Exploring the pastiche hegemony of men

In this article I explore the continued hegemony of certain men. I use interview extracts to help think through the notion of pastiche hegemony as a means of understanding how men, and narratives about them, have changed, but unequal power relations persist. In particular, I explore this process within men’s understandings of how they were able to gain and maintain influence and power at work. Through their reflexive reading of the changing shape of late modern Western society, these men believed they were able to craft selves and employ social scripts to produce social influence and power in situational and contingent forms. I argue that it is within this interactional process that the increasingly undermined ideological and material legacy of patriarchy might still be reified. As such, while there is clear evidence highlighting the undermining of men’s ability to assume power, within this article I theoretically unpack how certain men might be able to produce a localized, pastiche hegemony. This article is published as part of a thematic collection on gender studies

The counseling african americans to control hypertension (caatch) trial: baseline demographic, clinical, psychosocial, and behavioral characteristics

<p>Abstract</p> <p>Background</p> <p>Effectiveness of combined physician and patient-level interventions for blood pressure (BP) control in low-income, hypertensive African Americans with multiple co-morbid conditions remains largely untested in community-based primary care practices. Demographic, clinical, psychosocial, and behavioral characteristics of participants in the Counseling African American to Control Hypertension (CAATCH) Trial are described. CAATCH evaluates the effectiveness of a multi-level, multi-component, evidence-based intervention compared with usual care (UC) in improving BP control among poorly controlled hypertensive African Americans who receive primary care in Community Health Centers (CHCs).</p> <p>Methods</p> <p>Participants included 1,039 hypertensive African Americans receiving care in 30 CHCs in the New York Metropolitan area. Baseline data on participant demographic, clinical (<it>e.g</it>., BP, anti-hypertensive medications), psychosocial (<it>e.g</it>., depression, medication adherence, self-efficacy), and behavioral (<it>e.g</it>., exercise, diet) characteristics were gathered through direct observation, chart review, and interview.</p> <p>Results</p> <p>The sample was primarily female (71.6%), middle-aged (mean age = 56.9 ± 12.1 years), high school educated (62.4%), low-income (72.4% reporting less than $20,000/year income), and received Medicaid (35.9%) or Medicare (12.6%). Mean systolic and diastolic BP were 150.7 ± 16.7 mm Hg and 91.0 ± 10.6 mm Hg, respectively. Participants were prescribed an average of 2.5 ± 1.9 antihypertensive medications; 54.8% were on a diuretic; 33.8% were on a beta blocker; 41.9% were on calcium channel blockers; 64.8% were on angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs). One-quarter (25.6%) of the sample had resistant hypertension; one-half (55.7%) reported medication non-adherence. Most (79.7%) reported one or more co-morbid medical conditions. The majority of the patients had a Charlson Co-morbidity score ≥ 2. Diabetes mellitus was common (35.8%), and moderate/severe depression was present in 16% of participants. Participants were sedentary (835.3 ± 1,644.2 Kcal burned per week), obese (59.7%), and had poor global physical health, poor eating habits, high health literacy, and good overall mental health.</p> <p>Conclusions</p> <p>A majority of patients in the CAATCH trial exhibited adverse lifestyle behaviors, and had significant medical and psychosocial barriers to adequate BP control. Trial outcomes will shed light on the effectiveness of evidence-based interventions for BP control when implemented in real-world medical settings that serve high numbers of low-income hypertensive African-Americans with multiple co-morbidity and significant barriers to behavior change.</p

The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months

<p>Abstract</p> <p>Background</p> <p>Scotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation. This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes for the technique, with conventional restorations.</p> <p>Methods</p> <p>General dental practice based, split mouth, randomized controlled trial (132 children, aged 3–10). General dental practitioners (GDPs, n = 17) in Tayside, Scotland (dmft 2.7) placed conventional (Control) restorations in carious primary molars, and Hall Technique PMCs on the contralateral molar (matched clinically and radiographically). Dentists ranked the degree of discomfort they felt the child experienced for each procedure; then children, their carers and dentists stated which technique they preferred. The teeth were followed up clinically and radiographically.</p> <p>Results</p> <p>128 conventional restorations were placed on 132 control teeth, and 128 PMCs on 132 intervention teeth. Using a 5 point scale, 118 Hall PMCs (89%) were rated as no apparent discomfort up to mild, not significant; for Control restorations the figure was 103 (78%). Significant, unacceptable discomfort was recorded for two Hall PMCs (1.5%) and six Control restorations (4.5%). 77% of children, 83% of carers and 81% of dentists who expressed a preference, preferred the Hall technique, and this was significant (Chi square, p < 0.0001). There were 124 children (94% of the initial sample) with a minimum follow-up of 23 months. The Hall PMCs outperformed the Control restorations:</p> <p>a) 'Major' failures (signs and symptoms of irreversible pulpal disease): 19 Control restorations (15%); three Hall PMCs (2%) (P < 0.000);</p> <p>b) 'Minor' failures (loss of restoration, caries progression): 57 Control restorations (46%); six Hall PMCs (5%) (P < 0.000)</p> <p>c) Pain: 13 Control restorations (11%); two Hall PMCs (2%) (P = 0.003).</p> <p>Conclusion</p> <p>The Hall Technique was preferred to conventional restorations by the majority of children, carers and GDPs. After two years, Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations. The Hall Technique appears to offer an effective treatment option for carious primary molar teeth.</p> <p>Trial registration number</p> <p>Current Controlled Trials ISRCTN47267892 – A randomized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth: the Hall technique.</p

Borrelia burgdorferi BBK32 Inhibits the Classical Pathway by Blocking Activation of the C1 Complement Complex

Citation: Garcia, B. L., Zhi, H., Wager, B., Hook, M., & Skare, J. T. (2016). Borrelia burgdorferi BBK32 Inhibits the Classical Pathway by Blocking Activation of the C1 Complement Complex. Plos Pathogens, 12(1), 28. doi:10.1371/journal.ppat.1005404Pathogens that traffic in blood, lymphatics, or interstitial fluids must adopt strategies to evade innate immune defenses, notably the complement system. Through recruitment of host regulators of complement to their surface, many pathogens are able to escape complement-mediated attack. The Lyme disease spirochete, Borrelia burgdorferi, produces a number of surface proteins that bind to factor H related molecules, which function as the dominant negative regulator of the alternative pathway of complement. Relatively less is known about how B. burgdorferi evades the classical pathway of complement despite the observation that some sensu lato strains are sensitive to classical pathway activation. Here we report that the borrelial lipoprotein BBK32 potently and specifically inhibits the classical pathway by binding with high affinity to the initiating C1 complex of complement. In addition, B. burgdorferi cells that produce BBK32 on their surface bind to both C1 and C1r and a serum sensitive derivative of B. burgdorferi is protected from killing via the classical pathway in a BBK32-dependent manner. Subsequent biochemical and biophysical approaches localized the anti-complement activity of BBK32 to its globular C-terminal domain. Mechanistic studies reveal that BBK32 acts by entrapping C1 in its zymogen form by binding and inhibiting the C1 subcomponent, C1r, which serves as the initiating serine protease of the classical pathway. To our knowledge this is the first report of a spirochetal protein acting as a direct inhibitor of the classical pathway and is the only example of a biomolecule capable of specifically and noncovalently inhibiting C1/C1r. By identifying a unique mode of complement evasion this study greatly enhances our understanding of how pathogens subvert and potentially manipulate host innate immune systems

Assessment of the health of Americans: the average health-related quality of life and its inequality across individuals and groups

BACKGROUND: The assessment of population health has traditionally relied on the population's average health measured by mortality related indicators. Researchers have increasingly recognized the importance of including information on health inequality and health-related quality of life (HRQL) in the assessment of population health. The objective of this study is to assess the health of Americans in the 1990s by describing the average HRQL and its inequality across individuals and groups. METHODS: This study uses the 1990 and 1995 National Health Interview Survey from the United States. The measure of HRQL is the Health and Activity Limitation Index (HALex). The measure of health inequality across individuals is the Gini coefficient. This study provides confidence intervals (CI) for the Gini coefficient by a bootstrap method. To describe health inequality by group, this study decomposes the overall Gini coefficient into the between-group, within-group, and overlap Gini coefficient using race (White, Black, and other) as an example. This study looks at how much contribution the overlap Gini coefficient makes to the overall Gini coefficient, in addition to the absolute mean differences between groups. RESULTS: The average HALex was the same in 1990 (0.87, 95% CI: 0.87, 0.88) and 1995 (0.87, 95% CI: 0.86, 0.87). The Gini coefficient for the HALex distribution across individuals was greater in 1995 (0.097, 95% CI: 0.096, 0.099) than 1990 (0.092, 95% CI: 0.091, 0.094). Differences in the average HALex between all racial groups were the same in 1995 as 1990. The contribution of the overlap to the overall Gini coefficient was greater in 1995 than in 1990 by 2.4%. In both years, inequality between racial groups accounted only for 4–5% of overall inequality. CONCLUSION: The average HRQL of Americans was the same in 1990 and 1995, but inequality in HRQL across individuals was greater in 1995 than 1990. Inequality in HRQL by race was smaller in 1995 than 1990 because race had smaller effect on the way health was distributed in 1995 than 1990. Analysis of the average HRQL and its inequality provides information on the health of a population invisible in the traditional analysis of population health

Predictors of outcome after 6 and 12 months following anthroposophic therapy for adult outpatients with chronic disease: a secondary analysis from a prospective observational study

<p>Abstract</p> <p>Background</p> <p>Anthroposophic medicine is a physician-provided complementary therapy system involving counselling, artistic and physical therapies, and special medications. The purpose of this analysis was to identify predictors of symptom improvement in patients receiving anthroposophic treatment for chronic diseases.</p> <p>Methods</p> <p>913 adult outpatients from Germany participated in a prospective cohort study. Patients were starting anthroposophic treatment for mental (30.4% of patients, n = 278/913), musculoskeletal (20.2%), neurological (7.6%), genitourinary (7.4%) or respiratory disorders (7.2%) or other chronic indications. Stepwise multiple linear regression analysis was performed with the improvement of Symptom Score (patients' assessment, 0: not present, 10: worst possible) after 6 and 12 months as dependent variables. 61 independent variables pertaining to socio-demographics, life style, disease status, co-morbidity, health status (SF-36), depression, and therapy factors were analysed.</p> <p>Results</p> <p>Compared to baseline, Symptom Score improved by average 2.53 points (95% confidence interval 2.39-2.68, p < 0.001) after six months and by 2.49 points (2.32-2.65, p < 0.001) after 12 months. The strongest predictor for improvement after six months was baseline Symptom Score, which alone accounted for 25% of the variance (total model 32%). Improvement after six months was also positively predicted by better physical function, better general health, shorter disease duration, higher education level, a diagnosis of respiratory disorders, and by a higher therapy goal documented by the physician at baseline; and negatively predicted by the number of physiotherapy sessions in the pre-study year and by a diagnosis of genitourinary disorders. Seven of these nine variables (not the two diagnoses) also predicted improvement after 12 months. When repeating the 0-6 month analysis on two random subsamples of the original sample, three variables (baseline Symptom Score, physical function, general health) remained significant predictors in both analyses, and three further variables (education level, respiratory disorders, therapy goal) were significant in one analysis.</p> <p>Conclusion</p> <p>In adult outpatients receiving anthroposophic treatment for chronic diseases, symptom improvement after 6 and 12 months was predicted by baseline symptoms, health status, disease duration, education, and therapy goal. Other variables were not associated with the outcome. This secondary predictor analysis of data from a pre-post study does not allow for causal conclusions; the results are hypothesis generating and need verification in subsequent studies.</p

Single-grain TT-OSL bleaching characteristics: Insights from modern analogues and OSL dating comparisons

Previous assessments of thermally transferred optically stimulated luminescence (TT-OSL) signal resetting in natural sedimentary settings have been based on relatively limited numbers of observations, and have been conducted primarily at the multi-grain scale of equivalent dose (De) analysis. In this study, we undertake a series of single-grain TT-OSL bleaching assessments on nineteen modern and geological dating samples from different sedimentary environments. Daylight bleaching experiments performed over several weeks confirm that single-grain TT-OSL signals are optically reset at relatively slow, and potentially variable, rates. Single-grain TT-OSL residual doses range between 0 and 24 Gy for thirteen modern samples, with > 50% of these samples yielding weighted mean De values of 0 Gy at 2σ. Single-grain OSL and TT-OSL dating comparisons performed on well-bleached and heterogeneously bleached late Pleistocene samples from Kangaroo Island, South Australia, yield consistent replicate age estimates. Our results reveal that (i) single-grain TT-OSL residuals can potentially be reduced down to insignificant levels when compared with the natural dose range of interest for most TT-OSL dating applications; (ii) the slow bleaching properties of TT-OSL signals may not necessarily limit their dating applicability to certain depositional environments; and (iii) non-trivial differences may be observed between single-grain and multi-grain TT-OSL bleaching residuals in some modern samples. Collectively, these findings suggest that single-grain TT-OSL dating may offer advantages over multi-grain TT-OSL dating in certain complex depositional environments