Task structure as a limiting condition of the occurrence of the treatment effects of simulation instruction in application of the real-simulating model of hypnosis

The hypothesis tested was that lack of task structure facilitates the occurrence of the treatment effects of simulation instruction in application of the real-simulating model of hypnosis. Following appropriate instruction 10 susceptible and 10 insusceptible Ss were tested in 2 sessions by an E who wm blind to the hypnotic susceptibility of Ss. In Session I, Ss were tested on an unstructured (Rorschach) and a structured (Unusual Uses Test) task. In Session II, Ss were administered the same tests again but after hypnosis had been induced and terminated. It was predicted that after receiving instructions to simulate, insusceptible Ss, initially constricted in their response, would change their behavior in Session II in the direction of increased productivity of response, while hypnotic Ss would not, and that the change would be most apparent on the unstructured task. Data supported the hypothesis. In Session II, simulating Ss, but not hypnotic Ss, significantly increased responses on the Rorschach and not on the Uses test. Results suggested that task definition is a limiting condition of the occurrence of the treatment effects of faking instruction.     

Urban Tree Canopy and Asthma,Wheeze, Rhinitis,and Allergic Sensitization to Tree Pollen in a New York City Birth Cohort

Background: Urban landscape elements, particularly trees, have the potential to affect airflow, air quality, and production of aeroallergens. Several large-scale urban tree planting projects have sought to promote respiratory health, yet evidence linking tree cover to human health is limited.Objectives: We sought to investigate the association of tree canopy cover with subsequent development of childhood asthma, wheeze, rhinitis, and allergic sensitization.Methods: Birth cohort study data were linked to detailed geographic information systems data characterizing 2001 tree canopy coverage based on LiDAR (light detection and ranging) and multispectral imagery within 0.25 km of the prenatal address. A total of 549 Dominican or African-American children born in 1998–2006 had outcome data assessed by validated questionnaire or based on IgE antibody response to specific allergens, including a tree pollen mix.Results: Tree canopy coverage did not significantly predict outcomes at 5 years of age, but was positively associated with asthma and allergic sensitization at 7 years. Adjusted risk ratios (RRs) per standard deviation of tree canopy coverage were 1.17 for asthma (95% CI: 1.02, 1.33), 1.20 for any specific allergic sensitization (95% CI: 1.05, 1.37), and 1.43 for tree pollen allergic sensitization (95% CI: 1.19, 1.72).Conclusions: Results did not support the hypothesized protective association of urban tree canopy coverage with asthma or allergy-related outcomes. Tree canopy cover near the prenatal address was associated with higher prevalence of allergic sensitization to tree pollen. Information was not available on sensitization to specific tree species or individual pollen exposures, and results may not be generalizable to other populations or geographic areas.     

Protection by ultraviolet A and B sunscreens against in situ dipyrimidine photolesions in human epidermis is comparable to protection against sunburn

Sunscreens prevent sunburn and may also prevent skin cancer by protecting from ultraviolet-induced DNA damage. We assessed the ability of two sunscreens, with different spectral profiles, to inhibit DNA photodamage in human epidermis in situ. One formulation contained the established ultraviolet B filter octyl methoxycinnamate, whereas the other contained terephthalylidene dicamphor sulfonic acid, a new ultraviolet A filter. Both formulations had sun protection factors of 4 when assessed with solar simulating radiation in volunteers of skin type I/II. We tested the hypothesis that sun protection factors would indicate the level of protection against DNA photodamage. Thus, we exposed sunscreen-treated sites to four times the minimal erythema dose of solar simulating radiation, whereas vehicle and control sites were exposed to one minimal erythema dose. We used monoclonal antibodies against thymine dimers and 6-4 photoproducts and image analysis to quantify DNA damage in skin sections. A dose of four times the minimal erythema dose, with either sunscreen, resulted in comparable levels of thymine dimers and 6-4 photoproducts to one minimal erythema dose +/- vehicle, providing evidence that the DNA protection factor is comparable to the sun protection factor. The lack of difference between the sunscreens indicates similar action spectra for erythema and DNA photodamage and that erythema is a clinical surrogate for DNA photodamage that may lead to skin cancer.     

Stereotactic radiosurgery versus active surveillance for asymptomatic,skull-based meningiomas: an international,multicenter matched cohort study

Journal of Neuro-Oncology - The optimal management of asymptomatic, skull-based meningiomas is not well defined. The aim of this study is to compare the imaging and clinical outcomes of patients...     

Motion sickness: a cholinomimetic agent hypothesis

Motion sickness has been defined as a set of physiological signs and symptoms produced as a result of prolonged sensory conflict in central nervous system vestibular centers. It has long been noted that the particular pattern of motion sickness signs and symptoms does not fit the conventional "fight or flight vs. rest and digest" autonomic synergy. We argue that most of the progression of symptoms is consistent with a new etiologic hypothesis: that an as-yet-unidentified ganglionic cholinomimetic agent is slowly released in proportion to sensory conflict. The agent accumulates systemically and stimulates the peripheral sympathetic and parasympathetic ganglia, the adrenal medulla, and potentiates the response of central cholinergic emetic pathways to the same conflict stimulus. The predominant effects of ganglionic stimulation on each autonomic organ, determined by resting tone, are selectively enhanced or inhibited by adrenal catecholamine release, producing the atypical pattern of autonomic changes seen in motion sickness. The adrenergic response may eventually also counter the central emetic drive. The hypothesis could be experimentally pursued via human and animal experiments employing a nicotinic antagonist that has both central and peripheral ganglionic actions such as mecamylamine.     

Healthcare Costs Among Adults with Type 2 Diabetes Initiating DPP-4 Inhibitors

Introduction

Oral antidiabetes medications, including dipeptidyl peptidase-4 inhibitors (DPP-4is) saxagliptin and sitagliptin, are used for the treatment of type 2 diabetes (T2D). The study objective was to compare all-cause and diabetes-related costs following initiation of saxagliptin or sitagliptin.

Methods

Patients aged ≥18 years initiating saxagliptin or sitagliptin between January 1, 2009 and January 31, 2012 in the Truven Health MarketScan Commercial and Medicare Supplemental databases were identified. Patients were required to have continuous enrollment for ≥365 days before and ≥365 days after the index date (date of the first saxagliptin or sitagliptin claim). Additionally, patients were required to have a claim with a T2D diagnosis (ICD-9-CM 250.×0, 250.×2) and no claims for a DPP-4i medication before the index date. All-cause and diabetes-related medical costs and total costs (including pharmacy costs) were captured over the 1-year follow-up period. Generalized linear models with log link and gamma distribution were fit to compare costs between the two cohorts using cost ratios, controlling for patient baseline characteristics. Recycled prediction methods were used to generate adjusted predicted costs and confidence intervals.

Results

The final sample comprised 3354 saxagliptin initiators and 26,895 sitagliptin initiators. The average age of saxagliptin and sitagliptin initiators was 57 years and just over 50% were males. After adjusting for baseline characteristics, saxagliptin patients had significantly lower average all-cause medical costs (cost ratio = 0.901, P < 0.001; predicted mean costs: $8687 vs. $9646) compared with sitagliptin patients over the 1-year follow-up. Findings were consistent for diabetes-related medical costs (cost ratio = 0.890, P < 0.001; predicted mean costs: $2180 vs. $2450). Total costs were also lower for saxagliptin initiators (cost ratio = 0.950, P = 0.002; predicted mean costs: $13,911 vs. $14,651) over the 1-year follow-up period.

Conclusion

Initiation of treatment with saxagliptin was associated with lower medical costs over 1 year compared with initiation of sitagliptin among adults with T2D.

Funding

AstraZeneca.

     

Neighborhood Latino ethnic density and mortality among HIV-positive Latinos by birth country/region,Florida, 2005–2008

Objective. Lower mortality for Latinos has been reported in high Latino density areas. The objective was to examine the contribution of neighborhood Latino density to mortality among HIV-positive Latinos.

Methods. Florida HIV surveillance data for 2005–2008 were merged with the 2007–2011 American Community Survey data using zip code tabulation areas. Hazard ratios (HR) were calculated using multi-level weighted Cox regression and adjusted for individual-level factors and neighborhood poverty.

Results. Of 4649 HIV-positive Latinos, 11.8% died. There was no difference in mortality risk across categories of Latino ethnic density for Latinos as a whole. There were subgroup effects wherein mortality risk differed by ethnic density category for Latinos born in some countries/regions. Residing in an area with ≥50% Latinos compared with <25% was associated with increased mortality risk for Latinos born in Puerto Rico (HR 1.67; 95% confidence interval [CI] [1.01–2.70]). Residing in an area where Mexicans were the majority Latino group was associated with increased mortality risk for Latinos born in Mexico (HR 3.57; 95% CI [1.43–10.00]).

Conclusions. The survival advantage seen among the Latino population in high Latino density areas was not seen among HIV-positive Latinos. Research is needed to determine if this may be related to stigma or another mechanism.