Citizens' preferences for brand name drugs for treating acute and chronic conditions: a pilot study.

Background: Generic drugs have been advocated to decrease the proportion of healthcare costs devoted to drugs, but are still underused. Objective: To assess citizens' preferences for brand name drugs (BNDs) compared with generic drugs for treating acute and chronic conditions. Methods: A questionnaire with eight hypothetical scenarios describing four acute and four chronic conditions was developed, with willingness to pay (WTP) determined using a payment card system randomized to ascending (AO) or descending order (DO) of prices. The questionnaire was distributed with an explanation sheet, an informed consent form and a pre-stamped envelope over a period of 3 weeks in 19 community pharmacies in Lausanne, Switzerland. The questionnaire was distributed to every third customer who also had health insurance, understood French and was aged =16 years (up to a maximum of ten customers per day and 100 per pharmacy). The main outcome measure was preferences assessed by WTP for BNDs as compared with generics, and impact of participants' characteristics on WTP. Results: Of the 1800 questionnaires, 991 were distributed and 393 returned (pharmacy participation rate?=?55%, subject participation rate?=?40%, overall response rate?=?22%); 51.7% were AO and 48.3% DO. Participants were predominantly women (62.6%) and of median age 62 years (range 16-90). The majority (70%) declared no WTP for BNDs as compared with generics. WTP was higher in people with an acute disease than in those with a chronic disease, did not depend on the type of chronic disease, and was higher in people from countries other than Switzerland. Conclusions: Most citizens visiting pharmacies attribute no added value to BNDs as compared with generics, although some citizen characteristics affected WTP. These results could be of interest to several categories of decision makers within the healthcare system.

Speed Management Toolbox for Rural Communities, TR-630, 2012

The primary objective of this toolbox is to summarize various known traffic-calming treatments and their effectiveness. This toolbox focuses on roadway-based treatments for speed management, particularly for rural communities with transition zones. Education, enforcement, and policy strategies should also be considered, but are not the focus of this toolbox. The research team identified treatments based on their own research, a review of the literature, and discussion with other professionals. This toolbox describes each treatment and summarizes placement, advantages, disadvantages, effectiveness, appropriateness, and cost for each treatment. The categories of treatments covered in this toolbox are as follows: horizontal physical displacement, vertical physical displacement, narrowing, surroundings, pavement markings, traffic control signs, and other strategies. Separate 3- to 4-page Tech Briefs for various aspects of this toolbox are attached to this record: Center Islands with Raised Curbing for Rural Traffic Calming, Colored Entrance Treatments for Rural Traffic Calming, Dynamic Speed Feedback Signs for Rural Traffic Calming, Transverse Speed Bars for Rural Traffic Calming. This toolbox and the tech briefs are related to the report Evaluation of Low Cost Traffic Calming for Rural Communities – Phase II, which is also included in this record or can be found at http://publications.iowa.gov/id/eprint/14769

Decreased behavioral impairments in an Alzheimer mice model by interfering with TNF-alpha metabolism.

The performance of mice expressing PDAPP (+/+ or +/-) was studied in the Morris place navigation task. Different lines of questions were investigated using PDAPP+/- mice in which the activity of the cytokine Tumor Necrosing Factor alpha (TNFalpha) was attenuated by chronic treatment with anti-TNF or deleting TNFalpha (TNF-/-). Two different categories of behavior were analyzed in adult (6 months) and middle aged (15 months) subjects. Classically, the cognitive performance was assessed from the escape efficacy and quantitative bias toward the training position in a Morris water maze. Second, stereotyped circling was quantified, along with more qualitative behavioral impairments such as self-mutilation or increased reactivity. Our results can be summarized as follows. (1) All of the PDAPP mice expressed reduced cognitive performance in the Morris task, but only those with a clear-cut amyloid burden in the hippocampus showed behavioral abnormalities such as stereotyped circling. (2) Chronic treatment with anti-TNF prevented the development of pathological circling in the 6-month-old mice but not in the 15-month-old mice and had no significant effect on amyloid burden. (3) The absence of TNFalpha prevented the development of stereotyped circling in 6- and 15-month-old mice but increased amyloid burden after 15 months. These data indicate that PDAPP mice express cognitive impairments disregarding absence of TNF. The pathological behavioral anomalies related to the PDAPP mutation seem reduced by treatments interfering with TNFalpha.

Sequential therapist interventions and the therapeutic alliance: a pilot study

(from the journal abstract) Scientific interest for the concept of alliance has been maintained and stimulated by repeated findings that a strong alliance is associated with facilitative treatment process and favourable treatment outcome. However, because the alliance is not in itself a therapeutic technique, these findings were unsuccessful in bringing about significant improvements in clinical practice. An essential issue in modern psychotherapeutic research concerns the relation between common factors which are known to explain great variance in empirical results and the specific therapeutic techniques which are the primary basis of clinical training and practice. This pilot study explored sequences in therapist interventions over four sessions of brief psychodynamic investigation. It aims at determining if patterns of interventions can be found during brief psychodynamic investigation and if these patterns can be associated with differences in the therapeutic alliance. Therapist interventions where coded using the Psychodynamic Intervention Rating Scale (PIRS) which enables the classification of each therapist utterance into one of 9 categories of interpretive interventions (defence interpretation, transference interpretation), supportive interventions (question, clarification, association, reflection, supportive strategy) or interventions about the therapeutic frame (work-enhancing statement, contractual arrangement). Data analysis was done using lag sequential analysis, a statistical procedure which identifies contingent relationships in time among a large number of behaviours. The sample includes N = 20 therapist-patient dyads assigned to three groups with: (1) a high and stable alliance profile, (2) a low and stable alliance profile and (3) an improving alliance profile. Results suggest that therapists most often have one single intention when interacting with patients. Large sequences of questions, associations and clarifications were found, which indicate that if a therapist asks a question, clarifies or associates, there is a significant probability that he will continue doing so. A single theme sequence involving frame interventions was also observed. These sequences were found in all three alliance groups. One exception was found for mixed sequences of interpretations and supportive interventions. The simultaneous use of these two interventions was associated with a high or an improving alliance over the course of treatment, but not with a low and stable alliance where only single theme sequences of interpretations were found. In other words, in this last group, therapists were either supportive or interpretative, whereas with high or improving alliance, interpretations were always given along with supportive interventions. This finding provides evidence that examining therapist interpretation individually can only yield incomplete findings. How interpretations were given is important for alliance building. It also suggests that therapists should carefully dose their interpretations and be supportive when necessary in order to build a strong therapeutic alliance. And from a research point of view, to study technical interventions, we must look into dynamic variables such as dosage, the supportive quality of an intervention, and timing. (PsycINFO Database Record (c) 2005 APA, all rights reserved)

Ecologie trophique de deux espèces jumelles et sympatriques de chauves-souris: Myotis myotis et Myotis blythii (Chiroptera : Vespertilionidae). Premiers résultats

M. myotis and M. blythii are two sibling species of bats that live sympatrically over wide areas of the Western Palearctic region, and which often coexist intimately in their nursery roosts. According to the principle of <<limiting similarity>> this cohabitation should imply an interspecific ecological differentiation. The hypothesis of a niche separation at the trophic level is tested here. The fecal analysis of 300 droppings collected from a zone of sympatry shows a clear interspecific differentiation in diets : M. myotis eats mostly Carabidae (Coleoptera), whereas M. blythii captures essentially Tettigoniidae, Gryllidae and Acrididae (Orthoptera). Because they consume exclusively terrestrial arthropods, M. myotis and M. blythii are typical ground and/or grass gleaning bats. However, despite their narrow niches they are probably not specialized in the predation of only some definite categories of prey. The narrow diets probably reflect the high specialization of their modes of resource exploitation: M. myotis and M. blythii prey upon ground arthropods and they are likely to select for different foraging;g habitats. M. myotis probably prefers wooded feeding grounds (Carabidae) whereas M. blythii exploits herbaceous habitats (Orthoptera). The strong trophic segregation observed in sympatry between M. myotis and M. blythii shows that the interspecific competition is distinctly much weaker than the intraspecific one. This would explain the stable, intimate co-existence of these two virtual competitors.

Towards a consensus view on understanding nanomaterials hazards and managing exposure

The aim of this article is to present an overview of salient issues of exposure, characterisation and hazard assessment of nanomaterials as they emerged from the consensus-building of experts undertaken within the four year European Commission coordination project NanoImpactNet. The approach adopted is to consolidate and condense the findings and problem-identification in such a way as to identify knowledge-gaps and generate a set of interim recommendations of use to industry, regulators, research bodies and funders. The categories of recommendation arising from the consensual view address: significant gaps in vital factual knowledge of exposure, characterisation and hazards; the development, dissemination and standardisation of appropriate laboratory protocols; address a wide range of technical issues in establishing an adequate risk assessment platform; the more efficient and coordinated gathering of basic data; greater inter-organisational cooperation; regulatory harmonization; the wider use of the life-cycle approaches; and the wider involvement of all stakeholders in the discussion and solution-finding efforts for nanosafety.

Iowa Emergency Response Plan, October, 2010

The State of Iowa has adopted a multi-hazard approach to managing the consequences of emergency/disaster response. Underlying this approach is the principle that a standard set of generic functional capabilities can be employed to effectively address a wide variety of hazardous conditions and categories of incidents, whether these have a known probability of occurring or are totally unforeseen. Therefore, to the greatest extent possible, the activities described and assigned in this plan are organized along functional lines first, rather than by agency, type of hazard, or type of incident. Contained in this section of the Plan, known as the ―Basic Plan,‖ are instructions, policies, and explanatory information related to many or all of the agencies/entities involved in emergency/ disaster response, as well as information about the legal and administrative foundations for the Plan, the state’s characteristics and significant hazards, lines of succession for the state’s chief executive, plan activation requirements, and the structure of the response organization.

Closed soilless growing system for producing strawberry bare root transplants and runner tips

The objective of this work was to test a closed soilless growing system for producing bare root transplants and runner tips of two strawberry clones, using two categories of substrates. The system used corrugated roofing panels of fiber-cement, over which a substrate layer was used as a growing bed. The nutrient solution was pumped from a reservoir toward the upper end of the roofing panels and drained back to a reservoir. Plant growth and development were determined for two advanced strawberry clones, grown in sand or in Plantmax organic substrate. Growth of the stock plants and the number and dry mass of bare root transplants were similar in the substrates, but bare roots differed in their crown diameters by substrate. For number of runner tips, no significant differences were found in total, small, and medium categories in the substrates. A mean production of about 590 runner tips per square meter and 145 bare root transplants per square meter was obtained. For both clones, a large number of bare root transplants and runner tips of adequate size were produced in the closed soilless growing system using sand or organic substrate.

Alleviating Working Poverty in Postindustrial Economies

In order to identify the main social policy tools that can efficiently combat working poverty, it is essential to identify its main driving factors. More importantly, this work shows that all poverty factors identified in the literature have a direct bearing on working households through three mechanisms, namely being badly paid, having a below-average workforce participation, and high needs. One of the main purposes of this work is to assess whether the policies put forward in the specialist literature as potentially efficient really work. This is done in two ways. A first empirical prong provides an evaluation of the employment and antipoverty effects of these instruments, based on a meta-analysis of four instruments: minimum wages, tax credits for working households, family cash benefits and childcare policies. The second prong relies on a broader framework based on welfare regimes. This work contributes to the identification of a typology of welfare regimes that is suitable for the analysis of working poverty, and four countries are chosen to exemplify each regime: the US, Sweden, Germany, and Spain. It then moves on to show that the weight of the three working poverty mechanisms varies widely from one welfare regime to the other. This second empirical contribution clearly shows that there is no "one-size-fits-all" approach to the fight against working poverty. But none of this is possible without having properly defined the phenomenon. Most of the literature is characterized by a "definitional chaos" that probably does more harm than good to social policy efforts. Hence, this book provides a conceptual reflection pleading for the use of a very encompassing definition of being in work. It shows that "the working poor" is too broad a category to be used for meaningful academic or policy discussion, and that a distinction must be operated between different categories of the working poor. Failing to acknowledge this prevents the design of an efficient policy mix.

Land plants and DNA barcodes: short-term and long-term goals.

Land plants have had the reputation of being problematic for DNA barcoding for two general reasons: (i) the standard DNA regions used in algae, animals and fungi have exceedingly low levels of variability and (ii) the typically used land plant plastid phylogenetic markers (e.g. rbcL, trnL-F, etc.) appear to have too little variation. However, no one has assessed how well current phylogenetic resources might work in the context of identification (versus phylogeny reconstruction). In this paper, we make such an assessment, particularly with two of the markers commonly sequenced in land plant phylogenetic studies, plastid rbcL and internal transcribed spacers of the large subunits of nuclear ribosomal DNA (ITS), and find that both of these DNA regions perform well even though the data currently available in GenBank/EBI were not produced to be used as barcodes and BLAST searches are not an ideal tool for this purpose. These results bode well for the use of even more variable regions of plastid DNA (such as, for example, psbA-trnH) as barcodes, once they have been widely sequenced. In the short term, efforts to bring land plant barcoding up to the standards being used now in other organisms should make swift progress. There are two categories of DNA barcode users, scientists in fields other than taxonomy and taxonomists. For the former, the use of mitochondrial and plastid DNA, the two most easily assessed genomes, is at least in the short term a useful tool that permits them to get on with their studies, which depend on knowing roughly which species or species groups they are dealing with, but these same DNA regions have important drawbacks for use in taxonomic studies (i.e. studies designed to elucidate species limits). For these purposes, DNA markers from uniparentally (usually maternally) inherited genomes can only provide half of the story required to improve taxonomic standards being used in DNA barcoding. In the long term, we will need to develop more sophisticated barcoding tools, which would be multiple, low-copy nuclear markers with sufficient genetic variability and PCR-reliability; these would permit the detection of hybrids and permit researchers to identify the 'genetic gaps' that are useful in assessing species limits.

Prise en charge des plaies, quoi de neuf? [Advances in wound care]

Wound care made great progress during last years related to several factors. The first is an awakening of the importance of wounds. The progress made in the comprehension of the physiopathology of wounds led to innovations in all stages of this complex process which is the wound healing. Autologus platelet concentrate producing growth factors are in use to stimulate the first phase of the healing. The second phase which is the phase of proliferation and secretion is currently better managed with new categories of bandages which are true local treatments. The nutrition became one of the pillars of wound treatments especially among old patients. The reconstructive surgery took great steps since the physiology and the vascular anatomy of the skin and soft tissues are better known. Finally the bio-engineering has entered the treatment of the wound there is more than 20 years ago and methods have improved and become more reliable

Testing differentiation in diploid populations.

We examine the power of different exact tests of differentiation for diploid populations. Since there is not necessarily random mating within populations, the appropriate hypothesis to construct exact tests is that of independent sampling of genotypes. There are two categories of tests, FST-estimator tests and goodness of fit tests. In this latter category, we distinguish "allelic statistics", which account for the nature of alleles within genotypes, from "genotypic statistics" that do not. We show that the power of FST-estimator tests and of allelic goodness of fit tests are similar when sampling is balanced, and higher than the power of genotypic goodness of fit tests. When sampling is unbalanced, the most powerful tests are shown to belong to the allelic goodness of fit group.

Major mite allergen Der f 1 concentration is reduced in buildings with improved energy performance.

BACKGROUND: Environmental conditions play a crucial role in mite growth, and optimal environmental control is key in the prevention of airway inflammation in chronic allergic rhinoconjunctivitis or asthma. OBJECTIVE: To evaluate the relationship between building energy performance and indoor mite allergen concentration in a cross-sectional study. METHODS: Major allergen concentration (Der f 1, Der p 1, mite group 2, Fel d 1 and Bla g 2) was determined by quantitative dot blot analysis from mattress and carpet dust samples in five buildings designed for low energy use (LEB) and in six control buildings (CB). Inhabitants had received 4 weeks prior to mite measurement a personal validated questionnaire related to the perceived state of health and comfort of living. RESULTS: Cumulative mite allergen concentration (with Der f 1 as the major contributor) was significantly lower in LEB as compared with CB both in mattresses and in carpets. In contrast, the two categories of buildings did not differ in Bla g 2 and Fel d 1 concentration, in the amount of dust and airborne mould collected. Whereas temperature was higher in LEB, relative humidity was significantly lower than in CB. Perceived overall comfort was better in LEB. CONCLUSIONS: Major mite allergen Der f 1 preferentially accumulates in buildings not specifically designed for low energy use, reaching levels at risk for sensitization. We hypothesize that controlled mechanical ventilation present in all audited LEB may favour lower air humidity and hence lower mite growth and allergen concentration, while preserving optimal perceived comfort.

Alcohol and cannabis use as risk factors for injury--a case-crossover analysis in a Swiss hospital emergency department.

BACKGROUND: There is sufficient and consistent evidence that alcohol use is a causal risk factor for injury. For cannabis use, however, there is conflicting evidence; a detrimental dose-response effect of cannabis use on psychomotor and other relevant skills has been found in experimental laboratory studies, while a protective effect of cannabis use has also been found in epidemiological studies. METHODS: Implementation of a case-crossover design study, with a representative sample of injured patients (N = 486; 332 men; 154 women) from the Emergency Department (ED) of the Lausanne University Hospital, which received treatment for different categories of injuries of varying aetiology. RESULTS: Alcohol use in the six hours prior to injury was associated with a relative risk of 3.00 (C.I.: 1.78, 5.04) compared with no alcohol use, a dose-response relationship also was found. Cannabis use was inversely related to risk of injury (RR: 0.33; C.I.: 0.12, 0.92), also in a dose-response like manner. However, the sample size for people who had used cannabis was small. Simultaneous use of alcohol and cannabis did not show significantly elevated risk. CONCLUSION: The most surprising result of our study was the inverse relationship between cannabis use and injury. Possible explanations and underlying mechanisms, such as use in safer environments or more compensatory behavior among cannabis users, were discussed.

GENCODE: producing a reference annotation for ENCODE.

BACKGROUND: The GENCODE consortium was formed to identify and map all protein-coding genes within the ENCODE regions. This was achieved by a combination of initial manual annotation by the HAVANA team, experimental validation by the GENCODE consortium and a refinement of the annotation based on these experimental results. RESULTS: The GENCODE gene features are divided into eight different categories of which only the first two (known and novel coding sequence) are confidently predicted to be protein-coding genes. 5' rapid amplification of cDNA ends (RACE) and RT-PCR were used to experimentally verify the initial annotation. Of the 420 coding loci tested, 229 RACE products have been sequenced. They supported 5' extensions of 30 loci and new splice variants in 50 loci. In addition, 46 loci without evidence for a coding sequence were validated, consisting of 31 novel and 15 putative transcripts. We assessed the comprehensiveness of the GENCODE annotation by attempting to validate all the predicted exon boundaries outside the GENCODE annotation. Out of 1,215 tested in a subset of the ENCODE regions, 14 novel exon pairs were validated, only two of them in intergenic regions. CONCLUSION: In total, 487 loci, of which 434 are coding, have been annotated as part of the GENCODE reference set available from the UCSC browser. Comparison of GENCODE annotation with RefSeq and ENSEMBL show only 40% of GENCODE exons are contained within the two sets, which is a reflection of the high number of alternative splice forms with unique exons annotated. Over 50% of coding loci have been experimentally verified by 5' RACE for EGASP and the GENCODE collaboration is continuing to refine its annotation of 1% human genome with the aid of experimental validation.