The importance of the patient voice in vaccination and vaccine safety-are we listening?

Much has been written about the patient-physician relationship over the years. This relationship is essential in maintaining trust in the complex arena of modern diagnostic techniques, treatment and prevention, including vaccines and vaccine safety. However, a great deal of this material was written from the viewpoint of clinicians and academics. The patient voice may be positive or negative, fragmented or complex. Information sources are weighed and treated differently, according to the value system and risk perceptions of the individual. In post-trust societies, when people have less confidence in health authorities, communication needs to be more than a paternalistic top-down process. Notions of empowerment and individual patient choice are becoming crucial in medical care. The 'voice of the patient', which includes healthy individuals receiving vaccines, needs to be heard, considered and addressed. With respect to childhood immunizations, this will be the voice of the parent or caregiver. The key to addressing any concerns could be to listen more and to develop a communication style that is trust-based and science-informed. Regulatory agencies are encouraging clinical and patient-reported outcomes research under the umbrella of personalized medicine, and this is an important step forward. This paper attempts to reflect the paradigm shift towards increasing attention to the patient voice in vaccination and vaccine safety.

Epigenetics in ovarian cancer.

Ovarian cancer is the most lethal gynecological cancer. Due to few early symptoms and a lack of early detection strategies, most patients are diagnosed with advanced-stage disease. Most of these patients, although initially responsive, eventually develop drug resistance. In this chapter, epigenetic changes in ovarian cancer are described. Various epigenetic changes including CpG island methylation and histone modification have been identified in ovarian cancer. These aberrations are associated with distinct disease subtypes and present in circulating serum of ovarian cancer patients. Several epigenetic changes have shown promise for their diagnostic, prognostic, and predictive capacity but still need further validation.In contrast to DNA mutations and deletions, epigenetic modifications are potentially reversible by epigenetic therapies. Promising preclinical studies show epigenetic drugs to enhance gene re-expression and drug sensitivity in ovarian cancer cell lines and animal models.

Earthquakes as beacons of stress change

Aftershocks occurring on faults in the far-field of a large earthquake rupture can generally be accounted for by changes in static stress on these faults caused by the rupture. This implies that faults interact, and that the timing of an earthquake can be affected by previous nearby ruptures. Here we explore the potential of small earthquakes to act as 'beacons' for the mechanical state of the crust. We investigate the static-stress changes resulting from the 1992 Landers earthquake in southern California which occurred in an area of high seismic activity stemming from many faults. We first gauge the response of the regional seismicity to the Landers event with a new technique, and then apply the same method to the inverse problem of determining the slip distribution on the main rupture from the seismicity. Assuming justifiable parameters, we derive credible matches to slip profiles obtained directly from the Landers mainshock. Our results provide a way to monitor mechanical conditions in the upper crust, and to investigate processes leading to fault failure.