Integration of the mammalian shoulder girdle within populations and over evolutionary time.

Morphological integration has the potential to link morphological variation within populations with morphological evolution among species. This study begins to investigate this link by comparing integration among shoulder girdle elements (e.g. scapular blade, glenoid, coracoid, etc.) during the origin and evolution of therian mammals, and within modern bat, opossum and mouse populations. In this study, correlations among skeletal elements and patterns of allometry are used as proxies for integration. Results suggest that shoulder girdle elements tended to vary and evolve independently during the origin of mammals and subsequent radiation of placentals, consistent with the elements' distinct developmental and evolutionary origins. This finding suggests that skeletal element correlations, and therefore integration, can be conserved over large taxonomic and temporal scales. However, marsupials display a different pattern in which shoulder girdle elements tend to be more integrated, with the exception of the coracoid. This finding is consistent with a shift in the pattern of skeletal element integration coincident with the appearance of the marsupial mode of reproduction. This finding provides further evidence that development can play a significant role in the establishment of patterns of skeletal element correlation and that patterns of skeletal element correlation can themselves evolve when faced with sufficient selective pressures.

Torsion and volvulus of the transverse and descending colon in a German shepherd dog.

A German shepherd dog was presented two months after surgery for correction of acute gastric dilatation volvulus. The dog had been diagnosed with exocrine pancreatic insufficiency. Radiographs revealed marked gaseous distension of one loop of intestine with a generalised increase in intestinal gas content. A 360 degrees anticlockwise rotation of the descending and transverse colon, around the longitudinal axis of the mesocolon, was diagnosed at exploratory coeliotomy. The transverse and descending colon appeared uniformly necrotic and an end-to-end colo-colic resection and anastomosis was performed. The dog initially made satisfactory postoperative progress but was euthanased on the third postoperative day after it developed an intestinal intussusception.

High-grade surface osteosarcoma in a dog.

A case of a high-grade surface osteosarcoma in the thoracic limb of a dog is reported. Radiographically, there was no bone involvement but there was increased soft tissue opacity. An aggressive osteosarcoma was diagnosed on the basis of early metastatic disease and histopathological examination. Previously reported surface osteosarcomas in the dog have been periosteal and parosteal osteosarcomas which are generally considered to have a low to intermediate biological activity. The tumour described here had radiographical, gross pathological, histopathological and biological features consistent with human high-grade surface osteosarcoma. The characteristics of surface osteosarcomas are briefly reviewed.

Effect of a pediatric self-care book on utilization of services in a group model HMO.

The purpose of this study was to determine the effect of a pediatric self-care book (SCB) with nurse telephone support on use of health services. The study was performed in a pediatric department of Kaiser Permanente in a suburb of Denver, Colorado. Well patients seen at age 2 weeks to 2.5 months (infant group) or 14 to 19 months (toddler group) were enrolled. Intervention families received a copy of the book, Your Child's Health and were oriented on its use. Rates of sick visits, advice nurse calls, pharmacy prescriptions, emergency department visits, and hospital admissions were assessed. Visit and call rates were calculated, and mean rates of the SCB group and the control group were then compared. Of 1,104 enrols, 527 received the SCB; the other 577 served as controls. The SCB group had 14.0% fewer total visits (excluding well-baby visits) than controls did (p = 0.018). For infants and toddlers who were not first-borns, the intervention was associated with a statistically significant decrease in sick visits (23%), advice nurse phone calls (24%), and pharmacy prescriptions (26%); no statistically significant differences in study outcomes were seen among first-born study subjects. Promotion of self-care in a group model health maintenance organization can decrease use of services by families of young children.

Umbilical artery catheter position and intraventricular hemorrhage.

A historical cohort study was designed to examine high (T6-T11) versus low (L3-L5) umbilical artery catheter (UAC) positioning as a risk factor for subependymal/intraventricular hemorrhage (SEH/IVH) in very low birthweight infants. High and low UAC groups were similar for mode of delivery, severity of pulmonary disease, weight, gestation, Apgar scores, and air leak. Seventeen of 36 infants with high UACs and 6 of 44 infants with low UACs developed SEH/IVH. The incidence (P less than .001) and severity (P less than .01) of SEH/IVH was significantly greater in the high UAC positioning group. Retrograde arterial flow with or without embolization to the cerebral circulation from high UAC positioning is suggested as a possible cause for the association between high UAC positioning and SEH/IVH.

Using structured medical information to improve students' problem-solving performance.

In the study reported here, the authors assessed the use of efficient organization of knowledge and of problem-solving strategies to enhance medical students' clinical problem-solving skills. Thirty-five preclinical medical students were randomly assigned to a experimental or control group and given a knowledge base containing information on eight congenital heart diseases to learn. Information for the experimental group emphasized disease groupings (based on their similar clinical presentation), symptom-disease associations, and clinical problem-solving heuristics. The same information for the control group was presented in a textbook format that emphasized the pathophysiology of the diseases. The students then diagnosed three computerized diagnostic problems of varying difficulty while verbalizing their problem-solving strategies. The results showed that the experimental group acquired a higher ratio of diagnostic to nondiagnostic cues, mentioned the correct diagnosis sooner in their workups, and correctly diagnosed the most difficult case more often than the control group. These results provide support for revisions in the organization and presentation of information that are aimed at improving clinical problem-solving skills.

Visibility of handicap, self-concept, and social maturity among young adult survivors of end-stage renal disease.

This study examined the relationship between visibility of handicap and both self-image and social maturity in young adult survivors of end-stage renal disease. Ratings of visibility of handicap, social maturity, and a self-report measure of self-image were obtained through interviews with 31 patients. Results showed that visibility was inversely correlated with identity stability (p less than 0.05), social maturity (p less than 0.025), and self-esteem (p greater than 0.10), while jointly controlling for patients' age and years since last transplant. Although patients with visible handicaps remain at risk for maladjustment, many developed positive coping strategies in order to face the developmental challenges of adulthood.

A comparison of nurses' attitudes toward hospitalized adolescents and adults.

To examine possible health-care provider stereotypes of adolescent patients and the potential consequences for their management, this study compares nurses' responses to the same noncompliant behavior when evidenced by an adolescent or adult patient. Nurses (n = 136) read a description of a difficult adolescent or adult patient and indicated their probable responses to him. They also rated the patient with regard to difficulty of management, as well as several descriptive adjectives, and speculated on the cause of his behavior. No significant differences were found in nurses' preferred management alternatives or ratings for the adolescent or adult patient. However, nurses were significantly more likely to attribute the behavior of the adolescent patient to his developmental level (p less than 0.001). These findings suggest that health-care providers are aware of the hospitalized adolescents' problems, rather than supporting the existence of providers' stereotypes of or different management approach to, difficult adolescent patients.

Darier's disease: a kindred with a large number of cases.

Over 70 cases of keratosis follicularis (Darier's disease) were noted in a study of a single kindred consisting of more than 200 individuals. Data were obtained through questionnaires, interviews and physical examinations. Results strongly support an autosomal dominant mode of inheritance since the ratio of affected to unaffected members was I:I and there were nearly equal numbers of males and females with this condition. Large sibships were common in this kindred, which extended over seven generations, and most of the affected individuals were located in the southwestern New York-northwestern Pennsylvania region of the United States.