Crafting the success and failure of decentralized marine management

This paper presents an ethnographic case study of the design and revision of a decentralized marine management scheme implemented on the island of Moorea, French Polynesia named Plan de Gestion de l'Espace Maritime (PGEM). Drawing on an analysis of over 50 consultative workshops and meetings, held from 2018 to 2021 during the PGEM revision, we document the materials, discourses, and practices local stakeholders (e.g., fishers, cultural and environmental activists, government staff, and scientists) combine to build their interpretations of PGEM success or failure. We examine the diversity of domains these interpretations draw from (ecology, marine livelihoods, culture, religion, and politics) and how they are put into practice in people's engagement with-or resistance to-the local marine management and governance design. Our results highlight how the controversies around the revision of Moorea's PGEM overflowed the boundaries of ecology as construed by scientific experts. Stakeholders interpreted "marine resource management" as something well beyond just "marine resources" to include politics, identity, Polynesian cosmology, and livelihoods. Our findings provide generalizable patterns for understanding how natural-resource management policies are received and repurposed by local actors.

Spatial covariation in nutrient enrichment and fishing of herbivores in an oceanic coral reef ecosystem

Both natural and anthropogenic stressors are increasing on coral reefs, resulting in large-scale loss of coral and potential shifts from coral- to macroalgae-dominated community states. Two factors implicated in shifts to macroalgae are nutrient enrichment and fishing of reef herbivores. Although either of these factors alone could facilitate establishment of macroalgae, reefs may be particularly vulnerable to coral-to-algae phase shifts in which strong bottom-up forcing from nutrient enrichment is accompanied by a weakening of herbivore control of macroalgae via intense fishing. We explored spatial heterogeneity and covariance in these drivers on reefs in the lagoons of Moorea, French Polynesia, where the local fishery heavily targets herbivorous fishes and there are spatially variable inputs of nutrients from agricultural fertilizers and wastewater systems. Spatial patterns of fishing and nutrient enrichment were not correlated at the two landscape scales we examined: among the 11 interconnected lagoons around the island or among major habitats (fringing reef, mid-lagoon, back reef) within a lagoon. This decoupling at the landscape scale resulted from patterns of covariation between enrichment and fishing that differed qualitatively between cross-shore and long-shore directions. At the cross-shore scale, nutrient enrichment declined but fishing increased from shore to the crest of the barrier reef. By contrast, nutrient enrichment and fishing were positively correlated in the long-shore direction, with both increasing with proximity to a pass in the barrier reef. Contrary to widespread assumptions in the scientific literature that human coastal population density correlates with impact on marine ecosystems and that fishing effort declines linearly with distance from the shore, these local stressors produced a complex spatial mosaic of reef vulnerabilities. Our findings support spatially explicit management involving the control of anthropogenic nutrients and strategic reductions in fishing pressure on herbivores by highlighting specific areas to target for management actions.

Perceptions and responses of Pacific Island fishers to changing coral reefs

The transformation of coral reefs has profound implications for millions of people. However, the interactive effects of changing reefs and fishing remain poorly resolved. We combine underwater surveys (271 000 fishes), catch data (18 000 fishes), and household surveys (351 households) to evaluate how reef fishes and fishers in Moorea, French Polynesia responded to a landscape-scale loss of coral caused by sequential disturbances (a crown-of-thorns sea star outbreak followed by a category 4 cyclone). Although local communities were aware of the disturbances, less than 20% of households reported altering what fishes they caught or ate. This contrasts with substantial changes in the taxonomic composition in the catch data that mirrored changes in fish communities observed on the reef. Our findings highlight that resource users and scientists may have very different interpretations of what constitutes 'change' in these highly dynamic social-ecological systems, with broad implications for successful co-management of coral reef fisheries.

Indigenous people's detection of rapid ecological change

When sudden catastrophic events occur, it becomes critical for coastal communities to detect and respond to environmental transformations because failure to do so may undermine overall ecosystem resilience and threaten people's livelihoods. We therefore asked how capable of detecting rapid ecological change following massive environmental disruptions local, indigenous people are. We assessed the direction and periodicity of experimental learning of people in the Western Solomon Islands after a tsunami in 2007. We compared the results of marine science surveys with local ecological knowledge of the benthos across 3 affected villages and 3 periods before and after the tsunami. We sought to determine how people recognize biophysical changes in the environment before and after catastrophic events such as earthquakes and tsunamis and whether people have the ability to detect ecological changes over short time scales or need longer time scales to recognize changes. Indigenous people were able to detect changes in the benthos over time. Detection levels differed between marine science surveys and local ecological knowledge sources over time, but overall patterns of statistically significant detection of change were evident for various habitats. Our findings have implications for marine conservation, coastal management policies, and disaster-relief efforts because when people are able to detect ecological changes, this, in turn, affects how they exploit and manage their marine resources.

Indigenous knowledge and long-term ecological change: detection, interpretation, and responses to changing ecological conditions in Pacific Island communities

When local resource users detect, understand, and respond to environmental change they can more effectively manage environmental resources. This article assesses these abilities among artisanal fishers in Roviana Lagoon, Solomon Islands. In a comparison of two villages, it documents local resource users' abilities to monitor long-term ecological change occurring to seagrass meadows near their communities, their understandings of the drivers of change, and their conceptualizations of seagrass ecology. Local observations of ecological change are compared with historical aerial photography and IKONOS satellite images that show 56 years of actual changes in seagrass meadows from 1947 to 2003. Results suggest that villagers detect long-term changes in the spatial cover of rapidly expanding seagrass meadows. However, for seagrass meadows that showed no long-term expansion or contraction in spatial cover over one-third of respondents incorrectly assumed changes had occurred. Examples from a community-based management initiative designed around indigenous ecological knowledge and customary sea tenure governance show how local observations of ecological change shape marine resource use and practices which, in turn, can increase the management adaptability of indigenous or hybrid governance systems.

Coulomb excitation of neutron-rich Zn isotopes: first observation of the 2(1)+ state in 80Zn

Neutron-rich, radioactive Zn isotopes were investigated at the Radioactive Ion Beam facility REX-ISOLDE (CERN) using low-energy Coulomb excitation. The energy of the 2(1)+ state in 78Zn could be firmly established and for the first time the 2+ --> 0(1)+ transition in 80Zn was observed at 1492(1) keV. B(E2,2(1)+ --> 0(1)+) values were extracted for (74,76,78,80)Zn and compared to large scale shell model calculations. With only two protons outside the Z=28 proton core, 80Zn is the lightest N=50 isotone for which spectroscopic information has been obtained to date. Two sets of advanced shell model calculations reproduce the observed B(E2) systematics. The results for N=50 isotones indicate a good N=50 shell closure and a strong Z=28 proton core polarization. The new results serve as benchmarks to establish theoretical models, predicting the nuclear properties of the doubly magic nucleus 78Ni.

NO synthase-positive striatal interneurons are decreased in schizophrenia

The gaseous messenger NO has repeatedly been suggested to play a role in the pathogenesis of psychoses. Following a pilot study, we investigated whether the number of nitrinergic neurons in the putamen of patients suffering from schizophrenia, bipolar disorder or major depression is altered. Post-mortem striatum sections of 15 brains from patients with either disease were examined by NADPH-diaphorase staining, which selectively labels NO synthase-positive interneurons. Quantification of these cells revealed significantly lower numbers of NO synthase-containing neurons in the putamen of schizophrenic patients. Our results suggest that striatal nitrinergic interneurons are involved in the pathophysiology of at least some forms of schizophrenia, such as e.g. catatonic schizophrenia.

Bremsstrahlung in alpha decay reexamined

A high-statistics measurement of bremsstrahlung emitted in the alpha decay of (210)Po has been performed, which allows us to follow the photon spectra up to energies of approximately 500 keV. The measured differential emission probability is in good agreement with our theoretical results obtained within the quasiclassical approximation as well as with the exact quantum mechanical calculation. It is shown that, due to the small effective electric dipole charge of the radiating system, a significant interference between the electric dipole and quadrupole contributions occurs, which is altering substantially the angular correlation between the alpha particle and the emitted photon.

Leprecan distribution in the developing and adult kidney

The temporal and spatial deposition of extracellular matrix proteins is critical for nephrogenesis and glomerular maturation. We previously characterized leprecan as a novel chondroitin sulfate proteoglycan which has been recently shown to have prolyl hydroxylase activity. In this study, we examine the distribution of leprecan during nephrogenesis and after a hypertrophic stimulus to the adult kidney. During development, leprecan was localized to mesenchymal aggregates, early comma- and S-phase structures as determined by immunohistochemistry and in situ hybridization. Leprecan mRNA was increased in cells around the vascular cleft of the S- and comma-phase glomeruli. Expression was found in podocytes, mesangial cells, and parietal epithelial cells of loop-phase glomeruli. Leprecan mRNA was substantially decreased in the glomeruli of the adult kidney compared to the developing kidney with a uniform distribution between the glomeruli and the tubules. Within adult glomeruli, leprecan was found in the mesangium mesangial matrix, podocytes, and in Bowman's capsule. In response to glomerular hypertrophy, produced by unilateral nephrectomy, leprecan synthesis was increased in the adult kidney. We suggest that the regulated expression of leprecan during glomerular development or hypertrophy coupled with its reported prolyl hydroxylase activity plays a role during basement membrane assembly.

Neural stem cell proliferation is decreased in schizophrenia, but not in depression

The phenomenon of adult neurogenesis (AN), that is, the generation of functional neurons from neural stem cells in the dentate gyrus of the hippocampus, has attracted remarkable attention, especially as it was shown that this process is also active in the human brain. Based on animal studies, it has been suggested that reduced AN is implicated in the etiopathology of psychiatric disorders, and that stimulation of AN contributes to the mechanism of action of antidepressant therapies. As data from human post-mortem brain are still lacking, we investigated whether the first step of AN, that is, the level of neural stem cell proliferation (NSP; as quantified by Ki-67 immunohistochemistry), is altered in tissue from the Stanley Foundation Neuropathology Consortium comprising brain specimens from patients with bipolar affective disorder, major depression, schizophrenia as well as control subjects (n=15 in each group). The hypothesis was that stem cell proliferation is reduced in affective disorders, and that antidepressant treatment increases NSP. Neither age, brain weight or pH, brain hemisphere investigated nor duration of storage had an effect on NSP. Only in bipolar disorder, post-mortem interval was a significant intervening variable. In disease, onset of the disorder and its duration likewise did not affect NSP. Also, cumulative lifetime dose of fluphenazine was not correlated with NSP, and presence of antidepressant treatment did not result in an increase of NSP. Concerning the different diagnostic entities, reduced amounts of newly formed cells were found in schizophrenia, but not in major depression. Our findings suggest that reduced NSP may contribute to the pathogenesis of schizophrenia, whereas the rate of NSP does not seem to be critical to the etiopathology of affective disorders, nor is it modified by antidepressant drug treatment.

Dendritic excrescences seem to characterize hippocampal CA3 pyramidal neurons in humans

Excrescences are unique dendritic postsynaptic structures of the hippocampal formation. Only CA3 pyramidal neurones and hilar mossy cells possess these complex dendritic structures. Dendritic excrescences have so far only been investigated in rabbit, rat and rhesus monkey. Applying a Golgi impregnation method optimized for human brain tissue, we describe the detailed morphology of excrescences of CA3 pyramidal neurons of man. Human thorny excrescences possess a thin and single spine neck and multiple spine heads (4 on average, sometimes more than 10). Human cluster excrescences sit upon the dendrite with a broad stem, and exhibit a "papilloma-like" surface. Some human CA3 pyramidal neurons seem to possess markedly longer spine necks and larger spine heads compared to human neocortical pyramid cells; they were named long-neck spines. Thorny excrescences, cluster excrescences and the newly described long-neck spines can also be found on the dendritic main stem of human CA3 pyramidal neurons.CA2 pyramidal neurons neither possess these long neck spines nor thorny or cluster excrescences. Thus, the unique excrescences of CA3 pyramidal neurones seem to be another criterion for a demarcation between the CA3- and CA2 region of the human hippocampus.

"Safe" Coulomb excitation of 30Mg

We report on the first radioactive beam experiment performed at the recently commissioned REX-ISOLDE facility at CERN in conjunction with the highly efficient gamma spectrometer MINIBALL. Using 30Mg ions accelerated to an energy of 2.25 MeV/u together with a thin (nat)Ni target, Coulomb excitation of the first excited 2+ states of the projectile and target nuclei well below the Coulomb barrier was observed. From the measured relative deexcitation gamma-ray yields the B(E2;0(+)gs-->2(+)1) value of 30Mg was determined to be 241(31)e2 fm4. Our result is lower than values obtained at projectile fragmentation facilities using the intermediate-energy Coulomb excitation method, and confirms the theoretical conjecture that the neutron-rich magnesium isotope 30Mg resides outside the "island of inversion."

Increased volume of the nucleus accumbens in schizophrenia

The nucleus accumbens, an integral and important part of limbic and prefrontal cortico-striato-pallidal-thalamic circuits, is involved in several cognitive, emotional and psychomotor functions altered in schizophrenia. In animal models, developmental disturbances within the entorhinal cortex and the hippocampus induce a dysregulation of inputs to the nucleus accumbens resulting in behavioral abnormalities which point to psychotic psychopathology. Nonetheless, due to the complex neuroanatomy of the human ventral striatum hardly any morphometric data on the nucleus accumbens are available. A postmortem stereological investigation of the nucleus accumbens was performed in complete brains of 9 male schizophrenics and 9 male controls between the ages of 46 and 64. Complete serial coronal slices of both hemispheres were stained with a modified Nissl-technique. Tissue shrinkage after staining and embedding was corrected for both individual and regional shrinkage. Based on recent precise delimitations of the human ventral striatum, in vivo hemisphere-adjusted volumes of the nucleus accumbens (volume densities) and absolute accumbal volumes were calculated applying the Cavalieri-estimator. In schizophrenics, mean hemisphere-adjusted volumes of the nucleus accumbens were significantly increased on both sides (right accumbens: p = 0,005**; left accumbens: p = 0,016*). Hemispherical volumes and volumes of the nucleus accumbens were significantly correlated in both groups (p = 0,02*). Most likely, this increase in volume of the ventral striatum reflects a decrease in naturally occuring cell death following prenatal cortical neurodevelopmental disturbances.

Disturbed neural circuits in a subtype of chronic catatonic schizophrenia demonstrated by F-18-FDG-PET and F-18-DOPA-PET

Permanent verbal, visual scenic and coenaestetic hallucinations are the most prominent psychopathological symptoms aside from psychomotor disorders in speech-sluggish catatonia, a subtype of chronic catatonic schizophrenia according to Karl Leonhard. These continuous hallucinations serve as an excellent paradigm for the investigation of the assumed functional disturbances of cortical circuits in schizophrenia. Data from positron emission tomography (F-18-FDG-PET and F-18-DOPA-PET) from three patients with this rare phenotype were available (two cases of simple speech-sluggish catatonia, one case of a combined speech-prompt/speech-sluggish subtype) and were compared with a control collective. During their permanent hallucinations, all catatonic patients showed a clear bitemporal hypometabolism in the F-18-FDG-PET. Both patients with the simple speech-sluggish catatonia showed an additional bilateral thalamic hypermetabolism and an additional bilateral hypometabolism of the frontal cortex, especially on the left side. In contrast, the patient with the combined speech-prompt/speech-sluggish catatonia showed a bilateral thalamic hypometabolism combined with a bifrontal cortical hypermetabolism. However, the left/right ratio of the frontal cortex also showed a lateralisation effect with a clear relative hypometabolism of the left frontal cortex. The F-18-DOPA-PET of both schizophrenic patients with simple speech-sluggish catatonia showed a normal F-18-DOPA storage in the striatum, whereas in the right putamen of the patient with the combined form a higher right/left ratio in F-DOPA storage was discernible, indicating an additional lateralized influence of the dopaminergic system in this subtype of chronic catatonic schizophrenia. Most likely, the prominent bitemporal F-18-FDG- hypometabolism in these chronic schizophrenic patients with speech-sluggish catatonia suffering from permanent continuous hallucinations, reflects a deficit in sensoric gating following prenatal cortical neurodevelopmental disturbances. However, the functional disturbances underlying hallucinations in "the schizophrenias" seem to be more complex; in different subtypes of the schizophrenic spectrum disorder hallucinations seem to be based on alterations in additional cortical and subcortical brain regions.

Prediction of mortality using dobutamine echocardiography

OBJECTIVES

We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables.

BACKGROUND

Existing outcome studies with DbE have examined composite end points, rather than death, over a relatively short follow-up. Clinical and stress data were collected in 3,156 patients (age 63 +/- 12 years, 1,801 men) undergoing DbE. Significant stenoses (>50% diameter) were identified in 70% of 1,073 patients undergoing coronary angiography. Total and cardiac mortality were identified over nine years of follow-up (mean 3.8 +/- 1.9). Cox models were used to analyze the effect of ischemia and other variables, independent of other determinants of mortality.

RESULTS

The dobutamine echocardiogram was abnormal in 1,575 patients (50%). Death occurred in 716 patients (23%), 259 of whom (8%) were thought to have died from cardiac causes. Patients with normal DbE had a total mortality of 8% per year and a cardiac mortality of 1% per year over the first four years of follow-up. Ischemia and the extent of abnormal wall motion were independent predictors of cardiac death, together with age and heart failure. In sequential Cox models, the predictive power of clinical data alone (model chi-square 115) was strengthened by adding the resting left ventricular function (model chi-square 138) and the results of DbE (model chi-square 181). In the subgroup undergoing coronary angiography, the power of the model was increased to a minor degree by the addition of coronary anatomy data.

CONCLUSIONS

Dobutamine echocardiography is an independent predictor of death, incremental to other data. While a normal dobutamine echocardiogram predicts low risk of cardiac death (on the order of 1% per year), this risk increases with the extent of abnormal wall motion at rest and stress.

Standards for the function of an academic 12-lead electrocardiographic core laboratory

An academic 12-lead electrocardiogram (ECG) core laboratory aims to provide the highest possible quality ECG recording, measurement, and storage to aid clinicians in research into important cardiovascular outcomes and to maximize the credibility of scientific results based solely, or in part, on ECG data. This position paper presents a guide for the structure and function of an academic ECG core laboratory. The key functional aspects are: 1) Data collection, 2) Staff composition, 3) Diagnostic measurement and definition standards, 4) Data management, 5) Academic considerations, 6) Economic consideration, and 7) Accreditation. An ECG Core Laboratory has the responsibility for rapid and accurate analysis and responsible management of the electrocardiographic data in multicenter clinical trials. Academic Laboratories, in addition, provide leadership in research protocol generation and production of research manuscripts for submission to the appropriate peer-review journals.

Inhibitory cartridge synapses in the anterior cingulate cortex of schizophrenics

Axon cartridges are the specific terminal structures of GABAergic inhibitory chandelier interneurons. Cartridges form axo-axonal synapses with local projection neurons, thus modulating the neuronal output of diverse brain areas. In order to examine the distribution of cartridges, the anterior cingulate cortices from the brains of schizophrenic patients and control persons were examined with an antibody against parvalbumin. Axon cartridges were mainly located in layers V and VI. In our study, schizophrenic patients showed a significantly higher density of axon cartridges than controls. These findings add new evidence for disturbances of the circuitry of the anterior cingulate cortex in schizophrenia implicating that there may be an elevated inhibitory influence on the cortical output of this brain region.

[Severe cardiovascular complications relating to Gemeprost therapy]

The use of gemeprost vaginal pessaries is generally thought to be a method with little complications used for cervical softening within the first two trimesters of pregnancy. Though in our hospital two cases presented with severe cardiovascular reactions, to be attributed to the effect of prostaglandins. The first patient experienced a severe cardiogenic shock due to vasospasm several hours after primary administration of gemeprost vaginal pessaries and a cerebral stroke some hours later. The second patient suffered of a myocardial infarction ensuing from coronary spasm.

Cost analysis of diagnostic testing for coronary artery disease in women with stable chest pain. Economics of Noninvasive Diagnosis (END) Study Group

BACKGROUND

Seven clinical sites compiled data from 4638 women who were referred directly to coronary angiography (catheterization-first strategy; n = 3375) or who underwent stress myocardial perfusion imaging (MPI) first (n = 1263) followed by coronary angiography if at least one reversible myocardial perfusion abnormality was detected. The study examines the cost minimization potential of these available invasive and noninvasive diagnostic strategies in women with chest pain.

METHODS AND RESULTS

Women in both groups were subclassified by the core laboratory as being at low (<0.15), intermediate (0.15 to 0.60), or high (>0.60) pretest likelihood for coronary artery disease (CAD). Among the catheterization-first patients, at least one coronary stenosis >70% was present in 13% of low likelihood patients, 29% of intermediate likelihood patients, and 52% of patients with high CAD likelihood. Perfusion abnormality rates in the MPI-first group were 23% in low likelihood patients, 27% in intermediate likelihood patients, and 34% in high CAD likelihood patients. Of the MPI-first subset, 50%, 55%, and 76%, respectively, underwent catheterization in at least one coronary stenosis >70%. Cardiac death rates ranged from 0.5% to 2.2% in patients with CAD and did not differ from the 2 testing strategies (P = not significant). The composite cost per patient of diagnostic testing plus follow-up medical care over a period of 2.5 +/- 1.5 years (calculated for both strategies from inflation-corrected Medicare charges, adjusted for institutional cost-charge ratios) ranged from $2490 for patients with low likelihood to $3687 for patients with high likelihood with the catheterization-first strategy and from $1587 to $2585 for patients undergoing MPI first (P < .01 between risk subsets and strategies).

CONCLUSIONS

In women referred for diagnostic evaluation of stable chest pain, MPI followed by selective coronary angiography in patients with at least 1 perfusion abnormality minimizes the near-term composite cost per patient compared with a direct catheterization-first strategy, regardless of pretest CAD likelihood.

Blood pressure response during treadmill testing as a risk factor for new-onset hypertension. The Framingham heart study

BACKGROUND

Although systolic blood pressure (SBP) response to exercise has been shown to predict subsequent hypertension in small samples of men, this association has not been studied in a large population-based sample of middle-aged men and women. The purpose of this study was to examine, in normotensive subjects, the relations of SBP and diastolic blood pressure (DBP) during the exercise and recovery periods of a graded treadmill test to the risk of developing new-onset hypertension.

METHODS AND RESULTS

BP data from exercise testing in 1026 men and 1284 women (mean age, 42+/-10 years; range, 20 to 69 years) from the Framingham Offspring Study who were normotensive at baseline were related to the incidence of hypertension 8 years later. New-onset hypertension, defined as an SBP >/=140 mm Hg or DBP >/=90 mm Hg or the initiation of antihypertensive drug treatment, occurred in 228 men (22%) and 207 women (16%). Exaggerated SBP (Ex-SBP 2) and DBP (Ex-DBP 2) response and delayed recovery of SBP (R-SBP 3) and DBP (R-DBP 3) were defined as an age-adjusted BP greater than the 95th percentile during the second stage of exercise and third minute of recovery, respectively. After multivariable adjustment, Ex-DBP 2 was highly predictive of incident hypertension in both men (OR, 4.16; 95% CI, 2.15, 8.05) and women (OR, 2.17; CI, 1.19, 3.96). R-SBP 3 was predictive of hypertension in men in a multivariable model that included exercise duration and peak exercise BP (OR, 1.92; CI, 1.00, 3.69). Baseline resting SBP (chi2, 23.4 in men and 34.7 in women) and DBP (chi2, 11.3 in men and 13.1 in women) had stronger associations with new-onset hypertension than exercise DBP (chi2, 16.4 in men and 6.1 in women) and recovery SBP (chi2, 6.5 in men and 2.1 in women) responses.

CONCLUSIONS

An exaggerated DBP response to exercise was predictive of risk for new-onset hypertension in normotensive men and women. An elevated recovery SBP was predictive of hypertension in men. These findings may reflect subtle pathophysiological features in the preclinical stage of hypertension.

HCFA documentation guidelines and the need for discrete data: a golden opportunity for applied health informatics

BACKGROUND

The medical community is shocked by the complexity of the documentation now required to support the Medicare billing codes. This situation represents an opportunity for Electronic Medical Records that use discrete data to become a central factor at the point of care by fulfilling these stringent documentation specifications.

METHODS

This empirical study explores whether a discrete data EMR has the ability to generate automatically a report describing what billing code is consistent with the documentation recorded. We tested this hypothesis on HBOC Pathways SMR by attempting to create algorithms that reflected the HCFA guidelines. We validated this process using historical records from the Cleveland Clinic.

RESULTS

All the data elements required by HCFA were available as discrete data. Using algorithms, the billing code consistent with the documentation of the health care encounter could be automatically generated.

CONCLUSIONS

EMRs using discrete data can substantially reduce the burden placed on health care providers by HCFA's new documentation guidelines. This benefit creates a window of opportunity for health informatics to become an integral tool in the provision of health care. Using EMRs for billing purposes can help achieve the loftier goal of using EMRs for quality improvement.

Increased left ventricular cavity size, not wall thickness, potentiates myocardial ischemia

Left ventricular (LV) hypertrophy increases the vulnerability of the myocardium to ischemia. The purpose of this study was to determine whether LV diameter or wall thickness was the principal determinant of the effect of LV mass on the development of ischemia, measured by exercise thallium perfusion imaging, in a population with coronary artery disease (CAD). We studied 109 patients with CAD but no prior myocardial infarction who underwent exercise thallium imaging within 1 year of coronary angiography. Thallium perfusion defects were present in 76% of patients. LV mass index was associated with thallium perfusion abnormalities (odds ratio 2.09 for 50 gm increments), an association that persisted after adjusting for extent of CAD. LV end-diastolic diameter had a strong correlation with a thallium defect (odds ratio 3.7 for 10 mm increments), but LV wall thickness had no correlation (odds ratio 1.0 for 5 mm increments). In a stepwise regression model that included extent of CAD and other potential clinical variables, LV end-diastolic diameter was the strongest predictor of thallium defects (adjusted odds ratio 4.5). This study confirms the association of LV hypertrophy with ischemia in patients with CAD, specifically in patients with eccentric hypertrophy.

The human striatum in schizophrenia. II. Increased number of striatal neurons in schizophrenics

In neuropathological studies of schizophrenia, alterations of the basal ganglia are one main topic. Using the optical dissector, we performed an unbiased estimation of neurons and glia cells in the human striatum. To rule out an influence of age and gender, the brains of 9 male schizophrenic patients younger than 65 were closely matched in age with the brains of 9 male control persons. Absolute neuron numbers of the striatum and its subdivisions putamen and nucleus caudatus/nucleus accumbens of both hemispheres were compared between both groups, as were absolute glia cell numbers and the calculated glia index. We found a significant increase in absolute striatal neuron numbers in the schizophrenic group on the right side (P = 0.008**) and only a trend to higher absolute striatal neuron numbers on the left side. In a further analysis, the significant increase of absolute striatal neuron numbers in the right striatum of the schizophrenic group was only discernible for the nucleus caudatus/nucleus accumbens complex (P = 0.01*) and not for the putamen. Absolute striatal glia cell numbers did not differ significantly between both groups, neither on the right nor on the left side. There was only a trend towards a smaller glia index on both sides. Cortical development disturbances with a consecutive reduction of naturally occurring cell death during development could be responsible for this increase in absolute striatal neuron numbers in schizophrenics.

The human striatum in schizophrenia. I. Increase in overall relative striatal volume in schizophrenics

Postmortem volumetry of the human striatum and its subdivisions (putamen, n.caudatus, n.accumbens) was performed on serial coronal sections of complete hemispheres. Both hemispheres of 9 male schizophrenic patients younger than 65 years were closely matched in age with the hemispheres of 9 male control individuals. All obtained values were corrected with individual and region-specific shrinkage factors; the intrarater reliability was 1% difference in volume. The absolute striatal volume was significantly correlated with the volume of the hemisphere (r = 0.931; P = 0.0003***). Reflecting differences in the hemispheric volumes of the schizophrenic and the control group, the absolute striatal volume consequently did not differ between both groups (P > 0.55). However, we found a clear increase in the volume density (i.e. the relative striatal portion of the hemisphere; the relative striatal volume) in the schizophrenic group, highly significant on both sides (P = 0.003** for the right striatum, P = 0.002** for the left striatum). The increase in volume density concerned both the putamen (P = 0.003** for the right side) and the n.caudatus/n.accumbens (P = 0.01* for the right side). Discrepant volumetric results of previous authors who compared only absolute volume values in samples not matched for identical hemispheric volume could thus be explained by this high positive correlation with the hemispheric volume. Since exact matching for identical hemispheric volume is not feasible and examined groups will never be large enough to rule out the influence of the hemispheric volume, the determination of relative volumes (i.e. volume densities) seems to be advantageous for future volumetric studies.

[Diagnosis of keratoconjunctivitis sicca in rheumatoid arthritis. The value of various tests]

In this study we examined 85 patients in the range of 25 to 60 years with rheumatoid arthritis (RA) and a control group of 35 persons without any systemic diseases. The 85 patients with RA were split into two groups: first group was made up of 32 patients with keratoconjunctivitis sicca (KCS) and the second of 53 patients without KCS. The aim was to decide whether the simple ocular ferning test has more diagnostic value than the "classical" tests: break-up time (BUT), Schirmer-1-test and concentration of lysozyme in the tear fluid. Therefore, we compared the tests with reference to sensitivity, specificity and prognostic value in the three groups. The results of the ocular ferning test are markedly better than the results of the other tests: sensitivity is 82.2%, specificity 92.5% and prognostic value 86.6%. The corresponding values are: BUT: 51.6%-77.8%-63.1%; Schirmer-1-test: 34.4%-90.8%-73.5%, lysozyme concentration: 73.4%-51.0%-52.7%. The ocular ferning test is an easy, practical, cheap, and reliable completion to the conventional tests; it is also easy on the patients.

[Granulomatous thrombophlebitis in Lyme borreliosis--case report]

The presented case report shows a patient with Lyme disease who also developed thrombophlebitis saltans. Histopathologically we found a granulomatous perivasculitis, an immunohistological investigation showed deposits of IgG, IgA, IgM, C3 and C4 in the vessels. Antibody titers against Borrelia burgdorferi were elevated, but no anti-cardiolipin antibodies were found. A pathogenetic correlation due to anti-phospholipid antibodies that have been found in thrombosis and borreliosis or a vasculitis vasorum comparable to a previously described vasculitis nervorum might be discussed.

A partially deleted mitochondrial cytochrome oxidase gene in the NCS6 abnormal growth mutant of maize

The nonchromosomal stripe (NCS) mutations of maize are a set of maternally inherited mutations that result in reduced plant growth and lowered reproductive capacity. NCS6 mutants are characterized by stunted growth, yellow stripes on leaves, and sectors of aborted kernels on ears. The heteroplasmic NCS6 striped plants carry both partially deleted and normal versions of the mitochondrial cytochrome oxidase subunit 2 (cox2) gene and have low levels of cox2 transcripts when compared with nonstriped control plants. Other tested mitochondrial genes and their transcripts appear to be unaltered in NCS6 plants. The level of COXII protein is also specifically reduced in the striped plants relative to that of control plants. In the NCS6 mutant mitochondrial genome, a portion of the first exon of the cox2 gene is deleted along with the 5' flanking region. The formation of the defective cox2 gene appears to have involved a recombination event between 31-bp repeats.

Gliogenesis and myelination in the optic nerve of trisomy 19 mice. A quantitative electron-microscopic study

Trisomy 19 (ts19) of the mouse permits detailed studies on the influence of an extra autosome upon the postnatal development of the central nervous system. To examine gliogenesis and myelinogenesis, the optic nerves of 19 ts19 pugs aged 1-15 days have been examined by light and electron microscopy and compared to those of litter-mate controls. Differentiation of astrocytes and oligodendrocytes, myelinogenesis as well as the opening of the eyes are each delayed by about 2 days. Myelin sheaths are normally structured in ts19. There is a decrease in the percentage of myelinated fibres. The cross-sectional area of the ts19 optic nerve is reduced. The fibre density, which decreases with age both in ts19 and control mice, is higher in ts19 mice. Both with ts19 and control animals, the distribution of fibre diameters of myelinated axons overlaps with that of promyelinated and unmyelinated fibres, but myelinated axons cannot be observed below a diameter of 0.3 micron, and unmyelinated axons are always smaller than 1 micron. The mean diameter of promyelinated axons is identical in ts19 and control animals. Myelination is therefore not severely disturbed in the ts19 optic nerve. As retinal differentiation in ts19 is delayed by 2 days as well, reports on an asynchronous development of neurons and myelin sheaths cannot be confirmed for the visual system.

[Diverse ocular manifestations in Boeck disease]

The clinical picture of sarcoidosis varies widely; in many cases there are few symptoms. In cases where the initial symptoms of sarcoidosis are ocular the diagnosis can only be established if systemic disease is considered in differential diagnosis. Five cases with ocular manifestation and unusual findings or development are described.