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The ultrastructure of the optic nerve, brain, and some associated structures of larval zebrafish, grown under three different light regimens were studied. Fish grown under cyclic light (control), constant dark (CD), and constant light (CL) were studied for 4 and 8 days postfertilization (dpf). We also studied the control and CD fish at 15 dpf. The brains of the control and CL fish were larger at 4 dpf than at 8 dpf. In all 4 dpf fish, the brain occupied the entire expanse between the two retinas and the optic nerve extended the shortest distance between the retina and the brain. The 15 dpf zebrafish had the smallest brain size. Groups of skeletal muscle cells associated with the optic nerves became visible in all older larvae. In the 15 dpf larvae, bulges and dilations in the optic nerve occurred as it reached the brain and optic chiasms occurred proximal to the brain. Electron microscopy yielded information about myelinated and unmyelinated axons in the optic nerve, the dimensions of neurotubules, neurofilaments, and myofilaments, including a unique variation in actin myofilaments, and a confirmation of reported myosin myofilament changes (but with dimensions). We also describe the ultrastructure of a sheath-like structure that is confluent over the optic nerve and the brain, which has not been described before in zebrafish. Also presented are images of associated fibroblasts, epithelial cells lining the mouth, cartilage plates, blood vessels, nerve bundles, and skeletal muscle cells, most of which have not been previously described in the literature., (Copyright © 2012 Wiley Periodicals, Inc.)

The recent H1N1 pandemic influenza stimulated numerous studies into the attitudes and intentions about the H1N1 vaccine. However, no study has investigated prospective predictors of vaccination behaviour. We conducted a two-wave longitudinal study among residents in four U.S. cities during the course of the H1N1 outbreak, using Internet surveys to assess demographic, cognitive and emotional predictors of H1N1 vaccination behaviour. Surveys were conducted at two time points, before (Time 1) and after (Time 2) the H1N1 vaccine was widely available to the public. Results show that Time 2 vaccination rates, but not Time 1 vaccination intentions, tracked H1N1 prevalence across the four cities. Receipt of seasonal influenza vaccine in the previous year, worry, compliance with recommended interventions, household size and education assessed at Time 1 were significant prospective predictors of vaccination behaviour. Perception of the H1N1 vaccine, social influence and prioritised vaccine recipient status assessed at Time 2 also predicted vaccination behaviour. Critically, worry about H1N1 mediated the effects of both objective risk (prevalence at the city level) and perceived risk on vaccination behaviour. These results suggest that H1N1 vaccination behaviour appropriately reflected objective risk across regions, and worry acted as the mechanism by which vaccination behaviour followed objective risk.

Emergency departments and hospitals are being urged to implement onsite interventions to promote smoking cessation, yet little is known about the theoretical underpinnings of behavior change after a healthcare visit. This observational pilot study evaluated three factors that may predict smoking cessation after an acute health emergency: perceived illness severity, event-related emotions, and causal attribution. Fifty smokers who presented to a hospital because of suspected cardiac symptoms were interviewed, either in the emergency department (ED) or, for those who were admitted, on the cardiac inpatient units. Their data were analyzed using both qualitative and quantitative methodologies to capture the individual, first-hand experience and to evaluate trends over the illness chronology. Reported perceptions of the event during semistructured interview varied widely and related to the individual's intentions regarding smoking cessation. No significant differences were found between those interviewed in the ED versus the inpatient unit. Although the typical profile was characterized by a peak in perceived illness severity and negative emotions at the time the patient presented in the ED, considerable pattern variation occurred. Our results suggest that future studies of event-related perceptions and emotional reactions should consider using multi-item and multidimensional assessment methods rated serially over the event chronology.

Intestinal parasitic infections cause one of the largest global burdens of disease. To identify possible areas for interventions, a structured questionnaire addressing knowledge, attitude, and practice regarding parasitic infections as well as the less studied role of culture and resource availability was presented to mothers of school-age children in rural communities around San Juan del Sur, Nicaragua. We determined that access to resources influenced knowledge, attitude, and behaviors that may be relevant to transmission of parasitic infections. For example, having access to a clinic and prior knowledge about parasites was positively correlated with the practice of having fencing for animals, having fewer barefoot children, and treating children for parasites. We also found that cultural beliefs may contribute to parasitic transmission. Manifestations of machismo culture and faith in traditional medicines conflicted with healthy practices. We identified significant cultural myths that prevented healthy behaviors, including the beliefs that cutting a child's nails can cause tetanus and that showering after a hot day caused sickness. The use of traditional medicine was positively correlated with the belief in these cultural myths. Our study demonstrates that the traditional knowledge, attitude, and practice model could benefit from including components that examine resource availability and culture.

The development of consistent health behaviors is important for chronic illness prevention and management. The current study experimentally compared two strategies--a personal-rule and a deliberation strategy--designed to help participants consistently perform their intended behaviors over a 7-week period in a real-world setting. Although the personal-rule strategy had theoretical support from behavioral economics and empirical support from both animal and human lab experiments, the deliberation strategy group was significantly more successful than the personal-rule strategy group, both initially (time to first violation, p < .01, Cohen's d = .51) and over the entire 7-week period (overall success, p < .05, Cohen's d = .18). These effects were significant even after controlling for known predictors of behavioral success, including individual-difference variables, person-behavior factors, and resolution-related factors.

Purpose: We investigated three questions: (1) How do obstetrician-gynecologists communicate positive and negative test results? (2) When reporting screening test results, do obstetrician-gynecologists use quantitative or qualitative information? and (3) Is physician numeracy (i.e., the ability to use and understand numbers) associated with use of quantitative or qualitative information?, Method: Obstetrician-gynecologists (N = 203; 55.6% response rate) who were members of the American College of Obstetricians and Gynecologists completed a survey about their communication of Down syndrome screening test results, an Objective Numeracy Scale, and the Subjective Numeracy Scale., Results: Higher scores on the Subjective Numeracy Scale and younger age predicted obstetrician-gynecologists' use of numbers to explain testing results. The Objective Numeracy Scale did not predict use of numbers. Gender was correlated with scores on the Subjective Numeracy Scale (r = 0.2) and the Subjective Numeracy Scale-Ability Subscale (r = 0.3), with men scoring higher than women when controlling for age. Open-ended questions revealed that communication strategies vary, with approximately one in three obstetrician-gynecologists providing numerical information, and frequency format being the commonly used numerical format., Conclusion: Although physicians are often overlooked in the problem of low health literacy, it is important that we continue to investigate the impact of physician numeracy on patient care.

Background: The trajectory of an infectious disease outbreak is affected by the behavior of individuals, and the behavior is often related to individuals' risk perception. We assessed temporal changes and geographical differences in risk perceptions and precautionary behaviors in response to H1N1 influenza., Methods: 1,290 US adults completed an online survey on risk perceptions, interests in pharmaceutical interventions (preventive intervention and curative intervention), and engagement in precautionary activities (information seeking activities and taking quarantine measures) in response to H1N1 influenza between April 28 and May 27 2009. Associations of risk perceptions and precautionary behaviors with respondents' sex, age, and household size were analyzed. Linear and quadratic time trends were assessed by regression analyses. Geographic differences in risk perception and precautionary behaviors were evaluated. Predictors of willingness to take pharmaceutical intervention were analyzed., Results: Respondents from larger households reported stronger interest in taking medications and engaged in more precautionary activities, as would be normatively predicted. Perceived risk increased over time, whereas interest in pharmaceutical preventive interventions and the engagement in some precautionary activities decreased over time. Respondents who live in states with higher H1N1 incidence per population perceived a higher likelihood of influenza infection, but did not express greater interests in pharmaceutical interventions, nor did they engage in a higher degree of precautionary activities. Perceived likelihood of influenza infection, willingness to take medications and engagement in information seeking activities were higher for women than men., Conclusions: Perceived risk of infection and precautionary behavior can be dynamic in time, and differ by demographic characteristics and geographical locations. These patterns will likely influence the effectiveness of disease control measures.

Background: Antiviral coverage is defined by the proportion of the population that takes antiviral prophylaxis or treatment. High coverage of an antiviral drug has epidemiological and evolutionary repercussions. Antivirals select for drug resistance within the population, and individuals may experience adverse effects. To determine optimal antiviral coverage in the context of an influenza outbreak, we compared 2 perspectives: 1) the individual level (the Nash perspective), and 2) the population level (utilitarian perspective)., Methods: We developed an epidemiological game-theoretic model of an influenza pandemic. The data sources were published literature and a national survey. The target population was the US population. The time horizon was 6 months. The perspective was individuals and the population overall. The interventions were antiviral prophylaxis and treatment. The outcome measures were the optimal coverage of antivirals in an influenza pandemic., Results: At current antiviral pricing, the optimal Nash strategy is 0% coverage for prophylaxis and 30% coverage for treatment, whereas the optimal utilitarian strategy is 19% coverage for prophylaxis and 100% coverage for treatment. Subsidizing prophylaxis by $440 and treatment by $85 would bring the Nash and utilitarian strategies into alignment. For both prophylaxis and treatment, the optimal antiviral coverage decreases as pricing of antivirals increases. Our study does not incorporate the possibility of an effective vaccine and lacks probabilistic sensitivity analysis. Our survey also does not completely represent the US population. Because our model assumes a homogeneous population and homogeneous antiviral pricing, it does not incorporate heterogeneity of preference., Conclusions: The optimal antiviral coverage from the population perspective and individual perspectives differs widely for both prophylaxis and treatment strategies. Optimal population and individual strategies for prophylaxis and treatment might be aligned through subsidization.

Who should be saved when health resources are limited? Although bioethicists and policymakers continue to debate which metric should be used to evaluate health interventions, public policy is also subject to public opinion. We investigated how the public values life when evaluating vaccine-allocation policies during a flu epidemic. We found that people's ratings of the acceptability of policies were dramatically influenced by question framing. When policies were described in terms of lives saved, people judged them on the basis of the number of life years gained. In contrast, when the policies were described in terms of lives lost, people considered the age of the policy's beneficiaries, taking into account the number of years lived to prioritize young targets for the health intervention. In addition, young targets were judged as more valuable in general, but young participants valued young targets even more than older participants did.

The distribution and ultrastructural features of peripheral nerve processes in the extra-retinal layers of the eyes of the zebrafish, Danio rerio (Hamilton), were investigated using light and transmission electron microscopy. A comparative study of the quality of preservation provided by three different fixation procedures revealed no consistently striking general differences. However, somewhat subjectively, the fixative containing Millonig's buffer did consistently provide better fixation of myelin. Overall, nerve processes, depending on the site studied, were distributed as either (1) bundles (in the choroid near the optic nerve head and in the choroid adjacent to the limbus), (2) linear arrays (in the junction between the sclera and cartilage and in the choroid adjacent to the retina) or (3) individual units (in the choroid under the cartilage or in the sclera). Both myelinated and unmyelinated processes were identified in these locations. Myelinated processes usually contained both neurofilaments and neurotubules, but a few apparently contained only neurofilaments. Unmyelinated processes usually contained mainly neurotubules, but a few apparently contained only neurofilaments. Taken together, these findings indicate innervation of extra-retinal structures, as seen in zebrafish, is highly conserved among vertebrates, further supporting the use of zebrafish as a model for the vertebrate visual system.

When making judgments, people often favor information received from a few individual sources over large-sample statistical data. Individual information is usually acquired piece by piece, whereas statistical information combines many observations into a single summary. We examined whether this difference in the frequency of encounters affects how data are weighted. In two experiments, subjects read statistical information indicating an event to be rare and contrasting information from individual cases suggesting the event to be common. We controlled whether the individual cases were summarized into a single summary like statistical information, or presented serially, case by case. Subjects' estimates of event frequencies were higher when the individual cases were presented in serial, rather than summarized, format. A third study demonstrated that subjects treat each data sample as an instance, and do not weight according to sample size. These results support the conclusion that people weight information according to encounter frequency.

People overweight certainty, even when certainty is only an illusion. A vaccine that was described as 100% effective against 70% of disease targets was preferred to one described as 70% effective against 100% of disease targets (Studies 1 and 2). The appeal of 100% extends beyond the probability attribute. In Study 2, participants preferred both of the vaccines above to normatively equivalent vaccines that were less than 100% effective toward fewer than 100% of targets. In Study 3, participants preferred a 100% discount on a cup of coffee every 10 days to other more frequent, but lower amount, discounts. This preference evaporated, however, when savings were framed as points rather than as percentage discounts. We propose that people view 100% as a salient reference point and overweight it in those domains where it cannot be exceeded (e.g., probability, discount); the overweighting is weaker in domains where 100% can be exceeded (e.g., target range, points).

Human papillomavirus (HPV) vaccines provide an opportunity to reduce the incidence of cervical cancer. Optimization of cervical cancer prevention programs requires anticipation of the degree to which the public will adhere to vaccination recommendations. To compare vaccination levels driven by public perceptions with levels that are optimal for maximizing the community's overall utility, we develop an epidemiological game-theoretic model of HPV vaccination. The model is parameterized with survey data on actual perceptions regarding cervical cancer, genital warts, and HPV vaccination collected from parents of vaccine-eligible children in the United States. The results suggest that perceptions of survey respondents generate vaccination levels far lower than those that maximize overall health-related utility for the population. Vaccination goals may be achieved by addressing concerns about vaccine risk, particularly those related to sexual activity among adolescent vaccine recipients. In addition, cost subsidizations and shifts in federal coverage plans may compensate for perceived and real costs of HPV vaccination to achieve public health vaccination targets.

This study reports on morphological features of hepatic portal tracts in the liver of a rhesus monkey. The light microscope shows that the number of each type of principal component comprising a portal tract varies but that there are usually one to five lymphatics, one bile ductule, one bile duct, one arteriolar and one arterial branch of the hepatic artery, and one hepatic portal vein. Bile ductules, in cross section, have 6-10 cells (mostly low pyramidal, but with a few cuboidal) bordering the lumen, an outside diameter of from about 20 to 25 microm, and a luminal diameter of from 2 to 10 microm. Bile ducts, in cross section, have more than 10 cells (about equal numbers of low pyramidal and cuboidal) bordering the lumen, an outside diameter greater than 25 microm and a luminal diameter of greater than 10 microm. The term "pyramidal" has not previously been applied to the cells of the ductules and ducts. The monkey tracts show several cytological features previously undescribed, viz., abortive cilia and basal bodies in the duct cells, abortive cilia in the ductule cells, and an occasional aggregation of ribosomes in arterial endothelial cells. They also show a major histological feature previously mentioned but not illustrated, viz., bundles of nerve processes which exhibit a preferential location, i.e., proximity to the arterioles and arteries.

Pt nanoparticles having the same size ( approximately 10 nm) but different shapes (cubic or octahedral/tetrahedral), as determined by transmission electron microscopy, were synthesized via a polyol-based synthetic procedure. Their respective electrocatalytic activities for methanol oxidation were characterized by cyclic voltammetry and chronoamperometry in both sulfuric and perchloric acid electrolytes, which showed clear shape (surface orientation) dependences. Furthermore, the octahedral/tetrahedral Pt nanoparticles displayed an unexpectedly large enhancement in methanol electro-oxidation activity; about 3-fold increase in transient intrinsic activity and 10-fold increase in CO tolerance steady-state activity when compared to commercial Pt black. Gaseous and methanolic CO adsorption on the synthesized nanoparticles were also investigated by surface-enhanced IR absorption spectroscopy in perchloric acid electrolyte, which suggested that the different trends observed might be related to the electronic effects specific to a given ensemble of the nanofacets.

Over 60% of all Americans are classified as overweight or obese. This represents a major public health concern, as obesity is a risk factor for many other health ailments. While many people intend to lose weight, they often have difficulty changing their current behavioral patterns (as evidenced by modest correlations between intention and behavior). Therefore, one of the major challenges for obesity research is to address the gap between intentions to lose weight and actual behavior. The current study hypothesized that one reason for the intention-behavior discrepancy is that people mis-estimate the barriers that they will encounter as they follow through with their intentions. Specifically, we hypothesized that people underestimate barriers to exercise and diet, and because of these underestimations, there is a discrepancy between their intentions and behavior. To test these hypotheses, we surveyed faculty and staff at Rutgers University (N = 422) at two time points, 1 year apart. The results indicate that barriers to dieting behaviors are significantly underestimated and this underestimation partially explained the discrepancy between intentions and behavior. The results for barriers to exercise behavior were less consistent, however. As a whole, these results suggest a possible point of behavioral intervention for weight loss.

Normatively, a statistical pairwise comparison is a function of the mean, standard deviation (SD), and sample size of the data. In our experiment, 203 undergraduates compared product pairs and judged their confidence thatone product was better than the other. We experimentally manipulated (within subjects) theaverage productratings, the number of raters (sample size), and the SD of the ratings. Each factor had two levels selected, so that the same change in statistical power resulted from moving from the low to the high level. We also manipulated (between subjects) whether subjects were given only the product rating data as summarized in a statistical format orthe summariesplus the raw ratings. Subjects gave the most weight to mean product ratings, less weight to sample size, and very little weight to SD. Providing subjects with raw data did not increase their use of sample size and SD, as predicted.

Samples from the liver of a male rat (Sprague-Dawley), a monkey (Macacus rhesus), and a longnose gar pike (Lepisosteus osseus) were studied in a transmission electron microscope to provide cytological and histological information about structures previously poorly documented in the literature. Glisson's capsule consisted of dense, irregular connective tissue of typical Type-I collagen fibrils. The capsule was formed by a single stratum of fibroblasts in the rat and in the pike, but by one or two strata of fibroblasts in the monkey. In the rat, but not in the monkey or pike, fibroblast processes interdigitated with processes from the hepatocytes. In the pike, fibroblast processes extended toward both mesothelium and hepatocytes. In some areas of the rat and pike, mesothelial cells had desmosomal connections and microvillous projections into the peritoneal cavity. Marginated heterochromatin was more abundant in the rat and monkey. The mesothelium was discontinuous in the rat and monkey but, in areas of discontinuity, the capsular surface was covered by a basal lamina, often barely perceptible beneath mesothelial cells of the rat and monkey, but prominent in the pike. In the pike, the mesothelium had numerous pinocytotic vesicles on both peritoneal and capsular surfaces.

Background: Advance directives promise to preserve patient autonomy, but research indicates that end-of-life preferences can be influenced by the way in which questions are posed., Objective: To determine whether preferences expressed by geriatric patients on advance directives are influenced by the default response inherent in the question., Design: Mailed survey containing 1 of 3 versions of an advance directive., Setting: General internal medicine outpatient medical practice., Participants: Outpatients aged 65 or older (n = 106, response rate = 27%)., Interventions: In the "withhold" version of the survey, participants indicated situations where they would want treatments withheld (i.e., the default preference was in favor of treatment). In the "provide" version, participants indicated situations where they would want treatment provided (i.e., the default preference was against treatment). In the forced-choice control version, participants made an explicit decision to withhold or provide treatment for each situation., Main Outcome Measure: Participants' treatment preferences., Results: Preferences differed by condition, F(2, 103) = 3.61, MSE = 0.09, eta2 = .07, p = .03. Participants tended to express the default preference, and thus, were more likely to favor treatment in the "withhold" condition than in the "provide" condition. Preferences in the forced-choice control condition were intermediate., Conclusions: The default inherent in a question can impact preferences for medical treatment. This default effect limits the utility of advance directives.

Influenza vaccination is vital for reducing infection-mediated morbidity and mortality. To maximize effectiveness, vaccination programs must anticipate the effects of public perceptions and attitudes on voluntary adherence. A vaccine allocation strategy that is optimal for the population is not necessarily optimal for an individual. For epidemic influenza, the elderly have the greatest risk of influenza mortality, yet children are responsible for most of the transmission. The long-standing recommendations of the Centers for Disease Control follow the dictates of individual self-interest and prioritize the elderly for vaccination. However, preferentially vaccinating children may dramatically reduce community-wide influenza transmission. A potential obstacle to this is that the personal utility of vaccination is lower for children than it is for the elderly. We parameterize an epidemiological game-theoretic model of influenza vaccination with questionnaire data on actual perceptions of influenza and its vaccine to compare Nash equilibria vaccination strategies driven by self-interest with utilitarian strategies for both epidemic and pandemic influenza. Our results reveal possible strategies to bring Nash and utilitarian vaccination levels into alignment.

Background: Risk perceptions are central to many health behavior theories. However, the relationship between risk perceptions and behavior, muddied by instances of inappropriate assessment and analysis, often looks weak., Method: A meta-analysis of eligible studies assessing the bivariate association between adult vaccination and perceived likelihood, susceptibility, or severity was conducted., Results: Thirty-four studies met inclusion criteria (N = 15,988). Risk likelihood (pooled r = .26), susceptibility (pooled r = .24), and severity (pooled r = .16) significantly predicted vaccination behavior. The risk perception-behavior relationship was larger for studies that were prospective, had higher quality risk measures, or had unskewed risk or behavior measures., Conclusions: The consistent relationships between risk perceptions and behavior, larger than suggested by prior meta-analyses, suggest that risk perceptions are rightly placed as core concepts in theories of health behavior., ((c) 2007 APA, all rights reserved)

We examined how the format in which uncertainty information is presented affects two biases in humans' choice behavior. In a computer task, participants were given four common-ratio effect and four common-consequence effect problems in each of four different formats. In these problems, uncertainty information was described, as percentages (e.g., 80%) or as frequencies (e.g., 16/20), or was experienced, either serially (20 outcomes shown one at a time) or simultaneously (20 outcomes all shown at once). Presenting information as percentages attenuated the common-ratio effect and augmented the common-consequence effect, which suggests that these biases have different underlying mechanisms. Participants' percentage estimates of outcome likelihoods did not differ according to the format in which the information was presented; however, participants' nonverbal estimates of outcome likelihoods differed across formats. The results suggest that uncertainty information presented as percentages is processed differently than the same uncertainty information presented in other formats.

Ketogenic diets are used in the treatment of epilepsy in children refractory to drug therapy. This study identifies changes in liver morphology in rats fed four different diets: a normal rodent chow diet, a calorie-restricted high-fat (ketogenic) diet and each diet supplemented with clofibric acid. Hepatocytes of rats fed the ketogenic diet show many lipid droplets and these are reduced to control levels when clofibrate is present in the diet. Mitochondria are enlarged in the livers of rats fed the ketogenic diet and further enlarged if clofibrate is present. Alterations in the appearance or numbers of other organelles are also found.

Background: National vaccination guidelines recommend influenza vaccination for clinical employees with patient contact. For many other healthy working adults, influenza vaccination is optional., Purpose: We examined acceptance of a free influenza vaccine among clinical university employees who had patient contact and nonclinical university employees who did not have patient contact. We asked whether and why job role had an influence on the decision to be vaccinated., Method: Clinical (n = 103) and nonclinical (n = 339) employees of two universities completed a mailed questionnaire., Results: Vaccination rates were higher among clinical employees (62%) than among their nonclinical counterparts (47%). This effect of job role on vaccine acceptance was statistically mediated by perceived riskiness of getting vaccinated, knowledge about the vaccine, easy access to the vaccine, pro-Western medicine beliefs, and social influence. It was not vaccinated by perceived likelihood of getting infected or concern about infecting others., Conclusion: Clinical employees have higher vaccination rates than nonclinical employees, but not for the reasons that form the basis of national vaccination guidelines.

Transplantation of pancreatic islets can provide long-lasting insulin independence for diabetic patients, but the current islet supply is limited. Here we describe a new in vitro system that utilizes adult human pancreatic islet-enriched fractions to generate hormone-producing cells over 3-4 weeks of culture. By labeling proliferating cells with a retrovirus-expressing green fluorescent protein, we show that in this system hormone-producing cells are generated de novo. These hormone-producing cells aggregate to form islet-like cell clusters. The cell clusters, when tested in vitro, release insulin in response to glucose and other secretagogues. After transplantation into immunodeficient, nondiabetic mice, the islet-like cell clusters survive and release human insulin. We propose that this system will be useful as an experimental tool for investigating mechanisms for generating new islet cells from the postnatal pancreas, and for designing strategies to generate physiologically competent pancreatic islet cells ex vivo.

The arrival of rose rosette disease (RRD) in the Washington D.C. area prompted a transmission electron microscope study of ultrathin sections of leaves from symptomatic Rosa wichuraiana x safrano plants. Virus-like particles (VLPs) or double membrane-bound particles (DMPs) resembling those associated with RRD in other types of roses, and found in several other plant diseases, were seen in the cytoplasm of parenchymal and vascular bundle cells and shown, for the first time, in guard cells and budding into the vacuoles. Contrary to previous reports, starch granules were found in chloroplasts of the infected cells. A presumably unique intramitochondrial crystal was also observed. Variations in vacuolar content were noted.

Purpose: To examine the agreement between prostate cancer patients' utilities for selected health states and their rankings of the importance of six attributes of the health states and the clinicians' judgements of what would be in the patients' best interests., Method: Patients with newly diagnosed localized prostate cancer individually completed a time trade-off utility assessment shortly after being diagnosed. The health states evaluated were constructed from a multi-attribute utility model that incorporated six aspects of living with the disease and outcomes of treatment. Each patient assessed his current health state and three hypothetical states that might occur in the future, and provided rankings of the importance of the six attributes. The clinicians caring for each patient independently provided their views of what utilities and importance rankings would be in the patient's best interest., Results: The across-participant correlations between patients' and clinicians' utilities were very low and not statistically significant. Across-participant correlations between patient and clinician importance rankings for the six attributes were also low. Across-health state and across-attribute correlations between utilities or importance rankings were highly variable across patient-clinician pairs., Conclusion: In the clinical settings studied, there is not a strong relationship between valuations of current and possible future health states by patients with newly diagnosed prostate cancer and their clinicians. Implications of these results for substituted judgement, when clinicians advise their patients or recommend a treatment strategy, are discussed.

Researchers commonly use 2 models to explain contrast effects (CEs): the standard-of-comparison model and the set-reset model. The 2 models focus on the role of categorization to predict when a CE (instead of an assimilation effect) will happen, while minimizing the role of knowledge accessibility and relevance in determining whether any effect will occur. A 3rd model, the selective-accessibility model (F. Strack & T. Mussweiler, 1997), focuses on knowledge accessibility and relevance, but it is a model of assimilation effects in the anchoring bias. In the present study of CEs, the authors tested 3 predictions implied by the selective-accessibility model. The authors found a CE only when anchor- and target-rating dimensions matched and only in the 1st of multiple targets rated. The CE required a minimum amount of attention to the anchor. These results support the account that selective knowledge accessibility and relevance play an important role in CEs.

Vascular smooth muscle cells (SMCs) generate carbon monoxide (CO) from the degradation of heme by the enzyme heme oxygenase. Because recent studies indicate that CO influences the properties of vascular SMCs, we examined whether this diatomic gas regulates apoptosis in vascular SMCs. Treatment of cultured rat aortic SMCs with a cytokine cocktail consisting of interleukin-1beta (5 ng/ml), tumor necrosis factor-alpha (20 ng/ml), and interferon-gamma (200 U/ml) for 48 hr stimulated apoptosis, as demonstrated by DNA laddering, caspase-3 activation, and annexin V staining. However, the exogenous addition of CO (200 ppm) completely blocked cytokine-mediated apoptosis. The antiapoptotic action of CO was partially reversed by the soluble guanylate cyclase inhibitor, H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (10 microM). In contrast, the p38 mitogen-activated protein kinase inhibitor, SB203580 (10 microM), had no effect on SMC apoptosis. These findings indicate that CO is a potent inhibitor of vascular SMC apoptosis and that it blocks apoptosis, in part, by activating the cGMP signaling pathway. The ability of CO to inhibit vascular SMC apoptosis may play a critical role in attenuating lesion formation at sites of arterial damage.

OBJECTIVE: To examine the relation between illness cognitions and two measures of adherence in patients with hypercholesterolaemia, a disease marked by chronically high cholesterol. DESIGN: Cross-sectional. Based on the self-regulation model (Leventhal, Diefenbach, & Leventhal, 1992), patients' illness cognitions were predicted to be related to cholesterol control and medication adherence. Patients with illness cognitions consonant with an experts' mental model of hypercholesterolaemia were expected to show better control and adherence. METHOD: Hypercholesterolaemic patients (N = 169) were recruited at a university-based general medicine clinic. Patients completed a survey that assessed beliefs about hypercholesterolaemia and medication-taking behaviour. Cholesterol levels were obtained from patients' medical charts. RESULTS: Low-density lipoprotein (LDL) cholesterol control was related to believing that hypercholesterolaemia is a stable, asymptomatic disease with severe coronary consequences, and self-report of medication adherence was related to believing that the disease has severe coronary consequences (ps <.05). LDL cholesterol differences between groups low and high in various illness beliefs ranged between 0.04 and 0.24 mmol/l (2 and 9 mg/dl) which translated to between 1% and 18% lower LDL cholesterol levels. CONCLUSION: The present study shows several relations that have not been previously demonstrated between better LDL cholesterol control and illness cognition, cognitions that were similar to an expert or physician's mental model of hypercholesterolaemia. The magnitude of differences in patient cholesterol levels was small but may be clinically important.

Background: Time preferences reflect how future outcomes are valued relative to present ones. Previous research has found that time preferences for one domain (say, money) are inconsistent (uncorrelated) with those from another (say, health). The present studies evaluated whether this domain independence was due to decision makers' sensitivity to a normatively appropriate principle about the tradability of health and money., Method: Participants read a scenario in which health and money were described as tradable or not tradable and then responded to hypothetical intertemporal trade-off questions. RESULTS. In experiment 1, participants showed higher agreement between health and money time preferences in the tradable condition, as predicted. In experiment 2, participants responded from either an individual decision maker or policy maker perspective. Perspective had little effect on agreement between health and money discount rates, but there was again higher agreement in the tradable as compared to the not-tradable condition., Conclusion: Previous demonstrations of domain independence may have been due in part to decision makers' assumption that health and money are not tradable.

Objective: Carbon monoxide (CO) is generated from vascular smooth muscle cells via the degradation of heme by the enzyme heme oxygenase-1. Since smooth muscle cell apoptosis is associated with numerous vascular disorders, we investigated whether CO regulates apoptosis in vascular smooth muscle., Methods and Results: Treatment of cultured rat aortic smooth muscle cells with a combination of cytokines (interleukin-1beta, 5 ng/ml; tumor necrosis factor-alpha, 20 ng/ml; interferon-gamma, 200 U/ml) for 48 h stimulated apoptosis, as demonstrated by DNA laddering, annexin V binding, and caspase-3 activation. However, the exogenous administration of CO inhibited cytokine-mediated apoptosis. The antiapoptotic action of CO was partially dependent on the activation of soluble guanylate cyclase and was associated with the inhibition of mitochondrial cytochrome c release and with the suppression of p53 expression. Incubation of smooth muscle cells with the cytokines also resulted in a pronounced increase in heme oxygenase-1 protein after 24 h of stimulation. The addition of the heme oxygenase inhibitor, zinc protoporphyrin-IX, or the CO scavenger, hemoglobin, stimulated apoptosis following 24 h of cytokine exposure., Conclusions: These results demonstrate that CO, either administered exogenously or endogenously derived from heme oxygenase-1 activity, inhibits vascular smooth muscle cell apoptosis. The ability of CO to block smooth muscle cell apoptosis may play an important role in blocking lesion formation at sites of vascular injury.

Vascular smooth muscle cells (SMCs) generate carbon monoxide (CO) via the catabolism of heme by the enzyme heme oxygenase (HO). In the present study, we found that serum stimulated a time- and concentration-dependent increase in the levels of HO-1 messenger RNA (mRNA) and protein in vascular SMCs. The induction of HO-1 expression by serum was inhibited by actinomycin D or cycloheximide. In addition, serum stimulated HO activity, as reflected by an increase in the concentration of bilirubin in the culture media. Treatment of vascular SMCs with serum stimulated DNA synthesis and this was potentiated by the HO inhibitors, zinc and tin protoporphyrin-IX as well as by the CO scavenger, hemoglobin. The iron chelator desferrioxamine had no effect on DNA synthesis. However, exposure of vascular SMCs to exogenous CO inhibited serum-stimulated SMC proliferation and the phosphorylation of retinoblastoma protein. In addition, CO arrested SMCs at the G(1)/S transition phase of the cell cycle and selectively blocked the serum-stimulated expression of cyclin A mRNA and protein without affecting the expression of cyclin D1 and E. CO also inhibited the serum-stimulated activation of cyclin A-associated kinase activity and cyclin-dependent kinase 2 activity. These results demonstrate that serum stimulates HO-1 gene expression and CO synthesis. Furthermore, they show that CO acts in a negative feedback fashion to inhibit vascular SMC growth by regulating specific components of the cell cycle machinery. The capacity of vascular mitogens to induce CO synthesis may provide a novel mechanism by which these agents modulate cell growth.

Previously, it was reported that homocysteine (Hcy) specifically inhibits the growth of endothelial cells (ECs), suppresses Ras/mitogen-activated protein (MAP) signaling, and arrests cell growth at the G(1)/S transition of the cell cycle. The present study investigated the molecular mechanisms underlying this cell-cycle effect. Results showed that clinically relevant concentrations (50 microM) of Hcy significantly inhibited the expression of cyclin A messenger RNA (mRNA) in ECs in a dose- and time-dependent manner. G(1)/S-associated molecules that might account for this block were not changed, because Hcy did not affect mRNA and protein expression of cyclin D1 and cyclin E. Cyclin D1- and E-associated kinase activities were unchanged. In contrast, cyclin A-associated kinase activity and CDK2 kinase activity were markedly suppressed. Nuclear run-on assay demonstrated that Hcy decreased the transcription rate of the cyclin A gene but had no effect on the half-life of cyclin A mRNA. In transient transfection experiments, Hcy significantly inhibited cyclin A promoter activity in endothelial cells, but not in vascular smooth muscle cells. Finally, adenovirus-transduced cyclin A expression restored EC growth inhibition and overcame the S phase block imposed by Hcy. Taken together, these findings indicate that cyclin A is a critical functional target of Hcy-mediated EC growth inhibition.

Background: Heme oxygenase-1 (HO-1) catalyzes the degradation of heme into biliverdin, iron, and carbon monoxide (CO). Although HO-1 is induced in vascular smooth muscle cells (SMCs), the biological role of HO-1 in these cells has not been completely characterized., Methods and Results: In the present study, we overexpressed HO-1 in rat aortic SMCs by generating a recombinant defective adenovirus containing the rat HO-1 gene (AdHO-1) and examined the effect on SMC proliferation. Infection of SMCs with AdHO-1 resulted in a dose-dependent increase in the expression of HO-1 mRNA, protein, and activity. Infection of SMCs with AdHO-1 inhibited serum-stimulated SMC proliferation in a dose-dependent manner. In contrast, the control adenovirus expressing the green fluorescent protein failed to induce HO-1 expression and had minimal effects on SMC growth. Infection with AdHO-1 stimulated SMC apoptosis in a dose-dependent fashion, as demonstrated by DNA fragmentation, positive annexin V labeling, and caspase-3 activation. HO-1-mediated apoptosis was associated with a marked increase in the expression of the proapoptotic protein p53. Finally, the exogenous administration of biliverdin and bilirubin stimulated SMC apoptosis. In contrast, the administration of CO or iron failed to induce cell death., Conclusions: These results demonstrate that overexpression of HO-1 or the exogenous administration of biliverdin or bilirubin stimulates SMC apoptosis. Adenovirus-mediated transfer of the HO-1 gene may provide a novel therapeutic approach in treating occlusive vascular disease.

Objectives: In quality-adjusted life-years (QALY) models, it is customary to weigh life-years with quality of life via multiplication. As a consequence, for positive health states a longer duration has more QALYs than a shorter duration (i.e., longer is better). However, we have found that for poor health states, many prefer to live only a limited amount of time (i.e., longer is worse). Such preferences are said to be maximum endurable time (MET). In the present contribution, the following questions are asked: a) How low does the utility have to be in order for a MET to arise? and b) Do MET preferences occur when patients judge hypothetical health states?, Methods and Results: We reanalyzed data from 176 students for the hypothetical health states of "living with migraines" and "living with metastasized cancer." For utilities smaller than 0.7 (ranging from 0 to 1), the MET preference rate was larger than 50%. High MET preference rates were also found in two new studies on migraine and esophageal cancer patients, who evaluated hypothetical health states related to their disease., Conclusions: We discuss the interpretation of the MET preferences and the preference reversal phenomenon. Standard QALY models imply that longer is better. However, we find that more often, longer is worse for poorly evaluated health states. Consider the following question: are 3 years with a weight of 0.3 equally as valuable as 1 year with a weight of 0.9? Our results suggest that the 3-year period may be less valuable because for poor health, many will prefer a 1-year over a 3-year period.

We examined lay perceptions of what counts as a decision. Eighty-six subjects read 10 scenarios that described clear decisions (e.g., choosing a graduate school), clear "nondecisions" (e.g., an accidental wrong turn), or ambiguous actions (e.g., eating a donut when on a diet or allowing someone else to make the decision). The subjects rated each scenario as to whether the actor had made a decision and also rated six other attributes. The scenarios were rated as clearly illustrating a decision if the actor engaged in a lot of thought and did not act reflexively. Consideration of consequences and having alternatives were moderately related to decision ratings, whereas having self-control problems and the influence of physiological drives showed little relationship with decision ratings. Thus, lay concepts of decision making differ from decision theory in that thoughtful, intentional behavior is more important in defining a decision than are decision theoretic components, such as alternatives and consequences.

Many important decisions concern outcomes delayed by decades or centuries. Whereas some economists have argued that inter-generational discount rates should be lower than intra-generational rates, three experiments found that inter- and intra-generational discount rates were quite similar. Experiment 1 found that discount rates for long delays (30-900 years) were lower than those for shorter delays (1-30 years) but that, holding delay constant, discount rates for outcomes occurring to future generations were similar to those for outcomes occurring to the present generation. Experiment 2 compared inter-generational discount rates for three different types of outcomes and found similar discount rates for saving lives, improving health, and financial benefits. Experiment 3 found similar inter-generational discounting of life-saving programs that benefit people close to or distant from the decision maker. These studies indicate that the discount rate applied to outcomes occurring to future generations depends on the length of the time delay but not on other factors.

Many everyday decisions require trade-offs between immediate and delayed benefits. Although much research has assessed discounting of delayed outcomes by using hypothetical scenarios, little research has examined whether these discounting measures correspond to real-world behavior. Three studies examined the relationship between scenario measures of time preference and preventive health behaviors that require an upfront cost to achieve a long-term benefit. Responses to time preference scenarios showed weak or no relationship to influenza vaccination, adherence to a medication regimen to control high blood pressure, and adherence to cholesterol-lowering medication. The finding that scenario measures of time preference have surprisingly little relationship to actual behaviors exemplifying intertemporal trade-offs places limits on the applications of time preference research to the promotion of preventive health behavior.

The pathobiologic process of arterial stenosis following balloon angioplasty continues to be an enigmatic problem in clinical settings. This research project investigates the ability of YC-1, a benzyl indazole derivative that sensitizes sGC/cGMP, to stimulate endogenous cGMP and attenuate balloon injury-induced neointima (NI) formation in the rat carotid artery. Northern and Western blot analyses revealed enhanced acute expression of iNOS and inducible heme oxygenase (HO-1) mRNA and protein in the injured artery. The contralateral uninjured artery also demonstrated acute HO-1 mRNA and protein induction without detectable iNOS expression. Perivascular application of YC-1 immediately following injury significantly stimulated acute vessel wall cGMP compared to untreated controls. YC-1 treated sections demonstrated significant reduction in NI area (-74%), NI area/medial wall area (-72%), and NI thickness (-76%) 2 weeks post-injury. These results directly implicate YC-1 as a potent new therapeutic agent capable of reducing post-angioplasty stenosis through endogenous CO- and/or NO-mediated, cGMP-dependent processes., (Copyright 2000 Academic Press.)

The human tongue has been the subject of many cytological and histological studies. When a literature search disclosed no reports of the ultrastructure of the morphotypes of bacteria residing on the tongue's surface, a transmission electron microscope study of ultrathin sections of bacteria obtained by scraping eight human tongues was undertaken. The scrapings from the anterior dorsal tongue surfaces, processed conventionally for electron microscope study, revealed 33-35 different bacterial morphotypes. Several of the morphotypes were unique to a tongue. Morphotype differences were also related to donor characteristics such as smoking, tongue site, location in centrifuge pellet, diet, and medications. The predominant morphotypes were Gram-positive cocci. These preliminary findings suggest that the microbiota of the human tongue and variations in that microbiota, related to physical condition, lifestyle, medications, and dietary preferences, merit more attention from anatomists., (Copyright 2000 Wiley-Liss, Inc.)

Smooth muscle cells (SMC) are the major cellular component of the blood vessel wall and are continuously exposed to cyclic stretch due to pulsatile blood flow. This study examined the effects of a physiologically relevant level of cyclic stretch on rat aortic vascular SMC proliferation. Treatment of static SMC with serum, platelet-derived growth factor, or thrombin stimulated SMC proliferation, whereas exposure of SMC to cyclic stretch blocked the proliferative effect of these growth factors. The stretch-mediated inhibition in SMC growth was not due to cell detachment or increased cell death. Flow cytometry analysis revealed that cyclic stretch increased the fraction of SMC in the G(0)/G(1) phase of the cell cycle. Stretch-inhibited G(1)/S phase transition was associated with a decrease in retinoblastoma protein phosphorylation and with a selective increase in the cyclin-dependent kinase inhibitor p21, but not p27. These results demonstrate that cyclic stretch inhibits SMC growth by blocking cell cycle progression and suggest that physiological levels of cyclic stretch contribute to vascular homeostasis by inhibiting the proliferative pathway of SMC.

The rat tongue has been the subject of many cytological studies, both purely descriptive and experimental. To assess the suitability of the organ for additional cytological and histological senior research thesis projects, light and transmission electron microscope studies of thin and ultrathin sections, respectively, were conducted. Several samples from the anterior dorsal surface of the tongue of a male rat (Sprague-Dawley) were processed conventionally for light and electron microscope study. About 170 sections, each approximately 1 x 1 mm in area and 1.0 microm thick, collected from 12 adjacent areas, all including the mucosa, of a tongue were studied in the light microscope. Numerous mast cells were observed scattered throughout the submucosal region, adjacent to nerve bundles, blood vessels, and skeletal muscle, and up to six bundles each consisting of many myelinated and unmyelinated nerve processes were seen per section. Single, double, and quadruple myelinated nerve processes were also seen. Several of the multiple, mixed nerve bundles contained a mast cell. Mast cells were not found within the endoneurium or perineurium of exclusively myelinated processes. Ultrathin sections adjacent to the thin sections containing mast cells within the nerve bundles were sought and studied in the transmission electron microscope to confirm the identification of these mast cells. Mast cells occur within bundles containing both myelinated and unmyelinated nerves in the rat tongue, and this is an apparently previously unreported event. Furthermore, no clear evidence has been found in the literature of such specific mast cell distribution in other parts of the animal body. Single, double, and quadruple myelinated nerve processes were noted, but none contained a mast cell., (Copyright 1999 Wiley-Liss, Inc.)

Background: Previous studies investigating predictors of influenza vaccine acceptance have focused on high-risk patients or health care workers. Few studies have examined flu shot acceptance among healthy adults in workplace settings, even though influenza vaccine is recommended for this group as well., Methods: Two studies investigated predictors of flu vaccine acceptance in workplace samples of healthy adults. In the first study, 79 university employees were interviewed, while in the second, 435 corporate employees completed a questionnaire., Results: In the first study, flu shot acceptance was predicted by perceived effectiveness of the vaccine (r = 0.36), perceived likelihood of vaccine side effects (r = -0.32), and having received the shot in the previous year (r = 0.25). In the second study, flu shot acceptance was again predicted by perceived effectiveness (r = 0.49), likelihood of side effects (r = -0.31), and previous flu shot (r = 0.66) and was also related to older age (r = 0.10) and to predicted percentage of co-workers who also received the shot (r = 0.24)., Conclusions: The current studies indicate that predictors of vaccine acceptance among healthy adults are similar to those identified in studies of high-risk patient populations and health care workers.

Anchoring is a pervasive judgment bias in which decision makers are systematically influenced by random and uninformative starting points. While anchors have been shown to affect a broad range of judgments including answers to knowledge questions, monetary evaluations, and social judgments, the underlying causes of anchoring have been explored only recently. We suggest that anchors affect judgments by increasing the availability and construction of features that the anchor and target hold in common and reducing the availability of features of the target that differ from the anchor. We test this notion of anchoring as activation in five experiments that examine the effects of several experimental manipulations on judgments of value and belief as well as on measures of cognitive processes. Our results indicate that prompting subjects to consider features of the item that are different from the anchor reduces anchoring, while increasing consideration of similar features has no effect. The anchoring-as-activation approach provides a mechanism for debiasing anchoring and also points to a common mechanism underlying anchoring and a number of other judgment phenomena. Copyright 1999 Academic Press.

In an attempt to provide some essential basic data, currently very sparse, on the ultrastructure of solitary bees, the histology, cytology and ultrastructure of thin and ultrathin sections of ovarioles of the adult carpenter beeXylocopa virginica virginica were studied with the light and transmission electron microscopes. The work revealed an apparently previously unreported occurrence of intracellular paired membrane configurations in follicle cells of an ovariole and confirmed the presence in follicle cells of somatic intercellular bridges previously reported in follicle cells in a variety of bees, but not in the carpenter bee. Microtubules and bacteroids were also seen in the follicle cells.

Consumer choice research has shown that, contrary to normative theory, the introduction of an inferior alternative to an existing choice set can increase the likelihood that one of the original alternatives will be chosen. This phenomenon, the attraction effect, is relevant to physician decision making, particularly when the physician is in the role of a consumer who must make decisions about prescribing medications when a number of alternatives are available. To investigate the attraction effect in physician decision making, 40 internal medicine residents reviewed three patient cases (concerning depression, sinusitis, and vaginitis) and then chose the most appropriate medication for each patient. In some versions of the cases, two medication options were available. Other versions included a third medication (the decoy) that was inferior in every way to one of the original options (the target) but not to the other (the competitor). The results showed that addition of the "decoy" medication increased the likelihood of choosing the target medication. That is, the attraction effect does occur in physicians' decisions about medications. Physicians should be aware of this bias when evaluating or suggesting several similarly attractive medications or treatment options for the same medical condition.

Background: Many preventive health behaviors involve immediate costs and delayed benefits. Time preference is the extent to which decision makers value future outcomes relative to immediate ones. Consequently, people with future-oriented time preferences should be more likely to adopt preventive measures. The relationship between time preferences and acceptance of a free influenza vaccination was examined., Sample: The participants were 412 corporate employees who were offered free influenza vaccinations at their workplace., Measures: Participants' time preferences were measured in each of two domains: money and health. They also reported on whether they had accepted the influenza vaccination and their beliefs and attitudes about the vaccine., Results: There was a small (OR = 2.38) relationship of vaccination acceptance to monetary time preferences but not to the health time-preference measures. Other variables, such as perceived effectiveness of the vaccine, were more predictive., Conclusion: This study provides some evidence of a small relationship between time preferences and preventive health behavior.