009 and the black case patients were matched to 3 white control populations on demographics (age, year of diagnosis, and SEER site), presentation (demographics variables plus patient comorbid conditions and tumor characteristics such as stage, size, grade, and estrogen receptor status), and treatment (presentation variables plus details of surgery, radiation therapy, and chemotherapy).

The researchers found that the absolute difference in 5-year survival (blacks, 55.9 percent; whites, 68.8 percent) was 12.9 percent in the demographics match. This difference remained unchanged between 1991 and 2005. After matching on presentation characteristics, the absolute difference in 5-year survival was 4.4 percent and was 3.6 percent lower for blacks than for whites matched also on treatment.

Regarding differences in treatment by race, overall, 12.6 percent of black patients did not have evidence of receiving any treatment for their breast cancer, compared with 5.9 percent of whites. Average time from diagnosis to treatment was longer among blacks than among demographics-matched whites, 29.2 days vs 22.5 days. Blacks were also more likely to have long delays in treatment: 5.8 percent of blacks did not initiate treatment within the first 3 months from diagnosis, compared to 2.5 percent of white patients. Blacks also received breast-conserving surgery without any other treatment more often than presentation-matched whites (8.2 percent vs 7.3 percent). "Nevertheless, differences in survival associated with treatment differences accounted for only 0.81 percent of the 12.9 percent survival difference," the authors write.

There were large differences in the way black and white patients presented. "For the demographics match, blacks had significantly less evidence of at least l primary care visit than matched whites (80.5 percent vs 88.5 percent, respectively); significantly lower rates of breast cancer screening (23.5 percent vs 35.7 percent); and significantly lower rates of colon cancer and cholesterol screening," the authors write.

"Our results suggest that it may be difficult to eliminate the racial disparity in survival from diagnosis unless differences in presentation can be reduced. There is also a disparity in treatment, with blacks receiving treatment inferior to that received by whites with similar presentation, but this explains only a small part of the observed difference in survival. The disparity in treatment might matter more if the disparity in presentation were reduced, because blacks would then be diagnosed with less advanced disease, for which treatment is more effective."

The researchers add that black patients are diagnosed not only with more advanced breast cancers but also with more unrelated comorbid conditions. "Some of the effectiveness of cancer treatment for blacks may be blunted by other health problems. If the differences in comorbid conditions at diagnosis were reduced, it is possible that the differences in cancer treatment would matter more for the differences in survival."

(JAMA. 2013;310(4):389-397; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: This research was funded through a grant from the Agency for Healthcare Research and Quality, Department of Health and Human Services, and by the U.S. National Science Foundation. This study used the linked SEER-Medicare database. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Editorial: Black-White Differences in Breast Cancer Outcomes Among Older Medicare Beneficiaries - Does Systemic Treatment Matter?

Jeanne S. Mandelblatt, M.D., M.P.H., of the Georgetown Lombardi Comprehensive Cancer Center, Washington, D.C., and colleagues comment on the findings of this study in an accompanying editorial.

"The rigorous study by Silber et al provides additional clues to the black-white differences in breast cancer outcomes. Ultimately, for any cancer control strategy to succeed, improved care quality appears to be a necessary, but not sufficient, condition to eliminate race-based mortality differences in the United States."

(JAMA. 2013;310(4):376-377; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

Source: http://www.sciencecodex.com/difference_in_breast_cancer_survival_between_black_and_white_women_has_not_changed_substantially-116252

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Librarian for Western European Humanities - Yale University Library ...

Librarian for Western European Humanities - Yale University Library, New Haven. Position Focus: Reporting to the Head of Humanities Collections and Research Education and working in a collaborative environment, the Librarian for Western European Humanities serves the teaching and research needs of students and faculty studying Western European Humanities including history, languages and literatures. The Librarian also develops collections in all formats for French, German, Italian, Portuguese, and Spanish literature as well as philosophy and Western European history. Serves as professional liaison to the French, German, Italian, Spanish & Portuguese, Philosophy, and History Departments. Plans, promotes, and implements research education programs for undergraduates, graduates, and faculty of those departments. May contribute to general library research education programs, instructional sessions for large undergraduate classes, and the Personal Librarian program sponsored by the Director of Undergraduate Research Education. Provides specialized reference service to patrons. Develops and maintains web research guides and other online research support tools. In collaboration with faculty and key Library staff, may plan and implement digital library projects in support of teaching and research. Develops and manages the Library?s Western European Humanities collections, including selection, organization, preservation and use of information sources originating in or related to Western European countries. Contributes to the formulation of the Library?s major Western European approval plans and monitors the effectiveness of these plans. Leads library projects for collaborative collection development in Western European humanities with Yale?s peer institutions. Serves on library committees, working groups, and task forces, and is expected to be professionally active. May be required to assist in disaster recovery efforts. Principle Responsibilities: The Librarian 1 is the beginning rank and is expected to demonstrate excellence in meeting the position responsibilities, as defined by the job description and annual goals. Begin to fulfill the criteria for service to the library, university, and/or community. Begin to fulfill the criteria for professional contributions. For a complete description of the position and department, please see the department URL. Required Education and Experience: Master?s degree in Library Science from an American Library Association accredited Library school. In selected instances, a post-graduate degree in a related discipline may be required or substituted for an MLS. Appointment to this rank is limited to two years at which time it is expected that the individual will develop necessary requirements to meet expectations of performance at the Librarian 2 level. Required Skills and Abilities: PhD in Western European humanities required. Appointment to the rank of Librarian 2 requires 2 years of relevant professional experience and demonstrated professional accomplishments appropriate to the rank. Appointment to Librarian 3 or 4 requires respectively 5 or 8 years of professional library experience and demonstrated professional accomplishments appropriate to the rank. Excellent reading and speaking knowledge of two Western European languages, preferably French and Italian. A deep understanding of the research process and knowledge of the ways that new technologies are affecting the production of scholarship. Demonstrated commitment to outstanding public service. Excellent oral and written communication skills. Ability to work successfully in a highly collaborative environment. Preferred Education, Experience, and Skills: Master?s degree from an ALA-accredited program for library and information science and/or relevant professional experience as a librarian. Reading knowledge of German. Excellent teaching skills. Applications consisting of a cover letter, resume, and the names and contact information of three professional references should be sent by creating an account and applying online at http://www.yale.edu/jobs for immediate consideration - the STARS req ID for this position is 22017BR. Please be sure to reference #22017BR in your cover letter.

Source: http://ctlibraryjobs.blogspot.com/2013/07/librarian-for-western-european.html

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Know What Your Dog Really Wants With This Pooch-to-People Translator

With an olfactory potency hundreds of times more sensitive than ours, a dog's nose is an invaluable tool in the service of humans. But understanding exactly what your dog's nose is picking up has traditionally been limited to specific yes/no answers, such as airport drug dogs ("do you smell weed on this suitcase, yes or no?"). A new device from the Georgia Institute of Technology, though, aims to drastically expand your dog's vocabulary.

Read more...

Source: http://gizmodo.com/know-what-your-dog-really-wants-with-this-pooch-to-peop-870654352

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Wisconsin Energy's Leverett gets $750k raise

Wisconsin Energy Corp.

Allen Leverett was announced July 19 as president of Wisconsin Energy.

Wisconsin Energy Corp.?s newly named president Allen Leverett has received a pay increase to $750,000 in his annual base salary from the 2012 level of $652,856.

The Milwaukee-based public utility company said the raise was granted by Wisconsin Energy?s board in recognition of his new position, which the company announced July 19.

The company?s board also increased Leverett?s target award under the Wisconsin Energy short-term performance plan to 90 percent of his base salary, the company said in a regulatory filing Monday.

In 2012, Leverett?s total direct compensation was $4.15 million and his total compensation was $5.37 million. Included in his 2012 compensation was a long-term incentive award of $2.2 million and an annual incentive award of $1.29 million.

Leverett, who has served in several top executive positions for Wisconsin Energy since 2003, will become president effective Aug. 1, and Gale Klappa will relinquish that title while remaining chairman and CEO.

Leverett, 46, currently is an executive vice president of Wisconsin Energy and heads the company?s power generation group. Klappa, 62, will continue as chairman of the board and CEO, positions he has held since May 2004. Klappa had held the president?s position since April 2003.

Rich Kirchen is The Business Journal's senior reporter. He covers health care, insurance, politics, media and marketing/advertising.

Source: http://feedproxy.google.com/~r/vertical_29/~3/xcirVdIpbGw/wisconsin-energys-leverett-gets-750k.html

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Refurbished 320GB PS3s for $200 at Sony Store

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Source: contoso --- Sunday, July 21, 2013
If you're unwilling to wade into the calm, inviting waters of the Day 1 console launch pool this year, the Sony Store is offering refurbished 320 GB PS3 Slims for $200. ...

Source: http://n4g.com/news/1315383/refurbished-320gb-ps3s-for-200-at-sony-store

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Who will care for an aging generation in Florida?

When Mary Sterling faces an obstacle, she remembers her mother's credo: You come from a long line of strong, independent women.

Now that Sterling is in her 80s, that advice resonates more than ever, especially when it concerns her health. She still lives in her own apartment and is able to drive. But being strong and independent doesn't mean the same thing as when she was in her 40s.

"I think we so-called living longer people have a myriad of problems," the Tampa resident said of the unavoidable changes that come with aging. "It takes someone with special experience to take care of us."

About a year ago, Sterling dropped her primary care doctor for a geriatrician, a physician who specializes in treating patients in their golden years. She says that physician listens more and asks more age-relevant questions than other doctors. Treating specific maladies is secondary to making her day-to-day quality of health better, Sterling said.

This sort of approach sounds appealing, but there are just a handful of these specialists in the Tampa area today. And there is little chance the numbers will improve, as many of today's medical schools, including the one at the University of South Florida, don't encourage students to focus on the nuances of treating a community's oldest members.

In 2007, the American Association of Medical Schools created minimum geriatric competency guidelines for all of the nearly 150 accredited medical schools in the United States and Canada. But how and what is taught to future physicians is inconsistent, especially in Florida, home to the nation's biggest percentage of residents age 65 and older.

Florida, like the rest of the nation, may never have enough trained geriatric specialists. But limited exposure to geriatrics risks creating another generation of primary care doctors who are ill-prepared to care for the state's increasingly older, longer-living population, said Ken Brammel-Smith, director of Florida State University's geriatric department.

"Just because (a physician) can take care of adults doesn't mean they can take care of the oldest adults," he said.

FSU's College of Medicine, founded in 2000 with an emphasis on geriatrics, is the only one of the state's six public medical schools that requires academic and clinical geriatric training in all four years of medical school.

Three schools, including USF, incorporate geriatrics into a single course or short clerkship that can last anywhere from a single afternoon to a month.

And two schools have no specific classes focused on elder medical care, but say they teach geriatrics in classes such as anatomy or health care policy.

"You're right. We can do more," said Stephen Klasko, dean of the USF College of Medicine.

Part of the problem stems from the relative youth of the geriatric field itself. It wasn't until the late 1970s and '80s that the medical community started to think of the diagnoses and treatments of conditions related to old age as its own branch of medicine.

Geriatrics, by definition, is a sub-specialty for doctors practicing family medicine or internal medicine. But these primary care physicians take more than medical diagnoses under consideration, said Laurence Solberg, chief of geriatric medicine at the University of Florida College of Medicine.

For example, a 40-something patient may not need to leave the exam table for a doctor to assess health concerns. But geriatricians will watch a patient stand and walk to assess critical functional issues such as balance and strength of sensory muscles. And understanding a patient's ability to complete daily functions - say, getting dressed or cooking - is as important as knowing the chemical risks of prescription drugs.

"Those kind of clues are always key to the geriatrician," said Solberg, whose program at UF requires fourth-year students to spend a month practicing geriatric medicine. "Is this person going to be at greater risk for a fall? Get in there and talk to the patient. You can synthesize the keys."

Traditional medical schools are slow to adapt curriculum to newer ideas, despite the rapid aging of the nation's population, said Elizabeth Bragg, a geriatric education expert and associate professor at the University of Cincinnati College of Nursing.

It doesn't help that geriatrics is unpopular among 20-something medical students, she said. Salaries are low and there's no glamour in treating elderly men and women with multiple, chronic and sometimes incurable illnesses such as dementia, osteoporosis and cardiovascular disease.

"There has to be a critical mass of interest to get programs to change," she said.

Michelle Estevez, the lone staff geriatrician at USF's medical school, lectures every year to the college's third-year medical students, hoping to spark their interest in people like her patient Mary Sterling.

"They like me because I have energy and I'm young, but I don't think any of them want to think about going into geriatrics," Estevez said.

It's an uphill battle in a program that requires only a short-term clinical geriatric clerkship for internal medicine students, she said. Next fall, the 35-year-old will have her lecture time shortened to just one four-hour session in which to change minds.

"Why, when you are in your 20s, would you want to deal with (what you imagine are) a bunch of 80-year-olds with diapers and dementia," she said of her patients, who on average are in their 80s. "But I love my patients. They are fantastic human beings."

Some geriatric medicine advocates say focusing on undergraduate medical training is the only way to serve an aging population in Florida and elsewhere. Specialists can't meet the demand of nearly 3.3 million seniors in Florida.

USF's Estevez is among just 424 certified geriatric specialists practicing in Florida today, and one of 7,500 nationwide, American Geriatric Society data show. That certification requires doctors spend an additional year in a geriatrics fellowship after completing a three-year medical residency.

You're going to school longer, but you're making less than colleagues in sub-specialties such as cardiology, Bragg said.

Only 144 geriatric fellows are practicing in the United States this year, and only four are in Florida, the Accreditation Council for Graduate Medical Education reports.

USF, which discontinued its geriatric fellowship several years ago, is looking long-term at geriatric medical training, said Klasko, the medical school dean and chief executive officer of USF Health.

He would rather focus on long-term projects, such as USF Health's primary care practice in The Villages senior community in Central Florida. In mid-June, USF Health announced that a $3.6 million gift will create a post-residency geriatric fellowship program there.

The new Villages fellowship, which is being developed, will eventually lead to more concrete training for medical students in Tampa, Klasko said. Lessons learned in the primary care practices at The Villages can identify better ways to care for older patients, he said.

"It will create an optimum environment for geriatrics," said Klasko, who will leave USF this summer to lead Thomas Jefferson University in Philadelphia. "It will lead to more geriatric classes."

In the meantime, Estevez said, she'll continue to cheer on any and all medical students who are the least bit curious about treating society's oldest citizens. And she will keep searching for that balance between treating her elderly patients' illnesses and helping them enjoy life the best they can.

"Every day, I make a couple of lives better," she said. "That's pretty good."

mshedden@tampatrib.com

(813) 259-7365

Twitter: @MaryShedden

Source: http://feedproxy.google.com/~r/tbo/news/~3/vUH3-1EHxVA/

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Japan's Abe to Push Ahead with Reforms

Japanese Prime Minister Shinzo Abe has pledged to push ahead with painful reforms labeled, "Abenomics," to pull Japan out of two decades of an ailing economy and political gridlock.

Speaking to a news conference Monday, a day after winning a sweeping victory in parliamentary elections, Abe said what the people really want across the country is for the economy to recover.

Abe told reporters that Japan faces a slew of difficult problems, but those issues must be tackled for the sake of the country.

The Japanese leader's Liberal Democratic Party and its smaller partner, the New Komeito party, ended years of opposition control of the upper house by gaining 76 of the 121 seats contested Sunday. The coalition now has 135 seats in the 242 seat house, giving the parties a mandate in both houses.

Source: http://www.voanews.com/content/japans-abe-to-push-ahead-with-reforms/1706437.html

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