Epidemiology and cost of hospital care for Lyme borreliosis in Germany: lessons from a health care utilization database analysis.

To date, relatively little is known about the economic and medical impact of Lyme borreliosis (LB) on European health care systems, especially for the inpatient sector. This retrospective analysis is based on data provided for the years 2007-2011 by a German statutory health insurance company (DAK-Gesundheit) covering approximately 6 million insured. Total cost was calculated for a 1-year period both from the third-party payers and from the societal perspective, respectively. In our cohort the incident diagnosis of LB was coded for 2163 inpatient cases during the years 2008-2011. The median inpatient time was 9 days resulting in a median direct medical cost per hospital stay of 3917€ for adolescents and 2843€ for adults. Based on extrapolation of our findings to the German population, we would expect an average hospital admission of 5200 adults and 2300 adolescents (<18 years) for LB treatment incurring direct medical costs of more than 23 million Euro annually. The annual indirect costs due to loss of productivity would add up to more than 7 million Euro as assessed by the human capital method. Cases tended to accumulate between June and September with remarkable changes in disease manifestations in the course of the year documented in the coded secondary diagnoses. Also specific differences in the disease pattern of adolescents and adults became obvious. Age-specific incidence showed male predominance and a bimodal distribution. Incidence was highest in children aged between 3 and 17 (highest mean incidence of 29 cases/100,000 inhabitants in 6-9 year olds) with a second peak in 60-79 year old individuals. During the study period the nationwide inpatient incidence was 9/100,000 with marked regional variability. In summary, our study is one of the first European investigations on hospital care for LB inpatients and identifies LB as a possibly underestimated socioeconomic factor for health care in Germany.

Clinical and antiviral effect of a single oral dose of famciclovir administered to cats at intake to a shelter.

Although famciclovir is efficacious in feline herpesvirus type 1 (FHV-1)-infected cats, effects of a single dose early in disease course have not been reported. In this two part, randomized, masked, placebo controlled study, cats received a single dose of 125 mg famciclovir (n = 43) or placebo (n = 43; pilot study), or 500 mg famciclovir (n = 41) or placebo (n = 40; clinical trial) on entering a shelter. FHV-1 PCR testing was performed, bodyweight and food intake were recorded, and signs of respiratory disease were scored prior to and 7 days following treatment. FHV-1 DNA was detected in 40% of cats in both parts at study entry. In the pilot study, ocular and nasal discharge scores increased from days 1 to 7 in famciclovir and placebo treated cats. Sneezing scores increased and bodyweight decreased in famciclovir-treated cats. The proportion of cats in which FHV-1 DNA was detected increased over time in all cats in the pilot study. In the clinical trial, food intake and median clinical disease scores for nasal discharge and sneezing increased from days 1 to 7 in both groups and demeanor scores worsened in famciclovir-treated cats. The proportion of cats shedding FHV-1 DNA was greater on day 7 than on day 1 in cats receiving 500 mg famciclovir. A single dose of famciclovir (125 or 500 mg) administered at shelter intake was not efficacious in a feline population in which 40% were already shedding FHV-1.

A glycine-rich RNA-binding protein affects gibberellin biosynthesis in Arabidopsis.

The RNA-binding protein Arabidopsis thaliana glycine-rich RNA-binding protein 7 (AtGRP7) regulates the steady-state abundance of numerous target transcripts in A. thaliana. Here we show that the GA1 and GA2 transcripts encoding the first enzymes of the gibberellin biosynthetic pathway are expressed at reduced levels in transgenic plants ectopically over-expressing AtGRP7 (AtGRP7-ox plants). Furthermore, the levels of the bioactive phytohormone GA4 as well as of several intermediates of the GA biosynthetic pathway are reduced in AtGRP7-ox plants. The transgenic plants show a reduced length of the vegetative stem. The application of exogenous GA largely reverses the phenotype by increasing the number of vegetative internodes. AtGRP7-ox plants flower with fewer leaves than wt plants, suggesting that the floral promotive effect of AtGRP7 bypasses the effect of a reduced GA level in AtGRP7-ox plants. Upon GA treatment, AtGRP7-ox plants flower only slightly earlier than wild type plants. Thus, exogenous GA has only a small additional effect in reducing the number of leaves at the onset of flowering in AtGRP7-ox plants.

Diversity, distribution and role of wild crucifers in major cabbage and kale growing areas of Kenya.

An investigation of the diversity and distribution of wild crucifer species and their importance for cultivated crucifers was conducted during 2005 and 2006 in the highland and mid-altitude semi-arid areas of Kenya. Thirteen species of wild crucifers in nine genera were recorded: Raphanus raphanistrum, Erucastrum arabicum, Sisymbrium officinale, Crambe kilimandscharica, Capsella bursa-pastoris, Rorippa nudiuscula, Ro. micrantha, Ro. microphylla, Lepidium bonariense, Coronopus didymus, Brassica rapa, B. juncea and an unidentified Brassica species. Highland areas had significantly higher species diversity and species richness than mid-altitude semi-arid areas. Species richness, diversity and evenness varied with season and location. Raphanus raphanistrum was the dominant non-cultivated species in the highlands followed by E. arabicum, which was also present and dominant in the semi-arid study sites. Diamondback moth (DBM) was recorded from ten wild crucifer species and R. raphanistrum and E. arabicum were the preferred host plant species. Overall, four larval, one larval-pupal and one pupal parasitoid of DBM were recorded: Diadegma semiclausum, D. mollipla, Apanteles sp., Cotesia plutellae, Oomyzus sokolowskii and Brachymeria species, respectively. Diadegma semiclausum was the most dominant species on all crucifers. We conclude that wild crucifers act as alternative hosts for DBM and provide refugia for DBM parasitoids, which risk local extinction through pesticide application or competition from introduced exotic parasitoid species. The wild crucifers also act as recolonization sites for DBM parasitoids.

Interspecific competition between Diadegma semiclausum Hellen and Diadegma mollipla (Holmgren), parasitoids of the diamondback moth, Plutella xylostella (L), feeding on a new host plant.

Interspecific competition between an introduced parasitoid species aimed at controlling a herbivorous pest species and a native parasitoid parasitising the same host may influence the success of classical biological control programmes. In Kenya, interspecific competition between an introduced and a local parasitoid on two diamondback moth populations (DBM, Plutella xylostella) was investigated on two different host plants. We tested simultaneous and delayed competition of the local parasitoid Diadegma mollipla Holmgren and its exotic congenus D. semiclausum Hellen on a newly aquired DBM host plant (snowpea) in the laboratory. Under simultaneous competition, D. mollipla produced more progeny than D. semiclausum on snowpea. A head start of D. Mollipla, of four and eight hours before its congenus was introduced, resulted in a similar number of progeny of both species. In delayed competition (time intervals of 24 h, 48 h and 72 h), progeny production was similar for both parasitoids when the time interval was 24 h, irrespective of which species parasitized first. More progeny was produced by the species which attacked first, when the time interval was greater than 24 h, although it was only significant at 72 h. Competitive abilites of both parasitoids on the new host plant differed largely between laboratory and semi-field conditions. The influence of two host plants (snowpea and cabbage) on competition was studied in the greenhouse with different host and parasitoid densities. Parasitism levels of D. semiclausum were significantly higher than those of D. mollipla, regardless of host plant, host and parasitoid densities, but progeny production of D. mollipla on snowpea was still slightly higher than on cabbage. As compared to the confinement of parasitoids and larvae to small containers, D. mollipla parasitized very few larvae in the cages. Competitive ability of the two parasitoid species tested was influenced both by the density of the searching females and by parameters related to either the host plant and/or the herbivorous hosts.

Impact of an exotic parasitoid on Plutella xylostella (Lepidoptera: Plutellidae) population dynamics, damage and indigenous natural enemies in Kenya.

Diadegma semiclausum (Hellén) (Hymenoptera: lchneumonidae), an exotic diamondback moth parasitoid, was released in two pilot areas (Werugha in Coast Region and Tharuni in Central Province) in Kenya. Fifteen month before release, observations on the diamondback moth, Plutella xylostella (Linnaeus), and local natural enemy population dynamics and pest damage were initiated in both areas and continued for three years after release. The P. xylostella population was bimodal with higher records during dry seasons. At Werugha, the peak population of P. xylostella was 16.8 per plant (October 2001); at Tharuni it was 12.8 (February 2002). Populations at Werugha declined from three months after release and decreased from 5.4 per plant (before release) to 0.8 (year 3 after release). Concurrently, average damage (1.9 to 1.5) (on a 0-5 scale), proportion of attacked plants (72 to 31%) and proportion of plants in damage group >2 (plants with head damage) decreased (21.4 to 5.3%), while total parasitism increased from 14.4 (before) to 52.5% (year 3 after release, 90% due to D. semiclausum). At Tharuni, D. semiclausum was only recovered 3 months after release. Average populations of P. xylostella declined from 5.9 per plant (before release) to 2.4 (year 3 after release) and damage scores from 2.3 to 1.7. The proportion of plants in damage group >2 declined from 39.7 to 4.5% while overall parasitism increased from 4.2 to 40.6% (98.3% by D. semiclausum). Four species of indigenous parasitoids (Diadegma mollipla (Holmgren), Oomyzus sokolowskii (Kurdjumov), Apanteles sp. and Itoplectis sp., all primary parasitoids) were almost completely displaced by D. semiclausum. Possible reasons for the different parasitoid development between the two release areas and the displacement of the indigenous species are discussed.

Host shift to peas in the diamondback moth Plutella xylostella (Lepidoptera: Plutellidae) and response of its parasitoid Diadegma mollipla (Hymenoptera: Ichneumonidae).

Host shifts in herbivorous insects are thought to sometimes provide enemy-free space on the novel host plant. A population of the diamondback moth Plutella xylostella (Linnaeus), an oligophagous pest on crucifers, recently shifted to sugar snap- and snowpeas (Pisum sativum) in Kenya, resulting in heavy damage to these crops. The impact of this host shift on the interaction with Diadegma mollipla (Holmgren), one of the most frequent parasitoid species attacking P. xylostella in this area, was investigated. Parasitism rates and development of two strains of D. mollipla, one reared from a cabbage-feeding strain of P. xylostella and the second from the new pea-feeding strain, changed based on the host-plant that P. xylostella fed upon, with both parasitoid strains more effective on the novel host plant. Parasitism by the cabbage-D. mollipla strain on P. xylostella infesting peas was four times higher than on P. xylostella infesting cabbage when a single plant species was present. However, when both crops were offered together, the level of parasitism dropped to the level seen when cabbage was offered alone. Diadegma mollipla developed on both hosts, but cabbage-D. mollipla had a longer total development time. Pupae of cabbage-feeding P. xylostella were significantly heavier than pupae of pea-feeding P. xylostella and parasitism had no influence on these differences. Diadegma mollipla preferred to parasitize the pea-feeding P. xylostella. Thus, the host shift by P. xylostella to a novel host plant did not necessarily provide enemy-free space, with the parasitoid species tested. The implications of these findings for the host-parasitoid relationship are discussed.

A PCR-based approach to distinguish important Diadegma species (Hymenoptera: Ichneumonidae) associated with diamondback moth, Plutella xylostella (Lepidoptera: Plutellidae).

The diamondback moth, Plutella xylostella (Linnaeus) has a cosmopolitan distribution and is one of the major pests on cruciferous plants. Biological control, especially with species of the genus Diadegma, has been successfully employed in several parts of the world, mainly in South East Asia. The taxonomy of this genus based on classical morphological characters is still unclear and misidentifications are reported. In the present study seven Diadegma species associated with P. xylostella were separated using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses. The second internal transcribed spacer (ITS2) of the ribosomal DNA (rDNA) was successfully amplified in all 167 individuals and digested using 11 different restriction enzymes. One restriction enzyme (CfoI) showed different restriction profiles in all species and also between two population samples of D. mollipla (Holmgren) from eastern and southern Africa. In addition, a new Diadegma species associated with P. xylostella from Ethiopia was discovered.

Prospects for biological control of the western flower thrips, Frankliniella occidentalis, with the entomopathogenic fungus, Metarhizium anisopliae, on chrysanthemum.

The potential of Metarhizium anisopliae (Metsch.) Sorok. for the control of Frankliniella occidentalis (Pergande) on chrysanthemum cuttings was evaluated in greenhouse experiments. The fungus significantly reduced both the adult and larval populations of F. occidentalis, although the level of control of larval populations was much lower than for adults. Combined application of M. anisopliae and Methomyl (Lannate), however, resulted in a significant reduction of both the larval and adult stages. The use of both control agents might be helpful in reducing the selection pressure for resistance to chemical insecticides, thereby delaying or preventing the build-up of resistant populations in greenhouses.

Selective digestive tract decontamination and vancomycin-resistant enterococcus isolation in the surgical intensive care unit.

Vancomycin-resistant Enterococcus (VRE) has emerged as a significant nosocomial pathogen in the surgical intensive care unit (SICU). We wished to test the hypothesis that the use of selective digestive tract decontamination (SDD) in the SICU affects the frequency of VRE isolation. A retrospective review of hospital records and the SICU database was performed using patients admitted to the SICU service for three or more days from January 1, 1996 to December 31, 1999 at our large tertiary-care teaching hospital. During this time use of SDD in selected patient populations decreased due to physician preference. Information gathered included length of SICU stay, presence of VRE infection or colonization, and use and duration of SDD protocol, vancomycin, and ceftazidime. There were 110 newly diagnosed VRE cases in the SICU during this time period. During the same time period 54 patients received SDD. Eight patients who received SDD had positive VRE cultures and seven had the initial positive culture after receiving SDD. Overall, 9.1% of eligible SICU patients received SDD, 18.5% of patients in the SICU for over 3 days had VRE, 7.3% of VRE patients received SDD, and 13.0% of the SICU patients who received SDD subsequently developed VRE. SDD use was not associated with VRE in univariate analysis. Logistic regression analysis showed higher odds ratios for SDD use in combination with vancomycin than for vancomycin use alone (OR=4.3 vs. 10.9). Odds ratios were over three times higher for SDD plus vancomycin plus ceftazidime use when compared to vancomycin plus ceftazidime use alone (OR=70.5 vs. 19.8). We conclude that administration of SDD alone did not correlate with increased VRE isolation, but that SDD use in conjunction with vancomycin and ceftazidime was associated with VRE isolation.

Ultradian and circadian rhythms of sleep-wake and food-intake behavior during early infancy.

The early development of sleep-wake and food-intake rhythms in human infants is reviewed. The development of a 24 h day-night rhythm contains two observable developmental processes: the alterations in the periodic structure of behavior (decreased ultradian, increased circadian components) and the process of synchronization to external time (entrainment). The authors present the results of their studies involving 26 German children and compare them with previous investigations. In their research, it became evident that, during the first weeks of life, the time pattern of sleep-wake and food-intake behavior is characterized by different ultradian periodicities, ranging from 2 h to 8 h. In the course of further ontogenesis, the share of ultradian rhythms in the sleep-wake behavior decreases, while it remains dominant for food-intake behavior. The circadian component is established as early as the first weeks of life and increases in the months that follow. Besides, the authors' study supports the notion of broad interindividual variation in ultradian rhythms and in the development of a day-night rhythm. Examples of free-running rhythms of sleep-wake and food-intake behavior by various authors are strong indicators of the endogenous nature of the circadian rhythms in infants and show that the internal clock is already functioning at birth. It is still uncertain when the process of synchronization to external and social time cues begins and how differences in the maturation of perceptive organs affect the importance of time cues for the entrainment. Prepartally, the physiological maternal entrainment factors and mother-fetus interactions may be most important; during the first weeks of life, the social time cues gain importance, while light acts as a dominant "zeitgeber" at a later time only.

Detection of modulation in spectral envelopes and linear-rippled noises by budgerigars (Melopsittacus undulatus).

Budgerigars were trained to discriminate complex sounds with two different types of spectral profiles from flat-spectrum, wideband noise. In one case, complex sounds with a sinusoidal ripple in (log) amplitude across (log) frequency bandwidth were generated by combining 201 logarithmically spaced tones covering the frequency region from 500 Hz to 10 kHz. A second type of rippled stimulus was generated by delaying broadband noise and adding it to the original noise in an iterative fashion. In each case, thresholds for modulation depth (i.e., peak-to-valley in dB) were measured at several different ripple frequencies (i.e., cycles/octave for logarithmic profiles) or different repetition pitches (i.e., delay for ripple noises). Budgerigars were similar to humans in detecting ripple at low spatial frequencies, but were considerably more sensitive than humans in detecting ripples in log ripple spectra at high spatial frequencies. Budgerigars were also similar to humans in detecting linear ripple in broadband noise over a wide range of repetition pitches. Taken together, these data show that the avian auditory system is at least as good, if not better, than the human auditory system at detecting spectral ripples in noise despite gross anatomical differences in both the peripheral and central auditory nervous systems.

Cognitive behavior group therapy for body dysmorphic disorder: a case series.

The treatment of Body Dysmorphic Disorder (BDD) has received little empirical attention despite evidence that BDD is a debilitating mental health problem. This open case series provides data on a new cognitive-behavioral treatment for BDD. Participants diagnosed with BDD were treated in small groups that met for 12 weekly 90-minute sessions. Patients improved significantly over the course of treatment, with reductions in both BDD and depression symptoms. This finding adds to a nascent literature documenting the potential efficacy of short-term cognitive-behavior therapy for patients suffering from BDD.

Detection of changes in timbre and harmonicity in complex sounds by zebra finches (Taeniopygia guttata) and budgerigars (Melopsittacus undulatus).

Thresholds for detecting alterations in the timbre and harmonicity of complex harmonic signals were measured in zebra finches, budgerigars, and humans. The stimuli used in this experiment were designed to have particular salience for zebra finches by modeling them after natural zebra finch calls. All 3 species showed similar abilities for detecting an amplitude decrement in a single component of a harmonic complex. However, zebra finches and budgerigars were extraordinarily sensitive to the mistunings of single harmonics and exhibited significantly lower thresholds compared with humans at 2 different fundamental frequencies, 570 Hz and 285 Hz. Randomizing relative phases of components in a harmonic stimulus resulted in a significant increase in threshold for detecting mistunings in zebra finches but not in humans. Decreasing the duration of mistuned harmonic stimuli resulted in higher thresholds for both birds and humans. The overall superiority of birds in discriminating inharmonicity suggests that birds and mammals may use different strategies in processing these complex harmonic sounds.

Psychosocial factors in sports injury rehabilitation.

The psychology of sports injury rehabilitation is a relatively new field, even in comparison with the relatively youthful disciplines from which it has evolved. Although the psychology of sports injury has made a significant impact on the sports medicine team, the practical aspects of how and when to refer patients to psychologists need to be better understood. A recent survey of 20 sports medicine physicians indicated a high degree of psychological or behavioral concerns occurring in conjunction with sport injuries, and an increased interest in the services of clinical sports psychologists. An appreciation of mind-body interactions and how they function regarding stress, sports performance, and injury is fundamental to the acceptance of psychological techniques in the medical arena. Teaching these fundamental issues to those in sports and medicine is essential. Furthermore, the psychology of sports injury needs continuing development of a base of theory, empirical research, and clinical practice that is sensitive to the needs of the individual athlete. Research on the assessment of psychosocial factors influencing sports injury and performance, as well as the efficacy of treatment modalities, is warranted. The psychology of sports injury has emerged from several previously established areas of psychology including behavioral medicine, rehabilitation, and sport psychology. As the techniques derived from these arenas are modified to suit the special needs of injured athletes, a set of principles and practices can be-established to better assist the sports medicine team in rehabilitation and prevention of sports injury.

Sexual arousal to erotic and aggressive stimuli in sexually coercive and noncoercive men.

Sexual arousal to erotic stimuli depicting various levels of force were examined among college men. Study 1 used phallometric indices to measure penile circumferential change during combined audio-tape and slide presentations varying in degree of force. The results indicated that the sexually coercive group exhibited more penile tumescence than controls to scenes involving verbal pressure and verbal threats. Analyses across time blocks suggested that control participants inhibited sexual arousal with the introduction of force cues but that the sexually coercive group did not. Study 2 was a replication of Study 1 without slides. Both groups showed increases in penile tumescence in response to the consent scenario. Only the sexually coercive men demonstrated significant tumescence in response to force scenarios. The results indicated that the sexually coercive males had a lower threshold for arousal to sexual cues and did not inhibit sexual arousal when force cues were introduced.

Is homophobia associated with homosexual arousal?

The authors investigated the role of homosexual arousal in exclusively heterosexual men who admitted negative affect toward homosexual individuals. Participants consisted of a group of homophobic men (n = 35) and a group of nonhomophobic men (n = 29); they were assigned to groups on the basis of their scores on the Index of Homophobia (W. W. Hudson & W. A. Ricketts, 1980). The men were exposed to sexually explicit erotic stimuli consisting of heterosexual, male homosexual, and lesbian videotapes, and changes in penile circumference were monitored. They also completed an Aggression Questionnaire (A. H. Buss & M. Perry, 1992). Both groups exhibited increases in penile circumference to the heterosexual and female homosexual videos. Only the homophobic men showed an increase in penile erection to male homosexual stimuli. The groups did not differ in aggression. Homophobia is apparently associated with homosexual arousal that the homophobic individual is either unaware of or denies.