Discrimination in Medical Settings and Attitudes toward Complementary and Alternative Medicine: The Role of Distrust in Conventional Providers

This study examines the relationship between racial/ethnic discrimination in medical settings, distrust in conventional medicine, and attitudes toward complementary and alternative medicine (CAM) among a racially/ethnically diverse sample. We also investigate how this relationship differs by nativity. Data are from a 2008 statewide stratified sample of publicly insured adults in Minnesota (N=2,194). Discrimination was measured as self-reported unfair treatment in medical settings due to race, ethnicity, and/or nationality. Outcomes are trust in conventional providers/medicine and attitudes toward CAM modalities. Discrimination in medical settings was positively associated with 1) distrust in conventional providers and 2) favorable attitudes toward CAM. Foreign-born status was associated with more distrust in conventional providers/medicine and more positive attitudes toward CAM. Our findings show that for publicly insured, and especially minority and foreign-born individuals, CAM may represent a response to disenfranchisement in conventional medical settings and resulting distrust

A New Method for tackling Asymmetric Decision Problems

Chain Event Graphs are probabilistic graphical models designed especially for the analysis of discrete statistical problems which do not admit a natural product space structure. We show here how they can be used for decision analysis through designation of some nodes as decision nodes, and the addition of utilities. We provide a local propagation algorithm for finding an optimal decision strategy and maximising expected utility. We also compare CEGs with Influence diagrams, Valuation Networks, Sequential decision diagrams, Sequential influence diagrams and Decision circuits for the representation and analysis of asymmetric decision problems

Structured Decision-Making and Rapid Prototyping to Plan a Management Response to an Invasive Species

We developed components of a decision structure that could be used in an adaptive management framework for responding to invasion of hemlock woolly adelgid Adeleges tsugae on the Cumberland Plateau of northern Tennessee. Hemlock woolly adelgid, an invasive forest pest, was first detected in this area in 2007. We used a structured decision-making process to identify and refine the management problem, objectives, and alternative management actions, and to assess consequences and tradeoffs among selected management alternatives. We identified four fundamental objectives: 1) conserve the aquatic and terrestrial riparian conservation targets, 2) protect and preserve hemlock, 3) develop and maintain adequate budget, and 4) address public concerns. We designed two prototype responses using an iterative process. By rapidly prototyping a first solution, insights were gained and shortcomings were identified, and some of these shortcomings were incorporated and corrected in the second prototype. We found that objectives were best met when management focused on early treatment of lightly to moderately infested but relatively healthy hemlock stands with biological control agent predator beetles and insect-killing fungi. Also, depending on the cost constraint, early treatment should be coupled with silvicultural management of moderately to severely infested and declining hemlock stands to accelerate conversion to nonhemlock mature forest cover. The two most valuable contributions of the structured decision-making process were 1) clarification and expansion of our objectives, and 2) application of tools to assess tradeoffs and predict consequences of alternative actions. Predicting consequences allowed us to evaluate the influence of uncertainty on the decision. For example, we found that the expected number of mature forest stands over 30 y would be increased by 4% by resolving the uncertainty regarding predator beetle effectiveness. The adaptive management framework requires further development including identifying and evaluating uncertainty, formalizing other competing predictive models, designing a monitoring program to update the predictive models, developing a process for re-evaluating the predictive models and incorporating new management technologies, and generating support for planning and implementation

Great Apes' Risk-Taking Strategies in a Decision Making Task

We investigate decision-making behaviour in all four non-human great ape species. Apes chose between a safe and a risky option across trials of varying expected values. All species chose the safe option more often with decreasing probability of success. While all species were risk-seeking, orangutans and chimpanzees chose the risky option more often than gorillas and bonobos. Hence all four species' preferences were ordered in a manner consistent with normative dictates of expected value, but varied predictably in their willingness to take risks

A graphical method for simplifying Bayesian games

If the influence diagram (ID) depicting a Bayesian game is common knowledge to its players then additional assumptions may allow the players to make use of its embodied irrelevance statements. They can then use these to discover a simpler game which still embodies both their optimal decision policies. However the impact of this result has been rather limited because many common Bayesian games do not exhibit sufficient symmetry to be fully and efficiently represented by an ID. The tree-based chain event graph (CEG) has been developed specifically for such asymmetric problems. By using these graphs rational players can make analogous deductions, assuming the topology of the CEG as common knowledge. In this paper we describe these powerful new techniques and illustrate them through an example modelling a game played between a government department and the provider of a website designed to radicalise vulnerable people

Enhancing power density of biophotovoltaics by decoupling storage and power delivery

Biophotovoltaic devices (BPVs), which use photosynthetic organisms as active materials to harvest light, have a range of attractive features relative to synthetic and non-biological photovoltaics, including their environmentally friendly nature and ability to self-repair. However, efficiencies of BPVs are currently lower than those of synthetic analogues. Here, we demonstrate BPVs delivering anodic power densities of over 0.5 W m−2, a value five-fold higher than for previously described BPVs. We achieved this through the use of cyanobacterial mutants with increased electron export characteristics together with a microscale flowbased design that allowed independent optimisation of the charging and power delivery processes, as well as membrane-free operation by exploiting laminar flow to separate the catholyte and anolyte streams. These results suggest that miniaturisation of active elements and flow control for decoupled operation and independent optimisation of the core processes involved in BPV design are effective strategies for enhancing power output and thus the potential of BPVs as viable systems for sustainable energy generation

Loss of Biological Diversity: A Global Crisis Requiring International Solutions: A Report to the National Science Board

Executive Summary Biological diversity refers to the variety and variability among living organisms and the ecological complexes in which they occur. Diversity can be defined as the number of different items and their relative frequency. For biological diversity, these items are organized at many levels, ranging from complete ecosystems to the chemical structures that are the molecular basis of heredity. Thus, the term encompasses different ecosystems, species, genes, and their relative abundance (OTA, 1987). There is an ongoing, unprecedented loss of the variety as well as absolute numbers of organisms-from the smallest microorganism to the largest and most spectacular of mammals. Loss of tropical moist forests, which contain over half the total species of organisms, has been well documented by scientists and is now widely reported in the media. Many other ecosystems are also threatened; as human populations and their support systems expand, natural ecosystems at all latitudes are altered or converted. At its meeting on October 15, 1987, the National Science Board concluded that the world\u27s decreasing biological diversity is a critical scientific issue requiring immediate attention. The National Science Board\u27s Committee on International Science was asked to study the scientific and international aspects of the decline of biological diversity and to recommend a course of action. This report describes what the National Science Foundation (NSF) can do to influence the U.S. science and education base, articulates where international scientific cooperation is needed, and suggests roles for other agencies and organizations (both national and international) which have scientific, educational, and management responsibilities. The current disappearance of biota has several causes: the destruction or degradation of entire ecosystems; the accelerating loss of individual species from communities or ecosystems as a result of human disturb;mce; and the loss of genetically distinct parts of populations due to human-induced selective pressures. Although not all parts of the planet are equally affected, the problem is global, and human activities are the primary cause. The loss of biological diversity is important because human existence depends on the biological resources of 1 the earth. Human prosperity is based very largely on the ability to utilize biological diversity: to take advantage of the properties of plants, animals, fungi, and microorganisms for food, clothing, medicine, and shelter. Scientific knowledge about the earth\u27s biological diversity has huge gaps. This lack of information hampers society\u27s ability either to estimate the magnitude of the problem or to prevent further losses. It is impossible to identify all the biological resources at risk, since there is no complete inventory of all the life forms on earth. Approximately 1.4 million species have been given scientific names, but estimates of actual numbers range from 5 million to 80 million species. Although knowledge of some taxa is extensive, the vast majority of groups are largely unknown. The current wave of extinction is destroying both known biotic resources and those still undiscovered. As is proving to be the case with most environmental problems, neither the loss of biological diversity nor its solution is the exclusive province of any one nation. International cooperation is necessary to develop both scientific knowledge and successful mitigation and management strategies. The root causes of the problem include sociological and economic processes which operate on an global scale; a thorough understanding will require investigation and elucidation of both biological and non-biological components. There are several reasons for increasing National Science Foundation (NSF) involvement in biodiversity studies: the economic and social importance of biodiversity (and the risk of opportunity lost due to accelerating extinction); the contributions such leadership can make toward to conservation of biological diversity; the important role of such studies in the international growth of science, especially in tropical countries; the potential impact of such studies on the future course of biology as a whole; and enhancing public awareness of the issues. NSF should assume a scientific leadership position with respect to agencies in the U.S. and throughout the world. By insisting on the central importance of biodiversity, the NSF could encourage collaborative support for the actions recommended below. 1. The Committee believes that the role of the NSF is clear-NSF should, as a matter of National Science Board Policy, provide leadership to undertake the inventory of the world\u27s biodiversity. 2. The scientific basis for conservation biology, restoration ecology, and environmental management must be strengthened. 3. Educational and public awareness programs related to biodiversity need increased support. 4. The economic and social aspects of the biodiversity crisis need additional study. 5. Enhance support for developing country scientists and institutions for biodiversity research and conservation

Microbiological Evaluation of Water Quality from Urban Watersheds for Domestic Water Supply Improvement

Agricultural and urban runoffs may be major sources of pollution of water bodies and major sources of bacteria affecting the quality of drinking water. Of the different pathways by which bacterial pathogens can enter drinking water, this one has received little attention to date; that is, because soils are often considered to be near perfect filters for the transport of bacterial pathogens through the subsoil to groundwater. The goals of this study were to determine the distribution, diversity, and antimicrobial resistance of pathogenic Escherichia coli isolates from low flowing river water and sediment with inputs from different sources before water is discharged into ground water and to compare microbial contamination in water and sediment at different sampling sites. Water and sediment samples were collected from 19 locations throughout the watershed for the isolation of pathogenic E. coli. Heterotrophic plate counts and E. coli were also determined after running tertiary treated water through two tanks containing aquifer sand material. Presumptive pathogenic E. coli isolates were obtained and characterized for virulent factors and antimicrobial resistance. None of the isolates was confirmed as Shiga toxin E. coli (STEC), but as others, such as enterotoxigenic E. coli (ETEC). Pulsed field gel electrophoresis (PFGE) was used to show the diversity E. coli populations from different sources throughout the watershed. Seventy six percent of the isolates from urban sources exhibited resistance to more than one antimicrobial agent. A subsequent filtration experiment after water has gone through filtration tanks containing aquifer sand material showed that there was a 1 to 2 log reduction in E. coli in aquifer sand tank. Our data showed multiple strains of E. coli without virulence attributes, but with high distribution of resistant phenotypes. Therefore, the occurrence of E. coli with multiple resistances in the environment is a matter of great concern due to possible transfer of resistant genes from nonpathogenic to pathogenic strains that may result in increased duration and severity of morbidity

Veterinary Medicine Needs New Green Antimicrobial Drugs

Given that: (1) the worldwide consumption of antimicrobial drugs (AMDs) used in food-producing animals will increase over the coming decades; (2) the prudent use of AMDs will not suffice to stem the rise in human antimicrobial resistance (AMR) of animal origin; (3) alternatives to AMD use are not available or not implementable, there is an urgent need to develop novel AMDs for food-producing animals. This is not for animal health reasons, but to break the link between human and animal resistomes. In this review we establish the feasibility of developing for veterinary medicine new AMDs, termed green antibiotics, having minimal ecological impact on the animal commensal and environmental microbiomes.We first explain why animal and human commensal microbiota comprise a turnstile exchange, between the human and animal resistomes. We then outline the ideal physico-chemical, pharmacokinetic and pharmacodynamic properties of a veterinary green antibiotic and conclude that they can be developed through a rational screening of currently used AMD classes. The ideal drug will be hydrophilic, of relatively low potency, slow clearance and small volume of distribution. It should be eliminated principally by the kidney as inactive metabolite(s). For oral administration, bioavailability can be enhanced by developing lipophilic pro-drugs. For parenteral administration, slow-release formulations of existing eco-friendly AMDs with a short elimination half-life can be developed. These new eco-friendly veterinary AMDs can be developed from currently used drug classes to provide alternative agents to those currently used in veterinary medicine and mitigate animal contributions to the human AMR problem

Impact of discontinuity in health insurance on resource utilization

<p>Abstract</p> <p>Background</p> <p>This study sought to describe the incidence of transitions into and out of Medicaid, characterize the populations that transition and determine if health insurance instability is associated with changes in healthcare utilization.</p> <p>Methods</p> <p>2000-2004 Medical Expenditure Panel Survey (MEPS) was used to identify adults enrolled in Medicaid at any time during the survey period (n = 6,247). We estimate both static and dynamic panel data models to examine the effect of health insurance instability on health care resource utilization.</p> <p>Results</p> <p>We find that, after controlling for observed factors like employment and health status, and after specifying a dynamic model that attempts to capture time-dependent unobserved effects, individuals who have multiple transitions into and out of Medicaid have higher emergency room utilization, more office visits, more hospitalizations, and refill their prescriptions less often.</p> <p>Conclusions</p> <p>Individuals with more than one transition in health insurance status over the study period were likely to have higher health care utilization than individuals with one or fewer transitions. If these effects are causal, in addition to individual benefits, there are potentially large benefits for Medicaid programs from reducing avoidable insurance instability. These results suggest the importance of including provisions to facilitate continuous enrollment in public programs as the United States pursues health reform.</p