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Background: There is a growing body of in-vitro and in-vivo laboratory research on the skin bioactive properties of macroalgae.Objective: We sought to examine the scientific literature for evidence supporting the clinical safety and efficacy of macroalgae-derived ingredients in cosmeceuticals.Methods: We performed a systematic review of scientific and medical electronic databases for published, peer-reviewed, randomized controlled trials and nonrandomized reports on the clinical bioactivity of topical macroalgae extracts in skin.Results: Several human studies report scientific data supporting the safety and efficacy of macroalgae-based skincare products, focusing on skin-moisturizing, anti-melanogenic, and anti-cellulite (slimming) benefits.Conclusions: Further clinical research is necessary to determine the long-term safety, efficacy, optimal concentration and formulation of macroalgae extracts in cosmeceuticals with respect to previously reported and yet uninvestigated skin-directed potential functionally and bioactivity. [ABSTRACT FROM AUTHOR]

Background: Assessing the pre- and post-test probability of disease in the context of routine health care is challenging. We wished to study how test performance parameters relating to clinical utility vary by clinical indication in a 'real-world' setting. Methods: The diagnostic accuracy of serum total B12 and Active-B12® (holotranscobalamin) was evaluated in a primary care population, using serum methylmalonic acid as the reference standard. We used electronic requesting to establish the clinical indication for each request. Routine requests from primary care for serum total B12 were included if creatinine was also measured and estimated glomerular filtration rate was at least 60 mL/min/1.73 m2. Results: Clinical indications included peripheral neuropathy (n = 168), anaemia (n = 168), cognitive decline (n = 125), suspected dietary deficiency (n = 76), other (n = 362). For peripheral neuropathy, the area under the receiver operator curve ± 95% confidence interval (AUC ± CI) was 0.63 (0.54–0.71) (P = 0.002) for total B12 and 0.68 (0.60–0.77) (P < 0.0001) for Active-B12®. For anaemia, AUC ± CI was 0.56 (0.47–0.66) (P = 0.10) for total B12 and 0.69 (0.59–0.78) (P < 0.0001) for Active-B12®. For cognitive decline, AUC ± CI was 0.54 (0.43–0.65) (P = 0.26) for total B12 and 0.69 (0.58–0.80) (P = 0.0002) for Active-B12®. The pre–post-test change in probability of disease varied by clinical indication. Conclusion: Combining diagnostic accuracy studies and electronic testing in a 'real-world' setting allows clinical utility to be assessed by clinical indication. Wider application of this would permit more personalised laboratory medicine. In this study, diagnostic performance of total B12 and Active-B12® varied across all indications. Active-B12® provided better discrimination, but this may have reflected the cut-offs used. [ABSTRACT FROM AUTHOR]

Managed care significantly affects the service delivery patterns, business structures, ethics, and professional concerns of independent practitioners. This survey assessed psychologists' perceptions of the effects of managed care on practice and ethics. Most respondents reported significant increases in dependence on managed care services for income. Negative effects included loss of control over clinical decisions and potential harm to patients from erosion of confidentiality. A majority of respondents reported encountering ethical concerns not addressed by the American Psychological Association ethics code. Findings suggest directions for practice development, for public policy addressing confidentiality, and for clarification of ethical responsibilities.

Sixty percent of directors of clinical training (DCTs) at the nation's 164 clinical psychology programs accredited by the American Psychological Association (APA) responded to a survey regarding their attitudes toward the hypothetical implementation of a sample predoctoral prescription training model created by the APA's Ad Hoc Task Force on Psychopharmacology (APA, 1992). Results suggested that the majority of DCTs (62%) remained equivocal regarding the implementation of such training at their program. A majority (62%) identified postdoctoral specialization as the preferred method of prescription training. DCTs' perceptions of the benefits of adding predoctoral prescription training best predicted their estimations that such training would be incorporated at their clinical program.

Background: Disorders of hyperpigmentation, such as melasma, postinflammatory pigmentary alteration, and lentigines, pose significant cosmetic concerns for women of Hispanic or Latino race and ethnicity. Natural ingredients are gaining popularity as alternative, safe, and effective topical depigmenting agents.Objective: We sought to review clinical studies evaluating the use of natural ingredients in the topical management of hyperpigmentation in Hispanic and Latino women.Methods: We conducted a systematic review of scientific and medical electronic databases to identity randomized controlled trials (RCTs) and nonrandomized reports on topical natural agents for the treatment of disorders of hyperpigmentation, using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Results: Our review of the literature revealed relatively few (N=7) clinical studies (including six RCTs) that evaluated the topical management of hyperpigmentation using natural ingredients with specific reference to women of Hispanic or Latino race and ethnicity. Despite limited research data, a small number (N=7) of natural ingredients demonstrated efficacy and safety as depigmenting agents in this cohort, including niacinamide, soy, azelaic acid, ascorbic acid, licorice, emblica, and belides.Conclusion: Several natural ingredients have scientific data supporting their potential efficacy as topical treatments for disorders of hyperpigmentation in women of Hispanic or Latino race and ethnicity. However, the paucity of robust cosmetic trials in this setting reflects the generalized low representation of Hispanic and Latino individuals in clinical studies of other skin conditions. Many in-vivo cutaneous trials of natural ingredients are limited by their study design, including with respect to subject selection and short duration. Further research is needed to determine long-term efficacy, safety, optimal concentration, and formulation of natural ingredients for the topical management of hyperpigmentation in Hispanic and Latino women. [ABSTRACT FROM AUTHOR]

A study was conducted to determine the effects of decisions by the Boston Juvenile Court regarding the care and protection of 206 abused children. Of the 206 respondents who were all below 13 years of age, 63 were ordered to begiven back to their parents for custody. Findings revealed that majority of the children's parents were poor and had psychiatric illnesses. It was also learned that 18 of the children who were returned to their homes were again mistreated by their parents. These results point to an urgent need for the courts to revise parental custody criteria and improve services for abused children.

In order to effectively prepare students for medical decisions with complex, ethical disagreements and value-laden conflicts, a progression from simpler case analysis to multi-layered conflicts is often helpful. Presented here is a unique case of pregnancy in a true hermaphrodite from recent medical literature. The case is artificially layered with additional, medical and discoverable contextual issues to help analyze three distinct questions in medical ethics: 1) Is it ethically permissible to perform an elective termination of pregnancy (ETOP) on a minor, 2) Is it ethically permissible to keep this information from the parents, and 3) are additional and complicating medical features included in confidentiality agreements involving minors? The pedagogical goals include introducing and effectively utilizing the Orr-Shelton, four box method of clinical ethics assessment, demonstrating the need to uncover/discover important contextual (cultural, religious, family, etc.) features not usually incorporated fully into patient charts, to prepare medical students to research and become familiar with the local legal environment, and to illustrate that what appears to be a single a single ethical dilemma is likely far more complex requiring a multi-focused assessment. [ABSTRACT FROM AUTHOR]

Abstract Background Total cholesterol (TC) concentration is the most commonly used measure of statin efficacy in the UK. This study aimed to evaluate the effectiveness of statins in lowering TC, cardiovascular events (CV) and mortality five common chronic diseases (chronic obstructive pulmonary disease (COPD), osteoarthritis (OA), rheumatoid arthritis (RA), chronic kidney disease (CKD), and diabetes mellitus (DM)) and to compare effectiveness with the rest of the population not recorded as having these diseases. Methods A population-based cohort study was conducted in Tayside population who had at least two TC measurements between 1993 and 2007. There were 12,140 patients with chronic diseases and 9,481 patients in the rest of the population not recorded as having these chronic diseases. The main outcomes were TC change from baseline, CV events and all-cause mortality. Results Statin-associated TC reductions varied from 15% to 28% with baseline value of between 5.1 and 5.9 mmol/L in the primary prevention (PP) and from 7% to 23% with baseline value of 4.5 to 5.2 mmol/L in the secondary prevention (SP) among chronic diseases patients. In the rest of the population, TC reductions with statins were 31% in PP and 28% in SP with baselines of 6.3 mmol/L and 5.3 mmol/L, respectively (test of heterogeneity with chronic disease groups: p 0.05). Conclusions The effectiveness of statins in common chronic diseases varied. With the exception of diabetes, statins tends to be less effective in patients with the chronic diseases compared with the rest of the study population. Changes in TC with statins appear not to correlate well with the changes in cardiovascular events and all-cause mortality.

The only tall shrub fen community known to occur in Illinois was examined to determine its plant species composition and structure. Located along the east shore of Upper Peoria Lake, this fen community occurs within Spring Bay Fen Nature Preserve, Woodford County, Illinois. A total of 264 vascular plant species in 77 plant families and 183 genera were found in the preserve, including 26 adventive taxa. Of the 105 species found in the fen the ground layer was dominated by Apios americana Medic. (ground nut) (IV of 27.6, possible importance value of 200), followed by Symplocarpus foetidus (L.) Nutt. (skunk cabbage), Impatiens capensis Meerb. (spotted touch-me-not), Aster firmus Nees (swamp aster), and Sagittaria latifolia Willd. (common arrowhead). Shrubs dominated the fen, averaging 5975 stems/ha; the most important being Ribes americanum Mill. (wild black current), Viburnum lentago L. (nannyberry), Cornus sericea L. (red-osier dogwood), and Toxicodendron vernix (L.) Kuntze (poison sumac). The state threatened Filipendula rubra (Hill) Robins. (queen of the prairie) and the state/federally threatened Boltonia decurrens (Torr. & Gray) Wood (decurrent false aster) were found during the surveys. Overall, the survey determined that the fen community was of high natural quality, but recent flooding (2001 to 2020) has resulted in species loss and a perceived decrease in natural quality. [ABSTRACT FROM AUTHOR]