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Research Roundup
January 19, 2010, Volume 56, No. 18

Cooperation Is Key to Reducing Greenhouse Gases

A study by researchers at the University of Pennsylvania and University of Delaware shows that cooperation between local and regional governments and organizations is crucial to achieve carbon-reduction goals being negotiated in the Copenhagen Conference of the Parties, or COP15, summit.

The findings are presented in a new position paper presented at the summit, “An Urban Agenda for the New Climate,” from Penn’s T.C. Chan Center for Building Simulation and Energy Studies and the University of Delaware’s Center for Energy and Environmental Policy (CEEP).

“City and regional strategies will continue to commit to and achieve quantitative carbon reductions that surpass those adopted by the COP process because of the ‘bottom-up’ governance that settlements and their civil societies produce,” John Byrne of CEEP said. “The ‘top-down’ must support these efforts.”

Cities use 75% of global fossil-fuel production, and the buildings and transportation that constitute key infrastructures of cities account for 60% of the investment needed to limit global temperature rise to 2 C°.

“Technology exists that can guide policymakers in the regulation of all aspects of sustainable settlements and can guide investments in energy efficiency that maximize and accelerate the transition to low- and no-carbon-built environments,” said Ali Malkawi of Penn’s School of Design.

The researchers say reducing greenhouse gases will need cooperation from local governments and organizations where crucial energy and environmental decisions actually occur.

“The ‘gazelles’ among metropolitan settlements demonstrate a path forward that recognizes the need to re-align decision-making authority and resources in terms of regional ‘energysheds’ that will optimize a low-carbon transition,” said Mark Alan Hughes of Penn’s School of Design, which houses the T.C. Chan Center.

Technology Not as Isolating

People who use modern information and communication technologies have larger and more diverse social networks than previously thought, according to a national survey findings that for the first time explore how people use the Internet and mobile phones to interact with key family and friends.

These new findings challenge fears that use of new technologies has contributed to a long-term increase in social isolation in the United States.

The findings from a joint study by the Annenberg School for Communication and the Pew Internet & American Life Project show that, on average, the size of people’s discussion networks—those with whom people discuss important matters—is 12% larger amongst mobile phone users, 9% larger for those who share photos online, and 9% bigger for those who use instant messaging. The diversity of people’s core networks—their closest and most significant confidants—tends to be 25% larger for mobile phone users, 15% larger for basic Internet users, and even larger for frequent Internet users, those who use instant messaging, and those who share digital photos online.

The survey was conducted by researchers led by Keith N. Hampton, assistant professor of communication and the Pew Internet Project.

Hospital Checklists Need Improvement

A team of sociologists and health-care researchers is calling for greater understanding of how hospital and medical checklists can be used to improve patient safety. Furthermore, say the authors of a commentary in the journal The Lancet, widespread deployment of medical checklists without an appreciation of how or why they work is a potential threat to patient safety and to high-quality care.

“The big challenge is how to get staff to use checklists consistently,” said co-author Charles Bosk, professor of sociology in the School of Arts and Sciences at Penn and senior fellow in Penn’s Center for Bioethics. “They’re not a magic pill. A checklist isn’t something a hospital can swallow and expect care to get better, safer or cheaper.”

The mistake most commonly made when introducing checklists is to assume that a checklist can solve a cultural problem. It is a mistake, the authors contend, to think that you can get workers to use checklists just by insisting on it. A widely cited study that thrust medical checklists into favor involved using a five-step checklist to minimize the risk of patients getting catheter-related bloodstream infections. When the program was implemented in 103 intensive care units in Michigan for 18 months, infection rates dropped by 66%, resulting in estimated savings of $200 million and 2,000 lives. The program was implemented in many countries.

The authors say that the popular study fails to prove the efficacy of medical checklists as much as it shows the need to create incentives for people to cooperate. This includes using audit and feedback to create reputational and social incentives and having advocates within the organization who act as champions.

“The science of checklist implementation is in its infancy and needs much more attention,” said Mary Dixon-Woods, at the University of Leicester.

In the article, Dr. Bosk points out that simply having checklists in a hospital does not stop errors from occurring. He recounts the example of a 17-year-old girl who died in 2003 when she was given an organ transplant with a mismatched blood type.

“That error happened even though there were checklists for checking blood type,” he said.

The article also indicates that checklists work well for some types of problems in health care but not others. For example, aviation checklists help pilots complete take-off and landing safely. It’s less well known that checklists are also used for baggage handling, too, and there they don’t work so well.

“Reality checklist for checklists,” is authored by Charles Bosk, Mary Dixon-Woods; and Peter Pronovost and Christine Goeschel of Johns Hopkins.

Weight Loss Partners Help African-Americans Lose More

Enrolling in a weight loss program with a family member or friend appears to enhance weight loss among African-Americans, but only if the involved partner attends sessions frequently or also loses weight, according to a report in the October 26 issue of Archives of Internal Medicine.

Obesity and its cardiovascular complications affect many African-Americans, according to background information in the article. Standard behavioral treatments for obesity appear to be less successful in African-Americans than in whites. Cultural modifications to these standard programs—such as the inclusion of family members and support networks-may enhance their effectiveness.

Dr. Shiriki K. Kumanyika, professor of epidemiology at Penn’s School of Medicine; Dr. Tom Wadden, professor of psychology in psychiatry in the School of Medicine and director of the Center for Weight and Eating Disorders, and colleagues, conducted a two-year trial of a culturally specific weight loss program among 344 African-American men and women. The goal was to achieve and maintain a 5% to 10% weight loss. Components of the program included counseling that encouraged self-monitoring of food intake and physical activity, distribution of pedometers, group sessions involving weight and activity checks and skill building, and community-based field workshops such as cooking demonstrations and gym visits.

Antidepressants Work Best for Severe Depression

A study of 30 years of antidepressant-drug treatment data published in the Journal of the American Medical Association shows that the benefit of antidepressant medication compared with placebo may be minimal or nonexistent in patients with mild or moderate symptoms. Penn researchers say, however, the benefit of medications is substantial for patients with very severe depression.

The team, led by psychologists at Penn, collected data from placebo-controlled trials of antidepressants approved by the US Food and Drug Administration for the treatment of Major or Minor Depressive Disorder. Studies comprised adult outpatients and included a medication vs. placebo comparison for at least six weeks. Researchers calculated depression severity scores before and after treatment using the standard Hamilton Rating Scale for Depression.

The scientists learned that medication vs. placebo differences varied substantially, relative to the severity of depression suffered by patients. Those patients shown to have less severe depression experienced little to no greater improvement in their symptoms from antidepressant medication as compared to a placebo sugar pill.

“Antidepressant medications represent the best established treatment for Major Depressive Disorder, but there is little evidence that they have a specific pharmacological effect relative to pill-placebo for patients with less severe depression,” said Dr. Robert DeRubeis, principal investigator and professor in the department of psychology in the School of Arts and Sciences.

Researchers concluded that the ability of antidepressant medications to reduce depressive symptoms varied considerably. For people whose depression was considered to be mild, moderate or even severe, little evidence showed that the medications yield specific benefit beyond what is provided by engagement in treatment and the resulting boost in the patient’s expectation for improvement.

“For very severe depressions, the benefits of medications are clear and substantial,” said Jay Fournier, lead author and a doctoral candidate in Penn’s department of psychology. “But for others, the results of this study demonstrate how important it is for persons who are suffering from depression to take an active role in their care, regardless of the severity of their symptoms. Even placebo treatments help most people, and, although we do not fully understand how placebos work, part of the benefit comes from patients taking their depressive symptoms seriously and acting on their concern about their own mental health.”

Almanac - January 19, 2010, Volume 56, No. 18