Geography of conservation spending, biodiversity, and culture.

We used linear and multivariate models to examine the associations between geography, biodiversity, per capita economic output, national spending on conservation, governance, and cultural traits in 55 countries. Cultural traits and social metrics of modernization correlated positively with national spending on conservation. The global distribution of this spending culture was poorly aligned with the distribution of biodiversity. Specifically, biodiversity was greater in the tropics where cultures tended to spend relatively less on conservation and tended to have higher collectivism, formalized and hierarchical leadership, and weaker governance. Consequently, nations lacking social traits frequently associated with modernization, environmentalism, and conservation spending have the largest component of Earth's biodiversity. This has significant implications for setting policies and priorities for resource management given that biological diversity is rapidly disappearing and cultural traits change slowly. Therefore, we suggest natural resource management adapt to and use characteristics of existing social organization rather than wait for or promote social values associated with conservation spending. Supporting biocultural traditions, engaging leaders to increase conservation commitments, cross-national efforts that complement attributes of cultures, and avoiding interference with nature may work best to conserve nature in collective and hierarchical societies. Spending in modernized nations may be a symbolic response to a symptom of economic development and environmental degradation, and here conservation actions need to ensure that biodiversity is not being lost.

The Influence of Religious Affiliation on Participant Responsiveness to the Complete Health Improvement Program (CHIP) Lifestyle Intervention.

Seventh-day Adventist (SDA) and non-SDA (21.3 and 78.7 %, respectively) individuals (n = 7172) participating in the Complete Health Improvement Program, a 30-day diet and lifestyle intervention, in North America (241 programs, 2006-2012) were assessed for changes in selected chronic disease risk factors: body mass index (BMI), blood pressure (BP), pulse, lipid profile and fasting plasma glucose (FPG). Reductions were greater among the non-SDA for BMI, pulse and blood lipids. Furthermore, the majority of non-SDA in the highest risk classifications for BP, lipids and FPG, but only some lipids among SDA, were able to show improvement by 20 % or more.

The effect of milk on the attenuation of exercise-induced muscle damage in males and females.

PURPOSE: The consumption of 500 ml milk following muscle damaging exercise can attenuate decreases in muscle functional capacity and increases in markers of muscle damage and soreness in males. There has been no similar research in female participants. Therefore, the aim of this study was to investigate the effects of milk consumption on exercise-induced muscle damage (EIMD) in males and females. METHODS: Thirty-two team sport players (male n = 16; female n = 16) were randomly, but equally divided into four groups: male milk, male carbohydrate, female milk, and female carbohydrate. Immediately following muscle damaging exercise, participants consumed either 500 ml of milk or 500 ml of an energy-matched carbohydrate solution. Skeletal troponin I (sTnI), creatine kinase (CK), peak torque, counter movement jump height, 20 m sprint performance and passive and active soreness were recorded prior to and 24, 48 and 72 h post-EIMD. RESULTS: For females, milk had a likely/very likely beneficial effect on attenuating losses in peak torque at 60°/s from baseline to 24, 48 and 72 h, and a likely beneficial effect in minimising decrements in sprint performance and soreness over 72 h. Milk was unlikely to have a negative effect on serum markers of damage from baseline to 48 and 72 h. For males, milk had an unclear effect on muscle function variables. Milk had a most likely/likely beneficial effect on limiting muscle soreness from baseline to 72 h, and a possible beneficial effect on attenuating increases in CK. The effect on sTnI was unlikely to be negative from baseline-72 h. Overall gender comparisons provided many unclear outcomes. However, female participants demonstrated smaller increases in sprint time, passive soreness, active soreness (non-dominant leg) and sTnI values. CONCLUSION: Consumption of 500 ml of milk post-EIMD can limit decrements in muscle function in females, and limit increases in soreness and serum markers of muscle damage in females and males.

To speak, or not to speak? The feasibility of imaging overt speech in children with epilepsy.

We systematically compared fMRI results for covert (silent) and overt (spoken) versions of a language task in a representative sample of children with lesional focal epilepsy being considered for neurosurgical treatment (N=38, aged 6-17 years). The overt task was advantageous for presurgical fMRI assessments of language; it produced higher quality scans, was more sensitive for identifying activation in core language regions on an individual basis, and provided an online measure of performance crucial for improving the yield of presurgical fMRI.

Exploration of a 'double-jeopardy' hypothesis within working memory profiles for children with specific language impairment.

BACKGROUND: Children with specific language impairment (SLI) often experience difficulties in the recall and repetition of verbal information. Archibald and Gathercole (2006) suggested that children with SLI are vulnerable across two separate components of a tripartite model of working memory (Baddeley and Hitch 1974). However, the hierarchical relationship between the 'slave' systems (temporary storage) and the central executive components places a particular challenge for interpreting working memory profiles within a tripartite model. AIMS: This study aimed to examine whether a 'double-jeopardy' assumption is compatible with a hierarchical relationship between the phonological loop and central executive components of the working memory model in children with SLI. If a strong double-jeopardy assumption is valid for children with SLI, it was predicted that raw scores of working memory tests thought to tap phonological loop and central executive components of tripartite working memory would be lower than the scores of children matched for chronological age and those of children matched for language level, according to independent sources of constraint. In contrast, a hierarchical relationship would imply that a weakness in a slave component of working memory (the phonological loop) would also constrain performance on tests tapping a super-ordinate component (central executive). This locus of constraint would predict that scores of children with SLI on working memory tests that tap the central executive would be weaker relative to the scores of chronological age-matched controls only. METHODS & PROCEDURES: Seven subtests of the Working Memory Test Battery for Children (Digit recall, Word recall, Non-word recall, Word matching, Listening recall, Backwards digit recall and Block recall; Pickering and Gathercole 2001) were administered to 14 children with SLI recruited via language resource bases and specialist schools, as well as two control groups matched on chronological age and vocabulary level, respectively. Mean group differences were ascertained by directly comparing raw scores on memory tests linked to different components of the tripartite model using a series of multivariate analyses. OUTCOMES & RESULTS: The majority of working memory scores of the SLI group were depressed relative to chronological age-matched controls, with the exception of spatial recall (block tapping) and word (order) matching tasks. Marked deficits in serial recall of words and digits were evident, with the SLI group scoring more poorly than the language-ability matched control group on these measures. Impairments of the SLI group on phonological loop tasks were robust, even when covariance with executive working memory scores was accounted for. There was no robust effect of group on complex working memory (central executive) tasks, despite a slight association between listening recall and phonological loop measures. CONCLUSIONS & IMPLICATIONS: A predominant feature of the working memory profile of SLI was a marked deficit on phonological loop tasks. Although scores on complex working memory tasks were also depressed, there was little evidence for a strong interpretation of double-jeopardy within working memory profiles for these children, rather these findings were consistent with an interpretation of a constraint on phonological loop for children with SLI that operated at all levels of a hierarchical tripartite model of working memory (Baddeley and Hitch 1974). These findings imply that low scores on complex working memory tasks alone do not unequivocally imply an independent deficit in central executive (domain-general) resources of working memory and should therefore be treated cautiously in a clinical context.

Transient exacerbation of hemiplegia following minor head trauma in Sturge-Weber syndrome.

Sturge-Weber syndrome (SWS) is a sporadic disorder characterized by naevus (port wine stain), a pial angioma, and glaucoma. The angioma comprises abnormal tortuous vessels on the leptomeninges with underlying brain gliosis, calcification, and atrophy. The cerebral angioma is commonly unilateral but may be bilateral. Hemiplegia usually follows recurrent hemiconvulsions and may be related to venous stasis. The hemiplegia can be static, progressive, or fluctuating. Transient worsening of the hemiplegia can be seen with seizures and episodes resembling hemiplegic migraine. We report five patients (four females, one male) with SWS who have had transient worsening of hemiplegia following minor head injuries, occurring between the ages of 10 months and 12 years (median age 4y 6mo). An additional pilot survey suggests that this may affect up to 20% of patients.

Effects of Tennessee Medicaid managed care on obstetrical care and birth outcomes.

A comparative study was conducted in two neighboring states, Tennessee and North Carolina, to determine whether Medicaid managed care (implemented in Tennessee as TennCare) affected prenatal care, care patterns at labor-delivery, and birth outcomes. A pre- and post-design coupled with a difference-in-difference approach--using North Carolina as a control--was used to assess TennCare's effects for all births and for three categories of high-risk mothers (under age eighteen, unwed, or living in high poverty areas). Data from 328,296 singleton births in birth files and matched birth-death files for 1993 and 1995 in both states were used to analyze a number of variables related to maternal behavior during pregnancy, utilization of care before and after labor-delivery, patterns of obstetrical care at delivery, and birth outcomes. Under TennCare, Tennessee mothers were relatively more likely to obtain no prenatal care or to wait and initiate third trimester care as compared to those in North Carolina. Relative utilization of specific prenatal procedures declined, Apgar scores fell very slightly, and birth abnormalities increased in the poverty subsample. TennCare had no significant effect on infant mortality. Utilization reductions in obstetrical services were achieved with apparent spillovers to non-TennCare births, but without adverse effects overall. TennCare was neither a panacea nor an unmitigated disaster. It is a model worth examining, but not uncritically.

Medicaid, managed care, and the care of patients hospitalized for acute myocardial infarction.

BACKGROUND: TennCare, beginning in January 1994, channeled all Medicaid-eligible patients into managed care while expanding Medicaid coverage to large numbers of previously uninsured patients. We assessed the impact of TennCare on (1) coronary revascularization of patients who had had an acute myocardial infarction (AMI), (2) the likelihood of the patient having a usual provider of care after discharge from the hospital, and (3) health and functional status 1 to 3 years after the index AMI. METHODS AND RESULTS: With the use of 1996 to 1997 survey data from 438 patients hospitalized for AMI in 1993 and 1995 who were under age 65 years at the index admission, multivariate analysis was used to calculate effects of TennCare on utilization and outcomes. TennCare patients were as likely as privately insured patients to have received coronary revascularization within 30 days of the index AMI (odds ratio 0.87, P =.69). Persons enrolled in TennCare and in traditional Medicaid who received a revascularization procedure were much less likely to have received coronary angioplasty than coronary bypass surgery than were the privately insured (TennCare: odds ratio 0.37, P =.05; Medicaid: odds ratio 0.28, P =.08). Virtually all TennCare enrollees (94%) reported having a usual provider of care in the year before the survey versus 85% for privately insured patients with AMI in 1995 (P =.05). On health and functional status, TennCare enrollees overall fared as well as those with private insurance. CONCLUSIONS: Our results suggest that TennCare brought patients who otherwise would have been uninsured or enrolled in Medicaid into the medical mainstream, measured both in terms of utilization of services and health and functional status.

Physician participation and nonparticipation in Medicaid managed care: the TennCare experience.

BACKGROUND: TennCare is a significant state health reform effort, channeling all Medicaid recipients into managed care. We examined physician attitudes about TennCare. METHODS: In 1997, we surveyed a stratified random sample of Tennessee physicians using predominantly Likert-type scale questions. All physicians surveyed were involved in patient care and were selected from seven specialties: general practice, family practice, general internal medicine, obstetrics/gynecology, neurosurgery, general surgery, and pediatrics. We asked about participation, satisfaction, perceptions of quality, and appropriateness of care. RESULTS: Major reasons for nonparticipation included bureaucracy and low compensation. Overall, dissatisfaction with TennCare was high (72% not at all or not very satisfied), relating to reimbursement issues and constraints on obtaining services, particularly pharmaceuticals. More physicians (45.9%) thought quality had declined under TennCare than believed it improved (12.6%). CONCLUSIONS: Despite strong negative opinions about TennCare, physician participation is high (85.6%) because of a sense of professional responsibility.

The impact of TennCare on patient satisfaction with care.

OBJECTIVE: To measure the level of satisfaction with care by Medicaid-eligible patients before and after implementation of a mandatory managed care plan known as TennCare. STUDY DESIGN: We used multivariate logit analysis of survey data to calculate the effects of TennCare on patient satisfaction for TennCare patients compared to those on traditional Medicaid, using North Carolina as a control state. PATIENTS AND METHODS: Patients were respondents to a survey conducted in late 1996 and early 1997 who had been admitted to hospitals in 1993 and 1995 for labor/delivery (n = 986), acute myocardial infarction (n = 457), and head trauma (n = 248). Dependent variables were yes/no responses to satisfaction questions for labor/delivery and 5-category ordered responses for adults. RESULTS: We found no statistically significant differences in satisfaction between TennCare and traditional Medicaid for either pediatric or adult hospital patients. Generally, TennCare recipients had satisfaction levels as good or better than traditional Medicaid recipients. For pediatric care, TennCare odds ratios ranged from 1.00 to 2.17, the latter for satisfaction with care received (P = 0.107). For adult care, odds ratios ranged from 0.77 to 1.23, the latter for satisfaction with cost of care (P = 0.547). For many dimensions of care, lower rates of satisfaction were reported for respondents who were uninsured, less educated, and in poor health. For adult care, blacks or Hispanics tended to be less satisfied with some aspects of care. CONCLUSION: TennCare did not reduce patient satisfaction with care among those who were hospitalized.

Reality discrimination, reality monitoring and disposition towards hallucination.

This investigation tested the hypotheses that individuals disposed towards hallucination are deficient in the meta-cognitive skills of reality discrimination and reality monitoring, and that there is a strong correlation between the measures of these skills. Normal subjects scoring high or low on a scale measuring predisposition towards hallucination were tested on an auditory signal detection task. High scorers on the scale were found to differ from low scorers on a measure of perceptual bias but not on a measure of sensitivity. The same groups of subjects were tested on a reality monitoring measure in which they were required to monitor two different types of word: words they were required to listen to, and words they were required to listen to on some trials and imagine on others. On a surprise frequency test it was found that high scorers did not differ from low scorers on their ability to accurately count the memories of words they had heard. It was also found that both high scorers and low scorers overestimated the number of times they had heard words when they had also been required to imagine these words on tests; however, high scorers made this error to a significantly greater extent. A strong correlation was found between reality discrimination and reality monitoring measures for high scorers, but no correlation was found for low scorers.