Economics of medically unexplained symptoms: a systematic review of the literature

Objective: To review cost-of-illness studies (COI) and economic evaluations (EE) conducted for medically unexplained symptoms and to analyze their methods and results. Methods: We searched the databases PubMed, PsycINFO and National Health Service Economic Evaluations Database of the University of York. Cost data were inflated to 2006 using country-specific gross domestic product inflators and converted to 2006 USD purchasing power parities. Results: We identified 5 COI and 8 EE, of which 6 were cost-minimization analyses and 2 were cost-effectiveness analyses. All studies used patient level data collected between 1980 and 2004 and were predominantly conducted in the USA (n = 10). COI found annual excess health care costs of somatizing patients between 432 and 5,353 USD in 2006 values. Indirect costs were estimated by only one EE and added up to about 18,000 USD per year. In EE, educational interventions for physicians as well as cognitive-behavioral therapy approaches for patients were evaluated. For both types of interventions, effectiveness was either shown within EE or by previous studies

Cogmed training does not generalise to real-world benefits for adult hearing aid users: results of a blinded, active-controlled randomised trial

Objectives: Performance on working memory tasks is positively associated with speech-in-noise perception performance, particularly where auditory inputs are degraded. It is suggested that interventions designed to improve working memory capacity may improve domain-general working memory performance for people with hearing loss, to benefit their real-world listening. We examined whether a 5-week training program that primarily targets the storage component of working memory (Cogmed RM, adaptive) could improve cognition, speech-in-noise perception and self-reported hearing in a randomized controlled trial of adult hearing aid users with mild to moderate hearing loss, compared with an active control (Cogmed RM, nonadaptive) group of adults from the same population. Design: A preregistered randomized controlled trial of 57 adult hearing aid users (n = 27 experimental, n = 30 active control), recruited from a dedicated database of research volunteers, examined on-task learning and generalized improvements in measures of trained and untrained cognition, untrained speech-in-noise perception and self-reported hearing abilities, pre- to post-training. Participants and the outcome assessor were both blinded to intervention allocation. Retention of training-related improvements was examined at a 6-month follow-up assessment. Results: Per-protocol analyses showed improvements in trained tasks (Cogmed Index Improvement) that transferred to improvements in a trained working memory task tested outside of the training software (Backward Digit Span) and a small improvement in self-reported hearing ability (Glasgow Hearing Aid Benefit Profile, Initial Disability subscale). Both of these improvements were maintained 6-month post-training. There was no transfer of learning shown to untrained measures of cognition (working memory or attention), speech-in-noise perception, or self-reported hearing in everyday life. An assessment of individual differences showed that participants with better baseline working memory performance achieved greater learning on the trained tasks. Post-training performance for untrained outcomes was largely predicted by individuals' pretraining performance on those measures. Conclusions: Despite significant on-task learning, generalized improvements of working memory training in this trial were limited to (a) improvements for a trained working memory task tested outside of the training software and (b) a small improvement in self-reported hearing ability for those in the experimental group, compared with active controls. We found no evidence to suggest that training which primarily targets storage aspects of working memory can result in domain-general improvements that benefit everyday communication for adult hearing aid users. These findings are consistent with a significant body of evidence showing that Cogmed training only improves performance for tasks that resemble Cogmed training. Future research should focus on the benefits of interventions that enhance cognition in the context in which it is employed within everyday communication, such as training that targets dynamic aspects of cognitive control important for successful speech-in-noise perception

Micromotives of Vote Switchers and Macrotransitions: The Case of the Immigration Issue in a Regional Earthquake Election in Germany 2018

Which issue-related motives underlie voters' decision to switch parties at the polls? Do switchers stick to the newly chosen party, or do they oscillate in a short-term way at intermediate elections? Relying on the behavioral theory of elections, we assumed aspiration-based voting of boundedly rational voters. We elicited issue-related switch and stay motives in an open-ended survey question format to identify the individual dominant aspirational frame. We traced the respondents' voting trajectories over three consecutive elections, including two state (2013 and 2018) elections in Bavaria (Germany) and one German federal election (2017). We focused on one of the most polarizing and salient issues in these elections, namely immigration. The case of reference is the 2018 Bavarian state election. Here, the incumbent majoritarian center-right party Christian Social Union tried to deter the entry of the right-wing populist party Alternative for Germany by adapting to it on the immigration issue in tone and position. The selected case allows assessment of the impact of issue-based adaptive behavior of the incumbent party at the level of the voters' switch or stay choices. We estimated the direction and number of voter flows for two interelection sequences of different lengths between different types of polls (federal and state). Our transition estimates are based on the hybrid multinomial Dirichlet model, a new technique integrating individual-level survey data and official aggregate data. Our estimates uncover substantial behavioral differences in the immigration issue public

Electrochemical Oxidation for Treatment of PFAS in Contaminated Water and Fractionated Foam─A Pilot-Scale Study

publishedVersio

Recruiting young pre-symptomatic children for a clinical trial in type 1 diabetes: insights from the Fr1da insulin intervention study

Background: Although detection of children at high risk of developing type 1 diabetes and diagnosis of early stages is possible, up to now there exists no approved therapy to delay or prevent type 1 diabetes. Thus it is vital to develop evidence-based interventions. For this a sufficient number of trial participants is crucial but difficult to obtain especially in asymptomatic children. Aim: Identifying family characteristics that lead to or impede trial participation and analyze reasons stated by families for non-participation. Methods: Participants for the Fr1da Insulin Intervention study are recruited from the Fr1da study, a population based screening for early stage type 1 diabetes in Bavaria. Families with eligible children were invited to enroll. We analyzed sex and age of the child, distance of the family to the study center in Munich and the existence of a first degree family member with type 1 as possible influential factors for study participation. We also analyzed reasons stated by families who declined study participation in a phone interview. Results: Of 146 eligible children 77 (53%) were enrolled into the trial. None of the tested family characteristics differed significantly between the enrolling and the families not participating, but in general enrolling families lived closer to the study site than families not participating. This is also reflected in the reasons given by non-participating families. The most frequent reason stated were time restrictions. The second most frequent reason was the venous blood draw. Conclusion: The factors for non-participation identified in this project need be taken into account for the design of future trials in young children to ensure proper recruitment and thus to generate valid results for medical treatment of children. More research on the reason of participation and non-participation in clinical trials is needed. Keywords: Type 1 diabetes, Trial recruitment, Trial enrollment, Infants, Children, Asymptomati

Characterization of two novel antioxidant tetrahydroxyxanthones from Hypericum seeds and scanning electronmicroscopic investigations of their testa

Hypericum-Samen wurden kürzlich als natürliche Quelle für eine Reihe von Xanthon-Derivaten beschrieben. In Methanol-Extrakten von H. perforatum und H. tetrapterum konnten per HPLC(DAD)-MSn zwei Hauptkomponenten, die Tetrahydroxyxanthone THX-1 und -2, identifiziert werden, deren genaue Konfiguration bislang unbekannt war. Beide Substanzen wurden deshalb über chromatographische Auftrennung an Polyamid und Kieselgel aus dem Samenextrakt angereichert und mit Hilfe von 1D- und 2DNMR- Techniken eine Strukturanalyse vorgenommen. Durch Synthese von THX-1 und -2 und Vergleich ihrer chromatographischen sowie spektroskopischen/spektrometrischen Eigenschaften mit den natürlichen THX in H. perforatum wurde die exakte Konfiguration als 1,4,6,7-THX (THX-1) und 1,2,6,7-THX (THX-2) bestimmt. Die beiden neuartigen Verbindungen zeigten eine dreifach stärkere Radikalfängerwirkung im DPPH-Test als das wasserlösliche Vitamin E-Derivat Trolox® und sind somit starke Antioxidantien. Ferner konnte durch rasterelektronenmikroskopische Untersuchungen (SEM) die zweilagige Struktur der Hypericum-Samenschale (Testa) gezeigt werden, wobei die Xanthone wahrscheinlich in der sehr dickwandigen, lignifizierten Skerenchymschicht eingelagert sind.Hypericum seeds have recently been identified as a natural source of different xanthone derivatives. Two main constituents, the tetrahydroxyxanthones THX-1 and -2, were identified in methanolic extracts of H. perforatum and H. tetrapterum by means of HPLC(DAD)-MSn methods. However, the exact configuration of both THX was unknown so far. For this reason, the two compounds were enriched by chromatography on polyamide and silica, and the corresponding fraction was investigated by 1D- and 2D-NMR techniques. Based on a tentative structural assignment a total synthesis of THX-1 and -2 was performed. Comparing the chromatographic and spectroscopic/spectrometric features of synthetic THX-1 and -2 with their natural counterparts their exact configuration was determined as 1,4,6,7-THX (THX-1) and 1,2,6,7-THX (THX-2), respectively. The novel compounds exhibited a threefold higher radical scavenging activity in the DPPH assay than the vitamin E derivative Trolox®. Hence, they are strong antioxidants. Furthermore, scanning electron microscopy (SEM) provided insights into the two-layer structure of the testa (seed coat), with the thick lignified sclerenchyma layer presumably being the depository of the xanthones

Micromotives of Vote Switchers and Macrotransitions: The Case of the Immigration Issue in a Regional Earthquake Election in Germany 2018

Which issue-related motives underlie voters' decision to switch parties at the polls? Do switchers stick to the newly chosen party, or do they oscillate in a short-term way at intermediate elections? Relying on the behavioral theory of elections, we assumed aspiration-based voting of boundedly rational voters. We elicited issue-related switch and stay motives in an open-ended survey question format to identify the individual dominant aspirational frame. We traced the respondents' voting trajectories over three consecutive elections, including two state (2013 and 2018) elections in Bavaria (Germany) and one German federal election (2017). We focused on one of the most polarizing and salient issues in these elections, namely immigration. The case of reference is the 2018 Bavarian state election. Here, the incumbent majoritarian center-right party Christian Social Union tried to deter the entry of the right-wing populist party Alternative for Germany by adapting to it on the immigration issue in tone and position. The selected case allows assessment of the impact of issue-based adaptive behavior of the incumbent party at the level of the voters' switch or stay choices. We estimated the direction and number of voter flows for two interelection sequences of different lengths between different types of polls (federal and state). Our transition estimates are based on the hybrid multinomial Dirichlet model, a new technique integrating individual-level survey data and official aggregate data. Our estimates uncover substantial behavioral differences in the immigration issue public

Associations between the 17q21 region and allergic rhinitis in 5 birth cohorts

Non peer reviewe

Ambient Temperature Influences Australian Native Stingless Bee (Trigona carbonaria) Preference for Warm Nectar

The interaction between flowers and insect pollinators is an important aspect of the reproductive mechanisms of many plant species. Several laboratory and field studies indicate that raising flower temperature above ambient can be an advantage in attracting pollinators. Here we demonstrate that this preference for warmer flowers is, in fact, context-dependent. Using an Australian native bee as a model, we demonstrate for the first time a significant shift in behaviour when the ambient temperature reaches 34°C, at which point bees prefer ambient temperature nectar over warmer nectar. We then use thermal imaging techniques to show warmer nectar maintains the flight temperature of bees during the period of rest on flowers at lower ambient temperatures but the behavioural switch is associated with the body temperature rising above that maintained during flight. These findings suggest that flower-pollinator interactions are dependent upon ambient temperature and may therefore alter in different thermal environments

Mauthausen und die nationalsozialistische Expansions- und Verfolgungspolitik (Volume 1, Edition 1)

„Europa in Mauthausen" stellt erstmals umfassend die Geschichte der Überlebenden eines nationalsozialistischen Konzentrationslagers dar. Diese beruht auf einer einmaligen Sammlung von über 850 lebensgeschichtlichen Interviews mit Überlebenden aus ganz Europa, Israel, Nord- und Südamerika.Der erste Band präsentiert einen Überblick über das Lager und die Mauthausen-Forschung; er konzentriert sich einleitend auf methodologische Überlegungen und makropolitische Zusammenhänge. Die Beiträge zeigen, dass dem nationalsozialistischen Lagersystem in hohem Maße eine ‚Funktion‘ in den Besatzungs- und Verfolgungspolitiken des NS-Regimes (und der kollaborierenden Länder) zukam