Search

Background: There are limited tools to measure the burden of disease and effectiveness of medical/surgical interventions in patients with cryptoglandular fistulas. The aim of this study was to explore concepts that are relevant and important to patients with complex cryptoglandular fistulas (CCF) and to develop a patient-centred, disease-specific, patient-reported outcome measure (PROM) to assess symptom burden and impacts of CCF. Methods: A targeted literature review was conducted, followed by one-to-one telephone interviews with five colorectal surgeons (USA, n = 3; UK, n = 1; Spain, n = 1) and 20 US adult patients with CCF to inform the development of a conceptual model and a CCF-specific PROM. The targeted literature review informed the development of the preliminary conceptual model and identified a PROM in the literature that was used as a reference to generate the draft CCF-specific PROM. The colorectal surgeon interviews provided insights on the experience of patients with CCF to refine the conceptual model, formulate probing questions for use in patient interviews, and to develop the draft CCF-specific PROM. Patients' descriptions of their experiences with symptoms and the impacts on their lives and evaluation of the draft CCF-specific PROM in concept elicitation and cognitive interviews were used to develop the final conceptual model and final CCF-specific PROM. Results: Ten symptoms (odour, pain during bowel movement, abscess, post-operative pain, discharge/drainage/leakage, anal/perianal pain, inflammation/swelling, skin irritation, bleeding and itchiness) and 11 impacts (discomfort, inability to exercise, embarrassment, difficulty sitting, worry about disease, adapted life to maintain hygiene, negatively impacted social life/isolation, inability to perform daily activities, reduced interest in sex, negatively impacted intimate relationships and negatively impacted mood) were reported as most salient by patients. The patient experience, clinician perspective, and literature review provided input to item generation. Evaluation of relevance and patient understanding through cognitive interviews with patients provided evidence for the content validity of the new patient-reported outcome measure: the 20-item Complex Cryptoglandular Fistula Questionnaire™ (CCFQ-20™). Conclusion: The CCFQ-20™ is a new clinician-guided, patient-validated, disease-specific patient-reported outcome measure that measures disease impact and quality of life in patients with CCF. [ABSTRACT FROM AUTHOR]

Introduction: Gaucher disease type 3 (GD3) is a genetic, progressive lysosomal storage disorder characterized by visceral manifestations and chronic neurologic symptoms (e.g., horizontal ophthalmoplegia/supranuclear gaze palsy, ataxia, dystonia). The investigational agent venglustat is being studied in combination with imiglucerase as potential treatment for systemic and neuronopathic manifestations of GD3 in a single-arm, open-label, phase 2 trial (LEAP; N = 11). To understand perceived changes in GD3 symptoms from the perspectives of patients, caregivers, and clinicians, we conducted a qualitative case study of selected LEAP participants. Methods: Four patients in LEAP (age range, 20–28 years), four of their caregivers, and three clinicians involved in LEAP were interviewed individually by moderators using semi-structured guides. Clinicians' perceptions were based on observation of interviewed patients and those in LEAP who were not interviewed, as well as information provided by other staff involved in LEAP, patients, and caregivers. Results: Reported changes in GD3 symptoms varied among patients and among reporters. Only eye movement was spontaneously mentioned as improved by at least one patient, caregiver, and clinical expert. Symptom improvement also varied in terms of time to improvement. Within the first weeks, improvements were seen in understanding new information or complex instructions, remembering the weekday, eye movement, tremor, and seizures. Changes in alertness, engagement and responsiveness, memory, and concentration appeared after months or a year. Most caregivers and all clinical experts reported greater patient independence (e.g., increased ability to perform activities of daily living or travel independently during the trial) as a perceived treatment effect on a GD3 impact. For one patient who perceived benefits from venglustat therapy, pharmacokinetic analyses during LEAP found low to undetectable venglustat levels in their plasma and cerebrospinal fluid. Conclusion: Outcomes from this study provide insights into GD3 symptoms and the early signaling of changes reported during venglustat therapy. Trial Registration: ClinicalTrials.gov identifier, NCT02843035. [ABSTRACT FROM AUTHOR]

Background: Congenital thrombotic thrombocytopenic purpura (cTTP) is an ultra-rare, life-threatening hereditary disorder that causes patients to experience significant morbidity and decreased health-related quality of life (HRQoL). A cTTP disease-specific patient-reported outcome (PRO) instrument that is reflective of patients' experiences with the disorder does not currently exist. The objective of this study was to evaluate and validate the psychometric properties of the Congenital Thrombotic Thrombocytopenic Purpura–Patient Experience Questionnaire (cTTP-PEQ), developed using a literature review, interviews with expert clinicians, and qualitative concept elicitation and cognitive debriefing interviews. Methods: This prospective, observational study (NCT03519672) was conducted with patients diagnosed with cTTP currently receiving treatment. Patients were enrolled through investigator sites and direct-to-patient recruitment. Individuals completed electronic self-administered PRO measures, including the cTTP-PEQ, at baseline and Day 14 (+ up to 10 days). The cTTP-PEQ consisted of five multi-item domains (Pain/Bruising, Cognitive Impairment, Visual Impairment, Mood, Treatment Burden) and three single-item domains (Fatigue, Headache, Activity Limitation), and assessed symptoms and impact of cTTP in the previous 24 h, 7 days, and 2 weeks. Convergent and discriminant validity were evaluated using Spearman's rank correlation coefficients. Known-groups validity was assessed between patient groups separated by Patient Global Impression of Severity (PGI-S; normal vs. mild/moderate/severe). Internal reliability was assessed using Cronbach's alpha. Test–retest reliability was assessed using intraclass correlation coefficients (ICCs). Results: Thirty-six patients participated in this study. Convergent validity was confirmed with high-to-moderate correlations (r ≥ 0.4) for 12/15 hypothesized relationships between pairs of domains and/or total scores. Discriminant validity was confirmed with low correlations (r < 0.3) observed for 5/7 hypothesized relationships. Known-groups validity was confirmed with significant differences (p ≤ 0.05) in mean cTTP-PEQ scores between the two PGI-S groups for most domains and items at both timepoints. Cronbach's alpha was 0.88 at baseline and 0.91 at Day 14, confirming internal consistency of the instrument. Test–retest reliability was also confirmed with a high ICC (0.96). Conclusion: This study validates the psychometric properties of the novel cTTP-PEQ for use in research and clinical practice to assess HRQoL among patients with cTTP. This instrument will be particularly useful when assessing cTTP disease burden and the impact of new treatments. [ABSTRACT FROM AUTHOR]

Assessment methods have been developed to estimate a preliminary conservation status for species and subsequently to facilitate the building of Red Lists. Such pre-assessment methods could be particularly useful in the French Overseas Territories (FOTs) where Red Lists tend to be out-dated or absent and where a high number of endemic species face detrimental anthropogenic pressures. We first aimed to conduct a preliminary assessment (hereafter, pre-assessment) of the conservation status of endemic plants from Guadeloupe, Martinique, Réunion, Mayotte, French sub-Antarctic islands, New Caledonia, and Scattered Islands. We then compared the various methods used in conducting the pre-assessment and discussed ways to adapt these methods to small territories. We compiled occurrence data of endemic species identified thanks to a previous taxonomic work and pre-assessed their conservation status under Red List criteria A and B and the use of a Random Forest algorithm. We then measured the accuracy, specificity, and sensitivity of each method based on existing Red Lists. The Random Forest algorithm and a method based on range-size performed best at correctly attributing conservation status. Using these pre-assessment methods, we estimated that up to 60% of the endemic flora of the FOTs is potentially threatened. Range restriction but also anthropogenic pressures were key factors that explained these risks. Pre-assessment methods are useful tools to get a first measure of species conservation status. These methods should be adapted to the territories considered and their conservation issues in order to reach a good performance. [ABSTRACT FROM AUTHOR]

Tertiary lymphoid organs (TLOs) are collections of immune cells resembling secondary lymphoid organs (SLOs) that form in peripheral, non-lymphoid tissues in response to local chronic inflammation. While their formation mimics embryologic lymphoid organogenesis, TLOs form after birth at ectopic sites in response to local inflammation resulting in their ability to mount diverse immune responses. The structure of TLOs can vary from clusters of B and T lymphocytes to highly organized structures with B and T lymphocyte compartments, germinal centers, and lymphatic vessels (LVs) and high endothelial venules (HEVs), allowing them to generate robust immune responses at sites of tissue injury. Although our understanding of the formation and function of these structures has improved greatly over the last 30 years, their role as mediators of protective or pathologic immune responses in certain chronic inflammatory diseases remains enigmatic and may differ based on the local tissue microenvironment in which they form. In this review, we highlight the role of TLOs in the regulation of immune responses in chronic infection, chronic inflammatory and autoimmune diseases, cancer, and solid organ transplantation. [ABSTRACT FROM AUTHOR]

Caspase-dependent apoptosis accounts for approximately 90% of homeostatic cell turnover in the body1, and regulates inflammation, cell proliferation, and tissue regeneration2–4. How apoptotic cells mediate such diverse effects is not fully understood. Here we profiled the apoptotic metabolite secretome and determined its effects on the tissue neighbourhood. We show that apoptotic lymphocytes and macrophages release specific metabolites, while retaining their membrane integrity. A subset of these metabolites is also shared across different primary cells and cell lines after the induction of apoptosis by different stimuli. Mechanistically, the apoptotic metabolite secretome is not simply due to passive emptying of cellular contents and instead is a regulated process. Caspase-mediated opening of pannexin 1 channels at the plasma membrane facilitated the release of a select subset of metabolites. In addition, certain metabolic pathways continued to remain active during apoptosis, with the release of only select metabolites from a given pathway. Functionally, the apoptotic metabolite secretome induced specific gene programs in healthy neighbouring cells, including suppression of inflammation, cell proliferation, and wound healing. Furthermore, a cocktail of apoptotic metabolites reduced disease severity in mouse models of inflammatory arthritis and lung-graft rejection. These data advance the concept that apoptotic cells are not inert cells waiting for removal, but instead release metabolites as 'good-bye' signals to actively modulate outcomes in tissues. Apoptotic cells communicate with neighbouring cells by the regulated release of specific metabolites, and a cocktail of select apoptotic metabolites reduces disease severity in mouse models of inflammatory arthritis and lung transplant rejection. [ABSTRACT FROM AUTHOR]

Introduction: We qualitatively examined the symptoms and impact of recurrent primary focal segmental glomerulosclerosis (rpFSGS) in kidney transplant recipients, compared with two related FSGS populations, to characterize the experience of patients with rpFSGS.Methods: A literature review identified 58 articles concerning the experience of patients with pFSGS and/or rpFSGS in three groups: pre-transplant pFSGS, post-transplant rpFSGS, or post-transplant non-recurrent pFSGS. Literature findings were used to construct a preliminary conceptual model incorporating the symptoms and impact of rpFSGS, which was refined on the basis of qualitative interviews with clinicians. Twenty-five patients (rpFSGS: n = 15; pre-transplant pFSGS: n = 5; post-transplant non-recurrent pFSGS: n = 5) were interviewed to characterize the experience of patients with rpFSGS and compare it with other FSGS populations, and findings were used to finalize the conceptual model.Results: The impact of pFSGS/rpFSGS described in the literature was diverse. Treatment-related symptoms, along with anxiety and depression, were considered important features of rpFSGS in addition to the findings from the literature review, according to clinicians. Patient-reported tiredness and swelling were the most common/disturbing symptoms associated with rpFSGS, while physical activity restrictions and adverse effects on work/social life were considered the most profound impact concepts. The collective disease experience was different for patients with rpFSGS and non-recurrent pFSGS, although psychological impact, including treatment-related anxiety and depression, were common to both groups.Conclusions: Post-transplant recipients with rpFSGS display a greater symptom burden and experience a more diverse impact than those with non-recurrent pFSGS, highlighting the importance of effective patient monitoring and introducing effective treatments for the prevention and management of pFSGS recurrence.Funding: Astellas Pharma Global Development, Inc. [ABSTRACT FROM AUTHOR]

Conservation assessments present a formidable challenge for regions of the developing world such as the Lesser Antilles. Of the 2652 seed plant taxa recorded from this archipelago (Acevedo-Rodríguez & Strong, 2012, 2016), only 150 taxa (including 14 endemics) are listed in the IUCN Red List. Using only herbarium data, we carried out a preliminary conservation assessment of the 263 seed plant taxa unique to these islands by two methods. Using the algorithm originally developed to assess the Hawaiian flora (Krupnick et al. in Biodiversity and Conservation 18: 1459-1474, 2009), 8% of the taxa were deemed to be Potentially Extinct and 62% Potentially Threatened while 30% were assessed as Not Threatened. Using a Red List criteria approach, 70% were deemed Threatened (Critically Endangered, Endangered and Vulnerable), while 30% were assessed as Near Threatened, Least Concern or Data Deficient. The congruence between the assessments by these distinct methods and for the 14 Red Listed species validate this approach as a first step in prioritising plant conservation efforts. [ABSTRACT FROM AUTHOR]

Introduction: Acute myeloid leukemia (AML) imposes significant burden on patients, their families, and the healthcare system. Published literature has reported many AML signs and symptoms, as well as their impact on patients. However, there are no publications on the experience of living with AML from the patient's perspective. In this study, we performed qualitative interviews with patients with AML to understand their experience. Methods: Participants were recruited from the US and Japan. All patients were screened to assess eligibility, and were divided into four subgroups (i.e., newly-diagnosed, high-intensity chemotherapy; newly-diagnosed, low-intensity chemotherapy; relapse/refractory; and post-transplant). Patients were interviewed over the phone by a trained researcher and asked about their day-to-day experience with AML. Signs/symptoms and impacts were coded, analyzed using Atlas.ti software, and reported as frequencies, with the medians of patient-reported disturbance levels (0-10) computed for each symptom and impact. Results: The most commonly reported sign/symptom in the US was fatigue (95.7%), followed by bruising and weakness (both 78.3%), and in Japan, nausea (94.4%), followed by fatigue and headache (both 88.9%). The most commonly reported impact in the US was a decreased ability to maintain social/familial roles (91.3%), followed by anxiety and a decreased ability to function (both 87.0%), and most commonly reported in Japan was anxiety, a decreased ability to function, and remission uncertainty (94.4%). Conclusion: Although the frequency of signs/symptoms and their level of disturbance varied between the US and Japan, there was remarkable consistency in the types of signs/symptoms and impacts reported across all patients. The consistency in the experience of the disease across patients suggests that measurement of AML experience can be achieved by using the same tool for most, if not all, of these patients. Funding: Astellas Pharma Inc., Northbrook, IL, USA. [ABSTRACT FROM AUTHOR]

The Clean Air Act provides the regulatory framework for climate policy in the United States. Emissions rate performance standards are the metric identified for regulation of the electricity sector, the most important source of emissions. Rates for existing sources could be averaged to achieve flexibility in compliance, although the stringency of policies is ambiguous when flexibility is introduced. For example, a specific emissions rate improvement averaged over a larger set of generators may reduce the actual emissions change. We evaluate three policy designs according to emissions rate, emissions and marginal cost and show how a marginal abatement cost criterion can be applied within a technology-based regulation. This approach can quadruple the emissions reductions that are achieved, with net social benefits exceeding $25 billion in 2020, and with a 1.3 % electricity price increase. Over half of the benefits stem from improvements in conventional air quality. [ABSTRACT FROM AUTHOR]

Since 2013, four hospitals in northern Israel have been providing care for Syrian nationals, primarily those wounded in the ongoing civil war. We analyzed carbapenemase-producing Enterobacteriaceae (CPE) isolates obtained from these patients. Isolate identification was performed using the VITEK 2 system. Polymerase chain reaction (PCR) was performed for the presence of bla, bla, and bla. Susceptibility testing and genotyping were performed on selected isolates. During the study period, 595 Syrian patients were hospitalized, most of them young men. Thirty-two confirmed CPE isolates were grown from cultures taken from 30 patients. All but five isolates were identified as Klebsiella pneumoniae and Escherichia coli. Nineteen isolates produced NDM and 13 produced OXA-48. Among a further 29 isolates tested, multilocus sequence typing (MLST) showed that ST278 and ST38 were the major sequence types among the NDM-producing K. pneumoniae and OXA-48-producing E. coli isolates, respectively. Most were resistant to all three carbapenems in use in Israel and to gentamicin, but susceptible to colistin and fosfomycin. The source for bacterial acquisition could not be determined; however, some patients admitted to different medical centers were found to carry the same sequence type. CPE containing bla and bla were prevalent among Syrian wounded hospitalized patients in northern Israel. The finding of the same sequence type among patients at different medical centers implies a common, prehospital source for these patients. These findings have implications for public health throughout the region. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive hand-port-assisted laparoscopic vertical banded gastroplasty has the potential to reduce postoperative complications after bariatric surgery.Methods: We analyzed the postoperative course of 46 hand-port-assisted laparoscopic vertical banded gastroplasties (LVBG) completed between January 1998 and April 1999.Results: The operating time for the LVBG was shorter (140.8 +/- 6.0 vs 180.2 +/- 6.3 min; p < 0.05). Individuals were able to ambulate sooner (1.36 +/- 0.09 vs 2.44 +/- 0.16 days; p < 0.05), and start oral intake earlier (2.7 +/- 0.27 vs 3.7 +/- 0.17 days; p < 0.05) than the open vertical banded gastroplasty (VBG) controls. Three staple line leaks were detected in this group. Two leaks resolved without clinical sequelae, but one patient developed intraabdominal sepsis. This complication extended the average hospital stay to 6.8 +/- 2.00 days, as compared to 7.71 +/- 0.18 days for historical controls. By discounting this patient from the analysis, we arrive at a more representative length of hospitalization of 4.82 +/- 0.34 days (p < 0.05).Conclusions: LVBG offers a good alternative to the standard open VBG. Although this procedure has a relatively short learning curve, it should be done at centers with an interest in bariatric surgery. [ABSTRACT FROM AUTHOR]

Target two of the 2002 Global Strategy for Plant Conservation (GSPC), 'A preliminary assessment of the conservation status of all known plant species, at national, regional, and international levels' was not accomplished by its original 2010 target date and has therefore been included as a revised 2020 target, 'An assessment of the conservation status of all known plant species, as far as possible, to guide conservation action.' The most widely used system to estimate risk of extinction, the International Union for the Conservation of Nature Red List, provides conservation assessments for fewer than 15,000 plant species. Progress achieving Target two has been hampered by the large number of plant species and the difficulty assembling the data needed for Red List assessments. Two streamlined methods for identifying those plant species considered At Risk under the GSPC Target two are compared and contrasted. Both methods use readily available locality data from herbarium specimens to efficiently identify At Risk species and approximate the list of species that would be identified as threatened by Red List analyses. A comprehensive analysis of the native plant species of Puerto Rico using both streamlined methods identifies 570 of the 2,025 species at some risk of extinction. More efficient systems for assessing threat allow a more timely response to Target two, allow conservation efforts to be directed to the species that need attention, and the list of threatened plants can be used to identify priority areas for plant conservation. [ABSTRACT FROM AUTHOR]

Psychotherapy with low-income patients presents a variety of challenges for the clinician. This paper discusses some of those challenges, including the barriers that poor individuals face in obtaining treatment, as well as issues of stigma, mistrust of authority, and potential cultural differences and differing expectations between mental health providers from higher socioeconomic backgrounds and lower-income individuals in need of care. We review some of the findings reported in treatment studies with low-income, frequently minority, samples that shed light on the types of adaptations to treatment that have proven successful. Finally, we discuss some of the clinical research that has been conducted with low-income, predominantly minority women through the department of psychiatry at Georgetown University over the past several years, concluding with some of the lessons we have learned in developing and conducting psychotherapeutic treatments with this population. [ABSTRACT FROM AUTHOR]

the lung is constantly exposed to both innocuous and potentially noxious antigens, a thorough understanding of both innate and adaptive immune responses in this organ is of the essence. Imaging modalities such as magnetic resonance imaging, positron emission tomography, and confocal microscopy have expanded our knowledge about various molecular processes and cellular responses in the lung. Two-photon microscopy has evolved into a powerful tool to observe cellular interactions in real time and has markedly expanded our understanding of the immune system. Recently, two-photon microscopy has also been utilized to image the murine lung. As immune responses in the lung differ from those in other non-lymphoid tissues, this technique holds great promise to advance our knowledge of the biology that underlies a wide spectrum of pulmonary diseases. [ABSTRACT FROM AUTHOR]

The Global Strategy for Plant Conservation calls for a preliminary assessment of the conservation status of all known plant species by the year 2010. To date insufficient progress has been made on meeting this target. New efforts to develop a preliminary list beyond using the full IUCN criteria in plant assessments are needed. Here we present an algorithm that provides a preliminary assessment of the conservation status of plant species using data from herbarium specimens. We use Hawaiian specimen data from the United States National Herbarium to calibrate the parameters of the algorithm and then use specimen data from the Arecaceae, Commelinaceae, Gesneriaceae and Heliconiaceae as examples of the application of the algorithm. The algorithm was calibrated to insure 95% accuracy in placing the Hawaiian plant species into previously and independently determined threatened categories. Our results indicate that 28% of the Hawaiian taxa, 27% of the species of Arecaceae, 45% of the species of Commelinaceae, 32% of the species of Gesneriaceae, and 35% of the species of Heliconiaceae are Not Threatened and will not need any further evaluation for the preliminary assessment. Species identified here as Potentially Extinct and Potentially Threatened can be further assessed by additional herbarium material and/or conservation specialists for final evaluation using other assessment strategies (e.g., regional and national lists, taxonomic expert assessment, etc.). [ABSTRACT FROM AUTHOR]

A contingent valuation survey was conducted in Shizuoka, Japan, to estimate the willingness to pay (WTP) for reductions in the risk of dying and calculate the value of statistical life (VSL) for use in environmental policy in Japan. Special attention was devoted to the effects of age and health characteristics on WTP. We find that the VSLs are somewhat lower (103 to 344 million yen) than those found in a virtually identical survey applied in some developed countries. These values were subject to a variety of validity tests, which they generally passed. We find that the WTP for those over age 70 is lower than that for younger adults, but that this effect is eliminated in multiple regressions. Rather, when accounting for other covariates, we find that WTP generally increases with age throughout the ages in our sample (age 40 and over). The effect of health status on WTP is mixed, with WTP of those with cancer being lower than that of healthy respondents, while the WTP of those with heart disease is greater. The VSLs for future risk changes are lower than those for contemporaneous risk reductions. The implicit discount rates of 5.8%–8.0% are relatively larger than the discount rate regularly used in environmental policy analyses. This survey is the first of its kind in Japan, and provides information that is directly useful for estimating the benefits of environmental and other policies that lower mortality risks to the general population and subgroups with a variety of specific traits. [ABSTRACT FROM AUTHOR]

Using results from two contingent valuation surveys conducted in Canada and the U.S., we explore the effect of a latency period on willingness to pay (WTP) for reduced mortality risk using a structural model. We find that delaying the time at which the risk reduction occurs by 10 to 30 years reduces WTP by more than 60% for respondents in both samples aged 40 to 60 years. The implicit discount rates are equal to 3.0–8.6% for Canada and 1.3–5.6% for the U.S. [ABSTRACT FROM AUTHOR]

The objective of this study is to estimate willingness to pay (WTP) for the reduction of mortality risks caused by fossil fuel (natural gas, coal and oil) versus nuclear electric power generation systems and to examine the influence of risk characteristics involved with electric power generation on WTP. A choice experiment was conducted to achieve these objectives. The attributes for nuclear risks in the experiment included the probability of disasters and the expected losses if a disaster occurs. We find evidence of (i) a baseline effect (where WTP is sensitive to hypothetical versus actual baseline expected mortality); (ii) a ‘labeling effect,’ where, surprisingly, the term ‘nuclear’ has no effect on WTP, but the term ‘fossil-fueled power generation’ results in lower WTP; and (iii) disaster aversion, meaning that people focus on the conditional loss from a nuclear disaster, not the probability. We also find that the WTP for reducing deaths from a nuclear disaster is about 60 times the WTP for routine reducing fossil-fuel generation-related deaths. [ABSTRACT FROM AUTHOR]

The loss of biodiversity is now recognized as a global problem of significant magnitude [ Science 289: 2279]. Conservation efforts focus on measuring species diversity and distribution, assessing biodiversity threats, and managing habitats to maintain that diversity. The accuracy of measuring species diversity depends on the quality and scale of the data. Recently indirect estimates of diversity based on the skilled opinions of international taxonomic authorities were used to define 25 global conservation hotspots [ Nature 403: 853–858] and 871 ecoregions [ Bioscience 51: 933–938]. These data, originating from first-hand fieldwork and museum study, are readily available, but not necessarily repeatable nor testable. If this type of information prevails for conservation purposes, it is critical that we test the quality of this information with verifiable data at finer scales (e.g., regional inventories, specimen records, and accumulated distribution data). Here we perform such a test for the hotspots and ecoregions found in the Indo-Pacific by comparing the estimates of the expert scientists with authenticated published diversity data on flowering plants. We found a high correlation between our counts of species richness and endemism with the experts' estimates, but surprisingly found less congruity among the seven families examined. A revised list of conservation priority regions based on our plant data is provided. [ABSTRACT FROM AUTHOR]

This paper describes the origin, facilitation, and effectiveness of an innovative model of early secondary prevention designed to help high-risk, inner-city, elementary school children deal with multiple losses and trauma. Grieving is especially difficult for inner-city children who live in a chaotic environment of poverty and are often traumatized by witnessing and enduring violence. These emotionally vulnerable and often developmentally impaired children are unable to deal with the feelings of helplessness and hopelessness, the pain of grief, violent fantasies, and guilt. The result can be an underlying depression that children and adolescents try to avoid through aggressive acting out or self-destructive behavior. An innovative school-based model promotes mourning work. Clinical pre- and posttesting indicate the effectiveness of the intervention. Various extensions of the project are described. [ABSTRACT FROM AUTHOR]

Despite evidence that human non-hematopoietic cells, such as vascular endothelium, can activate allogeneic T lymphocytes in vitro, the prevailing view has been that hematopoietic antigen-presenting cells are required to trigger alloimmune responses in vivo. Here we report that mouse non-hematopoietic cells activate alloreactive CD8+ T lymphocytes in vitro and in vivo. We also show that vascularized cardiac allografts are acutely rejected via CD8+ direct allorecognition even if the alloantigen is not presented by hematopoietic professional antigen-presenting cells. Because activation of alloreactive CD8+ T cells by donor-type non-hematopoietic cells can continue for the life of the allograft, these findings present a new clinically relevant mechanism of allorecognition and should be taken into consideration when developing strategies to prevent allograft vasculopathy or to induce tolerance. [ABSTRACT FROM AUTHOR]

We present the results of a contingent valuation survey eliciting willingness to pay (WTP) for mortality risk reductions. The survey was self-administered using a computer by 930 persons in Hamilton Ontario aged 40 to 75. Visual and audio aides were used to enhance risk comprehension. Mean WTP figures for a contemporaneous risk reduction imply a value of a statistical life of approximately C$1.2 to C$3.8 million (1999 C$). Mean WTP is constant with age up to 70 years, and is about 30 percent lower for persons aged 70 and older. WTP is unaffected by physical health status, but is affected by mental health. [ABSTRACT FROM AUTHOR]

Non-specific factors refer to dimensions that are shared by most psychotherapies and include the therapeutic alliance, the therapist's competence and adherence to the treatment protocols whereas specific factors refer to the specific techniques and interventions that characterize particular psychotherapies. Review of the literature on non-specific treatment factors reveals that the therapeutic alliance and therapist competence may vary among patients and therapists, and that the therapeutic alliance also varies among treatment modalities. All three non-specific treatment factors, therapeutic alliance, therapist competence and adherence to the specific treatment modality, contribute significantly to treatment outcome and may account for more of the variance in outcome than specific treatment approach. Consequently, these factors need to be considered in the design of psychotherapy studies. In this paper we use the treatment study of infantile anorexia as an example of how to integrate these non-specific factors in the study design and the data analysis of treatment outcome in a psychotherapy study. [ABSTRACT FROM AUTHOR]

Demonstrates that beta-arrestin functions as an adapter in the receptor-mediated endocytosis pathway. The suggestion of a general mechanism for regulating the trafficking of G-protein-coupled receptors; The promotion by beta-arrestin and arrestin-3 of beta2-adrenergic receptor (beta2-AR) internalization; The binding stoichiometrically to clathrin; The use of immunofluorescence microscopy.

This article examines the effect of familiarity with chronic lung disease on people's willingness to pay to reduce their risk of contracting chronic bronchitis, and on their willingness to increase their risk of auto death to reduce chronic bronchitis risk. We find that persons who have a relative with chronic lung disease are willing to give up more income to reduce their risk of chronic bronchitis than persons with no first-hand knowledge of the disease: however, their willingness to increase their risk of auto death to reduce their risk of chronic bronchitis is no different, on average, than persons with no first-hand knowledge of lung disease. This suggests that responses to risk-risk tradeoffs may be more stable than responses to risk-income choices. [ABSTRACT FROM AUTHOR]

Flower-feeding insects may influence the reproductive behavior of their host plant. In plants with labile sex expression, the ratio of maternal to paternal investment may change in response to damage, an effect that goes beyond the direct reduction of plant gametes. We examined the effects of floral herbivory by the beetle Meligethes rufimanus (Nitidulidae) on the ratio of hermaphroditic flowers to male flowers in an andromonoecious shrub, Isomeris arborea (Capparaceae) in southern California. Plants exposed to herbivory had a greater rate of flower bud abortion than those protected from herbivory. Exposed plants produced a greater proportion of hermaphroditic flowers to male flowers, although damaged inflorescences still produced fewer fruit. An additional manipulative experiment showed that the removal of pistils on inflorescences led to an increase in the proportion of hermaphroditic flowers. This suggests that the presence of fruit may lead to pistil suppression in developing flowers. Adaptive responses to herbivory which favor andromonoecy thus include the continued production of hermaphroditic flowers when floral damage is high (and hence low fruit set), and a switch to male flower production when floral damage is low (and fruit production increases). The consequences of an altered six ratio induced by insect herbivores may lead to indirect effects on both the male and female reproductive success of this plant. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Traumatic diaphragmatic hernia: tertiary centure experience," by G. S. Kishore and colleagues.

Discusses the effectiveness of clobetasol foam for the treatment of psoriasis. Overview of drugs and combination therapies used for treatment; Chemical composition; Mechanism of action.