Pilot investigation of an activity-based approach to building hardiness

BACKGROUND

The purpose was to describe an activity-based psychological hardiness training programme delivered by an occupational therapist and examine its acceptability and effectiveness in improving hardiness.

METHOD

Participants (N=28) completed the 6-hour programme, which included pre/post-programme completion of the Dispositional Resilience Scale-15 (DRS-15) and a Program Evaluation Form. Paired t-tests were used to determine differences between pre-training and post-training scores on the DRS-15.

RESULTS

Results showed a significant increase (p<0.05) in total hardiness, commitment, and control scores on the DRS-15 from pre-training to post-training and good-excellent ratings for all categories on the Program Evaluation Form.

CONCLUSIONS

This programme evaluation described an occupational therapist's role in providing an activity-based psychological hardiness training programme and provided preliminary support for the acceptability of an activity-based approach to training psychological hardiness for service members.

STRIDER NZAus: a multicentre randomised controlled trial of sildenafil therapy in early-onset fetal growth restriction

OBJECTIVE

To assess the effect of maternal sildenafil therapy on fetal growth in pregnancies with early-onset fetal growth restriction.

DESIGN

A randomised placebo-controlled trial.

SETTING

Thirteen maternal-fetal medicine units across New Zealand and Australia.

POPULATION

Women with singleton pregnancies affected by fetal growth restriction at 22⁺⁰ to 29⁺⁶ weeks.

METHODS

Women were randomised to oral administration of 25 mg sildenafil citrate or visually matching placebo three times daily until 32⁺⁰ weeks, birth or fetal death (whichever occurred first).

MAIN OUTCOME MEASURES

The primary outcome was the proportion of pregnancies with an increase in fetal growth velocity. Secondary outcomes included live birth, survival to hospital discharge free of major neonatal morbidity and pre-eclampsia.

RESULTS

Sildenafil did not affect the proportion of pregnancies with an increase in fetal growth velocity; 32/61 (52.5%) sildenafil-treated, 39/57 (68.4%) placebo-treated [adjusted odds ratio (OR) 0.49, 95% CI 0.23-1.05] and had no effect on abdominal circumference Z-scores (P = 0.61). Sildenafil use was associated with a lower mean uterine artery pulsatility index after 48 hours of treatment (1.56 versus 1.81; P = 0.02). The live birth rate was 56/63 (88.9%) for sildenafil-treated and 47/59 (79.7%) for placebo-treated (adjusted OR 2.50, 95% CI 0.80-7.79); survival to hospital discharge free of major neonatal morbidity was 42/63 (66.7%) for sildenafil-treated and 33/59 (55.9%) for placebo-treated (adjusted OR 1.93, 95% CI 0.84-4.45); and new-onset pre-eclampsia was 9/51 (17.7%) for sildenafil-treated and 14/55 (25.5%) for placebo-treated (OR 0.67, 95% CI 0.26-1.75).

CONCLUSIONS

Maternal sildenafil use had no effect on fetal growth velocity. Prospectively planned meta-analyses will determine whether sildenafil exerts other effects on maternal and fetal/neonatal wellbeing.

TWEETABLE ABSTRACT

Maternal sildenafil use has no beneficial effect on growth in early-onset FGR, but also no evidence of harm.

Collaborating to Compete: Blood Profiling Atlas in Cancer (BloodPAC) Consortium

The cancer community understands the value of blood profiling measurements in assessing and monitoring cancer. We describe an effort among academic, government, biotechnology, diagnostic, and pharmaceutical companies called the Blood Profiling Atlas in Cancer (BloodPAC) Project. BloodPAC will aggregate, make freely available, and harmonize for further analyses, raw datasets, relevant associated clinical data (e.g., clinical diagnosis, treatment history, and outcomes), and sample preparation and handling protocols to accelerate the development of blood profiling assays.

Maternal pulmonary oedema during foetoscopic surgery

We report a case of maternal pulmonary oedema necessitating intubation and ventilation with associated hyperchloraemic metabolic acidosis during foetoscopic laser surgery for twin-twin transfusion syndrome (TTTS), believed to be secondary to absorption of normal saline irrigation fluid. TTTS complicates 10% to 20% of monochorionic twin pregnancies and develops due to imbalanced vascular anastomoses and consequent unidirectional transfusion between the twins. The recipient is at risk of cardiac failure due to circulatory overload and the donor twin becomes hypoperfused. The recipient is polyhydramniotic and the donor is oligohydramniotic. Untreated severe TTTS has a mortality rate of up to 90%. Treatment options include delivery if viable, serial amnioreduction or foetoscopic laser ablation of the communicating vessels. Since the Eurofoetus study, laser ablation has been the mainstay of treatment for pre-viable TTTS, involving insertion of endoscopes transabdominally into the polyhydramniotic sac to allow visualisation and ablation of the anastosmotic vessels. Amnioreduction does not correct the underlying pathology and offers very little in advanced disease. Foetoscopic laser ablation leads to an improved survival past 28 days and a lower incidence of neurological complications compared to serial amnioreduction.

Reproducibility of constituent time intervals of right and left fetal modified myocardial performance indices on pulsed Doppler echocardiography: a short report

OBJECTIVE

To assess reproducibility of constituent time intervals measured by pulsed Doppler echocardiography for calculation of the right and left fetal myocardial performance indices (MPIs).

METHODS

This was a prospective study of 30 normal singleton pregnancies (19-36 weeks). In each, five different time intervals were measured from the Doppler waveform and four repeated measures were taken for each time interval. Three were from the left heart: isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT) and ejection time (ET); two were from the right heart: 'a-interval' and 'b-interval'. The left and right modified MPIs (Mod-MPIs) generated by these constituent time intervals were also evaluated. Two operators evaluated the reproducibility of all measures.

RESULTS

There was generally good intra- and interobserver reproducibility for all time intervals and resultant Mod-MPIs: ICT, range, 19-43 ms with intraclass correlation coefficient (ICC), 0.91 (95% CI, 0.85-0.95); ET, range, 160-184.8 ms with ICC, 0.90 (95% CI, 0.84-0.95); IRT, range, 35.8-48.5 ms with ICC, 0.67 (95% CI, 0.52-0.81); a-interval, range 208-265 ms with ICC, 0.89 (95% CI, 0.82-0.94); b-interval, range, 163.1-188.3 ms with ICC, 0.82 (95% CI, 0.71-0.90); left Mod-MPI, range, 0.33-0.48 with ICC, 0.84 (95% CI, 0.74-0.91); right Mod-MPI, range, 0.21-0.49 with ICC, 0.82 (95% CI, 0.71-0.90). The 95% limits of agreement showed no statistically significant difference in measurements between the two examiners for all time intervals.

CONCLUSION

This is the first study to evaluate the reproducibility of the component time intervals of both right and left fetal Mod-MPIs in the second and third trimesters and supports the reproducibility of fetal functional cardiac assessment. The IRT is the main source of variation for the left Mod-MPI so should be the focus of further investigation. Even using two separate pulsed-wave Doppler gates and therefore separate cardiac cycles, the right Mod-MPI is reproducible.

A Quantitative Immunofluorescence Assay (AQUA) Suggests Significant Misclassification (15%) of Estrogen Receptor Status in Breast Cancer

Introduction: Estrogen Receptor (ER) is arguably the most powerful predictive marker in breast cancer. However, a recent incident in Canada revealed a strikingly high false-negative rate and raised awareness of the current limitations in our measurement of ER. The current clinical standard is both subjective and qualitative. Even though guidelines are about to be issued to standardize this assay, there is very little data on the misclassification rate in current practice in the US.Hypothesis: Our hypothesis is that the use of a quantitative assay for ER on a series of retrospective collections may reveal both the level and significance of the misclassification rate.Method: Cell lines with a range of ER expression levels were analyzed by quantitative western blotting in parallel with IF/AQUA analysis (r2 = 0.865), in order to create standard curves for assessment of absolute ER protein concentration in tissue. The optimized assay was then used to quantify ER protein expression in a large cohort of archival breast cancer samples from Yale (1962-1982, n =617).Results: Using a set of standard curves with recombinant ER and cell line controls, we developed a standardized method for quantifying ER as an absolute concentration (pg ER per μg total protein) in formalin-fixed tissue on TMAs. This ER AQUA assay has a range in sensitivity from 50 pg/μg to 1500pg/μg total protein. Quantification of ER protein expression on the Yale archival cohort revealed a unimodal distribution with 49.8% of cases above the 50pg/ug threshold and thus defined as positive. When compared to pathologist performed conventional ER classification, we found a false negative rate of 6.65% and a false positive rate of 10.2%, for a total misclassification rate of 16.6%. Although no response data is available on that cohort, data is under analysis on 4 other cohorts with endocrine therapy treatment information, including an independent Yale cohort, SWOG 9313, NSABP B14, and the TEAM trial.Conclusion: We have developed a quantitative method to measure absolute levels of ER in breast tissue. Use of this assay on a series of cohorts suggests a misclassification rate in the 15% range. The significance of this level of misclassification with respect to response to endocrine therapy is currently under study.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4068.

Evaluation of the false-negative rate of standardized and quantitative measurement of estrogen receptor (ER) in tissue using AQUA technology

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Background: The discovery of an astoundingly high false negative rate for estrogen receptor (ER) testing in Canada has raised questions about the accuracy and reproducibility of ER testing. One solution would be the introduction of a standardized and reproducible diagnostic test that is easily adaptable in the clinical setting. Here, we have tested the AQUA method of quantitative immunofluorescence for the standardized and reproducible quantification of ER protein expression in tissue. Methods: Quantitative Western blotting was used in conjunction with AQUA analysis to create standard curves for assessment of absolute ER protein concentration in tissue (n = 118). We used standard scoring methods and AQUA analysis to quantify ER protein expression in a large cohort of breast cancer samples (n =669). Results: Using a series of standard curves, we determined that the range of the ER AQUA assay is between 100 pg/μg and 1500 pg/μg total protein. ER protein concentration in breast cancer samples showed an expected unimodal distribution for quantitative assessment of ER. Reproducibility studies of AQUA analysis demonstrated significant instrument-to-instrument (laboratory-to-laboratory) reproducibility for 3 instruments across the range of AQUA scores (average %CV = 1.34; R2>0.99; ANOVA p = 0.67). The same cases were then read and classified by 3 pathologists using the Allred scoring system. Although their concordance is similar to that seen in the literature (Kappa = 0.81, 0.88, and 0.89), pathologist concordance rate is lower than for that observed with AQUA analysis (Kappa = 0.95, 0.96, and 0.97). Importantly, 9.0% of cases showed a change of diagnosis (positive/negative) across 3 pathologists whereas only 2.8% of cases changed classification using AQUA analysis. Additionally, misclassified cases occurred across the entire range of Allred scores, but were restricted to a narrow region defined by the cut-point for AQUA scoring. Conclusions: We have demonstrated that AQUA technology can provide for the standardized and reproducible quantification of ER with a 3 fold reduction in misclassification. This approach has the potential to decrease the problem of false negative tests for ER.

[Table: see text]

Contrasting mammal responses to vegetation type and fire

The response of terrestrial mammals and arboreal marsupials to past burning history as well as a year prior to, and then for 4 years after, a major wildfire in 2003 at Booderee National Park, Jervis Bay Territory was quantified. The present study encompassed extensive repeated surveys at a set of 109 replicated sites stratified by vegetation type and fire history. It was found that most species exhibited significant differences in presence and abundance between major vegetation types. Detections of long-nosed bandicoot (Perameles nasuta) increased significantly in all vegetation types surveyed, in both burnt and unburnt areas. Temporal patterns in captures of three species of small mammals (bush rat (Rattus fuscipes), swamp rat (Rattus lutreolus) and brown antechinus (Antechinus stuartii)) showed a trend for lower numbers of captures on burnt sites compared with unburnt sites. Three species of arboreal marsupials, common ringtail possum (Pseudocheirus peregrinus), greater glider (Petauroides volans) and common brushtail possum (Trichosurus vulpecula), were moderately common and all showed marked differences in abundance between vegetation types. Whereas P. peregrinus and P. volans exhibited a temporal decline between 2003 and 2006, T. vulpecula exhibited a general increase from 2003 levels. However, arboreal marsupial responses did not appear to be directly fire related.

Increased frequency and suppressive function of CD4+ CD25high regulatory T-cells in acute myeloid leukemia patients

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Background: Regulatory CD4+CD25+ T cells (T reg) are critical regulators of immune tolerance. However, the functional role of T reg in human tumor immunity has been less well studied. The frequency of circulating Treg is increased in patients with solid malignancies. We evaluated the frequency, phenotype and suppressive function of T reg in patients with acute myeloid leukemia (AML). Methods: The frequency and phenotype of CD4+ CD25high T cells were investigated in the peripheral blood of fifteen newly diagnosed AML patients prior to any treatment and fifteen healthy donors by multiparameter flow cytometry. The suppressive function of Treg was evaluated using CFSE-labeled fresh autologous CD4+CD25- T cells activated with an anti-CD3 antibody. Results: The percentage of circulating CD4+ CD25high Treg was higher (p <0.001) in the AML patients (5.2 ± 1.3%, range 0.4 −7%) compared to healthy donors (1.1 ± 0.2%, range 0.8–1.5%). T reg expressing Foxp3, CTLA-4, CD45 RO, CCR4 and Fas receptor (CD95) were significantly elevated in the circulation of AML patients, but GITR expression on Treg was low. Suppression mediated by T reg co-incubated with proliferating autologous responders was also significantly higher (p<0.001) in AML than that mediated by control T reg (75 ± 6% vs 12%± 4%). Conclusions: These results indicate that T reg accumulate in the periphery of patients with AML and have vigorous suppressive functions. This high suppressive activity may impair the host anti-tumor responses and promote leukemogenesis.

No significant financial relationships to disclose.

Factors influencing the diagnosis and treatment of periodontal disease by dental practitioners in Victoria

BACKGROUND

Healthy periodontal tissues are essential to overall dental health. Therefore, the detection and management of periodontal disease is an integral part of general dental practice. The aim of this study was to investigate confidence in diagnosis and management of periodontal disease by general dental practitioners (GDPs), assess if the Dental Practice Board guidelines on periodontal record keeping are being addressed, and, if necessary, try to find ways of improving the periodontal knowledge of GDPs.

METHODS

A survey assessing practitioner confidence in diagnosing and treating periodontal disease was sent to a random selection of 550 dental care providers registered with the Dental Practice Board of Victoria.

RESULTS

Two hundred and eighty five (51.8 per cent) of questionnaires were returned completed. It was found that 79.7 per cent of the sampled population screened all new patients for periodontal disease. The majority of respondents felt confident to diagnose and treat gingivitis and initial periodontitis. However, only 61.9 per cent felt confident to diagnose aggressive/early onset periodontitis, and many were not confident in treating advanced periodontitis (36.3 per cent) or aggressive periodontitis (51.6 per cent). The majority of dentists reported that they provided most of the non surgical periodontal therapy to their patients, while most surgical treatments were referred to specialist periodontists. Factors deemed to be important in influencing the decision to provide periodontal treatment included level of training and ability to motivate patients to improve oral hygiene. Many responents requested periodontic continuing education (CE) courses be run.

CONCLUSIONS

Most of the dentists surveyed were confident to diagnose periodontal disease and to treat the more common presentations of periodontal disease. There is some evidence to suggest that some practitioners are not following the minimum requirements set by the Dental Practice Board of Victoria in relation to periodontal record keeping. The results also indicate a need for more periodontic CE courses in Victoria.

Effects of trap position, trap history, microhabitat and season on capture probabilities of small mammals in a wet eucalypt forest

In this study, we use data drawn from a series of trapping events on four 0.5-ha trapping grids surveyed in the wet eucalypt forests of central Victoria, south-eastern Australia, to identify relationships between capture probabilities and several factors of interest for three species of small mammals that are common throughout the forests of this region: the agile antechinus (Antechinus agilis), the dusky antechinus (Antechinus swainsonii) and the bush rat (Rattus fuscipes). The design of our study – four regular trapping grids – generated spatio-temporal data with binary responses and many covariates. We used powerful and relatively new statistical methodology to deal with the spatio-temporal dependence patterns in the data – analytical problems that are common in trapping data such as these modelled here. Although A. agilis, A. swainsonii and R. fuscipes are among the best studied mammals in Australia, our data analysis produced new perspectives on their probability of being captured. In particular, we quantified how capture probability is affected by trap position within a trapping grid, day of capture in a sequence of trapping days, history of trap occupancy over time by different species and sexes of those species, time of the year or season, and microhabitat attributes. Our insights are discussed in terms of their consequences for trapping protocols that might be applied in the field.

Habitual fish consumption and glycated haemoglobin: the EPIC-Norfolk study

OBJECTIVE

To investigate the association between habitual fish consumption and a continuous measure of glycaemia.

DESIGN

Cross-sectional study.

SETTING

EPIC-Norfolk, a population-based cohort study of diet and chronic disease.

SUBJECTS AND METHODS

In all, 4500 men and 5509 women, aged 40-78 y, without self-reported diabetes. Diet was assessed by a semiquantitative food frequency questionnaire, and glycaemia was measured by glycated haemoglobin.

RESULTS

In women only, in analyses adjusted for age, the HbA(1c) level was positively associated with eating fried fish and inversely associated with eating oily fish (b=0.036, 95% confidence interval (CI): 0.0033, 0.069; and b=-0.046, 95% CI:-0.086, -0.0064 respectively). These associations were attenuated by adjustment for family history of diabetes, smoking status and physical activity level, but the association with fried fish remained statistically significant (b=0.033, 95% CI: 0.00056, 0.066). Adjusting for total energy, alcohol, fruit and vegetable intakes resulted in further attenuation and both associations were no longer statistically significant. In men, there was no evidence that HbA(1c) level was associated with fish consumption.

CONCLUSIONS

The study found no evidence of an association between fish consumption and HbA(1c) after taking other lifestyle factors into account.

Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity

The negative effects of sleep deprivation on alertness and cognitive performance suggest decreases in brain activity and function, primarily in the thalamus, a subcortical structure involved in alertness and attention, and in the prefrontal cortex, a region subserving alertness, attention, and higher-order cognitive processes. To test this hypothesis, 17 normal subjects were scanned for quantifiable brain activity changes during 85 h of sleep deprivation using positron emission tomography (PET) and (18)Fluorine-2-deoxyglucose ((18)FDG), a marker for regional cerebral metabolic rate for glucose (CMRglu) and neuronal synaptic activity. Subjects were scanned prior to and at 24-h intervals during the sleep deprivation period, for a total of four scans per subject. During each 30 min (18)FDG uptake, subjects performed a sleep deprivation-sensitive Serial Addition/Subtraction task. Polysomnographic monitoring confirmed that subjects were awake. Twenty-four hours of sleep deprivation, reported here, resulted in a significant decrease in global CMRglu, and significant decreases in absolute regional CMRglu in several cortical and subcortical structures. No areas of the brain evidenced a significant increase in absolute regional CMRglu. Significant decreases in relative regional CMRglu, reflecting regional brain reductions greater than the global decrease, occurred predominantly in the thalamus and prefrontal and posterior parietal cortices. Alertness and cognitive performance declined in association with these brain deactivations. This study provides evidence that short-term sleep deprivation produces global decreases in brain activity, with larger reductions in activity in the distributed cortico-thalamic network mediating attention and higher-order cognitive processes, and is complementary to studies demonstrating deactivation of these cortical regions during NREM and REM sleep.

Unusual cases of congenital cholesteatoma of the ear

Congenital cholesteatoma may originate at various sites in the temporal bone. For example, in the petrous apex, the cerebellopontine angle, the middle ear cavity, the mastoid process or the external auditory canal. The least common site being the mastoid process. We present two cases of congenital cholesteatoma of the mastoid process, each presenting with different symptoms and at different ages. Both patients underwent surgical treatment, which confirmed the diagnosis and radiological findings.

A comparison of four ultraviolet sources to alter graft-versus-host responses

Graft-versus-host disease (GVHD) is a major contributor to the morbidity and mortality associated with allogeneic bone marrow transplantation. Direct ultraviolet B (UVB) irradiation of bone marrow and spleen cell allografts in mice using broadband lamps is known to abolish alloreactive responses which would normally cause GVHD. Using a histoincompatible murine model, we have extended these observations by comparing the physical spectrum of four UV sources (the Philips TUV8W, TL12 and TL01, and the Spectronics XX15B) with in vitro assessment of bone marrow progenitor cell damage and suppression of lymphocyte proliferation and in vivo comparison of the effect on GVHD of the TL12 and XX15B and on the rate of engraftment with the TL12. At doses of uv found to abolish lymphocyte proliferation (2.5, 7, 12 and 1000 J m(-2) with the TUV8W, XX15B, TL12 and TL01 lamps) colony-forming unit granulocyte-macrophage (CFU-GM) proliferation was reduced to 81%, 71%, 79% and 62%, respectively. At an optimal dose found to suppress GVHD (100 J m(-2) integrated radiant energy from 200-320 nm for the TL12 and XX15B) CFU-GM proliferation showed a reduction of 98% with the XX15B and 86% with the TL12. At this radiant energy with the TL12, the rate of bone marrow engraftment was impaired with 72% marrow cellularity at 2 weeks, decreasing to 48% after 200 J m(-2). Our results with this model demonstrate that broadband UVB irradiation of bone marrow permits transplantation across a major histocompatibility barrier. Furthermore we have provided in vitro evidence that narrowband UVB or UVC might potentially be applied to this model.

The use of nest trees by the mountain brushtail possum (Trichosurus caninus) (Phalangeridae : Marsupialia). V. Synthesis of studies

A general synthesis is presented of the key results of a series of studies of den tree use by the mountain brushtail possum (Trichosurus caninus) at Cambarville in the mountain ash (Eucalyptus regnans) forests of the central highlands of Victoria, south-eastern Australia. The project produced a range of unexpected results including (1) the number of den trees used, (2) the extent of den sharing, especially among adult males, (3) the overlap in denning ranges of animals, and (4) the predictability of transitions between den trees. Possible reasons for these findings are outlined. We also discuss the limitations of our study, how it could be improved if it were to be repeated, and some of the important implications of the findings for the management of forests where T. caninus occurs.

Onset of action, efficacy, and safety of a single dose of fexofenadine hydrochloride for ragweed allergy using an environmental exposure unit

BACKGROUND

Fexofenadine hydrochloride is the active acid metabolite of terfenadine. Fexofenadine's anti-allergic properties require confirmation in a clinical setting.

OBJECTIVE

The purpose of this study was to characterize the time to onset of clinically important relief of symptoms of allergic rhinitis in subjects taking single doses of either 60 mg or 120 mg fexofenadine HCl, or placebo, after exposure to ragweed pollen in a controlled environment. Other objectives were to assess the efficacy and safety of single doses of fexofenadine HCl.

METHODS

One hundred forty-six ragweed-sensitive subjects were primed in the off-season with ragweed pollen in the environmental exposure unit. One hundred thirty-six subjects who adequately responded to priming entered a single-dose placebo phase. Placebo-responders were disqualified from the study, leaving 99 subjects with adequate symptoms to be randomized and given a single dose of either fexofenadine HCl 120 mg (33), 60 mg (33) or placebo (33), after 60 minutes of allergen exposure. Exposure continued over five hours and subjects recorded symptoms every 20 minutes. This study was of a randomized, placebo-controlled, double-blind, parallel design.

RESULTS

Median time to onset for relaxed criteria clinically important relief was 60 minutes for both fexofenadine treatment groups, and 100 minutes for placebo (P = .018). The proportion with relief was 82% at 60 mg, 85% at 120 mg, and 64% for placebo. Treated groups had reductions in symptom scores double that of placebo.

CONCLUSIONS

Fexofenadine is safe and efficacious at single doses of 60 mg and 120 mg. Average time to onset was 60 minutes using controlled pollen exposure in an environmental exposure unit.

Phylogeny of North American Cicindela tiger beetles inferred from multiple mitochondrial DNA sequences

Tiger beetles in the genus Cicindela (Coleoptera: Cicindelidae) have been used as a model system for studies in ecology and conservation biology. Work on this group will greatly benefit from the availability of a phylogenetic hypothesis. We selected a representative sample of 23 North American Cicindela and 6 outgroups to reconstruct a phylogeny based on 1896 nucleotide positions from three mitochondrial genes (Cytochrome b, Cytochrome oxidase III, and 16S rRNA). Cladistic analysis of these three data sets yielded widely different tree topologies, but character conflict between them appears to be relatively low. The combined analysis of all data resulted in three similar shortest trees of 3453 steps. One of these was also recovered after successive weighting and was considered the best estimate of relationships. The most basal taxa of North American Cicindela (s.l.) were in the cosmopolitan subgenus Cylindera. The derived taxa were in the subgenus Cicindela (s. str.), a group dominating at higher latitudes in the Nearctic and Palearctic Region. The molecular analysis was essentially in agreement with the traditional classification which has been worked out based on male genitalic structures by E. Rivalier (1954, Rev. Entomol. Française 21:249-268). In the molecular analysis, Rivalier's species groups and subgenera were mostly found to be composed of closely related taxa but several of them were not monophyletic. Implicit in the traditional classification is a sequence from basal to derived groups which we found to be essentially reversed in the molecular analysis. We also discuss the conceptual differences in the establishment of the traditional classification by Rivalier (1954) and the cladistic analysis presented in this study.

Pre- admission clinics in ENT: a national audit of UK practice and opinion

A one-year prospective audit (1989) of patient non-attendance for elective surgery in our department showed that of those summoned, five per cent defaulted on the day of admission without contacting the hospital (Hampal and Flood, 1992). Contributing factors such as lengthy waiting lists and inefficient communication with the patients were amenable to correction by the hospital. However, the current admission policy made inevitable a significant waste of theatre time. The pre-admission clinic (PAC), an outpatient attendance shortly before surgery, was recommended in ENT practice by Robin (1991) and introduced into our department the year. Failure to attend the PAC allowed adequate time for replacement on the theatre list and was recommended as a solution to the problem of unfilled theatre sessions (Dingle et al., 1993). A subsequent four-year experience of conducting PACs has confirmed several expected advantages. However, some of the hopes for development expressed in our earlier work (Dingle et al., 1993) have failed to materialize. This study aims to review retrospectively our experience and compare it with the admission practice and desires of ENT departments in the United Kingdom as revealed by a postal survey. The findings are of relevance to all surgical specialties and to anaesthetic departments wishing to adopt this system of admission.

Use of Nest Trees by the Mountain Brushtail Possum (Trichosurus caninus) (Phalangeridae : Marsupialia). III. Spatial Configuration and Co-occupancy of Nest Trees

Radio-tracking was used to examine the spatial configuration and co-occupancy of large trees with hollows occupied by 16 mountain brushtail possums (Trichosurus caninus) at Cambarville in the central highlands of Victoria, south-eastern Australia. The distance that animals moved between trees on successive days was also examined. Our analyses showed that animals often remained in a given den tree on successive days. On nights when animals did shift between den sites, they typically moved to a new tree that was relatively nearby (< 200 m). Long-distance movements (e.g. > 300 m) between den trees were rare. Considerable variation was found between individuals in the size of areas encompassing trees used frequently (≥5 times) (‘core denning range’) and those encompassing all occupied trees [i.e. including those used infrequently (< 5 times)] (‘total denning range’). The mean area of the core denning range averaged about 1·1 ha for males and 0·7 ha for females. The mean value for the total denning range was approximately 2·6 ha for males and females respectively. Considerable overlap was found in the total denning ranges of pairs of adult males and pairs of adult females. For most animals, the total denning range was shared with the total denning ranges of several other animals. There was substantial variation in the extent of this overlap, ranging from complete enclosure to the sharing of a single tree. The extent of overlap was more limited for the core denning ranges, particularly among females. We observed differences in the extent of the overlap of the total denning ranges of pairs of males and pairs of females in the breeding season (January–March) and non-breeding season (the remaining months of the year). Fewer instances of overlapping total denning ranges among pairs of both males and females were found during the breeding season. The total denning ranges in the breeding season were generally smaller than those in the non- breeding season. Simultaneous co-occupancy of a given den tree by T. caninus was relatively common. Unexpectedly, there was a number of instances of groups of three or four adult animals sharing the same den site on the same night. We recorded several instances of sharing by pairs of animals of the same sex, especially adult males. However, most records of simultaneous tree use were by an adult male and an adult female T. caninus. The extent of overlap in the denning ranges of animals and the prevalence of simultaneous co-occupancy of den trees indicate that the social behaviour of T. caninus at Cambarville may be different from that observed among populations of the species elsewhere in Australia. Possible reasons for these differences are outlined.

Phylogenetic analysis of slippage-like sequence variation in the V4 rRNA expansion segment in tiger beetles (Cicindelidae)

Sequence variation in the middle part of the small-subunit rRNA was studied for representatives of the major groups in the family Cicindelidae (Coleoptera). All taxa exhibited a much expanded segment in variable region V4 compared to D. melanogaster. This expanded segment was not found in other groups of beetles, including three taxa in the closely related Carabidae. Secondary structure predictions indicate that the expanded segment folds into a single stem-loop structure in all taxa. Despite its structural conservation, the fragment differs strongly in primary sequence, even between closely related sister taxa. Several features of these sequences are consistent with slippage replication as the mechanism that has generated this sequence variation: the level of internal sequence repetition as measured by the relative simplicity factor (RSF), its variation in length between close relatives, and the strong nucleotide bias compared to the remainder of the gene. With few exceptions, there was also a correlation between sequence length and the level of sequence repetition, frequently interpreted as the result of slippage. Phylogenies inferred from the expansion segment were not consistent with existing hypotheses from other molecular data for the group. This indicates that DNA sequences in this region are not homologous throughout the entire Cicindelidae, but it leaves open the possibility that this expansion segment can be used for phylogeny reconstruction within subgroups. The implications of a phylogenetic approach to the understanding of slippage-like evolution are discussed.

Use of Nest Trees by the Mountain Brushtail Possum (Trichosurus Caninus) (Phalangeridae: Marsupialia). Ii. Characteristics of Occupied Trees

The use of den trees by a population of the mountain brushtail possum (Trichosorus caninus) in forests of mountain ash (Eucalyptus regnans) at Cambarville, in the central Highlands of Victoria, is described. Relationships are explored between the use of trees with hollows by 16 radio-tracked T. caninus and a range of measures of the morphological characteristics of the 113 different den trees they occupied. The results of the analyses indicate that the most used trees contained a relatively large number of cavities and were not surrounded by dense vegetation. Male possums were found most frequently in the southern part of the 35-ha study area, and females were found most often in the northern part.

Use of Nest Trees by the Mountain Brushtail Possum (Trichosurus Caninus) (Phalangeridae: Marsupialia). I. Number of Occupied Trees and Frequency of Tree Use

A study was made of the use of trees with hollows by 10 adult male and 6 adult female mountain brushtail possums (Trichosurus caninus) at a 35-ha site in central Victoria, south-eastern Australia. Radio-tracking was used to identify which trees were being used as den sites by animals during an 18-month period between September 1990 and March 1992. Analyses of the data showed that, although 113 different trees were used by the 16 animals, most were occupied infrequently. The total number of trees used by a given animal ranged from 5 to 23. However, the majority of individuals spent most of their time denning in 1-3 trees. Of the 113 den trees, 70 were found to have been used by only 1 animal, 54 trees were used exclusively by males, and 28 trees by females only. Twelve trees were used extensively (on >40 occasions) but only 1 was used extensively by both sexes. Most of the T. caninus radio-tracked typically used 2 or more nest trees per week, indicating that animals moved frequently between den sites. Some animals used up to 6 different trees per week. Some possible reasons for this behaviour in T. caninus are discussed.

Double-blind food challenge in the diagnosis of food sensitivity in the adult

This study is an attempt to determine the role of double-blind food challenge (DBFC) in suspected food sensitivity in the adult as compared wih established tests of food allergy, including the skin test, RAST, and leukocyte histamine release (LHR) to specific food antigens. Twenty-two subjects (ages 18 to 67) with histories of reactions to foods were challenged with freeze-dried food or placebo in opaque dye-free capsules, in increasing doses over a 90 min span to a total of 13 to 15 gm. This was repeated twice at weekly intervals by similar DBFC. DBFC was preceded by skin testing and venapuncture for RAST and LHR studies. Patients were kept under observation for 2 hr, after which each was asked to maintain a detailed diary of related symptoms and food ingested over the following week. Of 46 DBFCs, 13 (21%) were positive. The correlation with positive skin tests and positive DBFC was 4/13 (30%). The correlation with positive LHR and positive DBFC was lower at 2/13 (15%), and 1/13 (7.6%) with RAST. We concluded that DBFC is an effective test of adult food sensitivity compared with tests usually performed and should be used when the diagnosis is in doubt.