Nodal marginal zone lymphoma resembles what is seen in either the splenic type or MALT lymphoma when it metastasises to lymph nodes, but without the extranodal disease. It is sometimes known as Monocytoid B-cell lymphoma. It comprises less than 2% of B cell lymphomas. Although the median age of presentation is about 60, it can occur in children. In about 20-25% of cases, Hepatitis C can be detected. It affects peripheral lymph nodes and very rarely bone marrow and peripheral blood.
The tumor usually surrounds a reactive follicle and expands into the interfollicular areas. The tumor cells are heterogeneous and are made up of the same sorts of cells seen in MALT lymphomas. The immunophenotype is non-specific and the only common chromosomal abnormalities are trisomies of 3, 7 and 18. The extranodal type translocations are not seen.
The tumor is usually indolent though transformation to a large B-cell lymphoma may occur.
A pediatric form is described. It occurs predominantly in boys (9:1), mainly in head and neck lymph nodes. This tumor is still very indolent and does not require aggressive systemic chemotherapy
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ReplyDeleteCan nurse wage regulation be deadly?
Study links regulated wages for nurses with increased deaths in UK hospitals
A study forthcoming in the Journal of Political Economy suggests that government regulation of nurses' pay leads to higher death rates in U.K. hospitals.
The U.K.'s National Health Service (NHS), which is responsible for most of the nation's health care, sets wages for nurses and other health professionals on a national scale. These regulated wages are essentially flat throughout the country, despite the fact that wages for private sector jobs vary widely from region to region. The study finds that in places where private sector wages are higher, death rates for heart attack victims admitted to emergency departments are higher.
The finding suggests that in places where private sector pay is better, it is difficult for NHS hospitals "to attract and retain skilled workers and this will lead to lower quality service," write the study's authors, Carol Propper of the University of Bristol and John Van Reenen of the Centre for Economic Performance at the London School of Economics.
On average, a 10 percent increase in the private sector wages is associated with a 7 percent increase in heart attack death rates, the study found. Heart attack death rates are a common measure of hospital quality.
The research suggests that the most skilled nurses in high-wage areas flee the NHS hospitals to work in health sectors where wages are not regulated, such as nursing homes. Productivity levels in nursing homes are significantly better in areas where private sector wages are higher, the study found.
The researchers used data from 1997 to 2006 on the population of 209 short term general hospitals across England.
"Publicly run healthcare markets would be wise to relax the regulatory systems and allow local wages to reflect local conditions as they do in the private sector," the researchers conclude. "According to our analysis such deregulation would lead to higher quality public services and fewer deaths."
"As the U.S. government becomes more involved in healthcare, this is a lesson worth heeding," Van Reenen said.
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I agree. There are parts of the UK where people don't want to work. We already have a health premium in Scotland. If you want to attract good people to unattractive areas you have to pay them more.
ReplyDeleteThis is why we don't need to pay our MPs more. There is no shortage of applicants.