Current Knowledge and Attitudes Concerning Cost-Effectiveness in Glaucoma Pharmacotherapy: A Glaucoma Specialists Focus Group Study.

Background:Rising healthcare costs motivate continued cost-reduction efforts. To help lower costs associated with open-angle glaucoma (OAG), a prevalent, progressive disease with substantial direct and indirect costs, clinicians need to understand the cost-effectiveness of intraocular pressure (IOP)-lowering pharmacotherapies. There is little published information on clinicians' knowledge and attitudes about cost-effectiveness in glaucoma treatment. Purpose:This pilot focus group study aimed to explore clinician attitudes and perspectives around the costs and cost drivers of glaucoma therapy; the implementation of cost-effectiveness decisions; the clinical utility of cost-effectiveness studies; and the cost-effectiveness of available treatments. Methods:Six US glaucoma specialists participated in two separate teleconferencing sessions (three participants each), managed by an independent, skilled moderator (also a glaucoma specialist) using a discussion guide. Participants reviewed recent publications (n=25) on health economics outcomes research in glaucoma prior to the sessions. Results:Participants demonstrated a clear understanding of the economic burden of glaucoma therapy and identified medications, diagnostics, office visits, and treatment changes as key cost drivers. They considered cost-effectiveness an appropriate component of treatment decision-making but identified the need for additional data to inform these decisions. Participants indicated that there were only a few recent studies on health economics outcomes in glaucoma which evaluate parameters important to patient care, such as quality of life and medication adherence, and that longitudinal data were scant. In addition to efficacy, participants felt patient adherence and side-effect profile should be included in economic evaluations of glaucoma pharmacotherapy. Recently approved medications were evaluated in this context. Conclusion:Clinicians deem treatment decisions based on cost-effectiveness data as clinically appropriate. Newer IOP-lowering therapies with potentially greater efficacy and favorable side-effect and adherence profiles may help optimize cost-effectiveness. Future studies should include: clinicians' perspectives; lack of commercial bias; analysis of long-term outcomes/costs; more comprehensive parameters; real-world (including quality-of-life) data; and a robust Markov model

Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts.

Decentering has been proposed as a potential mechanism of mindfulness-based interventions but has received limited empirical examination to date in experimental studies comparing mindfulness meditation to active comparison conditions. In the present study, we compared the immediate effects of mindful breathing (MB) to two alternative stress-management techniques: progressive muscle relaxation (PMR) and loving-kindness meditation (LKM) to test whether decentering is unique to mindfulness meditation or common across approaches. Novice meditators (190 female undergraduates) were randomly assigned to complete one of three 15-min stress-management exercises (MB, PMR, or LKM) presented by audio recording. Immediately after the exercise, participants completed measures of decentering, frequency of repetitive thoughts during the exercise, and degree of negative reaction to thoughts. As predicted, participants in the MB condition reported greater decentering relative to the other two conditions. The association between frequency of repetitive thought and negative reactions to thoughts was relatively weaker in the MB condition than in the PMR and LKM conditions, in which these two variables were strongly and positively correlated. Consistent with the construct of decentering, the relative independence between these two variables in the MB condition suggests that mindful breathing may help to reduce reactivity to repetitive thoughts. Taken together, results help to provide further evidence of decentering as a potential mechanism that distinguishes mindfulness practice from other credible stress-management approaches

Dispositional Mindfulness Uncouples Physiological and Emotional Reactivity to a Laboratory Stressor and Emotional Reactivity to Executive Functioning Lapses in Daily Life

Both dispositional mindfulness and mindfulness training may help to uncouple the degree to which distress is experienced in response to aversive internal experience and external events. Because emotional reactivity is a transdiagnostic process implicated in numerous psychological disorders, dispositional mindfulness and mindfulness training could exert mental health benefits, in part, by buffering emotional reactivity. The present studies examine whether dispositional mindfulness moderates two understudied processes in stress reactivity research: the degree of concordance between subjective and physiological reactivity to a laboratory stressor (Study 1); and the degree of dysphoric mood reactivity to lapses in executive functioning in daily life (Study 2). In both studies, lower emotional reactivity to aversive experiences was observed among individuals scoring higher in mindfulness, particularly non-judging, relative to those scoring lower in mindfulness. These findings support the hypothesis that higher dispositional mindfulness fosters lower emotional reactivity. Results are discussed in terms of implications for applying mindfulness-based interventions to a range of psychological disorders in which people have difficulty regulating emotional reactions to stress

GALEX Observations of CS and OH Emission in Comet 9P/Tempel 1 During Deep Impact

GALEX observations of comet 9P/Tempel 1 using the near ultraviolet (NUV) objective grism were made before, during and after the Deep Impact event that occurred on 2005 July 4 at 05:52:03 UT when a 370 kg NASA spacecraft was maneuvered into the path of the comet. The NUV channel provides usable spectral information in a bandpass covering 2000 - 3400 A with a point source spectral resolving power of approximately 100. The primary spectral features in this range include solar continuum scattered from cometary dust and emissions from OH and CS molecular bands centered near 3085 and 2575 A, respectively. In particular, we report the only cometary CS emission detected during this event. The observations allow the evolution of these spectral features to be tracked over the period of the encounter. In general, the NUV emissions observed from Tempel 1 are much fainter than those that have been observed by GALEX from other comets. However, it is possible to derive production rates for the parent molecules of the species detected by GALEX in Tempel 1 and to determine the number of these molecules liberated by the impact. The derived quiescent production rates are Q(H2O) = 6.4e27 molecules/s and Q(CS2) = 6.7e24 molecules/s, while the impact produced an additional 1.6e32 H2O molecules and 1.3e29 CS2 molecules, a similar ratio as in quiescent outgassing.Comment: 15 pages, 4 figures, accepted for publication in the Astrophysical Journa

Mindfulness predicts less texting while driving among young adults: Examining attention- and emotion-regulation motives as potential mediators.

Many young adult drivers read and send text messages while driving despite clear safety risks. Understanding predictors of texting-while-driving may help to indentify relevant targets for interventions to reduce this dangerous behavior. The present study examined whether individual differences in mindfulness is associated with texting-while-driving in a sample of young-adult drivers. Using path analysis, we tested whether this relationship would be mediated by the degree to which individuals use text-messaging as a means of reducing unpleasant emotions (emotion-regulation motives) and the degree to which individuals limit texting in order to focus on present-moment experiences (attention-regulation motives). Individuals lower in mindfulness reported more frequent texting-while-driving and this relationship appeared to be mediated primarily by emotion-regulation motives. Results may help inform the development of mindfulness-based interventions to prevent texting-while-driving

GALEX FUV Observations of Comet C/2004 Q2 (Machholz): The Ionization Lifetime of Carbon

We present a measurement of the lifetime of ground state atomic carbon, C(^3P), against ionization processes in interplanetary space and compare it to the lifetime expected from the dominant physical processes likely to occur in this medium. Our measurement is based on analysis of a far ultraviolet (FUV) image of comet C/2004 Q2 (Machholz) recorded by the Galaxy Evolution Explorer (GALEX) on 2005 March 1. The bright CI 1561 A and 1657 A multiplets dominate the GALEX FUV band. We used the image to create high S/N radial profiles that extended beyond one million km from the comet nucleus. Our measurements yielded a total carbon lifetime of 7.1 -- 9.6 x 10^5 s (scaled to 1 AU). Which compares favorably to calculations assuming solar photoionization, solar wind proton change exchange and solar wind electron impact ionization are the dominant processes occurring in this medium and that comet Machholz was embedded in the slow solar wind. The shape of the CI profiles inside 3x10^5 km suggests that either the CO lifetime is shorter than previously thought and/or a shorter-lived carbon-bearing parent molecule, such as CH_4 is providing the majority of the carbon in this region of the coma of comet Machholz.Comment: 26 pages, 6 figures, accepted for publication in the Astrophysical Journa

Structural diversity in the type IV pili of multidrug-resistant Acinetobacter

Acinetobacter baumannii is a Gram-negative coccobacillus found primarily in hospital settings that has recently emerged as a source of hospital-acquired infections. A. baumannii expresses a variety of virulence factors, including type IV pili, bacterial extracellular appendages often essential for attachment to host cells. Here, we report the high resolution structures of the major pilin subunit, PilA, from three Acinetobacter strains, demonstrating thatA. baumannii subsets produce morphologically distinct type IV pilin glycoproteins. We examine the consequences of this heterogeneity for protein folding and assembly as well as host-cell adhesion by Acinetobacter. Comparisons of genomic and structural data with pilin proteins from other species of soil gammaproteobacteria suggest that these structural differences stem from evolutionary pressure that has resulted in three distinct classes of type IVa pilins, each found in multiple species