PPAR? Signaling: One Size Fits All?

Outcome of PPAR? activation in cancer cells is not one-dimensional. PPAR? signaling is dependent upon PPAR? ligand affinity and binding characteristics, target cell context and interacting signaling networks.     

The Representation of Risk in Routine Medical Experience: What Actions for Contemporary Health Policy?

Background

The comprehension of appropriate information about illnesses and treatments, can have beneficial effects on patients’ satisfaction and on important health outcomes. However, it is questionable whether people are able to understand risk properly.

Aim

To describe patients’ representation of risk in common medical experiences by linking such a representation to the concept of trust. A further goal was to test whether the representation of risk in the medical domain is associated to the level of expertise. The third goal was to verify whether socio-demographic differences influence the representation of risk.

Methods

Eighty voluntary participants from 6 health-centers in northern Italy were enrolled to conduct a semi-structured interview which included demographic questions, term-associations about risk representation, closed and open questions about attitudes and perception of risk in the medical context, as well as about medical expertise and trust.

Results

The results showed that people do not have in mind a scientific definition of risk in medicine. Risk is seen as a synonym for surgery and disease and it is often confused with fear. However, general knowledge of medical matters helps people to have a better health management through risk identification and risk information, adoption of careful behaviors and tendency to have a critical view about safety and medical news. Finally, trust proved to be an important variable in risk representation and risk and trust were correlated positively.

Conclusions

People must receive appropriate information about the risks and benefits of treatment, in a form that they can understand and apply to their own circumstances. Moreover, contemporary health policy should empower patients to adopt an active self-care attitude. Methodologies to enhance people’s decision-making outcomes based on better risk communication should be improved in order to enable low literacy population as well elderly people to better understand their treatment and associated risk.     

Schwartz Formula: Is One k-Coefficient Adequate for All Children?

Background/Objective

Plasma-creatinine-based equations to estimate the glomerular filtration rate are recommended by several clinical guidelines. In 2009, Schwartz et al. adapted the traditional Schwartz equation to children and adolescents but did not find different k-coefficients between children and adolescents (k = 36.5 for all patients). We reevaluated the coefficient of the 2009-Schwartz formula according to sex and age in a pediatric population.

Patients/Methods

We used linear mixed-effects models to reestimate the 2009-Schwartz k-coefficient in 360 consecutive French subjects aged 1 to 18 years referred to a single centre between July 2003 and July 2010 (965 measurements). We assessed the agreement between the estimated glomerular filtration rate obtained with the new formula (called Schwartz-Lyon) and the rate measured by inulin clearance. We then compared this agreement to the one between the measured glomerular filtration rate and 2009-Schwartz formula, first in the French then in a Swedish cohort.

Results

In Schwartz-Lyon formula, k was estimated at 32.5 in boys <13 years and all girls and at 36.5 in boys aged ≥13 years. The performance of this formula was higher than that of 2009-Schwartz formula in children <13 years. This was first supported by a statistically significant reduction of the overestimation of the measured glomerular filtration rate in both cohorts, by better 10% and 30% accuracies, and by a better concordance correlation coefficient.

Conclusions

The performance and simplicity of Schwartz formula are strong arguments for its routine use in children and adolescents. The specific coefficient for children aged <13 years further improves this performance.     

One left-handed strand in DNA-oligonucleotide complexes?

A single strand of oligonucleotide can bind to double helical DNA under certain conditions. This must involve some unwinding of the original double helix in a process leading to the formation of a three-stranded region. The free energy for such an entropically unlikely reaction may come from a change in the degree of supercoiling of the original DNA. The conformation of the triple strand is investigated here using computer graphics and molecular mechanics calculations. It is suggested that on binding the oligonucleotide (strand 3) to two paired strands (1 and 2) in a supercoiled DNA molecule, strand 2 might adopt a left-handed conformation whilst strand 1 and strand 3 pair in the normal Watson-Crick B-configuration.     

Behavioral Priming: It's All in the Mind,but Whose Mind?

The perspective that behavior is often driven by unconscious determinants has become widespread in social psychology. Bargh, Chen, and Burrows' (1996) famous study, in which participants unwittingly exposed to the stereotype of age walked slower when exiting the laboratory, was instrumental in defining this perspective. Here, we present two experiments aimed at replicating the original study. Despite the use of automated timing methods and a larger sample, our first experiment failed to show priming. Our second experiment was aimed at manipulating the beliefs of the experimenters: Half were led to think that participants would walk slower when primed congruently, and the other half was led to expect the opposite. Strikingly, we obtained a walking speed effect, but only when experimenters believed participants would indeed walk slower. This suggests that both priming and experimenters' expectations are instrumental in explaining the walking speed effect. Further, debriefing was suggestive of awareness of the primes. We conclude that unconscious behavioral priming is real, while real, involves mechanisms different from those typically assumed to cause the effect.     

Critical Care Needs in Patients with Diffusion-Weighted Imaging Negative MRI after tPA - Does One Size Fit All?

MethodsA retrospective chart review was performed for 209 patients who received IV tPA for acute stroke. Data on stroke risk factors, physiologic parameters, stroke severity, MRI characteristics, and final diagnosis were collected. The timing and nature of ICU interventions, if needed, was recorded. Multivariable logistic regression was used to determine factors associated with subsequent ICU needs.ResultsPatients with cerebral infarct on MRI after tPA had over 9 times higher odds of requiring ICU care compared to patients with DWI negative MRI (OR 9.2, 95% CI 2.49–34.15). All DWI negative patients requiring ICU care did so by the end of tPA infusion (p = 0.006). Among patients with DWI negative MRI, need for ICU interventions was associated with higher NIH Stroke Scale (NIHSS) scores (p<0.001), uncontrolled hypertension (p<0.001), seizure at onset (p = 0.002), and reduced estimated glomerular filtration rate (eGFR) (p = 0.010).ConclusionsOnly a small number of DWI negative patients required ICU care. In patients without critical care needs by the end of thrombolysis, post-tPA MRI may be considered for triaging DWI negative patients to a less resource intense monitoring environment.     

Natural variation in linalool metabolites: One genetic locus,many functions?

The ubiquitous volatile linalool is metabolized in plants to nonvolatile derivatives. We studied Nicotiana attenuata plants which naturally vary in (S)-(+)-linalool contents, and lines engineered to produce either (R)-(-)- or (S)-(+)-linalool. Only (S)-(+)-linalool production was associated with slower growth of a generalist herbivore, and a large fraction was present as nonvolatile derivatives. We found that variation in volatile linalool and its nonvolatile glycosides mapped to the same genetic locus which harbored the biosynthetic gene, NaLIS, but that free linalool varied more in environmental responses. This study reveals how (S)-(+)-linalool and conjugates differ in their regulation and possible functions in resistance.     

Music Education for Young Children in Scandinavia: Policy,Philosophy, or Wishful Thinking?

The author discusses current policies, philosophies, and educational practices of early childhood music education in Scandinavia (Denmark, Norway, and Sweden) and to what extent they meet the challenges of music education for young children. Nearly all children use day care provisions, and they are a governmental responsibility. The author reviews governmental policies regarding general pedagogical goals of day care and kindergarten in Scandinavia. During the last decade, teaching plans for preschool pedagogy were implemented and the author discusses to what extent the plans meet current challenges of music education. The author also discusses the challenges of teacher-training programs in light of current policies regarding music education in early childhood.     

Who Benefits from Government Healthcare Subsidies? An Assessment of the Equity of Healthcare Benefits Distribution in China

Background

Improving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China’s healthcare sector reform in China.

Objectives

This study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution.

Methods

Benefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews.

Results

High-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95% confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95% CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95% CI, 0.2528 to 0.5322) and 0.4084 (95% CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95% CI, 0.0263 to 0.2603] and 0.3662 [95% CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95% CI, 0.1657 to 0.4469] and −0.0273 [95% CI, −0.1702 to 0.1156] in 2007).

Conclusions

Our study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.