The influence of psychological traits and prior experience on treatment expectations.

BACKGROUND: Placebo and nocebo responses are modulated by the treatment expectations of participants and patients. However, interindividual differences predicting treatment expectations and placebo responses are unclear. In this large-scale pooled analysis, we aim to investigate the influence of psychological traits and prior experiences on treatment expectations. METHODS: This paper analyses data from six different placebo studies (total n = 748). In all studies, participants' sociodemographic information, treatment expectations and prior treatment experiences and traits relating to stress, somatization, depression and anxiety, the Big Five and behavioral inhibition and approach tendencies were assessed using the same established questionnaires. Correlation coefficients and structural equation models were calculated to investigate the relationship between trait variables and expectations. RESULTS: We found small positive correlations between side effect expectations and improvement expectations (r = 0.187), perceived stress (r = 0.154), somatization (r = 0.115), agitation (r = 0.108), anhedonia (r = 0.118), and dysthymia (r = 0.118). In the structural equation model previous experiences emerged as the strongest predictors of improvement (ß = 0.32, p = .005), worsening (ß = -0.24, p = .005) and side effect expectations (ß = 0.47, p = .005). Traits related to positive affect (ß = - 0.09; p = .007) and negative affect (ß = 0.04; p = .014) were associated with side effect expectations. DISCUSSION: This study is the first large analysis to investigate the relationship between traits, prior experiences and treatment expectations. Exploratory analyses indicate that experiences of symptom improvement are associated with improvement and worsening expectations, while previous negative experiences are only related to side effect expectations. Additionally, a proneness to experience negative affect may be a predictor for side effect expectation and thus mediate the occurrence of nocebo responses.

Life and death of Picea abies after bark-beetle outbreak: ecological processes driving seedling recruitment.

The severity and spatial extent of bark-beetle outbreaks substantially increased in recent decades worldwide. The ongoing controversy about natural forest recovery after these outbreaks highlights the need for individual-based long-term studies, which disentangle processes driving forest regeneration. However, such studies have been lacking. To fill this gap, we followed the fates of 2,552 individual seedlings for 12 years after a large-scale bark-beetle outbreak that caused complete canopy dieback in mountain Norway spruce (Picea abies) forests in southeast Germany. We explore the contribution of advance, disturbance-related, and post-disturbance regeneration to forest recovery. Most seedlings originated directly within the three-year dieback of canopy trees induced by bark-beetle outbreak. After complete canopy dieback, the establishment of new seedlings was minimal. Surprisingly, advance regeneration formed only a minor part of all regeneration. However, because it had the highest survival rate, its importance increased over time. The most important factor influencing the survival of seedlings after disturbance was their height. Survival was further modified by microsite: seedlings established on dead wood survived best, whereas almost all seedlings surrounded by graminoids died. For 5 cm tall seedlings, annual mortality ranged from 20 to 50% according to the rooting microsite. However, for seedlings taller than 50 cm, annual mortality was below 5% at all microsites. While microsite modified seedling mortality, it did not affect seedling height growth. A model of regeneration dynamics based on short-term observations accurately predicts regeneration height growth, but substantially underestimates mortality rate, thus predicting more surviving seedlings than were observed. We found that P. abies forests were able to regenerate naturally even after severe bark-beetle outbreaks owing to advance and particularly disturbance-related regeneration. This, together with microsite-specific mortality, yields structurally and spatially diverse forests. Our study thus highlights the so far unrecognized importance of disturbance-related regeneration for stand recovery after bark-beetle outbreaks.

Small-scale spatial variability in phylogenetic community structure during early plant succession depends on soil properties.

During early plant succession, the phylogenetic structure of a community changes in response to important environmental filters and emerging species interactions. We traced the development of temperate-zone plant communities during the first 7 years of primary succession on catchment soils to explore patterns of initial species assembly. We found pronounced small-scale differences in the phylogenetic composition of neighbouring plant assemblages and a large-scale trend towards phylogenetic evenness. This small-scale variability appears to be mediated by soil properties, particularly carbonate content. Therefore, abiotic environmental conditions might counteract or even supersede the effects of interspecific competition among closely related species, which are usually predicted to exhibit patterns of phylogenetic evenness. We conclude that theories on phylogenetic community composition need to incorporate effects of small-scale variability of environmental factors.

Species-driven phases and increasing structure in early-successional plant communities.

Successional phases describe changes in ecological communities that proceed in steps rather than continuously. Despite their importance for the understanding of ecosystem development, there still exists no reliable definition of phases and no quantitative measure of phase transitions. In order to obtain these data, we investigated primary succession in an artificial catchment (6 ha) in eastern Germany over a period of 6 years. The data set consists of records of plant species and their cover values, and initial substrate properties, both from plots in a regular grid (20 m × 20 m) suitable for spatial data analysis. Community assembly was studied by analyses of species co-occurrence and nestedness. Additionally, we correlated lognormal and log series distributions of species abundance to each community. We here introduce a new general method for detection of successional phases based on the degree of transient spatial homogeneity in the study system. Spatially coherent vegetation patterns revealed nonoverlapping partitions within this sequence of primary succession and were characterized as two distinct ecological phases. Patterns of species co-occurrence were increasingly less random, and hence the importance of demographic stochasticity and neutral community assembly decreased during the study period. Our findings highlight the spatial dimension of successional phases and quantify the degree of change between these steps. They are an element for advancing a more reliable terminology of ecological successions.

Monitoring the formation of structures and patterns during initial development of an artificial catchment.

The objective of this paper is to present observations, results from monitoring measurements, and preliminary conclusions about the development of patterns and structures during the first 5 years of development of an artificial catchment starting from point zero. We discuss the high relevance of initial system traits and external events for the system development and draw conclusions for further research. These investigations as part of a Collaborative Research Center, aim to disentangle and understand the feedback mechanisms and interrelationships of processes and their co-development with spatial and temporal structures and patterns by studying an initial, probably less complex ecosystem. Therefore, intensive measurements were carried out in the catchment with regard to the development of surface structures, hydrological patterns, vegetation dynamics, water chemistry, and element budgets. During the first 5 years, considerable changes within the catchment were observed. Both internal and external factors could be identified as driving forces for the formation of structures and patterns in the artificial catchment. Initial structures formed by the construction process and initial substrate characteristics were decisive for the distribution and flow of water. External factors like episodic events triggered erosion and dissection during this initial phase, promoted by the low vegetation cover, and the unconsolidated sandy substrate. The transformation of the initial geosystem into areas with evolving terrestrial or aquatic characteristics and from a very episodic to a more permanent stream network and discharge, together with the observed vegetation dynamics increased site diversity and heterogeneity with respect to water and nutrient availability and transformation processes compared with the more homogenous conditions at point zero. The processes and feedback mechanisms in the initial development of a new landscape may deviate in rates, intensity, and dominance from those known from mature ecosystems. It is therefore crucial to understand these early phases of ecosystem development and to disentangle the increasingly complex interactions between the evolving terrestrial and aquatic, biotic, and abiotic compartments of the system. Long-term monitoring of initial ecosystems may provide important data and parameters on processes and the crucial role of spatial and temporal structures and patterns to solve these problems. Artificially created catchments could be a suitable tool to study these initial developments at the landscape scale under known, designed, and defined boundary conditions.

Sex- and age-specific variations, temporal trends and metabolic determinants of serum uric acid concentrations in a large population-based Austrian cohort.

Little is known about sex- and age-specific variations and temporal trends in serum uric acid (SUA) concentrations, the prevalence of hyperuricemia and its association with metabolic risk factors in the general population. Between January 1, 1985 and June 30, 2005 146,873 participants (42% women) were recruited. Prevalence of hyperuricemia was estimated applying a common (SUA > 360 µmol/L) and sex-specific cut-off points (women > 340 µmol/L, men > 420 µmol/L). At baseline, mean age was 41.2 years in men and 51.5 years in women, mean SUA concentration was 314.8 µmol/L and 243.6 µmol/L, respectively. Applying a common cut-off point, the prevalence of hyperuricemia was 18.5% in men and 4.4% in women and by sex-specific cut-off points it was 15.1% and 13.8%, respectively. SUA levels increased by 6.7 µmol/L per decade in men, but remained constant in women until the age of 50 years with a sharp increase by approximately 22 µmol/L per decade thereafter. In men and women, hyperuricemia was associated with obesity, hypertriglyceridemia and elevated gamma-glutamyl transferase. With increasing age SUA levels and the prevalence of hyperuricemia rise in a sex-specific manner. Above the age of 65 years, the sex-specific prevalence of hyperuricemia in women outreaches that in men.

Pharmaceutical quality of seven generic Levodopa/Benserazide products compared with original Madopar® / Prolopa®.

BACKGROUND: By definition, a generic product is considered interchangeable with the innovator brand product. Controversy exists about interchangeability, and attention is predominantly directed to contaminants. In particular for chronic, degenerative conditions such as in Parkinson's disease (PD) generic substitution remains debated among physicians, patients and pharmacists. The objective of this study was to compare the pharmaceutical quality of seven generic levodopa/benserazide hydrochloride combination products marketed in Germany with the original product (Madopar® / Prolopa® 125, Roche, Switzerland) in order to evaluate the potential impact of Madopar® generics versus branded products for PD patients and clinicians. METHODS: Madopar® / Prolopa® 125 tablets and capsules were used as reference material. The generic products tested (all 100 mg/25 mg formulations) included four tablet and three capsule formulations. Colour, appearance of powder (capsules), disintegration and dissolution, mass of tablets and fill mass of capsules, content, identity and amounts of impurities were assessed along with standard physical and chemical laboratory tests developed and routinely practiced at Roche facilities. Results were compared to the original "shelf-life" specifications in use by Roche. RESULTS: Each of the seven generic products had one or two parameters outside the specifications. Deviations for the active ingredients ranged from +8.4% (benserazide) to -7.6% (levodopa) in two tablet formulations. Degradation products were measured in marked excess (+26.5%) in one capsule formulation. Disintegration time and dissolution for levodopa and benserazide hydrochloride at 30 min were within specifications for all seven generic samples analysed, however with some outliers. CONCLUSIONS: Deviations for the active ingredients may go unnoticed by a new user of the generic product, but may entail clinical consequences when switching from original to generic during a long-term therapy. Degradation products may pose a safety concern. Our results should prompt caution when prescribing a generic of Madopar®/Prolopa®, and also invite to further investigations in view of a more comprehensive approach, both pharmaceutical and clinical.

Pharmaceutical quality of nine generic orlistat products compared with Xenical(r).

OBJECTIVE: To compare the pharmaceutical quality of Xenical (chemically produced orlistat) with nine generic products, each produced by fermentation processes. METHODS: Xenical 120 mg capsules (Roche, Basel, Switzerland) were used as reference material. Generic products were from India, Malaysia, Argentina, Philippines, Uruguay, and Taiwan. Colour, melting temperature, crystalline form, particle size, capsule fill mass, active pharmaceutical ingredient content, amount of impurities, and dissolution were compared. Standard physical and chemical laboratory tests were those developed by Roche for Xenical. RESULTS: All nine generic products failed the Xenical specifications in four or more tests, and two generic products failed in seven tests. A failure common to all generic products was the amount of impurities present, mostly due to different by-products, including side-chain homologues not present in Xenical. Some impurities were unidentified. Two generic products tested failed the dissolution test, one product formed a capsule-shaped agglomerate on storage and resulted in poor (