Effect of message congruency on attention and recall in pictorial health warning labels.

OBJECTIVE: The nine pictorial health warning labels (PWLs) proposed by the US Food and Drug Administration vary in format and feature of visual and textual information. Congruency is the degree to which visual and textual features reflect a common theme. This characteristic can affect attention and recall of label content. This study investigates the effect of congruency in PWLs on smoker's attention and recall of label content. METHODS: 120 daily smokers were randomly assigned to view either congruent or incongruent PWLs, while having their eye movements recorded. Participants were asked to recall label content immediately after exposure and 5 days later. RESULTS: Overall, the image was viewed more and recalled better than the text. Smokers in the incongruent condition spent more time focusing on the text than smokers in the congruent condition (p=0.03), but dwell time of the image did not differ. Despite lower dwell time on the text, smokers in the congruent condition were more likely to correctly recall it on day 1 (p=0.02) and the risk message of the PWLs on both day 1 (p=0.01) and day 5 (p=0.006) than smokers in the incongruent condition. CONCLUSIONS: This study identifies an important design feature of PWLs and demonstrates objective differences in how smokers process PWLs. Our results suggest that message congruency between visual and textual information is beneficial to recall of label content. Moreover, images captured and held smokers' attention better than the text.

HIV Pharmacist's Impact on Inpatient Antiretroviral Errors.

OBJECTIVES: Transitions in care between out-patient and in-patient settings provide ample opportunity for medication errors to occur in HIV-infected patients. The purpose of this study was to examine the effectiveness of an HIV pharmacist monitoring service in decreasing antiretroviral medication errors in a large south central teaching hospital in the USA. METHODS: A retrospective, observational study was conducted to examine the frequency of antiretroviral medication errors in HIV-seropositive patients with hospital admissions between 1 September 2011 and 30 September 2013 at a single tertiary care centre in Oklahoma. Patient assignment to the 12-month pre-intervention and intervention study periods was determined by admission date. Demographic, laboratory, and in-patient medication data were collected. Bivariate analyses were conducted using χ2 analysis with the Yates correction factor for continuity to examine frequencies in specific antiretroviral classes and error categories. A multivariable Poisson regression was employed to examine the frequency of medication errors before and after initiation of the pharmacist service. RESULTS: Medication errors were examined in a total of 330 patient admissions during the 2-year study period. A multivariable-adjusted decrease of 73.9% in the number of errors was observed between the pre-intervention and intervention periods (P < 0.001). Patients on protease inhibitor regimens or with impaired renal function had 2.6-fold and 2.8-fold higher numbers of errors, respectively (P < 0.001). CONCLUSIONS: HIV pharmacist monitoring can decrease medication errors in HIV-infected patients as they transition between out-patient and in-patient care. Patients receiving protease inhibitor-based therapy or with renal insufficiency are at higher risk for medication errors upon admission.

Lifestyle and youthful looks.

BACKGROUND: Lifestyle has been proven to have a dramatic effect on the risk of age-related diseases. The association of lifestyle and facial ageing has been less well studied. OBJECTIVES: To identify lifestyle factors that associate with perceived facial age in white north European men and women. METHODS: Lifestyle, facial wrinkling and perceived facial age were studied in two cross-sectional studies consisting of 318 Dutch men and 329 women aged 45-75 years who were part of the Leiden Longevity Study, and 162 English women aged 45-75 years who were nonsmokers. RESULTS: In Dutch men, smoking, having skin that went red in the sun, being outside in the sun most of the summer, sunbed use, wearing false teeth and not flossing teeth were all significantly associated (P < 0·05) with a total 9·3-year higher perceived facial age in a multivariate model adjusting for chronological age. In Dutch women, smoking, sunbathing, sunbed use, few remaining teeth and a low body mass index (BMI) were associated with a total 10·9-year higher perceived facial age. In English women, cleaning teeth only once a day, wearing false teeth, irregular skin moisturization and having skin that went red in the sun were associated with a total 9·1-year higher perceived facial age. Smoking and sunbed use were associated more strongly with wrinkling in women than in men. BMI, sun exposure and skincare were associated predominantly with perceived facial age via wrinkling, whereas oral care was associated via other facial features. CONCLUSIONS: Although associative in nature, these results support the notion that lifestyle factors can have long-term beneficial effects on youthful looks.

Serum insulin-like growth factor 1 and facial ageing: high levels associate with reduced skin wrinkling in a cross-sectional study.

BACKGROUND: Insulin-like growth factor (IGF)-1 is a growth factor that can influence fibroblast functioning, with effects including the inhibition of collagenases and the induction of collagen expression. OBJECTIVES: To assess whether serum IGF-1, IGF-binding protein (IGFBP)3 and the ratio between IGF-1 and IGFBP3, as a measure of IGF-1 bioavailability, are associated with facial ageing and skin wrinkling. METHODS: From a random sample comprising 617 subjects from the Leiden Longevity Study, perceived age and skin wrinkling were assessed from facial photographs, and IGF-1 and IGFBP3 were measured in serum. The associations were assessed using linear regression models, adjusted for chronological age, sex, body mass index, smoking and sun exposure. RESULTS: Across tertiles of the ratio of IGF-1 to IGFBP3, and after adjusting for all potential confounding factors, the mean perceived age decreased from 60·6 years in the lowest tertile to 59·5 years in the highest (P = 0·045). Similarly, the mean skin wrinkling grade decreased from 4·8 in the lowest tertile to 4·5 in the highest (P = 0·011). Adding skin wrinkling as a covariate in the analysis between IGF-1 and perceived age diminished this association. CONCLUSIONS: This study demonstrates that a higher ratio of IGF-1 to IGFBP3 associates with a lower perceived age, via its association with reduced skin wrinkling. Whether high IGF-1 levels actually delay the accumulation of skin wrinkling now needs investigating.

Automated coaching to help parents increase their children's brushing frequency: an exploratory trial.

UNLABELLED: Advances in digital communication, such as the internet, now provide a cost effective channel to reach and help families struggling to establish good oral hygiene in their homes. This paper describes a novel internet based oral hygiene intervention whose design draws from advances in social cognitive models of behaviour change. Intervention components included role-modelling cartoons for children, a guide for parents on using rewards, a personalised plan with clear steps, tips to follow and a weekly 10-minute review of progress. OBJECTIVE: To evaluate the efficacy of the online coaching programme; specifically we expected that those in the intervention group would brush their teeth more frequently during the intervention period than those in the control group. BASIC RESEARCH DESIGN: An exploratory trial using a randomised controlled parallel approach. PARTICIPANTS: Children aged 5 to 9 years from 44 families (23 control and 21 intervention). MAIN OUTCOME MEASURE: An objective monitoring of tooth brushing. RESULTS: In the 3-week intervention period, children from families assigned to the coaching programme brushed their teeth 38% more often than those in the control group. CONCLUSIONS: The programme was effective in a number of respects. Opportunities for further research are discussed, including the need to create a more engaging system and so increase compliance.

The spatial propagation and increasing dominance of Gilbertiodendron dewevrei (Fabaceae) in the eastern Congo basin.

Though substantial research has been conducted on possible historical, physiological, and symbiotic mechanisms that permit monodominance to occur within tropical lowland rainforests, less is known about the successional rates at which monodominance exerts itself on surrounding forest structures. Here we extend efforts to evaluate the longitudinal dynamics of Gilbertiodendron dewevrei-dominated forest in Central Africa by considering this species' spatial dynamics. Using three 10-ha censused field plots measured across three time periods, we present the first quantitative estimates of the spatial propagation of Gilbertiodendron into adjacent mixed species forest. Using three analytical strategies, we demonstrate that Gilbertiodendron is increasing in dominance and that monodominant forest patches are expanding into the surrounding forest at a statistically significant rate. The rates of successional advance vary by patch and direction, but average 0.31 m year-1, with speeds greatest in the direction of the prevailing winds. We show that the advancement of Gilbertiodendron is significantly slower than documented rates from other forest ecotones across Central Africa. When paired with stress tolerance traits and ectomycorrhizal associations, these findings help to clarify the means by which Gilbertiodendron dewevrei gains dominance in otherwise species-diverse regions.

Ageing appearance in China: biophysical profile of facial skin and its relationship to perceived age.

BACKGROUND: Perceived age is important to women and is a primary driver for topical product use and facial cosmetic surgery. Changes in facial features and biophysical skin parameters with chronological age and their associations with perceived age have not been described in Asian populations. OBJECTIVE: To investigate the relationship between biophysical properties of the skin, visual features of skin ageing and perceived facial age in Chinese women. METHODS: Facial photographs were collected of 250 Chinese women, aged 25-70 years in Shanghai, China. The perceived facial age was determined and related to the chronological age for each participant and to a range of visual assessments of skin appearance and objective biophysical measurements of the skin. The profile of changes in these parameters with age was investigated together with the differences in those parameters for women judged to look younger than their chronological age and those judged to look older than their chronological age. RESULTS: Large discrepancies in perceived age (up to 29 years) were found in women of the same chronological age. Each objective skin measure and visual assessment parameter had a stronger correlation with perceived age than with chronological age. The strongest relationships to perceived age were for wrinkles and hyperpigmentation. Skin colour, hydration and trans-epidermal water loss (TEWL) had weaker associations with perceived age. Women judged to look older than their chronological age had significantly higher scores than those judged to look younger for coarse wrinkles and hyperpigmentation across all age groups. The appearance differences between these groups were evident in composite facial images of the same average chronological age. CONCLUSIONS: We have identified the skin attributes which differ with perceived age in Chinese women. Perceived age is a better measure of the biological age of facial skin than is chronological age in this population.

Long-term efficacy and safety of raltegravir in the management of HIV infection.

Raltegravir is an integrase strand-transfer inhibitor approved for the treatment of HIV infection. It was the first medication in a novel class of antiretroviral agents to be approved for use in the United States in 2007. Raltegravir exhibits potent activity against wild-type HIV-1, but resistance development has been noted through three different pathways. It is metabolized primarily through uridine diphosphate glucuronosyltransferase 1A1 and has a single inactive glucuronide metabolite. Raltegravir is not a substrate, inhibitor, or inducer of cytochrome P450 enzymes and exhibits low potential for drug-drug interactions; however, strong uridine diphosphate glucuronosyltransferase 1A1 inhibitors or inducers can alter the pharmacokinetics of raltegravir. It is well tolerated, and the most commonly reported adverse effects include headache, nausea, and diarrhea. Serious adverse effects with raltegravir are rare but include rhabdomyolysis and severe skin and hypersensitivity reactions. It has been approved for use in both treatment-naïve and treatment-experienced patients and is a preferred first-line agent in both United States and European HIV treatment guidelines. Although initial approval was granted on 48-week data, 5-year clinical data have recently been published. This article reviews the data supporting long-term efficacy and safety of raltegravir in the treatment of HIV infection.

Single timepoint models of dynamic systems.

Many interesting studies aimed at elucidating the connectivity structure of biomolecular pathways make use of abundance measurements, and employ statistical and information theoretic approaches to assess connectivities. These studies often do not address the effects of the dynamics of the underlying biological system, yet dynamics give rise to impactful issues such as timepoint selection and its effect on structure recovery. In this work, we study conditions for reliable retrieval of the connectivity structure of a dynamic system, and the impact of dynamics on structure-learning efforts. We encounter an unexpected problem not previously described in elucidating connectivity structure from dynamic systems, show how this confounds structure learning of the system and discuss possible approaches to overcome the confounding effect. Finally, we test our hypotheses on an accurate dynamic model of the IGF signalling pathway. We use two structure-learning methods at four time points to contrast the performance and robustness of those methods in terms of recovering correct connectivity.

Symbolic reachable set computation of piecewise affine hybrid automata and its application to biological modelling: Delta-Notch protein signalling.

Hybrid automata are an eminently suitable modelling framework for biological protein regulatory networks, as the protein concentration dynamics inside each biological cell are modelled using linear differential equations; inputs activate or deactivate these continuous dynamics through discrete switches, which themselves are controlled by protein concentrations reaching given thresholds. This paper proposes an iterative refinement algorithm for computing discrete abstractions of a class of hybrid automata with piecewise affine continuous dynamics and forced discrete transitions, defined completely in terms of symbolic variables and parameters. Furthermore, these discrete abstractions are utilised to compute symbolic parametric backward reachable sets from the equilibria of the hybrid automata, that are guaranteed to be exact or conservative under-approximations. The algorithm is then implemented using MATLAB and QEPCAD, to compute reachable sets for the biologically observed equilibria of the multiple cell Delta-Notch protein signalling automaton with symbolic parameters. The results are analysed to show that novel, non-intuitive, and biologically interesting properties can be deduced from the reachability computation, thus demonstrating the utility of the algorithm.

A further examination of heavy metal inhibition of gas production by thermophilic anaerobic sludges.

Mesophilic anaerobic digestion is a well established method for stabilising municipal sewage sludges. However, digestion in the thermophilic range is very restricted. The main reason for this has been the imbalance between the energy produced in the form of biogas and the energy required to maintain the temperature of a thermophilic system. It has been shown recently that an energy-positive process can be achieved using thickened sludges as the feedstock and, therefore, thermophilic digestion must be considered as a potentially attractive process for sludge stabilisation. However, before it can properly be offered as an alternative technology, the effect of toxic materials must be known. Currently, there is little information about the effect that known toxic agents can have on the microbial flora of a thermophilic sludge. This paper examines the toxicity (measured in terms of gas inhibition) of heavy metals, both individually and in combinations, on the sludge produced by a laboratory-scale digester (10 litres) operating at 55 degrees C with a solids retention time of 20 days. The metals used were zinc, lead, nickel, copper and cadmium and the gas inhibition studies were done in small (500 ml) flasks so that the gas production could be monitored precisely. Statistical analysis of the results showed that a model, developed previously to describe the toxicity of a range of compounds to mesophilic systems, was applicable to heavy metals and thermophilic sludges.

Moving toward restraint-free patient care.

After reviewing the literature and regulatory requirements, a multidisciplinary team developed a comprehensive restraint reduction program that has reduced the use of restraints by more than 60% in the acute care setting. The authors discuss the research-based restraint education program and the implementation of a restraint consultant role.

Self-recognition in retarded children.

This study was designed to investigate the relationship between cognitive and affective development. Young preverbal retarded children watched TV images of themselves with faces marked or unmarked and of a peer whose face was marked. We used the objective technique of increased mark-directed responses as evidence of self-recognition and rated the children's reactions as they watched these images. The emergence of self-recognition was closely tied to the maturity of the children's general responsiveness to their reflections. The Down's syndrome children made a broad range of responses, including the curiosity and self-conscious behaviors characteristic of normal children during the second year of life, and all except one of these children showed evidence that they recognized their images. In contrast, the range of behaviors displayed by multihandicapped children was greatly restricted and similar to children in the first year of life. Less than half of these children showed an emergence of self-recognition.

Variation of method for measurement of brachial artery pressure significantly affects ankle-brachial pressure index values.

BACKGROUND: Mmeasurement of ankle brachial pressure indices (ABPI) is important in the assessment of patients with peripheral vascular disease. METHODS: Thirty-one hospitals with a vascular surgeon were selected at random. A telephone questionnaire was completed to assess the method used for the measurement of ABPI. Following the survey, 14 patients with peripheral vascular disease had their ABPI measurement done by two observers, a pre-registration house officer and a clinical nurse practitioner. Observers were blinded to their own and each other's results. Brachial systolic pressures were obtained using a DINAMAP(TM)(Critikon, Tampa, U.S.A.) automated blood pressure monitor, the Korotkoff method (12 cm cuff, parallel wrap) and an 8 MHz Doppler probe (Huntleigh) and sphygmomanometer. Ankle systolic pressures were obtained using the Doppler probe. The results were analysed using the Wilcoxon signed rank test. RESULTS: The survey demonstrated that at the majority of centres with vascular laboratories the brachial artery systolic pressures were measured using a Doppler probe. In contrast, at centres where the house officers performed the routine measurements, over 60% used the Korotkoff method to obtain this reading. One in four nurse practitioners used the Korotkoff method. When the ABPI values were calculated, the DINAMAP produced significantly higher median values than the Korotkoff (0.79 vs 0.72, p=0.003) and Doppler methods (0.79 vs 0.70, p<0.0001). The nurse had a higher median ABPI value of 0.76 compared with the doctor (0.71, p=0.01). CONCLUSION: This study shows that measurement of ABPI varies in different vascular units. The technique for ABPI measurement should be standardised.