Motor neuron diseases (MNDs) are a group of neurodegenerative disorders with involvement of upper and/or lower motor neurons, such as amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA), progressive bulbar palsy, and primary lateral sclerosis. Recently, we have mapped a new locus for an atypical form of ALS/MND (atypical amyotrophic lateral sclerosis [ALS8]) at 20q13.3 in a large white Brazilian family. Here, we report the finding of a novel missense mutation in the vesicle-associated membrane protein/synaptobrevin-associated membrane protein B (VAPB) gene in patients from this family. Subsequently, the same mutation was identified in patients from six additional kindreds but with different clinical courses, such as ALS8, late-onset SMA, and typical severe ALS with rapid progression. Although it was not possible to link all these families, haplotype analysis suggests a founder effect. Members of the vesicle-associated proteins are intracellular membrane proteins that can associate with microtubules and that have been shown to have a function in membrane transport. These data suggest that clinically variable MNDs may be caused by a dysfunction in intracellular membrane trafficking.

This paper reviews changes in the concept of 'equal opportunities' over the last twenty years and discusses the implications for women's experiences in the workplace. The shift to notions of diversity and difference as the motif for equality initiatives reflects the right-wing critique of bureaucratic control and regulation of labour markets, embodied in 1970s' EO policies. 'Diversity' symbolizes the employer's freedom from constraint in selecting and deploying the best 'talent' regardless of sex, ethnicity or disability. Ironically the radical feminist agenda, which asserts women's differences from men and their potential for creating a better world, has been adapted to the concerns of liberal feminism with providing a rationale for the promotion of women into management, on the grounds that women's nurturing capacities contribute to the diversity needed by post-modern organizations. A case study of a transnational computer and measurement systems manufacturer is used to illustrate the limited capacity of a market-driven version of diversity to dismantle the hierarchical gender order and its tendency to reinforce the ideology of competitive individualism with its white, male norms. In conclusion it is argued that we need to move beyond the ultimately limiting debate about whether women are the same as or different from men to a renewed concern with the material conditions of women's lives and with the construction of equality initiatives which address the continuing exclusion of many women from adequate standards of living.

Objective To evaluate the effectiveness of standardized, patient-centered label (PCL) instructions to improve comprehension of prescription drug use compared to typical instructions. Methods 500 adult patients recruited from two academic and two community primary care clinics in Chicago, IL and Shreveport, LA were assigned to receive: 1) standard prescription instructions written as times per day (once, twice three times per day) [usual care], 2) PCL instructions that specify explicit timing with standard intervals (morning, noon, evening, bedtime) [PCL], or 3) PCL instructions with a graphic aid to visually depict dose and timing of the medication [PCL + Graphic]. The outcome was correct interpretation of label instructions. Results Instructions with the PCL format were more likely to be correctly interpreted compared to standard instructions (Adjusted Relative Risk (RR) 1.33, 95% Confidence Interval (CI) 1.25 – 1.41). Inclusion of the graphic aid (PCL + Graphic) decreased rates of correct interpretation compared to PCL instructions alone (RR 0.93, 95% CI 0.89 - 0.97). Lower literate patients were better able to interpret PCL instructions (low literacy: RR 1.39, 95% CI 1.14 – 1.68; p=0.001). Conclusion The PCL approach could improve patients' understanding and use of their medication regimen.

Background Prior studies have documented a high prevalence of patients misunderstanding prescription drug warning labels, placing them at risk for medication error. We evaluated whether the use of ‘enhanced print’ drug warnings could improve patient comprehension beyond a current standard. Methods An evaluation of ‘enhanced print’ warning labels was conducted at two academic and two community health primary care clinics in Chicago, IL and Shreveport, LA. In total, 500 adult patients were consecutively recruited and assigned to receive 1) current standard drug warning labels on prescription containers (standard), 2) drug warnings with text rewritten in plain language (simplified text), or 3) plain language and icons developed with patient feedback (simplified text + icon). The primary outcome was correct interpretation of nine drug warning labels as determined by a blinded panel review of patients’ verbatim responses. Results Overall rates of correct interpretation of drug warnings varied among standard, simplified text, and simplified text + icon labels (80.3%, 90.6%, and 92.1% respectively; p<0.001). Warnings with simplified text and simplified text + icons were more likely to be correctly interpreted compared to standard labels (simplified text – Adjusted Odds Ratio (AOR) 2.64, 95% CI 2.00-3.49; simplified text + icons – AOR 3.26, 95% CI 2.46-4.32). Patients’ ability to correctly interpret labels was not significantly different with the inclusion of icons (simplified text + icons – AOR 1.23, 95% CI 0.90-1.67, p=0.20). Low literacy was also an independent predictor of misinterpretation (AOR 0.65, 95% CI 0.44-0.94). Patients with marginal and low literacy were better able to correctly interpret warning labels with simplified text + icons compared to labels with simplified text only (marginal – AOR 2.59, 95% CI 1.24-5.44, p=0.01; low – AOR 3.22, 95% CI 1.39-7.50, p=0.006). Conclusion Simple, explicit language on warning labels can increase patient understanding; the addition of appropriate icons is particularly useful for lower literate adults. Evidence-based standards are needed to promote patient-centered prescription labeling practices.

Our dependence on energy from fossil fuels is causing potentially disastrous global warming and posing fundamental questions about the commensurability of consumer capitalism and a sustainable society. UK and Scottish governments have taken a lead in climate change legislation intended to avoid worst-case scenarios through low carbon transition. There are, however, considerable uncertainties about whether individualized, market-driven, materialistic societies can manage such radical transformations. Policies to cut household emissions focus on behaviour change through social marketing and incremental modifications to consumption. This technocratic model produces very little societal change, and seems likely to be self-defeating. The framing of the problem as one of behavioural adjustments to individual self-interest obscures alternative understandings of society as a collective accomplishment. Through simultaneous 'knowing and not knowing' about unsustainable consumerism, a behavioural model allows governing to proceed, while marginalizing awkward questions about the contradictions between economic growth and low carbon transitions.