Octopus engineering, intentional and inadvertent

We previously published a description of discovery of a site where octopuses live in an unusually dense collection of individual dens near one another in a bed of scallop shells amid a rock outcrop. We believe the shell bed is an extended midden, accumulated over time by individual octopuses returning to their dens with food. Here we consider what aspects of material collection, den maintenance, and aggregation are intentional for the octopuses, versus inadvertent consequences of individual decisions. Collection of prey items, transport of prey to the den, den excavation, and collection and use of non-prey materials at the den appear to be intentional behaviors. The occurrence of many dens in close aggregation appears to be an inadvertent outcome of the availability of food and the risk of predation in the habitat. Popular media reports have described this site as an ‘city’ designed by octopuses, but that is not an accurate description of the site.

Diagnosis of human granulocytic anaplasmosis in Belgium by combining molecular and serological methods

We report here one new, hospitalized case of Anaplasma phagocytophilum in Belgium. The clinical presentation of anaplasmosis, its treatment and the molecular and serological relevant laboratory methods are briefly developed.

Seniors' decision making about pain management

BACKGROUND

Musculoskeletal pain is a problem with which many seniors must contend, many on a daily basis. Little is known, however, of the self-care decisions that seniors make regarding the management and control of this pain. These decisions can influence in a significant manner the delivery of health care to seniors and their overall health and well-being. Purpose. The purpose of our exploratory-descriptive study was to investigate seniors' decision making regarding the management and control of musculoskeletal pain by gathering data about the context of decision making, the types of decisions seniors made, their decisional conflict and the resources they used in decision making.

METHODS

Focus groups and a mail-back questionnaire were used. Data were gathered in 1997 from a convenience sample of 50 seniors in Canada who experienced musculoskeletal pain of a noteworthy nature.

RESULTS

Findings revealed that participants made decisions within a context of ageing and the health and social consequences of advancing age. The types of decisions they made included to ignore their pain and to use distraction. They also used exercise, the application of heat and cold, and medications to manage pain. Decisional conflict was minimal and consultation with family and friends superseded that with professionals.

CONCLUSIONS

This study contributed to knowledge of decision making in later life about health matters generally, and the management and control of pain specifically. Findings point to the resourcefulness of seniors with respect to self-care and decision making. Seniors want to make informed decisions. However, they need information about the risks and benefits of decisions.

Treatment of irritable bowel syndrome with Chinese herbal medicine: a randomized controlled trial

CONTEXT

Irritable bowel syndrome (IBS) is a common functional bowel disorder for which there is no reliable medical treatment.

OBJECTIVE

To determine whether Chinese herbal medicine (CHM) is of any benefit in the treatment of IBS.

DESIGN

Randomized, double-blind, placebo-controlled trial conducted during 1996 through 1997.

SETTING

Patients were recruited through 2 teaching hospitals and 5 private practices of gastroenterologists, and received CHM in 3 Chinese herbal clinics.

PATIENTS

A total of 116 patients who fulfilled the Rome criteria, an established standard for diagnosis of IBS.

INTERVENTION

Patients were randomly allocated to 1 of 3 treatment groups: individualized Chinese herbal formulations (n = 38), a standard Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received 5 capsules 3 times daily for 16 weeks and were evaluated regularly by a traditional Chinese herbalist and by a gastroenterologist. Patients, gastroenterologists, and herbalists were all blinded to treatment group.

MAIN OUTCOME MEASURES

Change in total bowel symptom scale scores and global improvement assessed by patients and gastroenterologists and change in the degree of interference in life caused by IBS symptoms assessed by patients.

RESULTS

Compared with patients in the placebo group, patients in the active treatment groups (standard and individualized CHM) had significant improvement in bowel symptom scores as rated by patients (P=.03) and by gastroenterologists (P=.001), and significant global improvement as rated by patients (P=.007) and by gastroenterologists (P=.002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P=.03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement.

CONCLUSION

Chinese herbal formulations appear to offer improvement in symptoms for some patients with IBS.

Severe clinical manifestations of primary HIV infection

Three cases of oesophageal candidiasis in association with primary HIV infection are described. In each case the candidiasis was associated with a decreased number of circulating CD4+ cells and responded well to treatment with ketoconazole. Clinicians should be aware that severe opportunistic infections may develop during this stage of infection, presumably as a result of transient immunodeficiency. We argue that the definition of primary HIV infection should be extended to include severe opportunistic infections and neurologic presentations.