bluuebunny/crossref_metadata_2025 huggingface dataset:
Guidelines for diagnosis, prevention and treatment of hand eczema – short version
Authors: Diepgen Thomas L , Andersen Klaus E , Chosidow Oliver , Coenraads Peter Jan , Elsner Peter , English John , Fartasch Manigé , Gimenez‐Arnau Ana , Nixon Rosemary , Sasseville Denis , Agner Tove
Published: January 2015

The guidelines aim to provide advice on the management of hand eczema (HE), using an evidence‐ and consensus‐based approach. The guidelines consider a systematic Cochrane review on interventions for HE, which is based on a systematic search of the published literature (including hand‐searching). In addition to the evidence‐ and consensus‐based recommendation on the treatment of HE, the guidelines cover mainly consensus‐based diagnostic aspects and preventive measures (primary and secondary prevention). Treatment recommendations include non‐pharmacological interventions, topical, physical and systemic treatments. Topical corticosteroids are recommended as first line treatment in the management of HE, however continuous long‐term treatment beyond six weeks only when necessary and under careful medical supervision. Alitretinoin is recommended as a second line treatment (relative to topical corticosteroids) for patients with severe chronic HE. Randomized control trials (RCT) are missing for other used systemic treatments and comparison of systemic drugs in “head‐to‐head” RCTs are needed.

The guidelines development group is a working group of the European Society of Contact Dermatitis (ESCD) and has carefully tried to reconcile opposite views, define current optimal practice and provide specific recommendations, and meetings have been chaired by a professional moderator of the AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; Association of the Scientific Medical Societies in Germany).

No financial support was given by any medical company. The guidelines are expected to be valid until December 2017 at the latest.
Photoallergy
Authors: Wilm Anna , Berneburg Mark
Published: January 2015

Many – topically applied or systemically administered – substances may trigger photoallergic skin reactions following exposure to ultraviolet (UV) radiation. While most cases represent photoallergic contact dermatitis due to topically applied agents, systemically triggered photoallergy is considerably less common. The photopatch test – a UV‐exposed variant of the conventional patch test – is the mainstay in the diagnosis of photoallergic or phototoxic reactions.
ENVIRONMENTAL POLICY AND VEHICLE SAFETY: THE IMPACT OF GASOLINE TAXES
Authors: Sheehan‐Connor Damien
Published: January 2015

Policies to reduce carbon emissions by vehicles, such as fuel economy standards and gasoline taxes, have impacts on vehicle weight and thus on safety. This paper develops a model that separately identifies the impact of vehicle weight on mortality and selection effects that impact accident propensity. The main results are that (1) the safety externalities associated with heavy vehicles are greater than the environmental ones; (2) under fuel economy standards, vehicle weights have recently decreased with little likely effect on accident deaths; and (3) similar environmental benefits could be combined with substantial reductions in deaths by implementing higher gasoline taxes. (JEL H23, D62)
Characterization of Pyrofomes demidoffii from Ethiopian Afromontane forests
Authors: Assefa A. , Abate D. , Stenlid J.
Published: January 2015

Pyrofomes demidoffii is a basidiomycetous fungus that causes a white heart rot in living junipers (Juniperus spp.). Morphological characters and genetic variation in species of Pyrofomes were investigated for specimens from Ethiopia, Tanzania, Macedonia, USA and Costa Rica. In addition, the behaviour of isolates from Ethiopia was studied in vitro. The Ethiopian specimens had relatively larger basidiospores than collections from other countries and showed a high sequence similarity in the ITS region of rDNA sequences with most of strains evaluated in this study (95–100%), but only 89–92% with P. demidoffii from the USA. Phylogenetic analysis of ITS‐5.8S rDNA sequences resulted in two well‐supported (99–100% bootstrap value), separate clades of P. demidoffii. Deeper branches were less well supported (bootstrap < 90%), but the two geographically and phylogenetically separated clades within P. demidoffii may still represent sister groups. For Ethiopian strains, the temperature optimum was between 20 and 25 °C and the pH optimum was around 5.0. A phylogenetic study with additional genetic markers and with a more representative collection of samples is needed.
Cognitive motor interference for gait and balance in stroke: a systematic review and meta‐analysis
Authors: Wang X.‐Q. , Pi Y.‐L. , Chen B.‐L , Chen P.‐J. , Liu Y. , Wang R. , Li X. , Waddington G.
Published: January 2015

Background and purpose

An increasing interest in the potential benefits of cognitive motor interference (CMI) for stroke has recently been observed, but the efficacy of CMI for gait and balance is controversial. A systematic review and meta‐analysis of randomized controlled trials was performed to estimate the effect of CMI on gait and balance in patients with stroke.

Methods

Articles in Medline, EMBASE, the Cochrane Library, Web of Science, CINAHL, PEDro and the China Biology Medicine disc were searched from 1970 to July 2014. Only randomized controlled trials examining the effects of CMI for patients with stroke were included, and no language restrictions were applied. Main outcome measures included gait and balance function.

Results

A total of 15 studies composed of 395 participants met the inclusion criteria, and 13 studies of 363 participants were used as data sources for the meta‐analysis. Pooling revealed that CMI was superior to the control group for gait speed [mean difference (MD) 0.19 m/s, 95% confidence interval (CI) (0.06, 0.31), P = 0.003], stride length [MD 12.53 cm, 95% CI (4.07, 20.99), P = 0.004], cadence [MD 10.44 steps/min, 95% CI (4.17, 16.71), P = 0.001], centre of pressure sway area [MD −1.05, 95% CI (−1.85, −0.26), P = 0.01] and Berg balance scale [MD 2.87, 95% CI (0.54, 5.21), P = 0.02] in the short term.

Conclusion

Cognitive motor interference is effective for improving gait and balance function for stroke in the short term. However, only little evidence supports assumptions regarding CMI's long‐term benefits.
Anticipated climate and land‐cover changes reveal refuge areas for Borneo's orang‐utans
Authors: Struebig Matthew J. , Fischer Manuela , Gaveau David L. A. , Meijaard Erik , Wich Serge A. , Gonner Catherine , Sykes Rachel , Wilting Andreas , Kramer‐Schadt Stephanie
Published: January 2015

Habitat loss and climate change pose a double jeopardy for many threatened taxa, making the identification of optimal habitat for the future a conservation priority. Using a case study of the endangered Bornean orang‐utan, we identify environmental refuges by integrating bioclimatic models with projected deforestation and oil‐palm agriculture suitability from the 1950s to 2080s. We coupled a maximum entropy algorithm with information on habitat needs to predict suitable habitat for the present day and 1950s. We then projected to the 2020s, 2050s and 2080s in models incorporating only land‐cover change, climate change or both processes combined. For future climate, we incorporated projections from four model and emission scenario combinations. For future land cover, we developed spatial deforestation predictions from 10 years of satellite data. Refuges were delineated as suitable forested habitats identified by all models that were also unsuitable for oil palm – a major threat to tropical biodiversity. Our analyses indicate that in 2010 up to 260 000 km2 of Borneo was suitable habitat within the core orang‐utan range; an 18–24% reduction since the 1950s. Land‐cover models predicted further decline of 15–30% by the 2080s. Although habitat extent under future climate conditions varied among projections, there was majority consensus, particularly in north‐eastern and western regions. Across projections habitat loss due to climate change alone averaged 63% by 2080, but 74% when also considering land‐cover change. Refuge areas amounted to 2000–42 000 km2 depending on thresholds used, with 900–17 000 km2 outside the current species range. We demonstrate that efforts to halt deforestation could mediate some orang‐utan habitat loss, but further decline of the most suitable areas is to be expected given projected changes to climate. Protected refuge areas could therefore become increasingly important for ongoing translocation efforts. We present an approach to help identify such areas for highly threatened species given environmental changes expected this century.
Influence of gravity upon some facial signs
Authors: Flament F. , Bazin R. , Piot B.
Published: January 2015

Objectives

Facial clinical signs and their integration are the basis of perception than others could have from ourselves, noticeably the age they imagine we are. Facial modifications in motion and their objective measurements before and after application of skin regimen are essential to go further in evaluation capacities to describe efficacy in facial dynamics. Quantification of facial modifications vis à vis gravity will allow us to answer about ‘control’ of facial shape in daily activities.

Methods

Standardized photographs of the faces of 30 Caucasian female subjects of various ages (24–73 year) were successively taken at upright and supine positions within a short time interval. All these pictures were therefore reframed – any bias due to facial features was avoided when evaluating one single sign – for clinical quotation by trained experts of several facial signs regarding published standardized photographic scales.

Results

For all subjects, the supine position increased facial width but not height, giving a more fuller appearance to the face. More importantly, the supine position changed the severity of facial ageing features (e.g. wrinkles) compared to an upright position and whether these features were attenuated or exacerbated depended on their facial location. Supine station mostly modifies signs of the lower half of the face whereas those of the upper half appear unchanged or slightly accentuated. These changes appear much more marked in the older groups, where some deep labial folds almost vanish. These alterations decreased the perceived ages of the subjects by an average of 3.8 years.

Conclusion

Although preliminary, this study suggests that a 90° rotation of the facial skin vis à vis gravity induces rapid rearrangements among which changes in tensional forces within and across the face, motility of interstitial free water among underlying skin tissue and/or alterations of facial Langer lines, likely play a significant role.
4‐Methylbenzylidene camphor microspheres: reconstituted epidermis (Skinethic®) permeation and distribution
Authors: Monti D. , Chetoni P. , Burgalassi S. , Tampucci S. , Centini M. , Anselmi C.
Published: January 2015

Synopsis

Objective

The UV filter 3(4‐methylbenzylidene) camphor (4‐MBC) is a common ingredient in sunscreen cosmetic products. However, different ‘in vitro’ and ‘in vivo’ studies suggest that 4‐MBC can cause endocrine disrupting effects. Therefore, there is a need for new systems able to minimize the skin penetration of this UV filter. The aim of this study was to evaluate cutaneous permeation and distribution, through and into EPISKIN reconstituted epidermis (RE) from an O/W emulsion containing 4‐MBC free or encapsulated in polymeric substantive microspheres.

Methods

Microspheres containing 4‐MBC were prepared using the emulsification‐solvent evaporation method and characterized for shape and surface morphology and encapsulation efficiency. O/A emulsions containing sunscreen free or encapsulated in microspheres were undergone to permeation tests through RE using vertical diffusion cells. At the end of the in vitro permeation experiments, the skin was subjected to tape stripping procedure to separate stratum corneum from viable epidermis. Each part was properly treated to extract the sunscreen retained and subject to quantitative analysis.

Results

The encapsulation of the sunscreen in the microspheres remarkably reduced the permeation of 4‐MBC and increased its retention on the skin surface where its action is more desirable.

Conclusions

The results of this study confirm the validity of substantive microspheres as an ideal formulation candidate to use in sunscreen preparation as they appear minimizing its systemic uptake and the potential associate toxicological risks. Therefore, more of the active sunscreen remains on the surface of the skin where it is intended to act and a higher activity it will explicate.
Audit Committee Characteristics and Accounting Conservatism
Authors: Sultana Nigar
Published: January 2015

This study examines the association between four pivotal audit committee characteristics and accounting conservatism. Using a sample of 7,668 Australian firm‐year observations from 2004 to 2012, a positive association is found between accounting conservatism and: (a) a director with financial expertise on the audit committee; (b) an experienced director on the audit committee; and (c) frequency of audit committee meetings. Within an agency theoretical framework, results suggest that audit committees act as effective monitoring mechanisms in restricting management's opportunistic behaviour and overstatement of earnings. Results also suggest that regulators (and other stakeholders) should pay greater attention to the financial expertise, experience of members and meeting frequency of the audit committee when judging the committee's value.
Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients
Authors: Burt M. G. , Drake S. M. , Aguilar‐Loza N. R. , Esterman A. , Stranks S. N. , Roberts G. W.
Published: January 2015

Background/Aim

Few studies have specifically investigated treatment of prednisolone‐induced hyperglycaemia.

Aim

To determine if a basal bolus insulin (BBI) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease.

Methods

In a cross‐sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty‐four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level.

Results

There were no significant differences in glycosylated haemoglobin (8.1 ± 1.0 vs 8.1 ± 1.6%, P = 0.88), age (77 ± 11 vs 75 ± 14 years, P = 0.57), male sex (63 vs 60%, P = 0.81) or body mass index (30.0 ± 5.3 vs 30.2 ± 11.5 kg/m2, P = 0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2 ± 0.3 vs 10.0 ± 0.1 mmol/L, P < 0.001). Blood glucose level was higher in patients on prednisolone at 1700 h (14.6 ± 0.6 vs 10.3 ± 0.3 mmol/L, P < 0.001) and 2100 h (14.5 ± 0.6 vs 10.5 ± 0.3 mmol/L, P < 0.001), with no significant differences at 0700 h and 1200 h. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67–0.70 vs 0.61–0.65 U/kg, P = 0.001) because of higher doses of ultra‐rapid‐acting insulin at 1200 h and 1700 h.

Conclusions

Hospitalised patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone‐induced hyperglycaemia are needed that recommend more insulin during this time period.
Investigations on Radiation Tolerance of Mn+1AXn Phases: Study of Ti3SiC2, Ti3AlC2, Cr2AlC, Cr2GeC, Ti2AlC, and Ti2AlN
Authors: Xiao Jingren , Yang Tengfei , Wang Chenxu , Xue Jianming , Wang Yugang
Published: January 2015

Nanolaminated Mn+1AXn phases as candidate materials for next generation nuclear reactor applications show great potential in tolerating radiation damage. However, different Mn+1AXn materials behave very differently when exposed to energetic neutron and ion irradiations. Based on first‐principle calculations, the radiation tolerance of two M3AX2 and four M2AX phases were studied in this work, covering all the Mn+1AXn phases previously investigated with experiments. We have calculated the formation energies of Frenkel pairs and antisite pairs in these materials. The improved radiation tolerance from Ti3AlC2 to Ti2AlC observed by experiments can be understood in terms of different Al/TiC layer ratio as the A atomic plane in the nanolaminated crystal Mn+1AXn accommodates radiation‐induced point defects. The formation of MA–AM antisite pair in Mn+1AXn materials would provide an alternative way to accommodate the defects resulted from radiation damage cascades, whereas this ideal substitution channel does not exist for Cr2GeC due to its pronouncedly higher MA–AM antisite pair formation energy. To further elucidate their radiation damage tolerance mechanism, we have made a detailed analysis on their interatomic M–X, M–A, and X–A bonding characters. Criteria based on the bonding analysis are proposed to assess the radiation tolerance of the six Mn+1AXn materials, which can be further applied to explore other Mn+1AXn phases with respect to their performances under radiation environment.
Lower vegetable protein intake and higher dietary acid load associated with lower carbohydrate intake are risk factors for metabolic syndrome in patients with type 2 diabetes: Post‐hoc analysis of a cross‐sectional study
Authors: Iwase Hiroya , Tanaka Muhei , Kobayashi Yukiko , Wada Sayori , Kuwahata Masashi , Kido Yasuhiro , Hamaguchi Masahide , Asano Mai , Yamazaki Masahiro , Hasegawa Goji , Nakamura Naoto , Fukui Michiaki
Published: January 2015

Aims/Introduction

A low‐carbohydrate diet based on animal sources is associated with higher all‐cause mortality, whereas a vegetable‐based low‐carbohydrate diet is associated with lower cardiovascular disease mortality. It has been suggested that acid/base imbalance might play an important role in some cardiometabolic abnormalities. The aims of the present study were to evaluate whether carbohydrate intake is associated with quality of dietary protein and acid load, and whether these are related to metabolic syndrome in patients with type 2 diabetes.

Materials and Methods

The present cross‐sectional study involved 149 patients with type 2 diabetes. Dietary intake was assessed using a validated self‐administered diet history questionnaire. Dietary acid load was assessed by potential renal acid load and net endogenous acid production.

Results

Mean daily total energy intake, carbohydrate intake, animal protein intake and vegetable protein intake were 1821.5 kcal, 248.8 g, 36.1 g and 31.1 g, respectively. Carbohydrate energy/total energy was negatively correlated with animal protein energy/total energy, potential renal acid load or net endogenous acid production score, and was positively correlated with vegetable protein energy/total energy. Logistic regression analyses showed that the subgroup of patients with a lower vegetable protein energy/total energy or higher potential renal acid load or net endogenous acid production score was significantly associated with the prevalence of metabolic syndrome.

Conclusions

The present study showed that carbohydrate intake was associated with the quality of dietary protein and dietary acid load. Furthermore, decreased vegetable protein intake and increased dietary acid load were associated with the prevalence of metabolic syndrome.
New mechanisms of metformin action: Focusing on mitochondria and the gut
Authors: Hur Kyu Yeon , Lee Myung‐Shik
Published: January 2015

The most well‐known mechanism of metformin action, one of the most commonly prescribed antidiabetic drugs, is adenosine monophosphate‐activated protein kinase activation; however, recent investigations have shown that adenosine monophosphate‐activated protein kinase‐independent pathways can explain some of metformin's beneficial metabolic effects as well as undesirable side‐effects. Such novel pathways include induction of mitochondrial stress, inhibition of mitochondrial shuttles, alteration of intestinal microbiota, suppression of glucagon signaling, activation of autophagy, attenuation of inflammasome activation, induction of incretin receptors and reduction of terminal endoplasmic reticulum stress. Together, these studies have broadened our understanding of the mechanisms of antidiabetic agents as well as the pathogenic mechanism of diabetes itself. The results of such investigations might help to identify new target molecules and pathways for treatment of diabetes and metabolic syndrome, and could also have broad implications in diseases other than diabetes. Accordingly, new antidiabetic drugs with better efficacy and fewer adverse effects will likely result from these studies.
Selection and characterization of Bacillus thuringiensis strains toxic against pyralid stored‐product pests
Authors: Azzouz H. , Kebaili‐Ghribi J. , Daoud F. , Abdelmalak N. , Ennouri K. , Belguith‐Ben Hassan N. , Tounsi S. , Rouis S.
Published: January 2015

In this study, we present the selection and the characterization of Bacillus thuringiensis strains toxic against pyralid pests of stored products. Among 201 new B. thuringiensis strains isolated from different countries, two strains (BLB249 and BLB384) showed greater toxicity than the commercialized strain B. thuringiensis kurstaki HD1 against Ephestia kuehniella larvae. Morphological, molecular and biochemical investigations revealed that these strains were similar to HD1 but presented different cry gene content. Additional bioassays revealed that only strain BLB249 displayed higher toxicity than HD1 against Plodia interpunctella larvae. The study of Cry protoxin activation by midgut proteases of E. kuehniella and P. interpunctella larvae supported that higher toxicity of BLB249 and BLB384 strains compared to HD1 was not due to differential protoxin activation. Moreover, the toxic strains produced δ‐endotoxins and spores in similar amounts to HD1. Interestingly, the δ‐endotoxin production and the yield of BUPM26 strain were 32.87% and 35.12% greater than that of HD1. The potent insecticidal activities of BLB249 and BLB384 strains and the high level of δ‐endotoxin production by BUPM26 strain make them excellent candidates for use against E. kuehniella and P. interpunctella larvae.
Feeding ecology and seasonal diet overlap betweenStellifer brasiliensisandStellifer stelliferin a tropical estuarine ecocline
Authors: Dantas D. V. , Barletta M. , Costa M. F.
Published: January 2015

Seasonal freshwater discharge was important for defining habitat utilization by different ontogenetic phases ofStellifer brasiliensisandStellifer stelliferalong the estuarine ecocline. The middle estuary was important as a nursery and feeding ground for young‐of‐the‐year, and a feeding ground for sub‐adults and adults of both species. These species are zoobenthivorous, but during their life cycle and between different habitats and seasons, their trophic guild can change to opportunist and zooplanktivore. During the late rainy season in the lower estuary, all phases of both species, except juveniles ofS. brasiliensisand adults ofS. stellifer, showed a niche overlap indicating similarity in prey utilization. The diet composition was qualitatively similar, showing an evident niche overlap of intra and interspecific competition among theStelliferspp. Although the niches of these species appeared to significantly overlap, some resource partitioning patterns were apparent. The niche overlap was significantly reduced due to the seasonal difference in habitat use and prey consumption along the ecocline of the estuary by different ontogenetic phases. The ingestion of blue nylon fragments by both species was observed and quantified.
Effect of Ohmic Heating on the Electrical Conductivity, Biochemical and Rheological Properties of Papaya Pulp
Authors: Gomathy K. , Thangavel K. , Balakrishnan M. , Kasthuri R.
Published: January 2015

A laboratory scale static ohmic heating unit of 1 L capacity was designed and fabricated for conducting the study. The electrical conductivity of the pulp was measured over a temperature range of 35–95C. Ohmic heating was conducted at three voltage gradients (6.66, 13.33 and 20 V/cm) and holding times (1, 2 and 3 min). Voltage gradient of 13.33 V/cm with a holding time of 2 min was optimized statistically for the pasteurization of papaya pulp based on the microbial analysis. The ohmic heated pulp was compared with fresh pulp with respect to the biochemical and rheological properties. Ohmic heated pulp retained 86.44% lycopene, 87.13% β‐carotene and 85.23% ascorbic acid. Rheologically, papaya pulp exhibited a non‐Newtonian (n < 1) and pseudoplastic behavior with yield stress following Herschel–Bulkley model (R2 0.99). The frequency sweep curve established the resemblance of ohmic heated pulp to that of the fresh pulp without any structural breakdown upon processing.

Practical Applications

Papaya fruit possesses high nutritional and medicinal properties which are recommended for infants and adults. But owing to its faster rate of deterioration, about 50% of the fruit harvest suffers heavy postharvest losses. A thermal processing technology is required in order to prevent the postharvest losses and make the pulp suitable for infant formulations. Novel thermal processing technology, such as ohmic heating, could preserve the pulp for a long period without compromising on the microbial stability and quality of the product. Hence, this research was planned to concentrate on understanding the suitability of ohmic heating for the pasteurization of papaya pulp. The research finding would contribute toward the growth of pulp processing and infant formulating industries.
A Novel Procedure on Vancomycin, Cephalothin and Sucrose for Isolation of Cronobacter spp. from Powdered Infant Formula
Authors: Ling Na , Ye Yingwang , Li Hui , Wu Qingping , Han Yongjia , Lu Yudong
Published: January 2015

A novel procedure on vancomycin, α‐glucosidase activity, cephalothin and sucrose for isolation of Cronobacter spp. from powdered infant formula (PIF) was developed. Meanwhile, a comparison between the new procedure, Druggan‐Forsythe‐Iversen (DFI) and modified lauryl sulfate tryptose (mLST) procedure was also carried out. The recovery rate is higher by the new procedure than those by DFI and mLST procedures. In combination with API‐20e test, 9, 9 and 8 PIF samples were found to be contaminated by Cronobacter spp. by the new procedure, DFI and mLST procedure, respectively. The sensitivity of 100, 87.5 and 87.5% and the specificity of 88.8, 77.7 and 87.5% were observed by the new procedure, DFI and mLST method, respectively. The new procedure, DFI and mLST procedure also gave the false‐positive/false‐negative rates of 11.1/0.0, 22.2/12.5 and 12.5/12.5%. The data presented here indicated that the new protocol could be widely used for monitoring Cronobacter in PIF and a combination of traditional methods and molecular assays is strongly recommended.

Practical Applications

The current culture‐based procedures for isolation of Cronobacter should be improved for assuring microbial safety of PIF. In this study, a selective and efficient procedure for isolation of Cronobacter was developed. The recovery rate was higher from artificially contaminated PIF by the new procedure than those by DFI and mLST procedures. In addition, the new procedure was found to be sensitive and specific for isolation of Cronobacter from commercial PIF.
Between Liberal Aspirations and Market Forces: Obamacare's Precarious Balancing Act
Authors: Oberlander Jonathan
Published: January 2015

The American health care system long has been distinctive in its embrace of market forces. For-profit private insurers play a major role in providing coverage, though they operate alongside public insurance programs that cover over one-third of the population. Historically, federal and state governments’ regulation of insurance markets was limited, leaving insurers to set premiums and coverage rules largely as they saw fit.

Government’s role in controlling health care spending has been even more circumscribed. Purchasing power is fragmented, with each insurer negotiating its own rates with physicians and hospitals. A formidable medical-industrial complex of for-profit providers, from hospitals to home-health care agencies, dialysis facilities, pharmaceutical companies and much more, has arisen to sell services.
Curing the Disobedient Patient: Medication Adherence Programs as Pharmaceutical Marketing Tools
Authors: Lamkin Matt , Elliott Carl
Published: January 2015

About a week after Maran Wolston was prescribed Copaxone, a drug for multiple sclerosis (MS), she got a phone call from a nurse at an organization called Shared Solutions. The organization was familiar to Wolston; when her neurologist had asked permission to share her health information with Shared Solutions, Wolston had agreed, assuming it was connected to her health insurance.

The nurse who called Wolston was checking in to see how the treatment was going. It was not going well. While Copaxone is not typically associated with some of the unpleasant side effects of other MS drugs, it does have at least one serious drawback: the drug must be injected every day. The injections can be brutally painful. “No matter where I injected the drug each day, the injection site swelled up into a huge welt and felt like a gigantic bee sting,” Wolston writes.
Medical versus Fiscal Gatekeeping: Navigating Professional Contingencies at the Pharmacy Counter
Authors: Chiarello Elizabeth
Published: January 2015

Commercialization of medicine is a growing trend that threatens to undermine physicians’ commitments to patient care in favor of personal financial interests. Bemoaned by Arnold Relman as early as 1980, growing for-profit sectors of health care have been reshaping medicine from a profession into a business, forming the foundation of what he terms a “medical-industrial complex” that threatens to undermine professional identity and reshape health care funding. Commercialization poses new ethical challenges for health care providers who have a financial stake in their health care decisions and may undermine their fiduciary duties to patients.

Certainly, commercialization has brought about new trends in medicine — one need only to look as far as the rise in for-profit hospitals, diagnostic laboratories, and proprietary nursing homes to see how opportunities for financial gain reposition physicians’ orientations vis-à-vis patients.
Factors Affecting Community Participation in the CDTI Program in Morogoro, Tanzania
Authors: York Kate J. , Kabole Ibrahim , Mrisho Mwifadhi , Berry Devon M. , Schmidt Elena
Published: January 2015

Background

Up to 4 million people in Tanzania are at risk for the parasitic disease onchocerciasis. A treatment program, Community‐Directed Treatment with Ivermectin (CDTI), has made significant gains in prevention and treatment. Understanding factors affecting participation could help boost treatment coverage and sustain gains made in controlling onchocerciasis in endemic areas.

Purpose

To explore community‐perceived factors related to participation in and sustainability of the CDTI program in southwest Tanzania.

Methods

Multilevel triangulation design using surveys, focus group discussions (FGDs), and semistructured interviews to collect data in two villages in the Morogoro Rural District of Tanzania. In total, 456 villagers participated in the survey and 42 in FDGs. Five community‐directed distributors (CDDs) and three community health workers were interviewed.

Findings

High levels of awareness of onchocerciasis (90%) and methods of prevention and treatment (95%) were reported. Over 75% of participants knew how ivermectin was distributed and 74% have taken the drug. Over 90% of villagers knew that distribution of the drug was for treatment and prevention. Only 43% knew the cause of onchocerciasis. Through FGDs, villagers reported barriers to participation, including lack of comprehensive understanding of the disease, fears of medication, distrust of the method determining dose, lack of health education materials, insufficient CDD‐resident communication, and inflexible drug distribution mechanisms.

Conclusions

Sustaining programs without supporting growth of CDDs and reinforcing education of communities could lead to a decrease in treatment and an increase in the public health threat. This research uncovered a need for more effective community education and sensitization.

Clinical Relevance

Understanding barriers to participation in community‐based programs can assist public health and community health nurses and key stakeholders including Ministries of Health and local and regional health systems in the development of education and support materials to enhance health literacy and encourage program participation.
The Affordable Care Act and Consumer Well‐Being: Knowns and Unknowns
Authors: Fitzgerald M. Paula , Bias Thomas K. , Gurley‐Calvez Tami
Published: January 2015

The Patient Protection and Affordable Care Act, signed into law in 2010, is the latest in a long string of efforts to reform health care in the United States. In this article, we provide a brief background and explore key components of this law. We examine extant research on what is known about how insurance coverage impacts consumer well‐being and the role health and financial literacy play in achieving well‐being. We then introduce important research questions highlighting areas where little is known and where much opportunity lies to inform policy and improve consumer well‐being.
Self‐Monitoring and the Metatraits
Authors: Wilmot Michael P. , DeYoung Colin G. , Stillwell David , Kosinski Michal
Published: January 2015

Prior attempts at locating self‐monitoring within general taxonomies of personality traits have largely proved unsuccessful. However, past research has typically neglected (a) the bidimensionality of the Self‐Monitoring Scale and (b) the hierarchical nature of personality. The objective of this study was to test hypotheses that the two self‐monitoring factors are located at the level of the metatraits. Using data from two large multi‐informant samples, one community (Sample 1: N = 552, Mage = 51.26, 61% female; NPeers = 1,551, Mage = 48.61, 37% female) and one online (Sample 2: N = 3,726, Mage = 24.89, 59% female; NPeers = 17,868, Mage = 26.23, 64% female), confirmatory factor analysis was used to test the hypotheses. Results confirmed hypotheses that acquisitive self‐monitoring would have a strong positive relation to metatrait Plasticity, whereas protective self‐monitoring would have a moderate negative relation to metatrait Stability. In both samples, constraining the correlation between acquisitive self‐monitoring and Plasticity to unity did not alter model fit indices, indicating that the two putatively distinct constructs are identical. Findings have wide‐ranging implications, including integration of the construct of self‐monitoring into the mainstream of personality research, as the latter moves toward the development of broad explanatory theories.
Specifying Associations Between Conscientiousness and Executive Functioning: Mental Set Shifting, Not Prepotent Response Inhibition or Working Memory Updating
Authors: Fleming Kimberly A. , Heintzelman Samantha J. , Bartholow Bruce D.
Published: January 2015

Conscientiousness is characterized by self‐control, organization, and goal orientation and is positively related to a number of health and professional outcomes. Thus, it is commonly suggested that conscientiousness should be related to superior executive functioning (EF) abilities, especially prepotent response inhibition. However, little empirical support for this notion has emerged, perhaps due to oversimplified and underspecified modeling of EF. The current study sought to fill this gap by testing relations between conscientiousness and three facets of EF using a nested factors latent variable approach. Participants (N = 420; Mage = 22.5; 50% male; 91% Caucasian) completed a measure of conscientiousness and nine EF tasks designed to tap three related yet distinguishable facets of EF: working memory updating, mental set shifting, and prepotent response inhibition. Structural equation models showed that conscientiousness is positively associated with the EF facet of mental set shifting but not response inhibition or working memory updating. Despite the common notion that conscientiousness is associated with cognitive abilities related to rigid control over impulses (i.e., inhibition), the current results suggest the cognitive ability most associated with conscientiousness is characterized by flexibility and the ability to adapt to changing environmental contingencies and task demands.
Sound the Alarm: The Effect of Narcissism on Retaliatory Aggression Is Moderated by dACC Reactivity to Rejection
Authors: Chester David S. , DeWall C. Nathan
Published: January 2015

Narcissists behave aggressively when their egos are threatened by interpersonal insults. This effect has been explained in terms of narcissists' motivation to reduce the discrepancy between their grandiose self and its threatened version, though no research has directly tested this hypothesis. If this notion is true, the link between narcissism and retaliatory aggression should be moderated by neural structures that subserve discrepancy detection, such as the dorsal anterior cingulate cortex (dACC). This study tested the hypothesis that narcissism would only predict greater retaliatory aggression in response to social rejection when the dACC was recruited by the threat. Thirty participants (15 females; Mage = 18.86, SD = 1.25; 77% White) completed a trait narcissism inventory, were socially accepted and then rejected while undergoing fMRI, and then could behave aggressively toward one of the rejecters by blasting him or her with unpleasant noise. When narcissists displayed greater dACC activation during rejection, they behaved aggressively. But there was only a weak or nonsignificant relation between narcissism and aggression among participants with a blunted dACC response. Narcissism's role in aggressive retaliation to interpersonal threats is likely determined by the extent to which the brain's discrepancy detector registers the newly created gap between the grandiose and threatened selves.
The effects of serum apolipoprotein E genetic variants and concentration on serum lipid parameters in haemodialysis patients
Authors: Wang Kai , Wang Pei , Qiao Yingjin , Lu Xiaoqing , Wang Xin , Liu Zhangsuo
Published: January 2015

Objectives

Many epidemiological studies demonstrate that the apolipoprotein E gene (ApoE) is an important candidate gene for playing key roles in the development of haemodialysis (HD). The purpose of this study is to evaluate the effects of ApoE genetic variants and concentration on serum lipid parameters in HD.

Methods

A total of 288 HD patients and 292 healthy controls were enrolled in this case–control study. The genotypes of ApoE genetic variants were investigated through the created restriction site-polymerase chain reaction and DNA-sequencing methods.

Key findings

Our data indicated that the levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein A-I (ApoA-I), ApoB, ApoE, lipoprotein (a) (Lp(a)) of mutant genotypes in ApoE c.61G > A and c.761T > A genetic variants were different from those subjects with wild genotype in HD patients and healthy controls.

Conclusions

These preliminary results from this study suggest that the ApoE genetic variants and concentration could affect the serum lipid parameters in HD and could be risk factors for evaluating HD.
Estimates on HCV disease burden worldwide – filling the gaps
Authors: Wedemeyer H. , Dore G. J. , Ward J. W.
Published: January 2015

Hepatitis C is caused by infection with the hepatitis C virus (HCV) and represents a major global health burden. Persistent HCV infection can lead to progressive liver disease with the development of liver cirrhosis and hepatocellular carcinoma, possibly accounting for up to 0.5 million deaths every year. Treatment of HCV infection is undergoing a profound and radical change. As new treatments are extremely safe and effective, there are virtually no medical reasons to withhold therapy. Yet, the new therapies are expensive. As resources are limited, solid data to estimate the disease burden caused by HCV are urgently needed. Epidemiology data and disease burden analyses for 16 countries are presented. For almost all countries, the peak of HCV‐related cirrhosis, hepatocellular carcinoma and liver‐related death is a decade or more away. However, a surprising heterogeneity in country‐specific HCV‐associated disease burden exists. Also, HCV diagnosis and treatment uptake varied markedly between countries. A consistent finding was that a reduction of HCV liver‐related mortality is dependent on access to therapy. Increasing efficacy of therapy alone with a constant numbers of treatments will not have a major impact on the HCV‐related disease burden. The data presented here should inform public health policy and help drive advocacy for enhanced strategic investment and action. HCV kills patients, and the disease burden will continue to rise in most countries unless action is taken soon. Chronic HCV is a curable infection and a reversible liver disease. Fortunately, the tools to eliminate HCV are now available.
Clinical Phenotype of X‐Linked Myotubular Myopathy in Labrador Retriever Puppies
Authors: Snead E.C.R. , Taylor S.M. , van der Kooij M. , Cosford K. , Beggs A.H. , Shelton G.D.
Published: January 2015

Background

Seven male Labrador Retriever puppies from 3 different litters, born to clinically normal dams and sires, were evaluated for progressive weakness and muscle atrophy. Muscle biopsies identified a congenital myopathy with pathologic features consistent with myotubular myopathy. Further investigations identified a pathogenic mutation in the myotubularin gene, confirming that these puppies had X‐linked myotubular myopathy (XLMTM).

Objective

To review the clinical phenotype, electrodiagnostic and laboratory features of XLMTM in this cohort of Labrador Retrievers.

Results

Male puppies with XLMTM were small and thin compared with their normal littermates. Generalized weakness and muscle atrophy were present by 7 weeks of age in some puppies and evident to most owners by 14 weeks of age. Affected puppies stood with an arched spine and low head carriage, and walked with a short, choppy stride. Muscle atrophy was severe and progressive. Patellar reflexes were absent. Laryngeal and esophageal dysfunction, and weakness of the masticatory muscles occurred in puppies surviving beyond 4 months of age. Serum creatine kinase activity was normal or only mildly increased. EMG findings were nonspecific and included positive sharp waves and fibrillation potentials. Clinical signs progressed rapidly, with most affected puppies unable to walk within 3–4 weeks after clinical signs were first noticed.

Conclusions and Clinical Importance

Although initial clinical signs of XLMTM are similar to the phenotypically milder centronuclear myopathy in Labrador Retrievers, XLMTM is a rapidly progressive and fatal myopathy. Clinicians should be aware of these 2 distinct myopathies with similar clinical presentations in the Labrador retriever breed.
Women's Life Writing in the Long 18th Century: A Critical Survey
Authors: Culley Amy
Published: January 2015

This essay provides an overview of developments in studies of British women's life writing in the long 18th century over the last 25 years and explores possible future directions at an exciting moment for the field. It addresses the expansion of the canon under the influence of feminist criticism and the shift in emphasis from autobiography to life writing as a hybrid and indeterminate form which works across disciplinary boundaries. It takes account of scholarly work on traditional categories of women's life writing, such as the scandalous memoir and spiritual autobiography, and considers more recent interests in biography, collective biography, afterlives and the letter. The article concludes with some reflections on potential avenues for future research, including a more rigorous approach to genre, the interrelations of manuscript and print and collaboration and collective authorship, as well as highlighting some of the challenges (and rewards) of working with life writing texts.
Evolution of phenotypic plasticity in colonizing species
Authors: Lande Russell
Published: January 2015

I elaborate an hypothesis to explain inconsistent empirical findings comparing phenotypic plasticity in colonizing populations or species with plasticity from their native or ancestral range. Quantitative genetic theory on the evolution of plasticity reveals that colonization of a novel environment can cause a transient increase in plasticity: a rapid initial increase in plasticity accelerates evolution of a new optimal phenotype, followed by slow genetic assimilation of the new phenotype and reduction of plasticity. An association of colonization with increased plasticity depends on the difference in the optimal phenotype between ancestral and colonized environments, the difference in mean, variance and predictability of the environment, the cost of plasticity, and the time elapsed since colonization. The relative importance of these parameters depends on whether a phenotypic character develops by one‐shot plasticity to a constant adult phenotype or by labile plasticity involving continuous and reversible development throughout adult life.
Emergence delirium, pain or both? a challenge for clinicians
Authors: Somaini Marta , Sahillioğlu Emre , Marzorati Chiara , Lovisari Federica , Engelhardt Thomas , Ingelmo Pablo M.
Published: January 2015

Background

Children commonly display early postoperative negative behavior (e‐PONB) after general anesthesia, which includes emergence delirium (ED), discomfort, temperament, and pain. However, it is often difficult for the caregiver to discriminate between various aspects of e‐PONB.

Objective

This prospective observational study evaluates the possibility to distinguish between ED and pain in young children using validated pediatric observational scales in the early postoperative phase.

Methods

Following institutional approval and written consent, children undergoing elective adenoidectomy and/or tonsillectomy were enrolled. Following standardized anesthesia, two trained observers simultaneously evaluated children's behavior with the Paediatric Anaesthesia Emergence Delirium Scale (PAED) and with the Face, Legs, Activity, Cry, Consolability scale (FLACC) at extubation, and at 5, 10, and 15 min.

Results

Of 150 children that completed the study, 32 (21%) had ED, 7 (5%) had pain, and 98 (65%) had simultaneously both ED and pain. The association of ‘No eye contact’, ‘No purposeful action’ and ‘No awareness of surroundings’ (ED1) had a sensitivity of 0.96 and a specificity of 0.80 (PPV 0.97, NPV 0.78) to identify ED. ‘Inconsolability’ and ‘Restlessness’ (ED2) had a sensitivity of 0.69 and a specificity of 0.88 (PPV 0.83 and NPV 0.78) to identify pain.

Conclusion

It is difficult to differentiate between ED and pain using FLACC and PAED scores. ‘No eye contact’, ‘No purposeful action’, and ‘No awareness of surroundings’ significantly correlated with ED. ‘Inconsolability’ and ‘Restlessness’ are not reliable enough to identify pain or ED in the first 15 min after awakening.