Background: Pulsed dye laser is the gold standard for treatment of port-wine stain birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects. Objective: We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome. Methods: Healthy individuals with PWS were treated with PDL and then randomized to (...) apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements for 57 PWS sites were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa and ΔE were measured to quantify treatment outcome. Results: Two patients developed minor skin irritation. Other adverse effects were not noted. Average a was 0.43 for PDL + placebo sites and 1.27 for PDL + imiquimod sites indicating a greater reduction in erythema with imiquimod. Average E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod, again indicating a greater color improvement with imiquimod. Limitations: Effects were evaluated after a single treatment and duration of effect is unknown. Conclusion: Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy. © 2011 by the American Academy of Dermatology, Inc. (shrink)

Avoiding whinges from various and potentially conflicting stakeholders is a major challenge for sustainable development and for the identification of sustainability scenarios or policies for biodiversity and ecosystem services. It turns out that independently complying with whinge thresholds and constraints of these stakeholders is not sufficient because dynamic ecological-economic interactions and uncertainties occur. Thus more demanding no whinge standards are needed. In this paper, we first argue that these new boundaries can be endogenously exhibited with the mathematical concepts of viability (...) kernel and viable controls. Second, it is shown how these no whinge kernels have components, such as harvesting of resources, that should remain within safe corridor while some other components, in particular biodiversity, have only lower conservation limits. Thus, using radar charts, we show how this no whinge kernels can take the shape of a tree that we name viability tree. These trees of viability capture the idea that the unbounded renewal potential of biodiversity combined with a bounded use of the different ecosystem services are crucial ingredients for the sustainability of socio-ecosystems and the design of no whinge policies reconciling the different stakeholders involved. (shrink)

For scholars of American philosophy, this anthology of essays on S. C. Pepper's works on metaphysics, aesthetics, and value theory is especially a welcome one. Also included is a reprint of a little known but valuable essay by Pepper entitled "Metaphor in Philosophy," which originally appeared in volume 3 of Phillip S. Wiener's Dictionary of the History of Ideas. In this essay, Pepper discusses his root metaphor theory in relation to Bacon and Kant, and some contemporary uses of the notion (...) of paradigm, e.g., Wittgenstein and Kuhn. Lewis E. Hahn's "The Stephen C. Pepper Papers, 1903-1972" gives an informative account of six book-length unpublished manuscripts in the Pepper Archives at the Southern Illinois University. The rest of the essays concentrate on the various aspects of Pepper's works. A few deal with aesthetic theory and its application to critical practice. Of philosophical interests are papers by Elmer H. Duncan, David B. Richardson, Robert J. Yanal, Robert L. Armstrong, and Brian Caraher, and a short essay by Charles Hartshorne and a response by Joseph H. Monast. Duncan gives a just but critical account of the neglect of Pepper's Sources of Value, and a highly appreciative appraisal of Pepper's World Hypotheses. Caraher's careful essay on the conflicting root metaphors in Frege's theory of meaning offers interesting application of Pepper's conception of formism and contextualism to problems in Frege's philosophy. A variety of problems such as the root metaphor theory, descriptive definition and aesthetic experience are discussed. Efron's long introductory essay entitled "Pepper's Continuing Value" serves its purpose well in terms of indicating Pepper's influence in non-philosophical disciplines and the problems that arise in Pepper's value theory. What is missed is a sustained critical examination of Pepper's root metaphor theory, characterization of the various world hypotheses including Pepper's own selectivism, and its relation to ethical theory. The anthology however is useful in indicating the scope of Pepper's influence and the need to examine his contributions with reference to contemporary philosophical problems.--A.S.C. (shrink)