Physicians who complain about accountants' exhorbitant fees may not be getting their money's worth - because they aren't asking enough of their accountants. Besides preparing tax returns, accountants can set up bookkeeping procedures, advise on financial management and generally put the doctor more in control of his own income.
When recommending a specific pharmaceutical, more has to be taken into account than whether the API is indicated for the illness in question. Based on the preceding discussion, product source can have a tremendous impact on efficacy, on therapeutic success, and on practitioners' credibility in the eyes of their clients. However, product source goes beyond simple credibility, encompassing professional ethics and liability. In answering the Ethical question of the month--December 2001 "Should private veterinary practitioners be allowed to produce autogenous vaccines or compound antimicrobial products for use in food producing animals?" Rollin concluded, "one cannot envision a clearer case of unethical behavior." The reality is that quality assurance, efficacy, potency, and safety are not defined for compounded products, and should veterinarians choose to script or dispense one, the responsibility for its quality, efficacy, potency, and safety falls squarely on their shoulders. Ultimately, this also translates into 100% liability should an ADR, illness, or lack of effect, befall the patient. While having access to ELDU and compounded products is crucial in facilitating the treatment of the various diseases that veterinarians face, the regulatory freedom that gives them this choice carries heightened responsibilities when electing this option. In a nutshell, ethical and responsible principles of pharmacy dictate that a veterinarian's first choice should be a veterinary-licensed pharmaceutical for the indication in question. Should this not exist, ELDU of a licensed product with clinically derived therapeutic protocols should be the next choice. Compounded pharmaceuticals should only be used when no licensed (those sporting a DIN) product exists, and extreme cautions should be exercised when using transdermal formulations. Liability dictates that this decision be undertaken with informed consent of the owner and with appropriate due diligence when selecting a compounding service provider. Various articles have been written that provide the veterinarian with guidance when making this decision.
Embedded librarianship has received much attention in recent years. A model of embeddedness rarely discussed to date is that of research-embedded health librarians (REHLs). This study explores the characteristics of Canadian REHLs and the situations in which they are employed.
The authors employed a sequential, mixed-method design. An online survey provided descriptive statistics about REHLs' positions and work experiences. This informed a series of focus group interviews that expanded upon the survey. Through constant comparison, we conducted qualitative descriptive analysis of the interviews.
Based on twenty-nine survey responses and four group interviews, we created a portrait of a “typical” REHL and discovered themes relevant to REHL work. REHLs may identify more strongly as researchers than as librarians, with corresponding professional needs and rewards. REHLs value “belonging” to the research team, involvement in full project lifecycles, and in-depth relationships with nonlibrarian colleagues. Despite widely expressed job satisfaction, many REHLs struggle with isolation from library and information science peers and relative lack of job security.
REHLs differ from non-embedded health librarians, as well as from other types of embedded librarians. REHLs' work also differs from just a decade or two ago, prior to widespread Internet access to digital resources.
Given that research-embedded librarianship appears to be a distinct and growing subset of health librarianship, libraries, master's of library and information science programs, and professional associations will need to respond to the support and education needs of REHLs or risk losing them to the health research field.
Sacred values, such as those associated with religious or ethnic identity, underlie many important individual and group decisions in life, and individuals typically resist attempts to trade off their sacred values in exchange for material benefits. Deontological theory suggests that sacred values are processed based on rights and wrongs irrespective of outcomes, while utilitarian theory suggests that they are processed based on costs and benefits of potential outcomes, but which mode of processing an individual naturally uses is unknown. The study of decisions over sacred values is difficult because outcomes cannot typically be realized in a laboratory, and hence little is known about the neural representation and processing of sacred values. We used an experimental paradigm that used integrity as a proxy for sacredness and which paid real money to induce individuals to sell their personal values. Using functional magnetic resonance imaging (fMRI), we found that values that people refused to sell (sacred values) were associated with increased activity in the left temporoparietal junction and ventrolateral prefrontal cortex, regions previously associated with semantic rule retrieval. This suggests that sacred values affect behaviour through the retrieval and processing of deontic rules and not through a utilitarian evaluation of costs and benefits.
functional magnetic resonance imaging; sacred values; utility; deontologic; rules
Despite the apparent decline in the popularity of roll-your-own (RYO) cigarettes over the past few decades, RYO tobacco products are widely available and used by a substantial number of adult smokers. Considering research has yet to examine the prevalence of RYO tobacco use among youth populations, this manuscript examines the prevalence of RYO tobacco use and factors associated with RYO use in a nationally representative sample of youth smokers from Canada.
This study used data collected from 3,630 current smokers in grades 9 to 12 as part of the 2008-09 Canadian Youth Smoking Survey (YSS). Descriptive analyses of the sample demographic characteristics, smoking status, cigarettes per day, weekly spending money, and frequency of marijuana use were examined by RYO tobacco ever use and RYO tobacco current use. Two logistic regression models were used to examine factors associated with RYO tobacco ever use and RYO tobacco current use.
We identified that 51.2% of current smokers were RYO ever users and 24.2% were RYO current users. The prevalence of RYO current users was highest in Atlantic Canada (40.1%) and lowest in Quebec (12.3%). RYO current users were more likely to be male (OR 1.27), to be daily smokers (OR 1.75), to use marijuana once a month or more (OR 2.74), and to smoke 11 or more cigarettes per day (OR 6.52). RYO current users were less likely to be in grade 11 (OR 0.65) or grade 12 (OR 0.40) and less likely to have between $20 to $100 (OR 0.44) or more than $100 (OR 0.45) of disposable income.
Developing a better understanding of RYO tobacco use among youth is important for advancing population-level tobacco control prevention strategies and cessation programs. We identified that RYO tobacco use is not a negligible problem among Canadian youth. Ongoing research is needed to continue monitoring the prevalence of RYO use among youth and the factors associated with its use, but to also monitor if this more affordable tobacco product is being targeted to price sensitive youth smokers.
Roll-your-own tobacco; Disposable income; Youth; Drug use; Smoking
The role of sodium hyaluronate (Healonid) in trabeculectomy to prevent a shallow or flat anterior chamber and hypotonia in the immediate postoperative period is reported. Twenty-nine eyes of 27 patients were included in a randomised controlled study. Thirteen eyes had trabeculectomy alone, and 16 eyes had trabeculectomy performed with Healonid injected into the anterior chamber. The results showed that shallowing of the anterior chamber and hypotonia occurred in both groups until day 21 postoperatively. There was no statistically significant difference between the two groups (p greater than 0.05). Healonid has no significant value in maintaining anterior chamber depth and preventing hypotonia in the early postoperative period following trabeculectomy.
The attribution of personal traits to other persons depends on the actions the observer performs at the same time (Bach & Tipper, 2007). Here, we show that the effect reflects a misattribution of appraisals of the observers’ own actions to the actions of others. We exploited spatial compatibility effects to manipulate how fluently—how fast and how accurately—participants identified two individuals performing sporty or academic actions. The traits attributed to each person in a subsequent rating task depended on the fluency of participants’ responses in a specific manner. An individual more fluently identified while performing the academic action appeared more academic and less sporty. An individual more fluently identified while performing the sporty action appeared sportier. Thus, social perception is—at least partially—embodied. The ease of our own responses can be misattributed to the actions of others, affecting which personal traits are attributed to them.
Social perception; Trait attribution; Fluency; Embodiment; Cingulate cortex; Action observation
Social aggression is one of the most conspicuous features of animal societies, yet little is known about the causes of individual variation in aggression within social hierarchies. Recent theory suggests that when individuals form queues for breeding, variation in social aggression by non-breeding group members is related to their probability of inheriting breeding status. However, levels of aggression could also vary as a temporary response to changes in the hierarchy, with individuals becoming more aggressive as they ascend in rank, in order to re-establish dominance relationships. Using the group-living fish, Neolamprologus pulcher, we show that subordinates became more aggressive after they ascended in rank. Female ascenders exhibited more rapid increases in aggression than males, and the increased aggression was primarily directed towards group members of adjacent rather than non-adjacent rank, suggesting that social aggression was related to conflict over rank. Elevated aggression by ascenders was not sustained over time, there was no relationship between rank and aggression in stable groups, and aggression given by ascenders was not sex-biased. Together, these results suggest that the need to re-establish dominance relationships following rank ascension is an important determinant of variation in aggression in animal societies.
aggression; dominance hierarchy; conflict over rank; Neolamprologus pulcher
Data from the longitudinal West of Scotland Twenty-07 Study: Health in the Community was used to examine whether, over a 20 year period, the self-reported health of people living in deprived areas became poorer faster compared to those living in more affluent areas. Three cohorts (born in the early 1930s, 1950s and 1970s) are included, covering 60 years of the life span. Using multilevel growth curve models, a 40% probability of reporting poor health was predicted among residents of more deprived areas at an earlier age (66) compared to those living in more affluent areas (83). Wider area differences were seen for men than for women. Our findings indicate that attempts to reduce area differences in health should start young but also continue throughout the lifespan.
► Longitudinal data used to examine changes in self-reported health over a 20 year period. ► Health of people in poorer areas deteriorated faster than those in more affluent areas. ► 16 year gap between richer and poorer areas in odds of reporting poor health. ► Wider area differences were seen for men than for women.
Area deprivation; Neighbourhood; Self-reported health; Longitudinal study; Health trajectories
Previous research has found that American patients strongly believe that more testing and more treatment lead to better outcomes and, to a lesser extent, that newer treatments are more effective. We conducted five focus groups with privately insured, healthy, middle-aged Americans (n = 43) to explore these apparent preferences. Contrary to previous research, an unexpected distinction emerged. Participants placed enormous value on testing and screening, reacting with hostility to guidelines recommending less of either. However, they were suspicious of overmedication. The wariness of pharmaceuticals and enthusiasm for testing and screening both appear to reflect participants’ efforts to take responsibility for their health. But recommendations to test and screen less conflicted with their active, engaged, information-seeking roles. Nonetheless, given patients’ concerns about overuse of pharmaceuticals, we maintain that they can learn to understand the connections between over-testing and over-treatment, and can actively choose to do less. We close with suggestions about how treatment guidelines can better communicate these connections to patients. Our findings cannot necessarily be generalized beyond privately-insured, healthy, middle-aged Americans. But because we found that, among these individuals, attitudes towards pharmaceuticals differ from attitudes towards testing and screening, we maintain that future research should also distinguish among and compare attitudes towards different types of medical interventions.
Compelling evidence of major health benefits of fruit and vegetable consumption, physical activity, and outdoor interaction with 'greenspace' have emerged in the past decade - all of which combine to give major potential health benefits from 'grow-your-own' (GYO) in urban areas. However, neither current risk assessment models nor risk management strategies for GYO in allotments and gardens give any consideration to these health benefits, despite their potential often to more than fully compensate the risks. Although urban environments are more contaminated by heavy metals, arsenic, polyaromatic hydrocarbons and dioxins than most rural agricultural areas, evidence is lacking for adverse health outcomes of GYO in UK urban areas. Rarely do pollutants in GYO food exceed statutory limits set for commercial food, and few people obtain the majority of their food from GYO. In the UK, soil contamination thresholds triggering closure or remediation of allotment and garden sites are based on precautionary principles, generating 'scares' that may negatively impact public health disproportionately to the actual health risks of exposure to toxins through own-grown food. By contrast, the health benefits of GYO are a direct counterpoint to the escalating public health crisis of 'obesity and sloth' caused by eating an excess of saturated fats, inadequate consumption of fresh fruit and vegetables combined with a lack of exercise. These are now amongst the most important preventable causes of illness and death. The health and wider societal benefits of 'grow-your-own' thus reveal a major limitation in current risk assessment methodologies which, in only considering risks, are unable to predict whether GYO on particular sites will, overall, have positive, negative, or no net effects on human health. This highlights a more general need for a new generation of risk assessment tools that also predict overall consequences for health to more effectively guide risk management in our increasingly risk-averse culture.
Experience with a urological waiting list initiative is presented, wherein a list of 231 non-urgent cases was cleared over a 5 month period by a single operator. Some patients had waited 10 years for surgery. Following a postal request, the waiting list was validated; 31.2% of patients wished to be removed. The remaining 68.8% desired surgery and consisted of 51 requiring minor surgical procedures and 108 who needed more major surgery mostly for the relief of bladder outflow obstruction. Minor cases received dates for surgery; however, only 68.2% of this group attended despite being given more than one date for admission. Major cases were reviewed in a pre-admission clinic. General and urological condition was assessed, improved where necessary and surgery booked or delayed accordingly. A small number of patients did not attend or only attended to be reassured that surgery was not needed. Following clinical review, 18.5% of this group did not require operation. The long urological waiting list is a unique situation where patients listed may no longer require surgery. Reviewing these patients not only reduces numbers but also markedly increases percentage attendance for surgery.
It is common for people to report strong preferences for certain types of alcohol, often as a function of past positive or negative experiences with particular types of drinks. Despite this individual difference, implicit measures related to alcohol frequently use nomothetic approaches – i.e., use a standard set of alcohol beverage stimuli – which may not match individuals’ actual drinking behavior. Moreover, this mismatch may account for some of the inconsistencies across studies using implicit measures. The present study used an idiographic variant of the Implicit Association Test (IAT) in which participants (N = 300) selected alcohol images that matched their drinking behavior (non-drinkers selected what they were offered most often). Results were consistent with previous research on alcohol preference: women selected more liquor and wine images, men selected more beer images; heavy episodic drinkers selected more beer and liquor images and selected fewer wine images than lighter drinkers and non-drinkers. In addition, IAT scores were sensitive to drinking levels in the expected direction and, importantly, were robust to stimuli selected. Thus, results provide initial validation of idiographic approaches to stimuli selection.
drinking; implicit cognition; individual differences; idiographic approaches; methodology
What makes people spontaneously adopt the perspective of others? Previous work suggested that perspective taking can serve understanding the actions of others. Two studies corroborate and extend that interpretation. The first study varied cues to intentionality of eye gaze and action, and found that the more the actor was perceived as potentially interacting with the objects, the stronger the tendency to take his perspective. The second study investigated how manipulations of gaze affect the tendency to adopt the perspective of another reaching for an object. Eliminating gaze cues by blurring the actor's face did not reduce perspective-taking, suggesting that in the absence of gaze information, observers rely entirely on the action. Intriguingly, perspective-taking was higher when gaze and action did not signal the same intention, suggesting that in presence of ambiguous behavioral intention, people are more likely take the other's perspective to try to understand the action.
spontaneous perspective taking; agency; action; gaze; incongruous cues; ambiguous intention
The growth hormone/IGF-1–signaling (GH/IGF-1–signaling) system is involved in numerous physiological processes during normal growth and development and also in the aging process. Understanding the regulation of this system is therefore of importance to the biologist. Studies conducted over the past decade have shown that the JAK/STAT pathways are involved in GH signaling to the nucleus. More recently, evidence has been presented that a member of the SOCS family, SOCS2, is a negative regulator of GH signaling. This story began several years ago with the dramatic demonstration of gigantism in the SOCS2-knockout mouse. A more specific definition of the role of SOCS2 in GH signaling is provided in this issue of the JCI by the demonstration that the overgrowth phenotype of the SOCS2–/– mouse is dependent upon the presence of endogenous GH and that administration of GH to mice lacking both endogenous GH and SOCS2 produced excessive growth.
The quality of one’s personal relationships has been linked to morbidity and mortality across different diseases. As a result, it is important to examine more integrative mechanisms that might link relationships across diverse physical health outcomes. In this study, we examine associations between relationships and telomeres which predict general disease risk. These questions are pursued in the context of a more comprehensive model of relationships that highlights the importance of jointly considering positive and negative aspects of social ties.
136 individuals from a community sample (ages 48 to 77) completed the social relationships index which allows a determination of relationships that differ in their positive and negative substrates (i.e., ambivalent, supportive, aversive, indifferent). Telomere length was determined from peripheral blood mononuclear cells via quantitative PCR.
Participants who had a higher number of ambivalent ties in their social networks evidenced shorter telomeres. These results were independent of other relationships types (e.g., supportive), as well as standard control variables (e.g., age, health behaviors, medication use). Gender moderated the links between ambivalent ties and telomere length with these associations seen primarily in women. Follow-up analyses revealed that the links between ambivalent ties and telomeres were primarily due to friendships, parents, and social acquaintances.
Consistent with epidemiological findings, these data highlight a novel and integrative biological mechanism by which social ties may impact health across diseases, and further suggests the importance of incorporating both positivity and negativity in the study of specific relationships and physical health.
Relationships; telomeres; gender; physical health
In the midst of the monumentally important 2008 presidential election, information about the candidates’ proposals for biomedical research is notably absent. Why is this the case, and more importantly, what can be done about it?
Patients have a 95% chance of being protected from rubeola if they received the proper vaccine, stored and handled in the correct manner, at the appropriate age. An increase in measles in teenagers is more likely due to technical problems (the vaccine, storage, handling, and age of administration) than to waning immunity. Provincial governments should follow the U.S. lead and mount programs to eradicate measles, just as we have done with smallpox. For patients whose immune status is unknown, serology should be done and only the susceptibles vaccinated.
Hypertension is a very common chronic condition that is disproportionately represented in certain populations. Although there have been many past successes in detection, evaluation, treatment, and control of high blood pressure, more successes are needed. Greater collaboration on multiple levels is essential in order to achieve better blood pressure control rates in people with hypertension. The readers collaborative help is requested.
It has been well documented that early detection and early intervention for breast and cervical cancer saves lives. However, the challenge is to ensure that physicians' practices are effective in implementing the standard guidelines for screening and that all women are screened and undergo appropriate follow-up. Early detection and intervention are imperative since African-American women are twice as likely as European-American women to die from breast cancer even though the incidence of breast cancer is lower. African-American women have fewer mammograms and are being diagnosed later after metastases have occurred. Studies also show that women are more likely to have mammograms if their physicians so advise. However, the most common reason women give for not obtaining mammograms is, "My doctor never recommended it." By using a simple critical path analysis tool to systematically evaluate an office practice and by implementing practical, simple principles, a physician can increase utilization of breast and cervical cancer screening.
Humans possess a remarkable capacity to understand the suffering of others. Cognitive neuroscience theories of empathy suggest that this capacity is supported by ‘shared representations’ of self and other. Consistent with this notion, a number of studies have found that perceiving others in pain and experiencing pain oneself recruit overlapping neural systems. Perception of pain in each of these conditions, however, may also cause unique patterns of activation, that may reveal more about the processing steps involved in each type of pain. To address this issue, we examined neural activity while participants experienced heat pain and watched videos of other individuals experiencing injuries. Results demonstrated (i) that both tasks activated anterior cingulate cortex and anterior insula, consistent with prior work; (ii) whereas self-pain activated anterior and mid insula regions implicated in interoception and nociception, other pain activated frontal, premotor, parietal and amygdala regions implicated in emotional learning and processing social cues; and (iii) that levels of trait anxiety correlated with activity in rostral lateral prefrontal cortex during perception of other pain but not during self-pain. Taken together, these data support the hypothesis that perception of pain in self and other, while sharing some neural commonalities, differ in their recruitment of systems specifically associated with decoding and learning about internal or external cues.
Empathy; pain; self; emotion; anterior cingulate; anterior insula
Questionnaires concerning models of depression were completed by 90 general practitioners (GPs) and 681 patients. GPs and patients held similar beliefs about the role of mood-related symptoms, psychological causes, and non-medical treatments. However, the GPs reported greater support for somatic symptoms, medical causes, and medical treatments. Therefore, GPs and patients report different models of depression, with GPs favouring a more medical perspective. In addition, the results illustrated a role for personal experience of depression. The implications for diagnosis, adherence, and a 'you are depressed; no I'm not' style of interaction are discussed.
Within-host competition is an important factor in host-parasite relationships, yet most studies consider interactions involving only single parasite species. We investigated the interaction between a virulent obligate entomopathogenic fungus, Metarhizium anisopliae var. anisopliae, and a normally avirulent, opportunistic fungal pathogen, Aspergillus flavus, in their leaf-cutting ant host, Acromyrmex echinatior. Surprisingly, the latter normally out-competed the former in mixed infections and had enhanced fitness relative to when infecting in isolation. The result is most probably due to Metarhizium inhibiting the host's immune defences, which would otherwise normally prevent infections by Aspergillus. With the host defences negated by the virulent parasite, the avirulent parasite was then able to out-compete its competitor. This result is strikingly similar to that seen in immunocompromised vertebrate hosts and indicates that avirulent parasites may play a more important role in host life histories than is generally realized.
Ground squirrels (Spermophilus spp.) have evolved a battery of defences against the rattlesnakes (Crotalus spp.) that have preyed on them for millions of years. The distinctive behavioural reactions by these squirrels to rattlesnakes have recently been shown to include self-application of rattlesnake scent—squirrels apply scent by vigorously licking their fur after chewing on shed rattlesnake skins. Here, we present evidence that this behaviour is a novel antipredator defence founded on exploitation of a foreign scent. We tested three functional hypotheses for snake scent application—antipredator, conspecific deterrence and ectoparasite defence—by examining reactions to rattlesnake scent by rattlesnakes, ground squirrels and ectoparasites (fleas). Rattlesnakes were more attracted to ground squirrel scent than to ground squirrel scent mixed with rattlesnake scent or rattlesnake scent alone. However, ground squirrel behaviour and flea host choice were not affected by rattlesnake scent. Thus, ground squirrels can reduce the risk of rattlesnake predation by applying rattlesnake scent to their bodies, potentially as a form of olfactory camouflage. Opportunistic exploitation of heterospecific scents may be widespread; many species self-apply foreign odours, but few such cases have been demonstrated to serve in antipredator defence.
antipredator behaviour; camouflage; chemical defence; ground squirrels; rattlesnakes
Portraits, both photographic and painted, are often produced with more of one side of the face showing than the other. Typically, the left side of the face is overrepresented, with the head turned slightly to the sitter's right. This leftward bias is weaker for painted male portraits and non-existent for portraits of scientists from the Royal Society. What mechanism might account for this bias? Examination of portraits painted by left- and right-handers and of self-portraits suggests that the bias is not determined by a mechanical preference of the artist or by the viewer's aesthetics. The leftward bias seems to be determined by the sitters and their desire to display the left side of their face, which is controlled by the emotive, right cerebral hemisphere. When we asked people to portray as much emotion as possible when posing for a family portrait, they tended to present the left side of their face. When asked to pose as scientists and avoid portraying emotion, participants tended to present their right side. The motivation to portray emotion, or conceal it, might explain why portraits of males show a reduced leftward bias, and also why portraits of scientists from the Royal Society show no leftward bias.