Behavior and morphology combine to influence energy dissipation in mantis shrimp (Stomatopoda)

Animals deliver and withstand physical impacts in diverse behavioral contexts, from competing rams clashing their antlers together to archerfish impacting prey with jets of water. Though the ability of animals to withstand impact has generally been studied by focusing on morphology, behaviors may also influence impact resistance. Mantis shrimp exchange high-force strikes on each other's coiled, armored telsons (tailplates) during contests over territory. Prior work has shown that telson morphology has high impact resistance. I hypothesized that the behavior of coiling the telson also contributes to impact energy dissipation. By measuring impact dynamics from high-speed videos of strikes exchanged during contests between freely moving animals, I found that approximately 20% more impact energy was dissipated by the telson as compared with findings from a prior study that focused solely on morphology. This increase is likely due to behavior: because the telson is lifted off the substrate, the entire body flexes after contact, dissipating more energy than exoskeletal morphology does on its own. While variation in the degree of telson coil did not affect energy dissipation, proportionally more energy was dissipated from higher velocity strikes and from strikes from more massive appendages. Overall, these findings show that analysis of both behavior and morphology is crucial to understanding impact resistance, and suggest future research on the evolution of structure and function under the selective pressure of biological impacts.

FAMILY PLANNING SERVICE UPTAKE IN HOSPITALS IN RIVERS STATE, NIGERIA

Introduction

Family planning refers to a couple's ability to have the number of children they want by spacing out their children appropriately or a person's ability to avoid unintended pregnancies by using various contraceptive methods and infertility treatment. All hospitals in Rivers State, Nigeria, that provide primary care, offer family planning services.

Aim

To describe the pattern of family planning service uptake in the hospitals in Rivers State.

Methodology

An 8-year retrospective review of data collection from the District Health Information System 2 (DHIS 2) platform in the Health Management Information System in Rivers State was conducted. Data from 387 health facilities were collated and keyed into the DHIS2 platform. Data was analysed using SPSS version 21 and represented as frequencies, percentages and charts.

Results

During the period under review, the Family Planning clinics counselled a total of 931,774 individuals, of whom 421,785 (45.3%) accepted family planning services. Condoms (65.3%) were the most widely utilized contraceptive, whereas bilateral tubal ligation (0.1%) was the least utilized. Other methods were injectable, implant, oral contraceptive pills and intrauterine contraceptive devices accounting for 16.1%, 9.4%, 7.8%, and 1.3%, respectively. A significant increase was observed in the trend of use of condoms, injectables and oral contraceptive pills between 2016-2021.

Conclusion

The findings were that there was an increasing trend in the yearly utilization of family planning services among women of childbearing age in the State from 2014 - 2021. Condom being the most utilized indicates that it is the most accepted and approved by clients in family planning clinics in Rivers State. The knowledge of contraceptive utilization trends can be used to monitor and appraise the acceptance and approval of each method and family planning program over a period.

Leaders of war: modelling the evolution of conflict among heterogeneous groups

War, in human and animal societies, can be extremely costly but can also offer significant benefits to the victorious group. We might expect groups to go into battle when the potential benefits of victory (V) outweigh the costs of escalated conflict (C); however, V and C are unlikely to be distributed evenly in heterogeneous groups. For example, some leaders who make the decision to go to war may monopolize the benefits at little cost to themselves ('exploitative' leaders). By contrast, other leaders may willingly pay increased costs, above and beyond their share of V ('heroic' leaders). We investigated conflict initiation and conflict participation in an ecological model where single-leader-multiple-follower groups came into conflict over natural resources. We found that small group size, low migration rate and frequent interaction between groups increased intergroup competition and the evolution of 'exploitative' leadership, while converse patterns favoured increased intragroup competition and the emergence of 'heroic' leaders. We also found evidence of an alternative leader/follower 'shared effort' outcome. Parameters that favoured high contributing 'heroic' leaders, and low contributing followers, facilitated transitions to more peaceful outcomes. We outline and discuss the key testable predictions of our model for empiricists studying intergroup conflict in humans and animals. This article is part of the theme issue 'Intergroup conflict across taxa'.

Mechanoethology: The Physical Mechanisms of Behavior

Research that integrates animal behavior theory with mechanics-including biomechanics, physiology, and functional morphology-can reveal how organisms accomplish tasks crucial to their fitness. Despite the insights that can be gained from this interdisciplinary approach, biomechanics commonly neglects a behavioral context and behavioral research generally does not consider mechanics. Here, we aim to encourage the study of "mechanoethology," an area of investigation intended to encompass integrative studies of mechanics and behavior. Using examples from the literature, including papers in this issue, we show how these fields can influence each other in three ways: (1) the energy required to execute behaviors is driven by the kinematics of movement, and mechanistic studies of movement can benefit from consideration of its behavioral context; (2) mechanics sets physical limits on what behaviors organisms execute, while behavior influences ecological and evolutionary limits on mechanical systems; and (3) sensory behavior is underlain by the mechanics of sensory structures, and sensory systems guide whole-organism movement. These core concepts offer a foundation for mechanoethology research. However, future studies focused on merging behavior and mechanics may reveal other ways by which these fields are linked, leading to further insights in integrative organismal biology.

Posterior urethral valves masquerading as neuropathic bladder following sacrococcygeal teratoma resection

Neuropathic bladder may be a co-associated morbidity in newborn babies following resection of a sacrococcygeal teratoma. We report a case of a male newborn showing features of incomplete urinary voiding requiring intermittent catheterisation after operation for bladder emptying. Videourodynamic assessment excluded neuropathic bladder and posterior urethral valves were demonstrated on micturating cystography. Urology outcomes have been excellent following curative valve ablation. This report highlights the crucial importance of being aware of the rare coexistence of lower urinary tract pathology in male babies with sacrococcygeal teratoma. Routine urodynamic assessment should be considered in all children following sacrococcygeal teratoma resection.

Assessment during Intergroup Contests

Research on how competitors assess (i.e., gather information on) fighting ability and contested resources, as well as how assessment impacts on contest processes and outcomes, has been fundamental to the field of dyadic (one-on-one) contests. Despite recent growth in studies of contests between social-living groups, there is limited understanding of assessment during these intergroup contests. We adapt current knowledge of dyadic contest assessment to the intergroup case, describing what traits of groups, group members, and resources are assessed, and how assessment is manifested in contest processes (e.g., behaviors) and outcomes. This synthesis helps to explain the role of individual heterogeneity in assessment and how groups are shaped by the selective pressure of contests.

Variations in the management of adolescents with blunt splenic trauma in England and Wales: are we preserving enough?

INTRODUCTION

Management of blunt splenic injury has changed drastically with non-operative management increasingly used in paediatric and adult patients. Studies from America and Australia demonstrate disparities in care of patients treated at paediatric and adult centres. This study assessed management of splenic injuries in UK adolescents.

MATERIALS AND METHODS

Data were acquired from the Trauma Audit and Research Network on isolated blunt splenic injuries reported 2006-2015. Adolescents were divided into age groups of 11-15 years and 16-20 years, and injuries classified as minor (grades 1/2) or major (3+). Primary outcomes were needed for splenectomy and blood transfusion.

RESULTS

A total of 445 adolescents suffered isolated blunt splenic injuries. Road traffic collisions were the most common mechanism. There were no deaths as a result of isolated blunt splenic injuries, but 49 (11%) adolescents needed transfusions and 105 (23.6%) underwent splenectomies. There was no significant difference observed in the management of adolescents with minor trauma. In major trauma, 11-15-year-olds were more likely to have splenectomies when managed at local trauma units compared with major trauma centres (31% vs 4%, odds ratio 11.5; 95% confidence interval 3.82-34.38, p < 0.0001). Within major trauma centres, older adolescents were more likely to have splenectomies than younger adolescents (35.5% vs 3.8%, odds ratio 14; 95% confidence interval 4.55-43.26, p < 0.0001). There were no significant differences in haemodynamic status, transfusion requirement or embolisation rates.

CONCLUSIONS

There appears to be a large variation in the management of isolated blunt splenic injuries in the UK. The reasons for this remain unclear however non-operative management is safe and should be first line management in the haemodynamically stable adolescent, even with major splenic injuries.

Mutual assessment during ritualized fighting in mantis shrimp (Stomatopoda)

Safe and effective conflict resolution is critical for survival and reproduction. Theoretical models describe how animals resolve conflict by assessing their own and/or their opponent's ability (resource holding potential, RHP), yet experimental tests of these models are often inconclusive. Recent reviews have suggested this uncertainty could be alleviated by using multiple approaches to test assessment models. The mantis shrimp Neogonodactylus bredini presents visual displays and ritualistically exchanges high-force strikes during territorial contests. We tested how N. bredini contest dynamics were explained by any of three assessment models-pure self-assessment, cumulative assessment and mutual assessment-using correlations and a novel, network analysis-based sequential behavioural analysis. We staged dyadic contests over burrow access between competitors matched either randomly or based on body size. In both randomly and size-matched contests, the best metric of RHP was body mass. Burrow residency interacted with mass to predict outcome. Correlations between contest costs and RHP rejected pure self-assessment, but could not fully differentiate between cumulative and mutual assessment. The sequential behavioural analysis ruled out cumulative assessment and supported mutual assessment. Our results demonstrate how multiple analyses provide strong inference to tests of assessment models and illuminate how individual behaviours constitute an assessment strategy.

Context-dependent scaling of kinematics and energetics during contests and feeding in mantis shrimp

Measurements of energy use, and its scaling with size, are critical to understanding how organisms accomplish myriad tasks. For example, energy budgets are central to game theory models of assessment during contests and underlie patterns of feeding behavior. Clear tests connecting energy to behavioral theory require measurements of the energy use of single individuals for particular behaviors. Many species of mantis shrimp (Stomatopoda: Crustacea) use elastic energy storage to power high-speed strikes that they deliver to opponents during territorial contests and to hard-shelled prey while feeding. We compared the scaling of strike kinematics and energetics between feeding and contests in the mantis shrimp Neogonodactylus bredini. We filmed strikes with high-speed video, measured strike velocity, and used a mathematical model to calculate strike energy. During contests, strike velocity did not scale with body size but strike energy scaled positively with size. Conversely, while feeding, strike velocity decreased with increasing size and strike energy did not vary according to body size. Individuals most likely achieved this strike variation through differential compression of their exoskeletal spring prior to the strike. Post-hoc analyses found that N. bredini used greater velocity and energy when striking larger opponents, yet variation in prey size was not accompanied by varying strike velocity or energetics. Our estimates of energetics inform prior tests of contest and feeding behavior in this species. More broadly, our findings elucidate the role behavioral context plays in measurements of animal performance.

A fatal case of amphetamine induced ischaemic colitis

Amphetamine induced ischaemic colitis is an exceedingly rare presentation of amphetamine toxicity. The cases reported in the literature have described mild or transient disease. We present a fatal case of ischaemic colitis induced by amphetamine use in a 44-year-old woman who presented in extremis after a cardiac arrest en route to the emergency department. A short history of headache, abdominal pain, vomiting and agitation preceded her admission. Imaging revealed changes consistent with ischaemic colitis. Emergency laparotomy revealed widespread colonic necrosis necessitating a subtotal colectomy. Despite aggressive resuscitation and inotropic support from arrival, the patient deteriorated intraoperatively and died in the immediate postoperative period. Histology showed arterial type ischaemia/reperfusion injury of the area supplied by the superior mesenteric artery. The patient's serum amphetamine level was 0.52mg/l (peak therapeutic levels <0.2mg/l). The postmortem examination concluded that amphetamines were the likely cause of the vasospasm, leading to profound colonic ischaemia.

Contests with deadly weapons: telson sparring in mantis shrimp (Stomatopoda)

Mantis shrimp strike with extreme impact forces that are deadly to prey. They also strike conspecifics during territorial contests, yet theoretical and empirical findings in aggressive behaviour research suggest competitors should resolve conflicts using signals before escalating to dangerous combat. We tested how Neogonodactylus bredini uses two ritualized behaviours to resolve size-matched contests: meral spread visual displays and telson (tailplate) strikes. We predicted that (i) most contests would be resolved by meral spreads, (ii) meral spreads would reliably signal strike force and (iii) strike force would predict contest success. The results were unexpected for each prediction. Contests were not resolved by meral spreads, instead escalating to striking in 33 of 34 experiments. The size of meral spread components did not strongly correlate with strike force. Strike force did not predict contest success; instead, winners delivered more strikes. Size-matched N. bredini avoid deadly combat not by visual displays, but by ritualistically and repeatedly striking each other's telsons until the loser retreats. We term this behaviour 'telson sparring', analogous to sparring in other weapon systems. We present an alternative framework for mantis shrimp contests in which the fight itself is the signal, serving as a non-lethal indicator of aggressive persistence or endurance.

Acute renal insufficiency due to oral acyclovir in a man with sickle cell trait

Several published reports have suggested that oral acyclovir can cause renal insufficiency, but baseline renal function was either abnormal or unclear in those reports. We describe a patient with oral acyclovir-induced acute renal failure and a normal serum creatinine level documented just before exposure to the drug. Conceivably, competition with a cephalosporin for renal tubular elimination predisposed our patient to nephrotoxic serum levels of acyclovir. In addition, the patient had sickle cell trait, which might have contributed to a disproportionate degree of hyperkalemia and acidosis seen early in the patient's clinical course.

Evaluation of the association between medial patellar luxation and hip dysplasia in cats

OBJECTIVE

To investigate the association between hip dysplasia (HD) and medial patellar luxation (MPL) in cats.

DESIGN

Cross-sectional prevalence study.

ANIMALS

78 cats.

PROCEDURE

A complete history was obtained. Cats were examined to detect MPL and HD. Radiographs of the stifle and hip joints were obtained. Hip joints were evaluated by use of Norberg angle, distraction index, and scoring consistent with that established by the Orthopedic Foundation for Animals.

RESULTS

There were 43 male and 35 female cats mean age, 2.5 years). Eleven cats had clinical signs of disease in the pelvic limbs. Medial subluxation of the patella (subgrade 1) was seen in 31 of 33 cats with otherwise normal stifle joints. Medial patellar luxation was found in 45 of 78 (58%) cats, and 35 of 45 (78%) had grade-1 MPL. Bilateral MPL was seen in 32 of 45 (71%) cats. A weak association existed between MPL and HD, because cats were 3 times more likely to have HD and patellar luxation than to have either condition alone. Concurrent MPL and HD were detected in 19 of 78 (24%) cats, and HD was diagnosed radiographically in 25 of 78 (32%) cats (19 mild, 4 moderate, 2 severe). Eighteen of the 25 cats with HD had bilateral HD.

CONCLUSIONS AND CLINICAL RELEVANCE

Clinically normal cats may have a certain degree of laxity in the stifle joint, evident as medial patellar subluxation (< grade 1). There is a weak association between MPL and HD, and both conditions may develop, alone or in combination, more frequently than has been reported.

Antiretroviral therapy, 1998

In summary, during 1996 and 1997 important improvements occurred in HIV therapy. The introduction of new drugs benefited patients with access to these medications. The use of antiretrovirals remains complex and is rapidly evolving. This is an inspiring challenge for physicians and health workers caring for HIV-infected patients.

Carbohydrate intake and recovery of intermittent running capacity

The purpose of the present study was to examine the influence of an increased carbohydrate intake on the recovery of endurance running capacity after exhaustive intermittent running. Six male subjects were randomly assigned to two dietary recovery conditions, each involving two running tests separated by 22 hr. The protocol comprised a prolonged, intermittent, high-intensity shuttle run test (I-HI). One week later subjects repeated the I-HI on consecutive days under different dietary conditions. During the 22-hr recovery, either the carbohydrate intake of the subjects was increased (CHO) or they ate an isocaloric diet by supplementing their normal diet with extra protein and fat (CON). Intermittent running capacity was improved when subjects increased their carbohydrate intake to 10 g.kg-1 bm during the 22-hr recovery between trials, but an isocaloric diet without additional carbohydrate did not bring about the same improvements.

Reduction of serum matrix metalloproteinase 1 and matrix metalloproteinase 3 in rheumatoid arthritis patients following anti-tumour necrosis factor-alpha (cA2) therapy

Matrix metalloproteinase (MMP)-1 and MMP-3 levels were measured in serum samples from rheumatoid arthritis (RA) patients undergoing a double-blinded placebo-controlled trial with the chimaeric anti-tumour necrosis factor (TNF)-alpha antibody cA2. Both MMP-1 (P < 0.015), but to a larger extent MMP-3 (P < 0.001) levels were elevated in all RA patients prior to the commencement of the trial compared with normal control sera. Following cA2 therapy, MMP-1 and MMP-3 levels were assessed in the placebo, and 1 and 10 mg/kg cA2-treated groups at 7, 14, 21 and 28 days. In both the 1 and the 10 mg/kg cA2-treated groups, a significant decrease in serum MMP-3 levels at all time points was observed, reducing maximally to 41% of pre-infusion values at day 7. MMP-1 levels were also reduced, but less dramatically than MMP-3, to 85% of pre-infusion values after 14 days in the 10 mg/kg cA2 treated group. In a separate non-placebo-controlled study, we also evaluated the tissue inhibitor of metalloproteinase (TIMP)-1 levels in plasma following cA2 infusion. Pre-infusion TIMP-1 levels were above the normal control range, but were significantly reduced (P < 0.035) 14 days after infusion to 72% of pre-infusion values. This study confirms previous reports that MMP-3 levels are elevated and correlate with measures of inflammation in RA, and furthermore demonstrate that serum MMP-3 and MMP-1 levels are downmodulated following anti-TNF-alpha antibody therapy. Whilst serum MMP-3 levels correlated with C-reactive protein (CRP) both prior to and following anti-TNF-alpha antibody therapy, it remains to be demonstrated that serum MMP-3 and/or MMP-1 levels reflect the cartilage and bone resorptive processes which are evident in this disease.

Do sociodemographics and economic status predict risks for type II diabetes in African Americans?

The prevalence of type II diabetes and the metabolic characteristics in high-risk African Americans were examined to determine whether certain socioeconomic and demographic characteristics (SED) increase the risk for type II diabetes in this population. Study participants were high-risk African Americans between the ages of 25 and 64 years. Glucose tolerance status was assessed and questionnaires were completed to obtain information regarding SED, hypertension, and physical activity. The majority of patients had normal glucose tolerance; undiagnosed type II diabetes was identified in 36 of 164 patients. Questionnaire data revealed that, in highly selected African Americans at risk for type II diabetes, there was a higher rate of obesity, prior gestational diabetes, and undiagnosed type II diabetes despite higher educational and income levels and greater access to health care and recreational facilities. Findings indicate that African Americans may be at higher risk for type II diabetes, regardless of socioeconomic status, due to genetic inheritance and other unknown environmental determinants. Further studies are needed to characterize SED and metabolic profiles that confer a high risk for type II diabetes in this population.

The impact of socioeconomic status on cardiovascular risk factors in African-Americans at high risk for type II diabetes. Implications for syndrome X

OBJECTIVE

The rate of type II diabetes in African-Americans is reaching epidemic proportions. African-Americans with type II diabetes suffer from more cardiovascular diseases (CVDs) associated with diabetes than the general population. Lower socioeconomic status (SES) and family history are often cited as contributory factors to the premature development of diabetes and CVDs in the general population. However, we are not aware of any study that has examined the relationships between SES and CVD risk factors (i.e., syndrome X) in a genetically enriched African-American population at high risk for type II diabetes.

RESEARCH DESIGN AND METHODS

We studied 200 healthy first-degree relatives of African-American patients with type II diabetes (age 25-65 years, mean 42.5 +/- 8.4 years; 42 men, 158 women). Standard oral glucose tolerance test, metabolic, and anthropometric parameters, as well as questionnaires on SES, demographic characteristics, and physical activity, were obtained for each subject. SES was divided into quartiles based on annual income. To assess the impact of insulin on CVD risk, we examined clinical characteristics and metabolic parameters according to quartiles of fasting insulin concentrations.

RESULTS

Clinical characteristics, including mean age, BMI, waist-to-hip ratio (WHR), percentage body fat and lean body mass, and blood pressure were not statistically different among SES quartiles. There were no significant differences in any of the metabolic, blood pressure, lipid and lipoprotein, or anthropometric parameters among SES quartiles. When examined by insulin quartile, BMI, WHR, and body fat content tended to be greatest in the fourth quartile. Similarly, fasting and postprandial serum C-peptide and glucose levels were significantly higher in the fourth quartile. We observed greater levels of very low density lipoprotein (VLDL) cholesterol and triglycerides and lower levels of HDL cholesterol in the fourth compared with the first through third insulin quartiles. Serum cholesterol and LDL cholesterol were not associated with increasing insulin concentration assessed by quartiles. We found similar systolic and diastolic blood pressure, irrespective of insulin quartiles. We found relationships between fasting insulin and systolic blood pressure (r = 0.181, P < 0.05) and triglycerides (r = 0.247, P < 0.01), VLDL cholesterol (r = 0.237, P < 0.01), WHR (r = 0.268, P < 0.005), BMI (r = 0.308, P < 0.001), and percentage of body fat (r = 0.237, P < 0.01).

CONCLUSIONS

The present study demonstrates no SES/income effect on CVD risk factors or syndrome X in African-Americans at high risk for type II diabetes. Clustering of several components of syndrome X was seen in individuals in the highest quartiles compared with the lowest quartiles of insulin in our high-risk African-American population. We conclude that the well-established conventional risk factors for CVD in genetically enriched African-Americans are found only in individuals with the highest insulin levels, independent of SES.

Muscle infarction in diabetes: clinical manifestations and course

OBJECTIVE

To characterize the initial manifestations and course of muscle infarction in diabetes, a rarely diagnosed condition.

METHODS

We describe two patients with this disorder and review the clinical characteristics of previously reported cases.

RESULTS

Usually, the initial complaint in patients with muscle infarction in diabetes is swelling of the thigh or calf that has evolved over days to months. Biopsy of the muscle is often necessary for diagnosis and reveals extensive muscle necrosis. Although the pathogenesis is unknown, hypercoagulability may have a role. Bilateral involvement and recurrent disease are common. Treatment is supportive; our patients required narcotics for alleviation of pain.

CONCLUSION

Muscle infarction in diabetes may mimic thrombophlebitis, soft tissue infection, or a neoplasm. Medical evaluation may be directed toward these entities, and the diagnosis of a diabetes-associated disorder may be completely overlooked. The presence of atraumatic swelling of an extremity in a patient with diabetes should suggest diabetes-related muscle infarction.

An Error Compensation Strategy for Replication by Rapid Prototyping

A generic closed-loop strategy for error compensation is presented which extracts and mathematically models the geometry of sculptured artifacts, and compensates for cumulative error build-up during replication. Experimental results using this strategy demonstrate that a considerable improvement in the accuracy of the end product can be achieved. The replication process involves scanning, CAD solid model creation, rapid prototyping utilizing the stereolithography process, the production of room temperature vulcanized (RTV) molds, the casting of polyurethane parts from the RTV mold, abrasive finishing processes associated with these prototyping processes, and the CNC machining of production molds and dies. At each stage in the replication process, the surface errors (caused primarily by material shrinkage, layer curling, internal stresses, chemical curing phenomena, and material removal during mechanical surface finishing) are tracked and used in subsequent production, through an iterative process of surface fitting and surface compensation.

Recurrent group B streptococcal infections in infants: clinical and microbiologic aspects

OBJECTIVE

To describe the potential for recurrence of group B streptococcal (GBS) infection in infants, using pulsed-field gel electrophoresis as an epidemiologic tool.

DESIGN

Retrospective review of cases identified by laboratory records and review of the literature.

SETTING

Neonatal nurseries of a county hospital system.

METHODS

Retrospective review of infants with second episodes of GBS bacteremia or meningitis. Digestion of chromosomal DNA with the restriction enzyme Sma I and separation of fragments by use of contour-clamped homogeneous electric field.

RESULTS

Nine cases of recurrent GBS infection were identified during a 14-year period. Eight of the nine infants were born at 25 to 36 weeks of gestation, and one was born at term. The first episode of invasive GBS infection occurred at a mean age of 10.4 days (median, 3 days; range, 1 to 27 days). Parenteral antibiotic therapy was administered for a mean of 13.9 days (median, 14 days; range, 10 to 21 days). Recurrence occurred at a mean age of 42.3 days (median, 48 days; range, 23 to 68 days). One patient died during the second episode; eight infants survived to discharge home. Of seven sets of isolates analyzed from first and second GBS episodes, five were confirmed to be the same genotypically.

CONCLUSION

Recurrence of GBS disease in infants may be associated with the original infecting strain or a second acquired strain.

Dual skin testing with Mycobacterium avium sensitin and purified protein derivative: an open study of patients with M. avium complex infection or tuberculosis

The sensitivity and specificity of dual mycobacterial skin testing were assessed in an unblinded study of 22 patients with culture-confirmed Mycobacterium avium complex (MAC) infection and 20 patients with culture-confirmed Mycobacterium tuberculosis infection. Intradermal skin tests were performed with 0.1 mL of M. avium sensitin, 0.1 mL of PPD (purified protein derivative), and two control antigens (mumps and Candida). All patients with M. tuberculosis infection reacted to the skin tests; the mean reaction size was 19.7 +/- 1.4 mm when PPD was administered and 10.3 +/- 1.5 mm when M. avium sensitin was administered. Four patients with MAC were anergic; for the remaining 18, mean reactions of 15.2 +/- 1.4 mm to M. avium sensitin and 4.3 +/- 1.3 to PPD were noted. A skin test was defined as M. avium-dominant or PPD (M. tuberculosis)-dominant if there was a minimum reaction size of > or = 5 mm to the given species, and the reaction to the given species was > or = 3 mm greater than the reaction to the heterologous species. Dominant skin test reactions were present in 18 (90%) of 20 patients with M. tuberculosis and 15 (83%) of 18 nonanergic patients with MAC. The specificity of dominant skin tests was 100% for infection with M. tuberculosis and 100% for infection with MAC. M. avium-dominant skin tests identify subjects with prior MAC infection and distinguish them from patients with M. tuberculosis infection.

Chronic low back pain: The relationship between patient satisfaction and pain, impairment, and disability outcomes

STUDY DESIGN

Treatment outcomes for low back pain have been measured by varying standards of pain, impairment, and disability. This study examines the relationship between these three outcomes and treatment satisfaction in patients with chronic low back pain (CLBP).

METHODS

Ninety CLBP patients underwent initial pain (VAS), impairment (PIS), and disability (OPQ) evaluations.

RESULTS

Correlation coefficients between initial VAS, PIS, and OPQ were all less than 0.50. At 5-year follow-up, pain and disability scores were closely matched, more with lower mean scores among workers (P = 0.04 and 0.001). For 65 rehabilitation participants, 5-year patients satisfaction scores did not relate closely with VAS, PIS, and OPQ improvements during treatment (r = 0.15, 0.01, and 0.14). Five-year satisfaction correlated weekly with current pain and disability (r = 0.32, -0.36). Satisfaction levels were higher for workers after 1 year (P = 0.01), and after 5 years (P = 0.34.

CONCLUSIONS

This study suggests that CLBP patients and their health care practitioners mutually set distinct pretreatment pain, impairment, and disability goals and judge outcomes accordingly.

Suspected botulism in three intensively managed Australian cattle herds

Serious outbreaks of a paralytic disease in cattle occurring in the spring and summer of 1988 were investigated on three farms in south eastern Queensland, Australia. On one farm 237 (31 per cent) of 770 cattle died, on the second 109 (40 per cent) of 271 cattle died and on the third 30 (8 per cent) of 380 cows died. Botulism was suspected on the basis of the clinical signs, the lack of significant pathology, a failure to incriminate other agents and a positive feeding trial in one sheep. Laboratory tests for the presence of botulinum toxin failed to confirm this diagnosis, and further feeding trials using ingredients of two rations were also negative.

Colorectal neoplasia in juvenile polyposis or juvenile polyps

Juvenile (retention) polyps are usually solitary lesions in the colorectum but may be multiple in juvenile polyposis. The association between juvenile polyps and colorectal neoplasia is controversial. We present three patients with juvenile polyposis who had colorectal adenomas or adenomatous epithelium in juvenile polyps at ages 3, 4, and 7 years. In a retrospective study of 57 additional patients with one or more juvenile polyps, 10 patients (18%) had colorectal neoplasia including three with adenocarcinoma, two with tubular adenoma, and six with adenomatous epithelium in a juvenile polyp (one had both adenomatous epithelium and an adenocarcinoma). Nine of these 10 patients had juvenile polyposis defined by the presence of at least three juvenile polyps; and eight of the nine had a family history of juvenile polyps. Colorectal neoplasia occurred at young age (mean (SEM) 37 (5) years). Our findings suggest that patients with juvenile polyps who have three or more juvenile polyps or a family history of juvenile polyps should undergo surveillance for colorectal neoplasia.

Phonological processing skills and deficits in adult dyslexics

This article presents 4 experiments aimed at defining the primary underlying phonological processing deficit(s) in adult dyslexia. 5 phonological processes, all involving spoken language, were studied: phoneme perception, phoneme awareness, lexical retrieval of phonology, articulatory speed, and phonetic coding in verbal short-term memory. 2 differently ascertained adult dyslexic groups, familial dyslexics (n = 15) and clinic dyslexics (n = 15), were the subjects in each experiment. These dyslexic groups were chosen because deficits that persist until adulthood and that are found in differently ascertained dyslexic groups are more likely to be primary. Each dyslexic group was compared to 2 control groups, chronological age (CA) controls who were similar in age and sex, and younger reading age (RA) controls who were similar in reading age and sex. The main finding was a clear deficit in phoneme awareness in both dyslexic groups, with each dyslexic group performing significantly worse than both CA and RA controls. Moreover, performance on the 2 phoneme awareness tasks together uniquely accounted for substantial variance in nonword reading. The clinic but not the familial dyslexics appeared to have an additional deficit in verbal short-term memory. No clear deficits were found in either dyslexic group in phoneme perception, lexical retrieval, or articulatory speed.

Left-handedness and immune disorders in familial dyslexics

We examined the frequency of left-handedness, various immune disorders, and comparison disorders in 87 dyslexics and 86 nondyslexics from 14 extended dyslexic families. These families were participants in our genetic linkage studies of dyslexia, which found linkage to chromosome 15 in some families but not others. In the present study, we found a significant elevation of both autoimmune and allergic disorders in the dyslexics only, but no elevation in mixed- or left-handedness in either group. Moreover, the frequency of immune disorders was not higher in the mixed- or left-handed subjects. There was also no elevation in the comparison disorders, which argues against an overreporting bias. The elevation of immune disorders did not vary with linkage status, arguing against a common cause for dyslexia and immune disorders. These findings are discussed in light of Geschwind's hypothesis of a testosterone-mediated association within families between left-handedness, immune disorders, and dyslexia.

A four-year reevaluation of the vocational interests of dental students on the Strong-Campbell Interest Inventory

A sample of dental students was inventoried on their vocational interests as freshmen. They were reinventoried as seniors with the same instrument. While most interests were found to be reliable over time for the group, male dental students lost some of their orientation toward physicians and females were found to have lost some social orientation. Male students' orientation was found to be investigative while that of females was found to be primarily artistic-investigative.

Molar occlusion and mandibular rotation: a longitudinal study

The human dentition undergoes a process of complex development. Growth of the skeleton, morphology and function of the soft tissues (muscles in particular and airway), space considerations, and other factors influence the development of the dentition. The present study considered two of the factors involved: molar relationship in the sagittal plane and mandibular rotation. Forty-two persons from the Burlington sample were studied to determine whether changes in molar relation between the mean of ages 7 to 12 years were correlated with the rotational growth pattern of the mandible. The sample was divided into forward rotators (FR) and backward rotators (BR), based on the changes in the SN-corpus axis angle over time. The statistically significant difference of 4.04 degrees in change of the SN-CA angle over time, between the FRs and BRs, indicates that this method of characterizing the two different types of growers is useful. It is interesting to note, however, that the FRs and BRs, on an average, initially had the same SN-corpus axis angles. The molar relationship was determined on the basis of the cusp-fossa relationship in the sagittal plane. In the twenty-eight forward rotators and fourteen backward rotators the molar relationship did not change in a predictable fashion. Statistically significant correlations were not found between molar occlusion and growth direction patterns. Also, the SN-corpus-axis angle, at a single point in time, is not a good predictor of whether an individual is going to exhibit a forward or backward mandibular rotational growth pattern. The change in molar occlusion during the process of growth and development is a multifactorial phenomenon and cannot be predicted on the basis of the direction of mandibular growth rotation between the ages of 7 and 12 years.

Determining the generalizability of rating scales in clinical settings

Traditional approaches to interrater reliability presuppose that reliability is diminished only by undifferentiated random measurement errors. Generalizability theory offers a more comprehensive and appropriate framework for viewing problems associated with assessments derived from multiple raters. A study involving the use of the Functional Limitation Scale (FLS) by three physicians to assess patient status at five points in time illustrates this new approach. Data were analyzed in a multi-way factorial ANOVA design with the levels of raters (3), occasions (5), and patients (15). Examination of the variance components and associated generalizability coefficients revealed that the raters along or in interaction with other factors contributed little variance, while the greatest proportion of variance was attributable to the difference measurement occasions and the patients or these factors in interaction. The FLS was found to be capable of differentiating between patients and the effect of time on patient status, regardless of the physician rater(s). This study illustrates how one multi-faceted design can answer questions that formerly required several separate data sets.

A comparison of a composite restorative material and wire ligation as methods of stabilizing excessively mobile mandibular anterior teeth

Eighteen patients with mobile mandibular anterior teeth were randomly assigned to one of two treatment groups in order to determine the relative effectiveness of two modalities of temporary stabilization. The two groups were well matched for initial horizontal tooth mobility, age and sex. Patients in Group I had their stabilized in the conventional fashion with extracoronal wire ligation. The Group II subjects' mandibular anterior teeth were acid-etched and then had composite restorative material applied to the lingual, facial and interproximal surfaces. Horizontal tooth mobility utilizing the periodontometer was recorded prior to, immediately after, and then at 1, 3, 6 and 12 months poststabilization. Löe's Gingival Index and the Silness and Löe Plaque Index were recorded for the same time periods. All subjects were instructed in oral hygiene techniques appropriate for splinted teeth. The mobility scores for both Group I and II dropped to significantly lower levels immediately after the splints were placed and then remained relatively unchanged for the next 12 months. There were no statistically significant changes in the gingival or plaque indices throughout the study. Three splints required repairs or adjustments in Group I subjects. Six fractures occurred in Group II subjects.

Predictive value of anti-DNA antibody and selected laboratory studies in systemic lupus erythematosus

In a retrospective study of 71 patients with systemic lupus erythematosus (SLE), a large number of clinical and laboratory variables were studied in order to determine their predictive value of morbidity and mortality. Patients were followed for an average of 57 months. Anti-DNA antibody, hemoglobin and creatinine levels at initial evaluation correlated significantly (p less than 0.05) for subsequent course of SLE, although each parameter was not a good predictor for final outcome. Anti-DNA correlated better with subsequent course in patients who were diagnosed within 12 months of the initial evaluation. By comparison, other measured parameters were not predictive at all. Anti-DNA, hemoglobin, creatinine and C3 levels at the time of most recent evaluation (date last seen) correlated strongly (p less than 0.01-p less than 0.001) with concurrent clinical status.

A comparison of interests of first year dental students and fellows of the Academy of General Dentistry on the Strong-Campbell Interest Inventory

The SCII was used to evaluate the similarity of interests of a sample of practicing dentists and those interests of a sample of dental students. The two groups were found to have similar interest patterns, except for business and office considerations. While the SCII's specific vocation scale for dentistry did not yield very strong positive results in terms of identifying the dental students, it did reveal useful interest patterns. As a general instrument for self-assessment, or for counselors advising the young about a vocation in dentistry, the SCII has some utility if the pattern of interests is used.

Heritable salivary proteins and dental disease

A sample consisting of 92 black subjects was examined in this study. According to results of preliminary statistical tests there is a significant relationship between certain genetically determined salivary factors and individual susceptibility to dental disease in the racial group studied. These findings are been validated by the examination of data from several additional studies involving large samples.

Discriminators of clinically defined emotional maladjustment. Predictive validity of the Behavior Problem Checklist and Devereux scales

From a population of 130 boys between 7 and 14 years of age who had been clinically diagnosed as aggressive, hyperactive, or withdrawn, 32, 31, and 32 Ss, respectively, were randomly selected. All Ss were rated on the Behavior Problem Checklist (BPC) and the Devereux Elementary School Behavior rating scales (DESB) during the 1971-72 academic year. A descriptive intercorrelation matrix was generated for the 4 BPC scales and the 14 DESB scales. Three stepwise discriminant analyses were run: (a) BPC scales only, (b) DESB scales only, and (c) BPC and DESB scales combined. In terms of statistical and practical considerations, the four BPC subscales by themselves attained the optimal predictive accuracy (65%, or 62 of 95 children correctly identified).