Using communication to manage uncertainty about cervical cancer screening guideline adherence among Appalachian women.

Changes to the United States Preventive Services Task Force (USPSTF) recommendations for cervical cancer preventive services have led to patient confusion, especially in medically underserved populations. We investigated how patient uncertainty concerning cervical cancer screening guidelines is appraised and managed through communication with healthcare providers by conducting in-depth, face-to-face interviews with 24 adult women between the ages of 24 and 65 (m = 41, SD = 14) living in Appalachia Kentucky. In general, participants expressed a high degree of uncertainty about the updated cervical cancer screening guidelines and appraised this uncertainty as both a danger and an opportunity. Communication with healthcare providers served both to exacerbate and to mitigate patient uncertainty. The study identifies how health care providers may use the change in USPSTF guidelines as a 'teachable moment' to productively counsel patients on the importance of timely screening, the typical progression of certain types of high-risk HPV infection to cervical cancer, and the importance of follow-up care.

Dermoscopy improves diagnosis of tinea nigra: a study of 50 cases.

BACKGROUND/OBJECTIVES: Tinea nigra is a relatively uncommon dematiaceous fungal infection of the palms and soles, which clinically may mimic a melanocytic lesion. We sought to ascertain how frequently misdiagnosis of this infection occurred and whether the use of dermoscopy helped in its diagnosis. METHODS: Fifty consecutive cases of tinea nigra diagnosed at a dermatopathology laboratory were examined with regard to the clinical diagnosis, use of dermoscopy and the mode of management. RESULTS: Of the 50 cases, 21 (42.0%) were treated by shave or surgical excision. The clinical diagnosis of tinea nigra was made in five cases (10.0%) and suggested along with other diagnoses in a further two cases (4.0%). The dermatologists (n = 9) gave the correct diagnosis in four patients (44.4%), the general practitioners (n = 38) gave the correct diagnosis in one patient (2.6%) and the three surgeons involved did not give the correct diagnosis. When dermoscopy was used, in seven of 13 (53.8%) cases tinea nigra was suggested as a probable diagnosis but when dermoscopy was not used (n = 37) tinea nigra was not clinically diagnosed (P < 0.001). CONCLUSIONS: The diagnosis of tinea nigra is significantly improved by dermoscopy, the disease should be considered as a cause of palmar or plantar pigmentation.

Nostalgia and Heroism: Theoretical Convergence of Memory, Motivation, and Function.

This article seeks to develop theoretical convergences between the science of nostalgia and the science of heroism. We take four approaches in forging a conceptual relationship between these two phenomena. First, we examine the definitions of nostalgia and heroism from scholars, laypeople, and across cultures, noting how the history of defining the two phenomena has shaped current conceptualizations. Second, we demonstrate how nostalgic experiences consist of reminiscences about our own personal heroism and about cultural role models and heroes. A review of heroism research, moreover, shows also that our recall of our heroes and of heroism is tinged with nostalgia. Third, we make linkages between heroism and nostalgia research focusing on functions, inspiration, sociality, and motivation. Nostalgia researchers have illuminated the functions of nostalgia implicating the self, existential concerns, goal pursuit, and sociality. Our review shows that heroism researchers invoke similar categories of hero functionality. Finally, we propose three areas of future research that can profit from the merging of nostalgia and heroism science, involving the mechanisms by which (a) heroism can fuel nostalgia, (b) nostalgia can promote heroic action, and (c) wisdom results from nostalgic reverie.

Warfarin is not needed in low-risk patients following atrial fibrillation ablation procedures.

BACKGROUND: The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low-risk patients. METHODS: A total of 630 consecutive patients who underwent 934 ablation procedures using an open irrigated tip catheter for symptomatic AF were evaluated. Outcomes were compared between patients treated with warfarin (goal INR: 2-3) versus aspirin only (325 mg/day) in CHADS2 0-1 patients after ablation. RESULTS: Of the 690 patients, 123 (20%) were treated with aspirin and 507 (80%) with warfarin. Prevalences of the CHADS2 scores of patients on aspirin were (0: 40.7%, 1: 59.3%) and on warfarin (0: 13.6%, 1: 31.6%, > or = 2: 54.8%), P < 0.0001. Patients in the warfarin group were older, had on average a lower ejection fraction, and had higher rates persistent/permanent AF, repeat ablations, hypertension, prior stroke/TIA, and diabetes. The 1-year survival free of AF for the total study population was 71.6%. There were no strokes/TIA in the aspirin group and 4 events (4 strokes, 0 TIAs) in the warfarin group. Two patients in the warfarin group died of fatal hemorrhage (1 intracranial, 1 gastrointestinal). CONCLUSION: Select low-risk patients with a low CHADS2 (0-1) score who undergo left atrial ablation with an aggressive anticoagulation strategy with heparin and use of an open irrigated tip catheter with low CHADS2 scores can safely be discharged following their procedure on aspirin alone.

Improving your spectacle patients' in-practice experience with contact lenses during frame selection.

PURPOSE: A market research survey was conducted to assess the impact of offering complimentary contact lenses (CLs) to spectacle-only wearing patients during frame selection with regards to their in-office experience, the transaction amount for their eyewear purchase and the likelihood of proceeding with a comprehensive contact lens fitting. METHODS: Five optometry offices in the US participated. An initial interviewing phase served as a control during which optometrists treated spectacle-only wearing patients in the usual manner for frame selection. After this, the offices transitioned into a test phase where patients were offered the opportunity to wear CLs while selecting new spectacle frames. Only patients 18 or older who had not expressed an interest in CLs were invited to participate. A brief survey was completed on an iPad following the visit by all patients in both control and test phases. RESULTS: 410 patients (205 test, 205 control) participated. 63% of the test group elected to wear CLs (40% spherical, 20% toric, 35% multifocal, 5% monovision). Patients wearing CLs spent more on their eyewear purchase ($708 vs $593, p = 0.04), were greater than 2.5X more likely to have received or scheduled a CL fit (p = 0.01), and were greater than 3X more likely to consider scheduling a CL fitting in the future (p = 0.0003). Additionally, 93% reported that they were highly satisfied with the experience and 86% said they would wear CLs to select frames again (86%). CONCLUSIONS: Offering CLs to spectacle-only patients positively impacts eyewear selection and purchase and can grow the overall CL business.

The Metamorphosis of the Hero: Principles, Processes, and Purpose.

This article examines the phenomenon of heroic metamorphosis: what it is, how it unfolds, and why it is important. First, we describe six types of transformation of the hero: mental, moral, emotional, spiritual, physical, and motivational. We then argue that these metamorphoses serve five functions: they foster developmental growth, promote healing, cultivate social unity, advance society, and deepen cosmic understanding. Internal and external sources of transformation are discussed, with emphasis on the importance of mentorship in producing metamorphic growth. Next we describe the three arcs of heroic transformation: egocentricity to sociocentricity, dependence to autonomy, and stagnation to growth. We then discuss three activities that promote heroic metamorphosis as well as those that hinder it. Implications for research on human growth and development are discussed.

To Be Immortal, Do Good or Evil.

Many people believe in immortality, but who is perceived to live on and how exactly do they live on? Seven studies reveal that good- and evil-doers are perceived to possess more immortality-albeit different kinds. Good-doers have "transcendent" immortality, with their souls persisting beyond space and time; evil-doers have "trapped" immortality, with their souls persisting on Earth, bound to a physical location. Studies 1 to 4 reveal bidirectional links between perceptions of morality and type of immortality. Studies 5 to 7 reveal how these links explain paranormal perceptions. People generally tie paranormal events to evil spirits (Study 5), but this depends upon location: Evil spirits are perceived to haunt houses and dense forests, whereas good spirits are perceived in expansive locations such as mountaintops (Study 6). However, even good spirits may be seen as trapped on Earth given extenuating circumstances (Study 7). Materials include a scale for measuring trapped and transcendent immorality.

The "frozen in time" effect in evaluations of the dead.

Two experiments tested the hypothesis that evaluations of the dead are more resistant to change than are evaluations of the living. In Experiment 1, perceivers formed an impression of a target person who performed either a moral or an immoral action and then either died or remained alive. Perceivers were later given new inconsistent information about the target's morality. The results revealed that perceivers' original impressions of the target were significantly less likely to change in response to the inconsistent information when the target was believed to be dead than when she was believed to be alive. Experiment 2 replicated the effect in impressions of real-world targets. The implications of these findings for research on posthumous impression processes are discussed.

Chromoblastomycosis in Australia: an historical perspective.

AIMS: To study the histological features of a large series of patients with chromoblastomycosis to ascertain whether the earlier presentation of patients with this disease has resulted in any changes in the histological features that were recorded over 60 years ago. METHODS: A key word search of the database of our pathology laboratory over the period 1 January 2004 to 30 June 2012 was carried out for cases reported as chromoblastomycosis. RESULTS: Seventy cases of chromoblastomycosis were reported over this period. A further four cases of subcutaneous chromomycosis were found in this search. They were excluded from the study because of their different aetiopathogenesis. Key histological features such as the presence of pseudoepitheliomatous hyperplasia, granulomas, suppurative granulomas, suppuration and the presence of brown (dematiaceous) sclerotic bodies were evaluated. Fewer cases showed pseudoepitheliomatous hyperplasia than in earlier studies. Sclerotic bodies were found easily in H&E sections in all cases, averting the need for any special stains. Only ten cases were submitted for culture; six grew Cladophialophora carionii and two Fonsecaea pedrosoi. CONCLUSIONS: Chromoblastomycosis has changed little, histologically, since the original descriptions over 60 years ago, despite its much earlier clinical presentation these days. Pseudoepitheliomatous hyperplasia was seen in 77.1% of our cases, compared to its almost universal presence in cases reported many years ago that often presented after many years with the disease.

Treatment of postpartum depression: clinical, psychological and pharmacological options.

Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.

Viva viva? Women's meanings associated with male nudity in a 1970s "for women" magazine.

Little research has been conducted with regard to how women view male nudity. The purpose of this analysis was to present an historical case study of Viva, a 1970s women's magazine geared toward the presentation of male nudity. Implicit in Viva's editorial direction was the assumption that women's sexuality is socially constructed and, thus, modifiable but also homologous to men's sexuality. Using sexual scripting theory as a sensitizing concept, a content analysis of women's letters to the editor was conducted. Letters justified inclusion of male nudity on the basis of principles of fairness and equality with men. In addition, letters tried to demarcate boundary conditions for what constituted acceptable male nudity in terms of the presence of erection, size, shape, and coloring of the penis, and whether inclusion of the penis was contextualized by other physical traits such as body musculature. Despite an early effort to modify cultural scripts on the basis of a constructivist world view, it was found that, ultimately, Viva advocated an essentialist viewpoint that reified existing conceptualizations of female sexuality as both static and uninterested in the visual representation of sexually related material. This study explored whether Viva's essentialist final position may have reflected financial exigencies rather than ideologies.

Malignant catatonia: role of right unilateral electroconvulsive therapy.

Malignant catatonia is defined as a life-threatening febrile neuropsychiatric disorder, characterized by psychosis with autonomic instability, hyperactivity, mutism, and stuperous exhaustion. Although historically nearly always fatal, there has been a recent decline in mortality, secondary to earlier diagnoses and appropriate treatment implementation. This includes administration of standing benzodiazepines, and without timely response to this pharmacological intervention, electroconvulsive therapy is the next appropriate treatment. We present a case of a young woman with malignant catatonia who was successfully treated with right-unilateral electroconvulsive therapy.

Temporary esophageal stenting allows healing of esophageal perforations following atrial fibrillation ablation procedures.

BACKGROUND: Left atrial catheter ablation (LACA) has emerged as a successful method to eliminate atrial fibrillation (AF). Recent reports have described atrio-esophageal fistulas, often resulting in death, from this procedure. Temporary esophageal stenting is an established therapy for malignant esophageal disease. We describe the first case of successful temporary esophageal stenting for an esophageal perforation following LACA. CASE: A 48-year-old man with symptomatic drug refractory lone AF underwent an uneventful LACA. Fifty-nine ablations with an 8-mm tip ablation catheter (30 seconds, 70 Watts, 55 degrees C), as guided by 3-D NavX mapping, were performed in the left atrium to isolate the pulmonary veins as well as a left atrial flutter and roof ablation line. In addition, complex atrial electrograms in AF and sites of vagal innervation were ablated. Two weeks later, he presented with sub-sternal chest pain, fever, and dysphagia. A chest CT showed a 3-mm esophageal perforation at the level of the left atrium with mediastinal soiling and no pericardial effusion. An urgent upper endoscopy with placement of a PolyFlex removable esophageal stent to seal off the esophago-mediastinal fistula was performed. After 3 weeks of i.v. antibiotics, naso-jejunal tube feedings, and esophageal stenting, the perforation resolved and the stent was removed. Over 18 months of follow-up, there have been no other complications, and he has returned to a physically active life and remains free from AF on previously ineffective anti-arrhythmic drugs. CONCLUSION: Early diagnosis of esophageal perforations following LACA may allow temporary esophageal stenting with successful esophageal healing. Prompt chest CT scans with oral and i.v. contrast should be considered in any patient with sub-sternal chest pain or dysphagia following LACA.

Department of Defense picture archiving and communication system acceptance testing: results and identification of problem components.

The PACS implementation process is complicated requiring a tremendous amount of time, resources, and planning. The Department of Defense (DOD) has significant experience in developing and refining PACS acceptance testing (AT) protocols that assure contract compliance, clinical safety, and functionality. The DOD's AT experience under the initial Medical Diagnostic Imaging Support System contract led to the current Digital Imaging Network-Picture Archiving and Communications Systems (DIN-PACS) contract AT protocol. To identify the most common system and component deficiencies under the current DIN-PACS AT protocol, 14 tri-service sites were evaluated during 1998-2000. Sixteen system deficiency citations with 154 separate types of limitations were noted with problems involving the workstation, interfaces, and the Radiology Information System comprising more than 50% of the citations. Larger PACS deployments were associated with a higher number of deficiencies. The most commonly cited systems deficiencies were among the most expensive components of the PACS.

The Feature-Positive Effect, Attitude Strength, and Degree of Perceived Consensus.

The feature-positive effect refers to the tendency in animals and humans to experience difficulty processing nonoccurrences. The present study investigated the role of this phenomenon in self-perception and in estimates of consensus. Subjects were asked to express a preference either by doing something, the active response, or by doing nothing, the passive response. Afterward, subjects' attitudes on the issue were measured and they were asked to estimate the percentage of their peers who would have responded similarly. The results revealed that subjects who responded actively held significantly stronger attitudes in the direction of their responses than did subjects who responded passively. Moreover, active respondents' consensus estimates were significantly greater than those of passive respondents. Interpretations of these results are discussed.