Private pension failure for much of the economics mainstream would be regarded as an artifact of markets that are insufficiently regulated, such that suppliers are able to exploit monopoly advantages, and are free to make serious errors of judgment. Market failure analysis is flawed, however, by its own failure to acknowledge salient elements of the institutional context of private pension provision, which, while it has been regulated according to approved public interest ends, has been prone to suboptimal investment performance. Drawing on classical liberal political economy, an alternative account of private pension failure would emphasize the perverse consequences of state intrusion in the market for retirement income protection. The origins of regulation failure can be traced back to a combination of two policy decision dynamics, one of intentional rent creation, a second of imperfect knowledge and understanding of markets resulting in flawed regulatory arrangements. By stifling competition, regulation diminishes the capacity of pension markets to serve pension plan participants by means of improved investment performance. The prevalence of private pension failure is an artifact of regulatory intrusiveness. Given this direction of causality, a better approach to policy would rest centrally on the deregulation of pension markets.

Workplace conflict naturally occurs in any organization and can be constructive or outright destructive and costly. There are many types of conflict; leaders are tasked specifically with managing behavioral conflict and challenging interpersonal interactions. This is often a stressful task, yet it is imperative to do so successfully to create a positive workplace culture. This article outlines strategies to successfully manage workplace conflict as a foundation for creating a healthy organization.

Non-invasive assessment of pigmented skin lesions is gaining adoption by clinicians and provides a tool for enhanced evaluation of lesions suggestive of melanoma. One such test detects gene expression of LINC00518 and PRAME in samples of pigmented skin lesions collected non-invasively via adhesive patches that can rule out melanoma with a negative predictive value (NPV) of 99%. The purpose of the current study was to further characterize this test's performance in patients with Fitzpatrick skin types IV-VI. Performance metrics for samples from skin types I-III (n=4047) and IV-VI (n=125) were calculated and compared. Since the prevalence of melanoma is known to be lower in skin types IV-VI, lesions that test negative in these subjects would be expected to have a very low probability of being melanoma (false negative result). To estimate performance conservatively in this group, a 10% false negative "handicap" rate was therefore imputed. Among the 4047 Fitzpatrick I-III lesions, 66 were diagnosed as melanoma by histopathologic assessment. Test performance in this group was sensitivity 0.97, specificity 0.91, and NPV 0.9994. Among the 125 Fitzpatrick IV-VI subjects, all three melanomas diagnosed by histopathology had been correctly identified by positive rule-out test results as higher risk. The test performance was sensitivity 0.91, specificity 0.94, and NPV 0.9974. Performance of the test in skin types IV-VI is similar to that in types I-III in the cohorts evaluated. Sensitivity and specificity were 90% or higher in both groups. Most importantly, the NPV was also similar for both groups, at greater than 99%.

Background: ​ Pigmented lesion evaluation remains a challenging aspect of dermatology. The DermTech Melanoma Test (DMT) is a non-invasive gene-expression test designed to rule-out melanoma. It consists of the pigmented lesion assay, which detects RNA products of Long Intergenic Non-Coding RNA 00518 (LINC00518) and Preferentially Expressed Antigen in Melanoma (PRAME), and an add-on assay for DNA promoter mutations in telomerase reverse transcriptase (TERT). This registry study examines the concordance of PRAME detection by polymerase chain reaction (PCR) in samples obtained non-invasively prior to biopsy and PRAME detection by immunohistochemistry (IHC) on the same lesions after biopsy.​ Methods: ​ Between April 2021 and March 2022, multiple geographically diverse sites throughout the US submitted data to a registry to assess real-world use of the DMT. Approximately 8,000 clinically atypical lesions were tested. After receiving the test result, providers followed their clinical judgement for biopsy decision. When lesions expressed genomic markers (LINC, PRAME, and/or TERT) and were biopsied, pathology reports were also submitted to the registry. The presence or absence of PRAME by immunohistochemistry (IHC) was reviewed and compared to the detection of PRAME by PCR from the DMT on the same lesion.​ Results: ​ At the 1-year mark of the registry, there were roughly 8,000 unique entries. Of those, 1,021 (12.8%) were positive for one or more of the DMT genomic markers. One thousand three lesions (98.2%) had records available. Pathologists used PRAME IHC for 102 lesions (10.2%). Of those, 40 (39.2%) were positive by IHC, and 62 (60.8%) were negative by IHC. PRAME positivity by PCR correlated with PRAME positivity by IHC in 35 of 40 lesions (87.5%). Conversely, PRAME was detected using PCR in 28 of 62 lesions (45.2%) where it was not detected using IHC. ​ Conclusions: ​ The higher sensitivity of PCR compared to IHC may explain the higher concordance when PRAME is positive by IHC than when it is negative by IHC. In this data set, when PRAME is positive by IHC it is usually also positive by PCR. When PRAME is negative by IHC, it can still be detected by PCR in a substantial percentage of cases. The increased sensitivity of PCR is likely due to several factors, including its detection of the PRAME mRNA and sampling of the entire lesion. As such, PRAME PCR status may aid pathologists in understanding the risk of melanoma even when IHC is negative. Further research is warranted to understand the clinical implications of PRAME PCR versus IHC positivity. ​

Background: Pigmented lesion analysis remains a challenging aspect of dermatology. The DermTech Melanoma Test (‘the test’) is a non-invasive genomic test designed to rule-out melanoma. It consists of the pigmented lesion assay, which detects RNA products of Long Intergenic Non-Coding RNA 00518 (LINC00518) and Preferentially Expressed Antigen in Melanoma (PRAME), and an add-on assay for DNA promoter mutations in telomerase reverse transcriptase (TERT). In previous studies, the test was found to have a negative predictive value ≥99%. This interim analysis of a registry study examines the genomic patterns of the Lentigo Maligna (LM) subtype of melanoma. Methods: Between April 2021 and March 2022, multiple geographically diverse sites throughout the US submitted data to a registry to assess real-world use of the test. Approximately 8,000 clinically atypical lesions were tested. After receiving the test result, providers followed their clinical judgement for biopsy decision. Histopathologic diagnoses for biopsied lesions were correlated with test results and all melanomas were sorted into LM subtype vs non-LM subtype. In addition, lesions that were noted to be on sun exposed skin and/or noted to have solar elastosis and called atypical melanocytic hyperplasia were included. Results: At the 1-year mark of the registry, there were roughly 8000 unique entries. Of those, 1003 expressed one or more genomic markers from the DMT and had records available, and 134 (13.2%) were found to be melanoma or melanoma in-situ. More than a third (n=46, 34.3%) of the melanomas were of the Lentigo Maligna sub-type, with 7 of those being Lentigo Maligna Melanoma (LMM). Seven additional lesions were called atypical junctional melanocytic hyperplasia (AJMH) on sun-damaged skin. This group of 53 LM, LMM, and AJMH lesions were all evaluated for correlations to the DMT markers. LINC was the most commonly expressed genomic marker (n=45, 84.9%), with PRAME (n=36, 67.9%) and TERT (n=24, 45.3%) following. Most invasive tumors (LMM) expressed all three markers (n=4) and all 7 expressed LINC. Conclusion: While the original validation study included the LM subtype, this interim registry analysis demonstrates real-world use of the DMT in assessing pigmented macules concerning for LM. Over 1/3 of the melanomas reported in the registry were LM subtypes. LINC had a higher correlation with the lentigo maligna subtype of melanoma and was present in all invasive tumors. While AJMH is considered borderline, it may be worthwhile in the clinical context to group AJMH lesions with LM due to similarities in treatment.

The clinical evaluation of pigmented lesions represents a 'high-stakes' scenario as a missed melanoma can be fatal. Traditional clinical assessment visually sorts pigmented lesions into those that merit a biopsy and those that do not. In our practice there exists a group of lesions judged to not merit biopsy where melanoma, while very unlikely, cannot be excluded with absolute certainty. These ambiguous pigmented lesions (APLs) were often photographed and followed for clinical evolution. This article evaluates the presence of APLs and describes the use of non-invasive genomic testing to sort them. An informal survey using pictures of 10 APLs found that 6 of 8 dermatology providers were unable to identify which were melanomas. Next, our single practice chart review of 1,254 APLs evaluated by non-invasive genomic testing revealed 35 melanomas. All 1,254 were lesions that fell below our biopsy threshold. Non-invasive genomic testing can improve biopsy decisions particularly in clinically indeterminate pigmented lesions.

Advances in genomic technology have allowed providers to evaluate pigmented lesions with greater reliability. Using all available methods to evaluate changing lesions has led to earlier detection and actionable results.

OBJECTIVE The incidence of melanoma is increasing. Other than limiting UV exposure, few factors prevent or reduce the risk of melanoma. The aim of this study is to evaluate the relationship between vitamin D intake and melanoma risk in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial. METHODS A secondary data analysis was performed on PLCO data. More than 1,300 participants developed melanoma. RESULTS Melanoma risk may be increased among men within the highest quartile of vitamin D intake (HR 1.27, 95% CI 0.99, 1.61). Women in the highest quartile of vitamin D intake had a decreased risk of invasive melanoma (HR 0.63, 95% CI 0.41, 0.96). Higher education and being white corresponded with deeper tumors (P < .001). CONCLUSION High reported vitamin D intake resulted in an increased risk of melanoma among men. Vitamin D intake yielded a protective effect against invasive melanoma in women.

Importance:Staged excision of lentigo maligna (LM) often requires multiple stages and can result in significant cosmetic morbidity. Imiquimod cream has been used off-label as monotherapy in the treatment of LM and may be used in the neoadjuvant setting prior to staged excision as a strategy to reduce the size of the surgical margins required to confirm negative histologic margins.Objective:To examine the rate of recurrence of LM in patients treated with neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions.Design, Setting, and Participants:This was a retrospective medical record review of 334 patients with 345 biopsy-confirmed LM tumors from June 2004 to January 2012 who were treated with imiquimod prior to undergoing staged excisions at the University of Utah Medical Center and Huntsman Cancer Institute, large academic hospitals in Salt Lake City.Interventions:Patients were treated with off-label imiquimod, 5%, cream 5 nights per week for 2 to 3 months. Those deemed to have an inadequate inflammatory response were also treated with tazarotene, 0.1%, gel twice weekly. Conservatively staged excisions, beginning with 2-mm margins, were then performed.Main Outcomes and Measures:The rate of recurrence of LM after long-term follow-up.Results:Patients included 235 men (70%) and 99 women (30%) with a mean (SD) age of 67 (13) years. Patients were treated with imiquimod cream for a mean of 2.5 months prior to undergoing conservatively staged excisions. There were 12 local recurrences (a rate of 3.9%) with a mean time to recurrence of 4.3 years and a mean length of follow-up of 5.5 years.Conclusions and Relevance:Neoadjuvant topical imiquimod, 5%, cream prior to conservatively staged excisions for LM allowed for negative histologic margins with a median final margin of 2 mm and a rate of recurrence similar to reported recurrence rates with standard staged excisions by either Mohs surgery or en face permanent sections.

This study uses a two-stage logistic regression model to explore the determinants of retirement planning behavior. A survey of 516 UK women and men of prestate retirement age was used to establish interrelationships between gender, retirement planning, and financial literacy, taking account of attitudinal and expectational variables. Findings confirm lower levels of planning among women, but contrary to previous studies, this study reveals that financial literacy is not significantly related to planning. Furthermore, when attitudinal and expectational variables are incorporated as independent variables, gender becomes statistically insignificant as a determinant of planning.

Pay-as-you-go state pension schemes such as that operated in the United Kingdom face growing pressures from the rising old-age dependency ratio and improvements to life expectancies. Alongside compulsory increases in the statutory retirement age, governments have used incentives to encourage workers to postpone voluntarily their exit from employment, deferring their Basic State Pension in exchange for the additional financial reward of an enhanced pension at a later point in time. The impact of pension deferral upon the sustainability of the state pension system is dependent on the interplay of short-term savings from payment delay and increased subsequent longer-term payments to pension recipients. This article presents a model that simulates the financial effect of deferral uptake on the National Insurance Fund over a 40-year projection under alternative scenarios, including current and revised post-2016 deferral incentives. The findings indicate that the recent change in enhancement rate from 10.4 per cent to 5.8 per cent will significantly impact on state pension sustainability while still providing an incentive to defer. We estimate that any reduction below 4 per cent would result in zero uptake of the deferral option, based on a rational financial choice.

skipping and a premature terminal codon in exon 87. The latter is degraded by the nonsense-mediated mRNA decay mechanism, resulting in formation of sufficient anchoring fibril formation to bind to the basement membrane, which seems to be independent of blister formation. However, exon skipping leads to the in-frame deletion of 23 amino acid residues in the triple helical region of COL7A1, which disturbs the anchoring fibril formation in our patient, as has been reported previously by other authors. Although most of the reported mutations in DEB-Pr are heterozygous splicing site mutations near the 30 end of exon 87, the mechanism of development of the characteristic skin features in DEB-Pr remains unknown, and further investigation is needed to clarify this issue.

This book addresses the tendency to mischaracterise liberalism as a "neoliberal" reform project, arguing that liberal political philosophy is concerned only to sustain the conditions that make individ

As a principle of justice, Citizenship designates the universal rights and obligations that are required to protect liberty. While all liberals assert the importance of individual sovereignty, there has been substantial disagreement around the legitimate scope and substance of citizenship. Classical liberals maintain that liberty is optimised only where governmental action is directed towards the possibility of coercive intrusion by other people. While accepting the requirement for an appropriate regime of negative rights, egalitarian liberals insist that liberty requires access to external resources, such as those made possible by redistributive income transfers. Considered only in terms of citizenship, a just retirement system must address the reality of financial insecurity, as well as the possibility of coercion.