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This paper examines two speculative examinations of humanity as a unified species and agent of ecological change: Ursula K. Le Guin's Hainish Cycle and the rights of nature movement. Le Guin's Cycle imagines the slow interplanetary reintegration of human polities against a backdrop of cultural and environmental difference. I read the novels of the Cycle as an allegory for the rights of nature movement, which seeks to synthesize traditional and modern knowledge in a legal solution to ecological crisis. Both discourses, I argue, productively imagine a new historical understanding of humanity's place on Earth, but they provide a weak theory of law's capacity to initiate and institutionalize this new understanding. In place of a static theory of history and legal revolution, I propose a dynamic view of how narrative projects like the rights of nature contribute to cultural and political change. This comparative reading shows the utility of speculation in law and literature. [ABSTRACT FROM AUTHOR]

This article describes how the law inflects the narration of environmental conflict in William T. Vollmann's Dying Grass (2015) and Leslie Marmon Silko's Almanac of the Dead (1991). By focusing on the legal common sense of settler colonialism—its emphasis on private property in land and its subjugation of Indigenous peoples to the guardianship of the state—the article explores the ways in which Vollmann's and Silko's novels present counternarratives to the law's story of justified conquest. Combining a law and literature approach with ecocriticism, this article highlights the importance of the legal imagination in defining human-land relations in the United States. It demonstrates how The Dying Grass and Almanac of the Dead critique this legal imagination while also using it as a model for changing environmental politics through discourse. [ABSTRACT FROM AUTHOR]

Twenty-five patients with extensive psoriasis were randomly assigned into one of the three groups, each receiving 0.5 mg/kg of oral liquid methoxsalen photochemotherapy followed 1 h later by exposure to long-wave ultraviolet light (UVA). The sole difference between the three groups was the method used to determine the initial UVA dose, which was either based on skin type, 25% of the minimal phototoxic dose (MPD), or 50% of the MPD. All patients were treated in the Phototherapy Unit at the Massachusetts General Hospital. Data were obtained until reaching the endpoint of clearance. At clearance, the results of the number of treatments required to clea, final UVA dose, cumulative UVA dose, and side effects were tabulated, compared, and analysed for each of the three groups. The 25% and 50% MPD groups required a mean of 15.0 ± 1.7% and 13.4 ± 1.9 treatments to clear, respectively, as compared to the skin type group, which needed an average of 17.6 ± 2.5 treatments. The mean final UVA dose was 7.4 ± 0.9 J/cm2 for the 25% and 50% MPD groups respectively, in contrast to 11.6 ± J/cm2 for the skin type group. The mean cumulative UVA dose at clearance for the 25% and 50% MPD groups was 79 ± 16 J/cm2 and 87 ± 27 J/cm2, respectively, versus 136 ± 30 J/cm2 for the skin type group. The comparisons between the individual MPD groups and the skin type group did not achieve statistical significance with the exception of a marginally significant difference in final dose between the skin type group and the 25% MPD group (p = 0.06). However, the results of the two MPD group were then pooled ant the mean final (7.9 ± 0.8 J/cm2) and cumulative (83 ± 15 J/cm2) UVA doses were significantly (p = 0.04) and marginally significantly (p = 0.07) lower than the respective means of the skin type group, did not attain statistical significance (p = 0.19). Our data suggest that the MPD measurement may be superior to the skin-typing system when calculating the initial UVA dose in oral liquid methoxsalen photochemotherapy for the treatment of psoriasis. [ABSTRACT FROM AUTHOR]

Objectives: We examined Adventist Health System (AHS)-affiliated providers and staff regarding controversial spiritual practices such as praying led by a practitioner, sharing of personal religious beliefs, and encouraging patients' religious beliefs for health reasons.Methods: Approached were 1082 providers to participate in a project to integrate spirituality into outpatient care. Those who agreed were asked to identify staff in their practice to assist. Providers and staff were asked to complete a baseline questionnaire examining attitudes/practices concerning spiritual activities with patients. Regression models were used to identify predictors.Results: Questionnaires were completed by 520 providers (83% physicians and 17% mid-level practitioners) and 217 nurses and other staff members. A significant proportion of providers and staff (29.6% vs 49.1%) indicated "often/very often" to a statement that healthcare professionals should pray with patients, should initiate an offer to pray (25.7% vs 49.1%), should pray if the patient initiates the request (72.2% vs 79.5%), and should encourage greater religious activity for health reasons (48.9 vs 48.1%). With regard to behaviors, 15.3% of providers and 8.8% of nurses and other staff members currently often or always prayed with patients, 24.2% and 25.1% shared their personal faith, and 28.2% compared with 22.0% encouraged patients to become more active in their religious faith; however, 93.3% had little or no training on how to do so. The strongest and most consistent predictor of religious activity with patients was self-rated religiosity of the health professional.Conclusions: A significant proportion of Adventist Health System providers and staff favor engaging in spiritual practices with patients. Training is needed to engage appropriately and sensitively in these activities. [ABSTRACT FROM AUTHOR]

A response by Christopher E.M. Griffiths and colleagues to a letter to the editor about their article "Restoration of Collagen Formation in Photodamaged Human Skin by Tretinoin (retinoic acid)," in the August 19, 1993 issue is presented

Context The high prevalence of acne vulgaris and its significant morbidity underscore the need for convenient, low-risk, and efficacious therapy. Treatment with various lasers has been reported to improve acne. Objective To evaluate the clinical efficacy of pulsed dye laser therapy in the treatment of acne. Design, Setting, and Patients Randomized, single-blind, controlled, split-face clinical trial of a volunteer sample of 40 patients aged 13 years or older with facial acne conducted at an academic referral center from August 2002 to September 2003. Intervention One or 2 nonpurpuric pulsed dye laser treatments to half of the face (fluence of 3 J/cm2), serial blinded clinical assessments (lesion counts), and grading of acne severity using standardized bilateral serial photographs. Main Outcome Measures Comparison of the changes in lesion counts from baseline to 12 weeks between treated and untreated sides of the face and changes in photographic evidence of acne severity as graded by a panel of dermatologists blinded to treatment assignment. Results After 12 weeks, using intent-to-treat analysis with last observation carried forward, there were no significant differences between laser-treated and untreated skin for changes in mean papule counts (-4.2 vs -2.2; P = .08), mean pustule counts (0 vs -1.0; P = .12), or mean comedone counts (2.9 vs 1.6; P = .63). Grading of serial photographs confirmed the clinical assessments, showing no significant mean (SE) differences in Leeds scores (range, 1-12) for treated skin (3.98 [0.32] at baseline and 3.94 [0.27] at week 12) compared with untreated skin (3.83 [0.32] at baseline and 3.79 [0.28] at week 12) (P>.99). Conclusions In this study, the nonpurpuric pulsed dye laser therapy did not result in significant improvement of facial acne. More research is needed before this laser therapy may be recommended as an acne treatment. [ABSTRACT FROM AUTHOR]

Objectives: Patients' spiritual values, beliefs, and preferences are identified in outpatient medical settings by the taking of a screening spiritual history (SSH). We report the impact of an educational/training program on the attitudes/practices of physicians (MDs) and midlevel practitioners (MLPs).Methods: A convenience sample of 1082 MDs or MLPs in outpatient practices was approached to participate in a 12-month educational/training program in this single-group experimental study. Of the 1082 professionals, 48% (427 physicians, 93 MLPs) agreed to complete a questionnaire assessing demographics, practice characteristics, religiosity, and attitudes/practices regarding the SSH. Changes in attitudes/practices over time were examined and baseline predictors identified using mixed-effects regression.Results: Of the 520 participants completing questionnaires at baseline, 436 were assessed at 1 month (83.8%) and 432 were assessed at 12 months (83.1%). The belief that MDs should take a SSH did not significantly change over time (B = -0.022, standard error [SE] 0.028, P = 0.426). However, those who took an SSH often/always increased from 16.7% at baseline to 34.8% at 12-month follow-up (B = 0.328, SE 0.030, P < 0.0001), and perceived patient acceptance/appreciation increased from 72.1% to 80.5% (B = 0.074, SE 0.023, P = 0.001). Predictors of increased SSH taking across time among MDs were older age, female sex, family medicine specialty, prior training, and importance of religion; older age was the only predictor in MLPs.Conclusions: Although attitudes toward taking an SSH were not affected, taking an SSH increased initially and was sustained over time, as did the sense that patients accepted/appreciated this practice. Educational programs of this type may be used to increase SSH taking by outpatient MDs and MLPs. [ABSTRACT FROM AUTHOR]

Background There remains the need for more effective therapeutic options to treat acne vulgaris. Interest in light-based acne treatments has increased, but few randomized, controlled clinical trials assessing the value of photodynamic therapy (PDT) for acne have been reported. Aims We sought to examine the efficacy of PDT using 5-aminolevulinic acid (ALA) and pulsed dye laser therapy in the treatment of acne. Patients/methods We conducted a randomized, controlled, split-face, single-blind clinical trial of 44 patients with facial acne. Patients were randomized to receive three pulsed dye laser treatments to one side of the face after a 60–90 min ALA application time, while the contralateral side remained untreated and served as a control. Serial blinded lesion counts and global acne severity ratings were performed. Results Global acne severity ratings improved bilaterally with the improvement noted to be statistically significantly greater in treated skin than in untreated skin. Erythematous macules (remnants of previously active inflammatory lesions) decreased in number in treated skin when compared with control skin and there was a transient but significant decrease in inflammatory papules in treated skin when compared with untreated skin. There were no other statistically significant differences between treated and untreated sides of the face in terms of counts of any subtype of acne lesion. Thirty percent of patients were deemed responders to this treatment with respect to improvement in their inflammatory lesion counts, while only 7% of patients responded in terms of noninflammatory lesion counts. Conclusions PDT with the treatment regimen employed here may be beneficial for a subgroup of patients with inflammatory acne. [ABSTRACT FROM AUTHOR]

We have quantitatively assessed the relation between type I and type III procollagen precursor levels and the severity of clinical photodamage in human skin. Levels of procollagen, pN collagen (collagen without the carboxypropeptide), and/or pC collagen (collagen without the aminopropeptide) were determined by radioimmunoassay, Western blot, and immunohistology in punch biopsy specimens from mildly and severely photodamaged forearm skin and from sun-protected underarm and buttock skin of the same subjects. Collagen precursor levels in forearm and underarm skin were expressed relative to buttock levels for comparison. In the mildly photodamaged group, collagen precursors in the forearm did not differ from those in the underarm by any measurement, except for type I collagen precursors measured by radioimmunoassay, which were reduced 16%. In severely photodamaged forearm skin, both type I and type III collagen precursor levels, measured by radioimmunoassay, were significantly reduced (approximately 40%). Western analysis revealed similar significant reductions in type I and type III collagen precursor levels in severely photodamaged forearm skin compared with the sun-protected underarm. Immunohistology localized both type I and III pN collagens predominantly to the extracellular papillary dermis. Relative staining intensities of type I and type III pN collagen were also significantly reduced in severely photodamaged forearm skin. Multiple linear regression modeling of all data demonstrated that reductions in collagen precursor levels were significantly correlated (p < 0.03) with the severity of photodamage, but not with chronologic age. These data demonstrate, by three independent methods, coordinate reductions of both type I and type III collagen precursors in photodamaged human skin, and the degree of reduction correlated with the degree of photodamage. It is likely that such changes in collagen precursors lead to reduced levels and/or altered organization of fibrillar collagen, and thus may contribute to the wrinkled appearance of photodamaged human skin. [ABSTRACT FROM AUTHOR]

Although topical applications of retinoids on rodents and humans have been shown to cause epidermal hyperplasia, a detailed study of the influence of retinoids on epidermal differentiation in vivo has not been performed. In order to assess the pharmacologic effects of chronic topical tretinoin application used to improve the appearance of patients with photoaged skin, cutaneous biopsies from 25 patients in a controlled clinical study were examined histologically and immunocytochemically. Chronic application of tretinoin causes epidermal thickening (25 of 25 samples), stratum granulosum thickening (15 of 25), parakeratosis (13 of 25), a marked increase in the number of cell layers expressing epidermal transglutaminase (13 of 25), and focal expression of two keratins, K6 (12 of 25) and K13 (8 of 25), not normally expressed in the epidermis. The morphologic changes correlated with immunohistochemical abnormalities; neither of these correlated with the subjective cosmetic response. Three major epidermal differentiation products, keratins K1, K10, and K14 were not altered, within the limits of the methods used. Thus, chronic topical tretinoin reprograms some, but not all, aspects of human epidermal differentiation in vivo. [ABSTRACT FROM AUTHOR]

Focuses on a study which revealed that treating photoaged skin with topical tretinoin increase epidermal-dermal anchoring fibrils. Information on anchoring fibrils; Methodology; Results of the study.

Background: Topical tretinoin (retinoic acid) modifies fine wrinkles and certain other features of human skin damaged by exposure to the sun (photodamage), but histologic changes do not account for this improvement. In mice with photodamage induced by ultraviolet light, effacement of fine wrinkles by tretinoin is correlated with dermal collagen synthesis but not with histologic changes. We investigated whether collagen synthesis was reduced in photodamaged human skin and, if so, whether it could be restored by treatment with topical tretinoin. Methods: Biopsies of photodamaged skin from the extensor aspect of the forearm and skin from the buttocks, which had been protected from the sun, were performed on 26 healthy subjects. In addition, 29 patients with photodamaged skin were treated for 10 to 12 months with a daily application of 0.1 percent tretinoin cream (15 patients) or vehicle cream (14 patients). Skin-biopsy specimens obtained at base line and after treatment were assessed immunohistologically for evidence of dermal collagen I formation (collagen synthesis). Results: Collagen I formation was 56 percent less in the papillary dermis of photodamaged skin than in skin protected from the sun (P<0.001) and was correlated with the clinical severity of photodamage (r = -0.58, P = 0.002). Treatment of photodamaged skin with tretinoin produced an 80 percent increase in collagen I formation, as compared with a 14 percent decrease in collagen formation with the use of vehicle alone (P = 0.006). Conclusions: The formation of collagen I is significantly decreased in photodamaged human skin, and this process is partly restored by treatment with tretinoin. (N Engl J Med 1993;329:530-5.) [ABSTRACT FROM AUTHOR]

Background: and Methods Irregular disfiguring skin hyperpigmentation due to inflammation may develop in black persons. We investigated the treatment of this hyperpigmentation with topical tretinoin (0.1 percent retinoic acid cream). Fifty-four subjects completed a 40-week randomized, double-blind, vehicle-controlled study. Twenty-four subjects applied tretinoin daily to the face, arms, or both areas, and 30 subjects applied vehicle cream. At base line and after 40 weeks of treatment, each subject's postinflammatory hyperpigmented lesions and normal skin were assessed by clinical and colorimetric evaluations and by analysis of biopsy specimens. Results: The facial postinflammatory hyperpigmented lesions of the tretinoin-treated subjects were significantly lighter after the 40 weeks of therapy than those of the vehicle-treated subjects (P<0.001); overall improvement was first noted after 4 weeks of tretinoin treatment. At the end of treatment, colorimetry demonstrated a 40 percent lightening of the lesions toward normal skin color in the tretinoin-treated lesions, as compared with an 18 percent lightening in vehicle-treated lesions (P = 0.05). The epidermal melanin content in the lesions decreased by 23 percent with tretinoin and by 3 percent with vehicle (P = 0.24). Normal skin was minimally lightened by tretinoin as compared with vehicle, according to both clinical evaluation (0.1 vs. -0.1 unit change on an 8-point scale; P = 0.055) and colorimetry (P<0.001). Retinoid dermatitis developed in 12 of the 24 tretinoin-treated subjects who completed the study (50 percent) and in 1 tretinoin-treated subject who withdrew from the study, but diminished as the study progressed. Conclusions: Topical application of tretinoin significantly lightens postinflammatory hyperpigmentation; to a clinically minimal but statistically significant degree, it also lightens normal skin in black persons. (N Engl J Med 1993;328:1438-43.) [ABSTRACT FROM AUTHOR]