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1.  The unsuitability of html-based colour charts for estimating animal colours – a comment on Berggren and Merilä (2004) 
Frontiers in Zoology  2005;2:14.
A variety of techniques are used to study the colours of animal signals, including the use of visual matching to colour charts. This paper aims to highlight why they are generally an unsatisfactory tool for the measurement and classification of animal colours and why colour codes based on HTML (really RGB) standards, as advocated in a recent paper, are particularly inappropriate. There are many theoretical arguments against the use of colour charts, not least that human colour vision differs markedly from that of most other animals. However, the focus of this paper is the concern that, even when applied to humans, there is no simple 1:1 mapping from an RGB colour space to the perceived colours in a chart (the results are both printer- and illumination-dependent). We support our criticisms with data from colour matching experiments with humans, involving self-made, printed colour charts.
Colour matching experiments with printed charts involving 11 subjects showed that the choices made by individuals were significantly different between charts that had exactly the same RGB values, but were produced from different printers. Furthermore, individual matches tended to vary under different lighting conditions. Spectrophotometry of the colour charts showed that the reflectance spectra of the charts varied greatly between printers and that equal steps in RGB space were often far from equal in terms of reflectance on the printed charts.
In addition to outlining theoretical criticisms of the use of colour charts, our empirical results show that: individuals vary in their perception of colours, that different printers produce strikingly different results when reproducing what should be the same chart, and that the characteristics of the light irradiating the surface do affect colour perception. Therefore, we urge great caution in the use of colour charts to study animal colour signals. They should be used only as a last resort and in full knowledge of their limitations, with specially produced charts made to high industry standards.
PMCID: PMC1201160  PMID: 16131394
2.  First Fossil Record of Alphonsea Hk. f. & T. (Annonaceae) from the Late Oligocene Sediments of Assam, India and Comments on Its Phytogeography 
PLoS ONE  2013;8(1):e53177.
A new fossil leaf impression of Alphonsea Hk. f. & T. of the family Annonaceae is described from the Late Oligocene sediments of Makum Coalfield, Assam, India. This is the first authentic record of the fossil of Alphonsea from the Tertiary rocks of South Asia. The Late Oligocene was the time of the last significant globally warm climate and the fossil locality was at 10°–15°N palaeolatitude. The known palaeoflora and sedimentological studies indicate a fluvio-marine deltaic environment with a mosaic of mangrove, fluvial, mire and lacustrine depositional environments. During the depositional period the suturing between the Indian and Eurasian plates was not complete to facilitate the plant migration. The suturing was over by the end of the Late Oligocene/beginning of Early Miocene resulting in the migration of the genus to Southeast Asia where it is growing profusely at present. The present study is in congruence with the earlier published palaeofloral and molecular phylogenetic data. The study also suggests that the Indian plate was not only a biotic ferry during its northward voyage from Gondwana to Asia but also a place for the origin of several plant taxa.
PMCID: PMC3551915  PMID: 23349701
3.  Punch biopsy of iris lesions: a novel technique for obtaining histology samples 
To obtain iris biopsy samples of sufficient quality and quantity for histopathological analysis using a novel punch biopsy technique.
Two patients underwent iris tumour biopsy at an ocular oncology service. A trabeculectomy punch (Kelly Descemet's membrane punch) with a 1.0 mm diameter head and a 0.75 mm deep bite was inserted through a clear cornea perforated by a SatinSlit 3.2 mm angled slit knife into a viscoelastic‐filled anterior chamber. The Kelly punch was placed over the lesion and pressed down before the punch was made. After obtaining the sample, the Kelly punch was removed from the eye and then opened over a dry cellulose sponge. Tissue samples were placed in 4% formalin and processed routinely for standard staining with H&E, periodic acid Schiff and immunostains.
In both patients, by using the punch biopsy technique with the Kelly punch, we were able to obtain a 0.8×0.6 mm piece of tissue, large enough for any histological analysis. H&E staining showed spindle cell melanoma. Tissue sections, stained positive with MART‐1 (melanoma antigen recognised by T cells) and negative with cytokeratin, established the diagnosis of melanoma of the iris in each of these patients.
Iris biopsy with the punch technique yields a tissue biopsy specimen, as opposed to cytology samples obtained by fine needle aspiration biopsy. This technique is quick, simple to perform and requires non‐expensive and easily available equipment. The tissue obtained is of sufficient quality and quantity to enable routine and special stainings.
PMCID: PMC1954730  PMID: 17446506
4.  Psychosocial Interventions for Perinatal Common Mental Disorders Delivered by Providers Who Are Not Mental Health Specialists in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis 
PLoS Medicine  2013;10(10):e1001541.
In a systematic review and meta-analysis, Kelly Clarke and colleagues examine the effect of psychosocial interventions delivered by non–mental health specialists for perinatal common mental disorders in low- and middle-income countries.
Please see later in the article for the Editors' Summary
Perinatal common mental disorders (PCMDs) are a major cause of disability among women. Psychosocial interventions are one approach to reduce the burden of PCMDs. Working with care providers who are not mental health specialists, in the community or in antenatal health care facilities, can expand access to these interventions in low-resource settings. We assessed effects of such interventions compared to usual perinatal care, as well as effects of interventions based on intervention type, delivery method, and timing.
Methods and Findings
We conducted a systematic review, meta-analysis, and meta-regression. We searched databases including Embase and the Global Health Library (up to 7 July 2013) for randomized and non-randomized trials of psychosocial interventions delivered by non-specialist mental health care providers in community settings and antenatal health care facilities in low- and middle-income countries. We pooled outcomes from ten trials for 18,738 participants. Interventions led to an overall reduction in PCMDs compared to usual care when using continuous data for PCMD symptomatology (effect size [ES] −0.34; 95% CI −0.53, −0.16) and binary categorizations for presence or absence of PCMDs (odds ratio 0.59; 95% CI 0.26, 0.92). We found a significantly larger ES for psychological interventions (three studies; ES −0.46; 95% CI −0.58, −0.33) than for health promotion interventions (seven studies; ES −0.15; 95% CI −0.27, −0.02). Both individual (five studies; ES −0.18; 95% CI −0.34, −0.01) and group (three studies; ES −0.48; 95% CI −0.85, −0.11) interventions were effective compared to usual care, though delivery method was not associated with ES (meta-regression β coefficient −0.11; 95% CI −0.36, 0.14). Combined group and individual interventions (based on two studies) had no benefit compared to usual care, nor did interventions restricted to pregnancy (three studies). Intervention timing was not associated with ES (β 0.16; 95% CI −0.16, 0.49). The small number of trials and heterogeneity of interventions limit our findings.
Psychosocial interventions delivered by non-specialists are beneficial for PCMDs, especially psychological interventions. Research is needed on interventions in low-income countries, treatment versus preventive approaches, and cost-effectiveness.
Please see later in the article for the Editors' Summary
Editors' Summary
Perinatal common mental health disorders are among the most common health problems in pregnancy and the postpartum period. In low- and middle-income countries, about 16% of women during pregnancy and about 20% of women in the postpartum period will suffer from a perinatal common mental health disorder. These disorders, including depression and anxiety, are a major cause of disability in women and have been linked to young children under their care being underweight and stunted.
Why Was This Study Done?
While research shows that both pharmacological (e.g., antidepressants or anti-anxiety medications) and non-pharmacological (e.g., psychotherapy, education, or health promotion) interventions are effective for preventing and treating perinatal common mental disorders, most of this research took place in high-income countries. These findings may not be applicable in low-resource settings, where there is limited access to mental health care providers such as psychiatrists and psychologists, and to medications. Thus, non-pharmacological interventions delivered by providers who are not mental health specialists may be important as ways to treat perinatal common mental health disorders in these types of settings. In this study the researchers systematically reviewed research estimating the effectiveness of non-pharmacological interventions for perinatal common mental disorders that were delivered by providers who were not mental health specialists (including health workers, lay persons, and doctors or midwives) in low- and middle-income countries. The researchers also used meta-analysis and meta-regression—statistical methods that are used to combine the results from multiple studies—to estimate the relative effects of these interventions on mental health symptoms.
What Did the Researchers Do and Find?
The researchers searched multiple databases using key search terms to identify randomized and non-randomized clinical trials. Using specific criteria, the researchers retrieved and assessed 37 full papers, of which 11 met the criteria for their systematic review. Seven of these studies were from upper middle-income countries (China, South Africa, Columbia, Mexico, Argentina, Cuba, and Brazil), and four trials were from the lower middle-income countries of Pakistan and India, but there were no trials from low-income countries. The researchers assessed the quality of the selected studies, and one study was excluded from meta-analysis because of poor quality.
Combining results from the ten remaining studies, the researchers found that compared to usual perinatal care (which in most cases included no mental health care), interventions delivered by a providers who were not mental health specialists were associated with an overall reduction in mental health symptoms and the likelihood of being diagnosed with a mental health disorder. The researchers then performed additional analyses to assess relative effects by intervention type, timing, and delivery mode. They observed that both psychological interventions, such as psychotherapy and cognitive behavioral therapy, and health promotion interventions that were less focused on mental health led to significant improvement in mental health symptoms, but psychological interventions were associated with greater effects than health promotion interventions. Interventions delivered both during pregnancy and postnatally were associated with significant benefits when compared to usual care; however, when interventions were delivered during pregnancy only, the benefits were not significantly greater than usual care. When investigating mode of delivery, the researchers observed that both group and individual interventions were associated with improvements in symptoms.
What Do These Findings Mean?
These findings indicate that non-pharmacological interventions delivered by providers who are not mental health specialists could be useful for reducing symptoms of perinatal mental health disorders in middle-income countries. However, these findings should be interpreted with caution given that they are based on a small number of studies with a large amount of variation in the study designs, settings, timing, personnel, duration, and whether the intervention was delivered to a group, individually, or both. Furthermore, when the researchers excluded studies of the lowest quality, the observed benefits of these interventions were smaller, indicating that this analysis may overestimate the true effect of interventions. Nevertheless, the findings do provide support for the use of non-pharmacological interventions, delivered by non-specialists, for perinatal mental health disorders. Further studies should be undertaken in low-income countries.
Additional Information
Please access these websites via the online version of this summary at
The World Health Organization provides information about perinatal mental health disorders
The UK Royal College of Psychiatrists has information for professionals and patients about perinatal mental health disorders
PMCID: PMC3812075  PMID: 24204215
5.  GP recruitment and retention: a qualitative analysis of doctors' comments about training for and working in general practice. 
BACKGROUND AND AIMS: General practice in the UK is experiencing difficulty with medical staff recruitment and retention, with reduced numbers choosing careers in general practice or entering principalships, and increases in less-than-full-time working, career breaks, early retirement and locum employment. Information is scarce about the reasons for these changes and factors that could increase recruitment and retention. The UK Medical Careers Research Group (UKMCRG) regularly surveys cohorts of UK medical graduates to determine their career choices and progression. We also invite written comments from respondents about their careers and the factors that influence them. Most respondents report high levels of job satisfaction. A noteworthy minority, however, make critical comments about general practice. Although their views may not represent those of all general practitioners (GPs), they nonetheless indicate a range of concerns that deserve to be understood. This paper reports on respondents' comments about general practice. ANALYSIS OF DOCTORS' COMMENTS: Training Greater exposure to general practice at undergraduate level could help to promote general practice careers and better inform career decisions. Postgraduate general practice training in hospital-based posts was seen as poor quality, irrelevant and run as if it were of secondary importance to service commitments. In contrast, general practice-based postgraduate training was widely praised for good formal teaching that met educational needs. The quality of vocational training was dependent upon the skills and enthusiasm of individual trainers. Recruitment problems Perceived deterrents to choosing general practice were its portrayal, by some hospital-based teachers, as a second class career compared to hospital medicine, and a perception of low morale amongst current GPs. The choice of a career in general practice was commonly made for lifestyle reasons rather than professional aspirations. Some GPs had encountered difficulties in obtaining posts in general practice suited to their needs, while others perceived discrimination. Newly qualified GPs often sought work as non-principals because they felt too inexperienced for partnership or because their domestic situation prevented them from settling in a particular area. Changes to general practice The 1990 National Health Service (NHS) reforms were largely viewed unfavourably, partly because they had led to a substantial increase in GPs' workloads that was compounded by growing public expectations, and partly because the two-tier system of fund-holding was considered unfair. Fund-holding and, more recently, GP commissioning threatened the GP's role as patient advocate by shifting the responsibility for rationing of health care from government to GPs. Some concerns were also expressed about the introduction of primary care groups (PCGs) and trusts (PCTs). Together, increased workload and the continual process of change had, for some, resulted in work-related stress, low morale, reduced job satisfaction and quality of life. These problems had been partially alleviated by the formation of GP co-operatives. Retention difficulties Loss of GPs' time from the NHS workforce occurs in four ways: reduced working hours, temporary career breaks, leaving the NHS to work elsewhere and early retirement. Child rearing and a desire to pursue interests outside medicine were cited as reasons for seeking shorter working hours or career breaks. A desire to reduce pressure of work was a common reason for seeking shorter working hours, taking career breaks, early retirement or leaving NHS general practice. Other reasons for leaving NHS general practice, temporarily or permanently, were difficulty in finding a GP post suited to individual needs and a desire to work abroad. CONCLUSIONS: A cultural change amongst medical educationalists is needed to promote general practice as a career choice that is equally attractive as hospital practice. The introduction of Pre-Registration House Officer (PRHO) placements in general practice and improved flexibility of GP vocational training schemes, together with plans to improve the quality of Senior House Officer (SHO) training in the future, are welcome developments and should address some of the concerns about poor quality GP training raised by our respondents. The reluctance of newly qualified GPs to enter principalships, and the increasing demand from experienced GPs for less-than-full-time work, indicates a need for a greater variety of contractual arrangements to reflect doctors' desires for more flexible patterns of working in general practice.
PMCID: PMC2560447  PMID: 12049026
6.  A grand convergence in mortality is possible: comment on Global Health 2035 
The grand challenge in global health is the inequality in mortality and life expectancy between countries and within countries. According to Global Health 2035, the Lancet Commission celebrating the 20th anniversary of the World Development Report (WDR) of 1993, the world now has the unique opportunity to achieve a grand convergence in global mortality within a generation. This article comments on the main findings and recommendations of the Global Health 2035.
PMCID: PMC3937948  PMID: 24596900
Global Health; Investing in Health; Macro-Economic Benefits; Mortality Inequality
7.  Response to Comment on “Log or Linear? Distinct Intuitions of the Number Scale in Western and Amazonian Indigene Cultures” 
Science (New York, N.Y.)  2009;323(5910):38.
The performance of the Mundurucu on the number-space task may exemplify a general competence for drawing analogies between space and other linear dimensions, but Mundurucu participants spontaneously chose number when other dimensions were available. Response placement may not reflect the subjective scale for numbers, but Cantlon et al.'s proposal of a linear scale with scalar variability requires additional hypotheses that are problematic.
PMCID: PMC3393850  PMID: 19119201
8.  Comment: Applications of robotics in the clinical laboratory 
The implementation of a robotic workstation in the clinical laboratory involves considerations and compromises common to any instrument design and development activity. The trade-off between speed and flexibility not only affects the way the instrument interacts with human operators and other devices (the ‘real-world interface’), but also places limitations on the adaptation of chemistries to the given instrument. Mechanical optimization for speed and reproducibility places restrictions on the imprecision of consumables. Attempts to adapt a robot to a constrained system may entail compromises that either degrades the theoretically-attainable quality of results, or requires human interaction to compensate for physical or mechanical limitations. The general considerations of function and workflow, programming and support, and reliability place practical limits on the implementation of robotic workstations in the clinical laboratory.
PMCID: PMC2547824  PMID: 18925267
9.  What the Public Was Saying about the H1N1 Vaccine: Perceptions and Issues Discussed in On-Line Comments during the 2009 H1N1 Pandemic 
PLoS ONE  2011;6(4):e18479.
During the 2009 H1N1 pandemic, a vaccine was made available to all Canadians. Despite efforts to promote vaccination, the public's intent to vaccinate remained low. In order to better understand the public's resistance to getting vaccinated, this study addressed factors that influenced the public's decision making about uptake. To do this, we used a relatively novel source of qualitative data – comments posted on-line in response to news articles on a particular topic. This study analysed 1,796 comments posted in response to 12 articles dealing with H1N1 vaccine on websites of three major Canadian news sources. Articles were selected based on topic and number of comments. A second objective was to assess the extent to which on-line comments can be used as a reliable data source to capture public attitudes during a health crisis. The following seven themes were mentioned in at least 5% of the comments (% indicates the percentage of comments that included the theme): fear of H1N1 (18.8%); responsibility of media (17.8%); government competency (17.7%); government trustworthiness (10.7%); fear of H1N1 vaccine (8.1%); pharmaceutical companies (7.6%); and personal protective measures (5.8%). It is assumed that the more frequently a theme was mentioned, the more that theme influenced decision making about vaccination. These key themes for the public were often not aligned with the issues and information officials perceived, and conveyed, as relevant in the decision making process. The main themes from the comments were consistent with results from surveys and focus groups addressing similar issues, which suggest that on-line comments do provide a reliable source of qualitative data on attitudes and perceptions of issues that emerge in a health crisis. The insights derived from the comments can contribute to improved communication and policy decisions about vaccination in health crises that incorporate the public's views.
PMCID: PMC3078916  PMID: 21533161
10.  Attitudes towards chiropractic: an analysis of written comments from a survey of north american orthopaedic surgeons 
There is increasing interest by chiropractors in North America regarding integration into mainstream healthcare; however, there is limited information about attitudes towards the profession among conventional healthcare providers, including orthopaedic surgeons.
We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopaedic surgeons that inquired about demographic variables and their attitudes towards chiropractic. Our survey included an option for respondants to include written comments, and our present analysis is restricted to these comments. Two reviewers, independantly and in duplicate, coded all written comments using thematic analysis.
487 surgeons completed the survey (response rate 49%), and 174 provided written comments. Our analysis revealed 8 themes and 24 sub-themes represented in surgeons' comments. Reported themes were: variability amongst chiropractors (n = 55); concerns with chiropractic treatment (n = 54); areas where chiropractic is perceived as effective (n = 43); unethical behavior (n = 43); patient interaction (n = 36); the scientific basis of chiropractic (n = 26); personal experiences with chiropractic (n = 21); and chiropractic training (n = 18). Common sub-themes endorsed by surgeon's were diversity within the chiropractic profession as a barrier to increased interprofessional collaboration, endorsement for chiropractic treatment of musculoskeletal complaints, criticism for treatment of non-musculoskeletal complaints, and concern over whether chiropractic care was evidence-based.
Our analysis identified a number of issues that will have to be considered by the chiropractic profession as part of its efforts to further integrate chiropractic into mainstream healthcare.
PMCID: PMC3212887  PMID: 21970333
orthopaedics; chiropractic; attitude of health personnel; survey
11.  “Who writes what?” Using written comments in team-based assessment to better understand medical student performance: a mixed-methods study 
BMC Medical Education  2012;12:123.
Observation of the performance of medical students in the clinical environment is a key part of assessment and learning. To date, few authors have examined written comments provided to students and considered what aspects of observed performance they represent. The aim of this study was to examine the quantity and quality of written comments provided to medical students by different assessors using a team-based model of assessment, and to determine the aspects of medical student performance on which different assessors provide comments.
Medical students on a 7-week General Surgery & Anesthesiology clerkship received written comments on ‘Areas of Excellence’ and ‘Areas for Improvement’ from physicians, residents, nurses, patients, peers and administrators. Mixed-methods were used to analyze the quality and quantity of comments provided and to generate a conceptual framework of observed student performance.
1,068 assessors and 127 peers provided 2,988 written comments for 127 students, a median of 188 words per student divided into 26 “Areas of Excellence” and 5 “Areas for Improvement”. Physicians provided the most comments (918), followed by patients (692) and peers (586); administrators provided the fewest (91). The conceptual framework generated contained four major domains: ‘Student as Physician-in-Training’, ‘Student as Learner’, ‘Student as Team Member’, and ‘Student as Person.’
A wide range of observed medical student performance is recorded in written comments provided by members of the surgical healthcare team. Different groups of assessors provide comments on different aspects of student performance, suggesting that comments provided from a single viewpoint may potentially under-represent or overlook some areas of student performance. We hope that the framework presented here can serve as a basis to better understand what medical students do every day, and how they are perceived by those with whom they work.
PMCID: PMC3558404  PMID: 23249445
Written comments; Undergraduate; Assessment; Medical students; Clerkship; Mixed-methods; Qualitative; Clinical performance; Team
12.  Contagious Comments: What Was the Online Buzz About the 2011 Quebec Measles Outbreak? 
PLoS ONE  2013;8(5):e64072.
Although interruption of endemic measles was achieved in the Americas in 2002, Quebec experienced an outbreak in 2011 of 776 reported cases; 80% of these individuals had not been fully vaccinated. We analyzed readers’ online responses to Canadian news articles regarding the outbreak to better understand public perceptions of measles and vaccination.
We searched Canadian online English and French news sites for articles posted between April 2011 and March 2012 containing the words “measles” and “Quebec”. We included articles that i) concerned the outbreak or related vaccination strategies; and ii) generated at least ten comments. Two English and two bilingual researchers coded the unedited comments, categorizing codes to allow themes to emerge.
We analyzed 448 comments from 188 individuals, in response to three French articles and six English articles; 112 individuals expressed positive perceptions of measles vaccination (2.2 comments/person), 38 were negative (4.2 comments/person), 11 had mixed feelings (1.5 comments/person), and 27 expressed no opinion (1.1 comments/person). Vaccine-supportive themes involved the success of vaccination in preventing disease spread, societal responsibility to vaccinate for herd immunity, and refutation of the autism link. Those against measles vaccination felt it was a personal rather than societal choice, and conveyed a distrust of vaccine manufacturers, believing that measles infection is not only safe but safer than vaccination. Commenters with mixed feelings expressed uncertainty of the infection’s severity, and varied in support of all vaccines based on perceived risk/benefit ratios.
The anti-vaccine minority’s volume of comments translates to a disproportionately high representation on online boards. Public health messages should address concerns by emphasizing that immunization is always a personal choice in Canada, and that the pharmaceutical industry is strictly controlled. Illustrating the dangers of measles through personal stories, rather than scientific data only, may also serve to strengthen messaging.
PMCID: PMC3654905  PMID: 23691152
13.  Where are the young men in HIV prevention efforts? Comments on HIV prevention programs and research from young men who have sex with men in Los Angeles County 
The journal of primary prevention  2012;33(5-6):271-278.
Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted in a diverse sample of YMSM (N = 100, Mage = 25.0 years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0% of all participants had previously attended an HIV prevention program, and that 21.3% of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6 months compared to those who had not (p < .05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0%), not perceiving themselves to be at risk for HIV infection (14.0%), and believing that they already knew everything they needed to know about HIV transmission (23.0%). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM.
PMCID: PMC3513361  PMID: 23132515
YMSM; HIV prevention; barriers to participation
14.  Responses to gestational weight management guidance: a thematic analysis of comments made by women in online parenting forums 
The National Institute for Health and Clinical Excellence (NICE) published guidance on weight management in pregnancy in July 2010 (NICE public health guidance 27: 2010), and this received considerable press coverage across a range of media. This offered an opportunity to examine how gestational weight management guidance was received by UK women.
A thematic analysis was conducted of 400 posts made in UK-based parenting internet forums in the week following the publication of the NICE guidance. This allowed us to examine the naturally occurring comments from 202 women who posted about the guidance on public forums.
Three main themes were identified and explored: i) Perceived control/responsibility ii) Risk perception iii) Confused messages.
Women differed in their perceptions of the level of control that they had over being overweight with some feeling responsible and motivated to maintain a healthy lifestyle. Others felt there were multiple factors influencing their weight issues beyond their control. There were reports of feeling guilty about the impact of weight on the growing baby and experiencing significant obesity stigma from the public and health professionals. Information about the risks of overweight and obesity in pregnancy were difficult messages for women to hear, and for health professionals to deliver. Women reported being confused by the messages that they received. Health messages need to be delivered sensitively to women, and health professionals need support and training to do this. Risk information should always be accompanied with clear advice and support to help women to manage their weight in pregnancy.
PMCID: PMC4091654  PMID: 24981024
Internet-mediated research; Gestational weight gain; Parenting forums; NICE; Women; Views; Risk perception
15.  Adolescents' experience of comments about their weight – prevalence, accuracy and effects on weight misperception 
BMC Public Health  2009;9:271.
Weight comments are commonly received by adolescents, but the accuracy of the comments and their effects on weight misperception are unclear. We assessed the prevalence and accuracy of weight comments received by Chinese adolescents from different sources and their relation to weight misperception.
In the Hong Kong Student Obesity Surveillance (HKSOS) project 2006–07, 22612 students aged 11–18 (41.5% boys) completed a questionnaire on obesity. Students responded if family members, peers and professionals had seriously commented over the past 30 days that they were "too fat" or "too thin" in two separate questions. The accuracy of the comments was judged against the actual weight status derived from self-reported height and weight. Self-perceived weight status was also reported and any discordance with the actual weight status denoted weight misperception. Logistic regression yielded adjusted odd ratios for weight misperception by the type of weight comments received.
One in three students received weight comments, and the mother was the most common source of weight comments. Health professional was the most accurate source of weight comments, yet less than half the comments were correct. Adolescents receiving incorrect comments had increased risk of having weight misperception in all weight status groups. Receiving conflicting comments was positively associated with weight misperception among normal weight adolescents. In contrast, underweight and overweight/obese adolescents receiving correct weight comments were less likely to have weight misperception.
Weight comments, mostly incorrect, were commonly received by Chinese adolescents in Hong Kong, and such incorrect comments were associated with weight misperception.
PMCID: PMC2731749  PMID: 19642972
16.  Can Social Contagion Help Global Health ‘Jump the Shark’? Comment on “How to Facilitate Social Contagion?”  
The instrumental use of social networks has become a central tenet of international health policy and advocacy since the Millennium project. In asking, ‘How to facilitate social contagion?’, Karl Blanchet of the London School of Hygiene and Tropical Medicine therefore reflects not only on the recent success, but also hints to growing challenges; the tactics of partnerships, alliances and platforms no longer seem to be delivering at the same rate and maybe reversing. A better understanding of how social networks work may therefore be needed to strengthen a tactical instrument that has been used to remarkable recent effect. But in focusing on the unbounded rhetoric and narrative options of Global Health, the danger will surely be on missing the fundamental factors constraining network growth. Future growth will depend on understanding these constraints, and Global Health may do well to think of social networks not only instrumentally, but also analytically in terms of the strategic contexts and environments in which such instruments are deployed.
PMCID: PMC3937907  PMID: 24596889
Health Systems; Social Network Analysis; Network Theory; Health Co-Production
17.  Comments on the nature of the bonding in oxygenated dinuclear copper enzyme models 
Journal of molecular structure  2006;764(1-3):77-86.
The nature of the bonding in model complexes of di-copper metalloenzymes has been analyzed by means of the electronic localization function (ELF) and by the quantum theory of atoms in molecules (QTAIM). The constrained space orbital variations (CSOV) approach has also been used. Density functional theory (DFT) and CASSCF calculations have been carried out on several models of tyrosinase such as the sole Cu2O22+ central core, the Cu2O2(NH3)62+ complex and the Cu2O2(Imidazol)62+ complex. The influence on the central Cu2O2 moiety of both levels of calculation and ligand environment have been discussed. The distinct bonding modes have been characterized for the two major known structures: [Cu2(μ–η2: η2–O2)]2+ and [Cu2(μ–O2)]2+. Particular attention has been given to the analysis of the O–O and Cu–O bonds and the nature of the bonding modes has also been analyzed in terms of mesomeric structures. The ELF topological approach shows a significant conservation of the topology between the DFT and CASSCF approaches. Particularly, three-center Cu–O–Cu bonds are observed when the ligands are attached to the central core. At the DFT level, the importance of self interaction effects are emphasized. Although, the DFT approach does not appear to be suitable for the computation of the electronic structure of the isolated Cu2O2 central core, competitive self interaction mechanisms lead to an imperfect but acceptable model when using imidazol ligands. Our results confirm to a certain extent the observations of [M.F. Rode, H.J. Werner, Theoretical Chemistry Accounts 4–5 (2005) 247.] who found a qualitative agreement between B3LYP and localized MRCI calculations when dealing with the Cu2O2 central core with six ammonia ligands.
PMCID: PMC1993802  PMID: 17893747
Copper; ELF; QTAIM; Topological analysis; Tyrosinase; Hemocyanin; DFT; CASSCF
18.  Permeability of dura mater: a possible link between cortical spreading depression and migraine pain? A comment 
In the wake of cortical spreading depression (CSD) it has been suggested that noxious substances diffuse through the dura with resulting firing of epidural nerves. In my view this is unlikely because there are good reasons to suggest that there must be a dura-brain barrier. Alternatively collateral branches from the trigeminal nerve to the pia and the dura may signal what is happening with ions and substances on the brain surface during CSD to the epidural space.
PMCID: PMC3072496  PMID: 20821244
19.  Permeability of dura mater: a possible link between cortical spreading depression and migraine pain? A comment 
In the wake of cortical spreading depression (CSD) it has been suggested that noxious substances diffuse through the dura with resulting firing of epidural nerves. In my view this is unlikely because there are good reasons to suggest that there must be a dura-brain barrier. Alternatively collateral branches from the trigeminal nerve to the pia and the dura may signal what is happening with ions and substances on the brain surface during CSD to the epidural space.
PMCID: PMC3072496  PMID: 20821244
20.  Comment on “Strong signature of the active Sun in 100 years of terrestrial insolation data” by W. Weber 
Annalen Der Physik  2011;523(11):946-950.
An analysis of ground-based observations of solar irradiance was recently published in this journal, reporting an apparent increase of solar irradiance on the ground of the order of 1% between solar minima and maxima [1]. Since the corresponding variations in total solar irradiance on top of the atmosphere are accurately determined from satellite observations to be of the order of 0.1% only [2], the one order of magnitude stronger effect in the terrestrial insolation data was interpreted as evidence for cosmic-ray induced aerosol formation in the atmosphere. In my opinion, however, this result does not reflect reality. Using the energy budget of Earth's surface, I show that changes of ground-based insolation with the solar cycle of the order of 1% between solar minima and maxima would result in large surface air temperature variations which are inconsistent with the instrumental record. It would appear that the strong variations of terrestrial irradiance found by [1] are due to the uncorrected effects of volcanic or local aerosols and seasonal variations. Taking these effects into account, I find a variation of terrestrial insolation with solar activity which is of the same order as the one measured from space, bringing the surface energy budget into agreement with the solar signal detected in temperature data.
PMCID: PMC3263400  PMID: 22279242
Climate; solar activity; solar irradiance; cosmic rays
21.  How to discover modules in mind and brain: The curse of nonlinearity, and blessing of neuroimaging. A comment on Sternberg (2011) 
Cognitive Neuropsychology  2011;28(3-4):209-223.
Sternberg (2011) elegantly formalizes how certain sets of hypotheses, specifically modularity and pure or composite measures, imply certain patterns of behavioural and neuroimaging data. Experimentalists are often interested in the converse, however: whether certain patterns of data distinguish certain hypotheses, specifically whether more than one module is involved. In this case, there is a striking reversal of the relative value of the data patterns that Sternberg considers. Foremost, the example of additive effects of two factors on one composite measure becomes noninformative for this converse question. Indeed, as soon as one allows for nonlinear measurement functions and nonlinear module processes, even a cross-over interaction between two factors is noninformative in this respect. Rather, one requires more than one measure, from which certain data patterns do provide strong evidence for multiple modules, assuming only that the measurement functions are monotonic. If two measures are not monotonically related to each other across the levels of one or more experimental factors, then one has evidence for more than one module (i.e., more than one nonmonotonic transform). Two special cases of this are illustrated here: a “reversed association” between two measures across three levels of a single factor, and Sternberg's example of selective effects of two factors on two measures. Fortunately, functional neuroimaging methods normally do provide multiple measures over space (e.g., functional magnetic resonance imaging, fMRI) and/or time (e.g., electroencephalography, EEG). Thus to the extent that brain modules imply mind modules (i.e., separate processors imply separate processes), the performance data offered by functional neuroimaging are likely to be more powerful in revealing modules than are the single behavioural measures (such as accuracy or reaction time, RT) traditionally considered in psychology.
PMCID: PMC3330956  PMID: 21714750
Cognitive neuroscience; Cognitive psychology; functional magnetic resonance imaging; Electroencephalography; Dissociations
22.  Taxing Sugar-Sweetened Beverages: Not a “Holy Grail” but a Cup at Least Half Comment on “Food Taxes: A New Holy Grail?”  
In this commentary, we argue for the implementation of a sugar-sweetened beverage (SSB) tax as a tool to help address the global obesity and diabetes epidemics. Consumption of SSBs has increased exponentially over the last several decades, a trend that has been an important contributor to the obesity and diabetes epidemics. Prior evidence demonstrates that a SSB tax will likely decrease SSB consumption without significantly increasing consumption of other unhealthy food or beverages. Further, this tax is unlikely to have effects on income inequality and should not contribute to weight-based discrimination. A SSB tax also should raise revenue for government entities that already pay, through health care expenditures and health programs, for the consequences of excess SSB consumption.
PMCID: PMC3937927  PMID: 24596861
Sugar-Sweetened Beverages; Tax; Economics; Obesity; Overweight
23.  Globalization and medical tourism: the North American experience Comment on "Patient mobility in the global marketplace: a multidisciplinary perspective" 
Neil Lunt and Russel Mannion provide an overview of the current state of the medical tourism literature and propose areas for future research in health policy and management. The authors also identify the main unanswered questions in this field ranging from the real size of the medical tourism market to the particular health profiles of transnational patients. In addition, they highlight unexplored areas of research from health economics, ethics, policy and management perspectives. To this very insightful editorial I would add the international trade perspective. While globalization has permeated labor and capital, services such as healthcare are still highly regulated by governments, constrained to regional or national borders and protected by organized interests. Heterogeneity of healthcare regulations and lack of cross-country reciprocity agreements act as barriers to the development of more widespread and dynamic medical tourism markets. To picture these barriers to transnational health services I use evidence from North America, identifying different "pull and push factors" for medical tourist in this region, discussing how economic integration and healthcare reform might shift the incentives to utilize healthcare abroad.
PMCID: PMC4075104  PMID: 24987723
Medical Tourism; Patient Mobility; Cross-Border Care; North America; Healthcare Reform
24.  Magic Mountains and multi-disciplines in international medical mobilities Comment on "Patient mobility in the global marketplace: a multidisciplinary perspective" 
Medical mobilities offer both opportunities and challenges. This tension follows the same ratio as many other historic fora, but offers at the same time a sustainable equilibrium. Multi-disciplines are, therefore, the key to the medical lifeworld for the global health and well-being of transnational health users around the globe.
PMCID: PMC4075106  PMID: 24987724
Global Health; Transnational Healthcare; Medical Mobilities; Well-being; Regionalism; Citizenship
25.  Comments on the process and product of the health impacts assessment component of the national assessment of the potential consequences of climate variability and change for the United States. 
Environmental Health Perspectives  2001;109(Suppl 2):177-184.
In 1990 Congress formed the U.S. Global Change Research Program and required it to conduct a periodic national assessment of the potential impacts of climate variability and change on all regions and select economic/resource sectors of the United States. Between 1998 and 2000, a team of experts collaborated on a health impacts assessment that formed the basis for the first National Assessment's analysis of the potential impacts of climate on human health. The health impacts assessment was integrated across a number of health disciplines and involved a search for and qualitative expert judgment review of data on the potential links between climate events and population health. Accomplishments included identification of vulnerable populations, adaptation strategies, research needs, and data gaps. Experts, stakeholders, and the public were involved. The assessment is reported in five articles in this issue; a summary was published in the April 2000 issue of Environmental Health Perspectives. The assessment report will enhance understanding of ways human health might be affected by various climate-associated stresses and of the need for further empirical and predictive research. Improved understanding and communication of the significance and inevitability of uncertainties in such an assessment are critical to further research and policy development.
PMCID: PMC1240664  PMID: 11359684

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