Team Situation Awareness, Cohesion, and Autonomic Synchrony

OBJECTIVE

This study evaluated the causal relationships among situation awareness (SA), cohesion, and autonomic synchrony (SE) within teams. SA is often a team effort and should be more accurate in better-functioning teams.

BACKGROUND

Cohesive teams perform better overall, although the relationship appears reciprocal; the relationship to SA has not been considered previously. SE is a collective neurocognitive activity that has been connected to team coordination, communication, and performance in some circumstances.

METHOD

In this experiment, 71 undergraduates, organized into 16 teams, played two matches of a first-person shooter computer game and completed self-report measures of cohesion and SA. SE was determined through time series analysis of electrodermal responses using the driver-empath framework.

RESULTS

Empaths and those who came from more synchronized teams reported less cohesion in the team. Granger causality regression showed reciprocal relations among SA, SE, and cohesion that were both positive and negative after controlling for match difficulty.

CONCLUSION

The cohesion-SA relationship is similar to the reciprocal cohesion-performance relationship. SE plays an important and independent role in both the social and cognitive aspects of team behavior. It is possible, furthermore, that individuals who are more attuned to their co-workers reported a more accurate, and less obliging, social situation.

APPLICATION

Results are applicable to situations requiring teamwork in a dynamic environment.

Antineutrophil cytoplasmic antibodies in inflammatory arthritis--potential for misdiagnosis?

Antineutrophil cytoplasmic antibodies (ANCA) are well described in Wegener's granulomatosis and some forms of vasculitis. They have also been described in patients with arthritis, but the specificity of these ANCA and their relationship to the presence of vasculitis, antinuclear antibodies (ANA) and granulocyte-specific ANA (GS-ANA), and to disease activity are uncertain. We studied 101 patients with forms of inflammatory arthritis and detected four cytoplasmic ANCA, eight perinuclear ANCA and 16 atypical ANCA. There was no association between the presence of ANCA and ANA or rheumatoid factor. No anti-PR3 antibodies were found and no strong anti-myeloperoxidase antibodies were detected. Four GS-ANA were detected and were distinct from ANCA. There was no association between rheumatoid arthritis disease activity or disability and ANCA status. ANCA did not predict vasculitis over a 3 yr follow-up. These ANCA appear to be epiphenomena. Their importance lies in their potential to mislead physicians towards a misdiagnosis of vasculitis.

Cyclical etidronate plus ergocalciferol prevents glucocorticoid-induced bone loss in postmenopausal women

OBJECTIVE

To assess the benefit of cyclical etidronate plus ergocalciferol for the prevention of glucocorticoid-induced bone loss in a 2-year, prospective, open study based in an osteoporosis clinic.

PATIENTS AND METHODS

Group 1 consisted of 15 postmenopausal women (mean age 62.6 +/- 3.3 years) who commenced glucocorticoid therapy and were treated with cyclical etidronate (400 mg/d for the first month; thereafter, 400 mg/d for 2 weeks of every 3-month period), elemental calcium (1 g/d), and ergocalciferol (0.5 mg/wk). Group 2 consisted of 11 postmenopausal women (mean age 60.2 +/- 4.7 years) with glucocorticoid-induced osteoporosis, who were attending the clinic at the same time and were treated with calcium supplements only (1 g/d).

MEASUREMENTS

Lumbar spine and femoral neck bone mineral densities (BMD) were measured at baseline and after 12 and 24 months of glucocorticoid therapy using a dual energy x-ray absorptiometer.

RESULTS

The two groups did not differ with respect to age, years since the menopause, mean daily glucocorticoid dose, and baseline BMD values. During the first year of therapy, mean lumbar spine BMD increased from an initial value of 0.88 g/cm2 to 0.94 g/cm2, an increase of 7% per year (95% confidence interval [CI] 3.7% to 10.2%; P < 0.001 compared with controls). Significant increases in BMD of 2.5% per year were also observed in the femoral neck (95% CI -1% to 6%; P < 0.01 compared with controls). After the second year of cyclical etidronate therapy, femoral neck BMD continued to increase (P < 0.05 compared with value at 12 months), while lumbar spine BMD remained stable.

CONCLUSION

Chronic glucocorticoid therapy may result in bone loss at most skeletal sites. Therapy with cyclical etidronate plus ergocalciferol not only prevented glucocorticoid-induced bone loss, but even increased lumbar spine and femoral neck BMD in postmenopausal women commencing glucocorticoid therapy.

Sacral insufficiency fractures in the elderly

Sacral insufficiency fractures are not uncommon in elderly patients. We have diagnosed 20 cases in a five-year period, and have reviewed the clinical records, radiographs, CT and bone scans. We also assessed the degree of osteoporosis by measuring bone density using dual-energy X-ray absorptiometry and bone histomorphometry, and monitored the patients' functional outcome. Bone scans were positive in all 20 patients, CT showed a fracture or sclerosis in 7 of 12 patients and was useful in excluding malignancy. Plain radiographs were the least helpful, showing sclerosis in only 4 of the 20 patients. Involutional osteoporosis with a reduced bone formation rate was the most common underlying cause. Seventeen patients had complete resolution of pain within nine months, and no patient lost independence in daily activities. Increased awareness of these fractures may help to avoid unnecessary investigation and treatment. Bedrest and analgesia followed by rehabilitation provide good relief of symptoms.

Sacral insufficiency fractures in the elderly

Sacral insufficiency fractures are not uncommon in elderly patients. We have diagnosed 20 cases in a five-year period, and have reviewed the clinical records, radiographs, CT and bone scans. We also assessed the degree of osteoporosis by measuring bone density using dual-energy X-ray absorptiometry and bone histomorphometry, and monitored the patients' functional outcome. Bone scans were positive in all 20 patients, CT showed a fracture or sclerosis in 7 of 12 patients and was useful in excluding malignancy. Plain radiographs were the least helpful, showing sclerosis in only 4 of the 20 patients. Involutional osteoporosis with a reduced bone formation rate was the most common underlying cause. Seventeen patients had complete resolution of pain within nine months, and no patient lost independence in daily activities. Increased awareness of these fractures may help to avoid unnecessary investigation and treatment. Bedrest and analgesia followed by rehabilitation provide good relief of symptoms.

Rheumatic autoantibodies in the sera of patients with paraproteins

OBJECTIVE

A high incidence of autoantibody activity has been previously described in the sera of patients with paraproteins. In this study we determined the incidence of autoantibodies of particular interest to rheumatologists (including antinuclear antibodies (ANA), anti-DNA, rheumatoid factor (RF), anticardiolipin antibodies (aCL) and the Sjögren's-related antibodies anti-SS.A/Ro and anti-SS.B/La) in the sera of patients with paraproteins, and the frequency with which the autoantibody activity isotype and the paraprotein isotype were identical.

METHODS

ANA was determined by indirect immunofluorescence on HEp2 cells, anti-DNA by the Farr and Crithidia assays, aCL by ELISA, RF by nephelometry, antibodies to the extractable nuclear antigens (anti-ENA) by counter-immunoelectrophoresis (CIE), and anti-SS.B by immunoblot using a recombinant human SS.B antigen source. Incidences of these antibodies was compared in 3 groups of sera: 98 myeloma, 27 monoclonal gammopathy of uncertain significance (MGUS), and 24 age matched controls, using confidence interval analysis.

RESULTS

There was no significant difference between the incidence of ANAs in paraprotein sera (8.8%) and control sera (16%). Neither was there a significant incidence of RF or aCL in the paraprotein sera. No anti-DNA antibodies were found and no anti-SS.B antibodies were found either with CIE or immunoblotting. Of the 11 ANAs detected in the paraprotein sera, isotype specific immunofluorescence suggested that 6 were monoclonal autoantibodies.

CONCLUSIONS

These results indicate that the incidence of rheumatic autoantibodies is not raised in paraprotein sera compared to control sera. In particular, we could not confirm previous reports of a high incidence of anti-SS.B antibodies. However, of the ANAs detected half were monoclonal, unlike the polyclonality of the ANAs in the control group. That 4.8% of the paraproteins were monoclonal ANAs suggests that the process leading to paraproteinemia may activate usually silent autoreactive B cells as well as the normal B cell repertoire.

Septic arthritis of the shoulder after mastectomy and radiotherapy for breast carcinoma

We report five patients who developed septic arthritis of the shoulder after cancer of the ipsilateral breast had been treated by surgery and radiotherapy. Lymphoedema was present in all cases. The infections were not obvious, having subacute onsets, and delays in diagnosis led to destruction of the joint in all but one patient.

Measurement of human phospholipase A2 in arthritis plasma using a newly developed sandwich ELISA

A sandwich enzyme-linked immunosorbent assay (ELISA) for human non-pancreatic phospholipase A2 (PLA2) was developed using monoclonal antibodies raised against purified recombinant PLA2. This assay was shown to be specific for human non-pancreatic PLA2, showing no cross-reactivity with human pancreatic PLA2 or with snake venom PLA2 (Crotalus durissus). The immunoassay showed no cross-reactivity with plasma components, and was reproducible and quantitative between 39 pmol and 2.7 nmol PLA2/1. The levels of non-pancreatic PLA2 in the plasma of patients with arthritis was measured using this immunoassay. There were significantly higher levels of PLA2 in patients with rheumatoid arthritis than in those with osteoarthritis or healthy controls. Plasma PLA2 was highest in those patients with active rheumatoid arthritis.

Systemic disease presenting as arthritis--a diagnostic approach

It is not uncommon for patients with 'arthritis' to be presenting with a rheumatological manifestation of a systemic disease. Frequently the pain is not even of articular origin. The diagnostic challenge for the practitioner is to determine the nature of the underlying pathologic process. This article sets out to provide some guidelines for diagnosis.

Role of bone scintigraphy in the early diagnosis of discitis

Nine cases of recorded discitis are presented, in which scintigraphy played an important part in the diagnosis. The patients (five men (aged 21-75 years) and four women (aged 40-73 years)) had a history of back pain varying in duration from two days to three months. Final diagnosis was confirmed microbiologically (seven patients) or radiographically (two patients). Bone scintigraphy was a valuable diagnostic procedure for discitis with earlier detection than plain radiography in three patients and similar initial detection to that of third generation computed tomography. Single photon emission computed tomographic imaging increased diagnostic confidence by indicating the involvement of the adjacent vertebral bodies rather than of the pedicles or spinous processes.

Inhibition of blood-aqueous humor barrier breakdown with diclofenac. A fluorophotometric study

Various doses of a new topical nonsteroidal anti-inflammatory agent, diclofenac sodium, were tested against prednisolone sodium phosphate in a randomized double-masked study to determine comparative efficacy and safety regarding the reduction of postsurgical ocular inflammation. Inflammation was assessed by measuring fluorescein leakage into the anterior chamber using fluorophotometry techniques. Increased leakage in each patient's operated-on eye compared with the unoperated-on control eye was attributed to a breakdown in the blood-aqueous barrier caused by the cataract surgery. Elimination or significant reduction of fluorescein leakage within a treatment group constituted increased efficacy in controlling inflammation. A total of 124 cases were analyzed. There were no preoperative differences among groups in fluorescein leakage. At 1 week after surgery, all three diclofenac groups had significantly less fluorescein leakage compared with the prednisolone group. Mean percent increases were 56% to 118% in diclofenac groups vs 324% in the prednisolone group. No differences among diclofenac concentrations were detected. The differences between prednisolone and diclofenac were also present, although of lesser magnitude, at 3 weeks. This demonstration of increased efficacy of the nonsteroidal anti-inflammatory agent vs prednisolone is promising given the known side effects of ocular steroids.

Clinical features and followup study of HLA-B27 positive patients presenting with peripheral arthritis

A comparison was made between HLA-B27 positive patients with peripheral arthritis and patients with ankylosing spondylitis (AS). The distribution of peripheral joint involvement in HLA-B27 positive seronegative arthritis was not the same as that in AS; significant differences were also noted in the sex ratio and incidence of uveitis. Followup of the patients with peripheral arthritis revealed that 25% had developed a further criterion for Reiter's syndrome, 45% had persistent seronegative arthritis and in 55% the arthritis had resolved.

Pericardial mesothelioma presenting as systemic lupus erythematosus

A case of mesothelioma of the pericardium with many features of systemic lupus erythematosus (SLE) is described. We stress that satisfaction of the American Rheumatism Association's classification criteria for SLE does not confirm the diagnosis, even though their diagnostic sensitivity and specificity has recently been improved.

The significance of discrepant Farr and Crithidia luciliae tests

The most specific serological test for systemic lupus erythematosus (SLE) is the detection of anti-dsDNA antibodies by the Farr or Crithidia luciliae (CL) assay. Serological interpretation is difficult when these assays give discrepant results (i.e., one is positive and the other negative). In the present study 34 patients with discrepant results (18 CL positive Farr negative; 16 CL negative Farr positive) were reviewed to determine whether they fulfilled ARA criteria for SLE at presentation or at follow up 1-50 months (mean 15.8 months) later. Only 2 patients had SLE, both of whom fulfilled ARA criteria at presentation. Discrepant CL and Farr assays are associated with SLE uncommonly and rarely precede the development of clinical lupus.

Osteonecrosis of the humerus related to pregnancy

A case of osteonecrosis of the head of the humerus is described in which the only likely precipitant was pregnancy. The association of pregnancy and osteonecrosis is reviewed. This is the first reported case of osteonecrosis of the humerus alone associated with pregnancy.

Tarsal tunnel syndrome and peripheral neuropathy in rheumatoid disease

Thirty patients with classical or definite rheumatoid disease (RD) with foot pain and radiologically demonstrated erosions were studied electrodiagnostically to ascertain the frequency of the tarsal tunnel syndrome and peripheral neuropathy. Four patients (13.3%) had evidence of the tarsal tunnel syndrome. The electrical abnormalities were mild and unassociated with specific clinical features. Two patients (6.6%) had evidence of sensory peripheral neuropathy. There may be an appreciable frequency of clinically unsuspected tarsal tunnel syndrome in RD.