The Effect of Carbohydrate Restriction on Lipids, Lipoproteins, and Nuclear Magnetic Resonance-Based Metabolites: CALIBER, a Randomised Parallel Trial.

Low-carbohydrate high-fat (LCHF) diets can be just as effective as high-carbohydrate, lower-fat (HCLF) diets for improving cardiovascular disease risk markers. Few studies have compared the effects of the UK HCLF dietary guidelines with an LCHF diet on lipids and lipoprotein metabolism using high-throughput NMR spectroscopy. This study aimed to explore the effect of an ad libitum 8-week LCHF diet compared to an HCLF diet on lipids and lipoprotein metabolism and CVD risk factors. For 8 weeks, n = 16 adults were randomly assigned to follow either an LCHF (n = 8, <50 g CHO p/day) or an HCLF diet (n = 8). Fasted blood samples at weeks 0, 4, and 8 were collected and analysed for lipids, lipoprotein subclasses, and energy-related metabolism markers via NMR spectroscopy. The LCHF diet increased (p < 0.05) very small VLDL, IDL, and large HDL cholesterol levels, whereas the HCLF diet increased (p < 0.05) IDL and large LDL cholesterol levels. Following the LCHF diet alone, triglycerides in VLDL and HDL lipoproteins significantly (p < 0.05) decreased, and HDL phospholipids significantly (p < 0.05) increased. Furthermore, the LCHF diet significantly (p < 0.05) increased the large and small HDL particle concentrations compared to the HCLF diet. In conclusion, the LCHF diet may reduce CVD risk factors by reducing triglyceride-rich lipoproteins and improving HDL functionality.

Evaluation of digital photography for quantifying Cryptococcus fagisuga (Hemiptera: Eriococcidae) density on American beech trees.

Beech scale (Cryptococcus fagisuga Lindinger) (Hemiptera: Eriococcidae) is an invasive forest insect established in the eastern United States and Canada. It predisposes American beech (Fagus grandifolia Ehrhart) trees to infection by Neonectria spp. Fungi causing beech bark disease. White wax secreted by the diminutive scales obscures individual insects, making it difficult to accurately quantify beech scale density. Our goals were to 1) evaluate the relationship between the area of wax and number of beech scales on bark samples, 2) determine whether digital photos of bark could accurately quantify beech scale density, and 3) compare efficiency and utility of a qualitative visual estimate and using the quantitative digital photo technique to assess beech scale populations. We visually estimated beech scale abundance and photographed designated areas on the trunk of 427 trees in 40 sites across Michigan. Photos were analyzed using a binary threshold technique to quantify the area of beech scale wax on each photo. We also photographed and then collected 104 bark samples from 45 additional beech trees in ten sites. We removed the wax, counted individual scales on each sample using a microscope, and assessed the linear relationship between wax area and scale counts. Area of wax explained approximately 80% of the variability in scale density. We could typically quantify beech scale density on 15 photographs per hour. Qualitative visual assessments of beech scale in the field corresponded with estimates derived from photos of bark samples for 79% of trees.

Estimating the influence of population density and dispersal behavior on the ability to detect and monitor Agrilus planipennis (Coleoptera: Buprestidae) populations.

Emerald ash borer, Agrilus planipennis Fairmaire (Coleoptera: Buprestidae), a phloem-feeding pest of ash (Fraxinus spp.) trees native to Asia, was first discovered in North America in 2002. Since then, A. planipennis has been found in 15 states and two Canadian provinces and has killed tens of millions of ash trees. Understanding the probability of detecting and accurately delineating low density populations of A. planipennis is a key component of effective management strategies. Here we approach this issue by 1) quantifying the efficiency of sampling nongirdled ash trees to detect new infestations of A. planipennis under varying population densities and 2) evaluating the likelihood of accurately determining the localized spread of discrete A. planipennis infestations. To estimate the probability a sampled tree would be detected as infested across a gradient of A. planipennis densities, we used A. planipennis larval density estimates collected during intensive surveys conducted in three recently infested sites with known origins. Results indicated the probability of detecting low density populations by sampling nongirdled trees was very low, even when detection tools were assumed to have three-fold higher detection probabilities than nongirdled trees. Using these results and an A. planipennis spread model, we explored the expected accuracy with which the spatial extent of an A. planipennis population could be determined. Model simulations indicated a poor ability to delineate the extent of the distribution of localized A. planipennis populations, particularly when a small proportion of the population was assumed to have a higher propensity for dispersal.

Dispersal of Agrilus planipennis (Coleoptera: Buprestidae) from discrete epicenters in two outlier sites.

Emerald ash borer, Agrilus planipennis (Fairmaire) (Coleoptera: Buprestidae), a phloem-feeding beetle native to Asia, has become one of the most destructive forest pests in North America. Since it was first identified in 2002 in southeast Michigan and Windsor, Ontario, dozens of isolated A. planipennis populations have been discovered throughout Michigan and Ontario, and in 12 other states and the province of Quebec. We assessed realized A. planipennis dispersal at two discrete outlier sites that originated 1 yr and 3 yr earlier from infested nursery trees. We systematically sampled ash trees within an 800 m radius of the origin of each infestation to locate galleries constructed by the progeny of dispersing A. planipennis adults. Our sampling identified eight trees at the 1 yr site infested with a mean +/- SE of 11.6 +/- 8.4 A. planipennis larvae and 12 trees at the 3 yr site with 25.8 +/- 11.1 larvae per meter squared. Dendroentomological analysis indicated that A. planipennis populations were predominantly undergoing a 2 yr (semivoltine) life cycle at both sites. Colonized trees were found out to 638 and 540 m from the epicenters at the 1 yr and 3 yr sites, respectively. Logistic regression was used to determine whether the likelihood of A. planipennis colonization was affected by wind direction, ash phloem abundance, distance from the epicenter, or land-use type (i.e., wooded, residential, agricultural, or urban). Results show that the probability of A. planipennis colonization was significantly affected by ash phloem abundance and decreased with distance from the epicenter.

In situ population structure and ex situ representation of the endangered Amur tiger.

The Amur tiger (Panthera tigris altaica) is a critically endangered felid that suffered a severe demographic contraction in the 1940s. In this study, we sampled 95 individuals collected throughout their native range to investigate questions relative to population genetic structure and demographic history. Additionally, we sampled targeted individuals from the North American ex situ population to assess the genetic representation found in captivity. Population genetic and Bayesian structure analyses clearly identified two populations separated by a development corridor in Russia. Despite their well-documented 20th century decline, we failed to find evidence of a recent population bottleneck, although genetic signatures of a historical contraction were detected. This disparity in signal may be due to several reasons, including historical paucity in population genetic variation associated with postglacial colonization and potential gene flow from a now extirpated Chinese population. Despite conflicting signatures of a bottleneck, our estimates of effective population size (N(e) = 27-35) and N(e)/N ratio (0.07-0.054) were substantially lower than the only other values reported for a wild tiger population. Lastly, the extent and distribution of genetic variation in captive and wild populations were similar, yet gene variants persisted ex situ that were lost in situ. Overall, our results indicate the need to secure ecological connectivity between the two Russian populations to minimize loss of genetic diversity and overall susceptibility to stochastic events, and support a previous study suggesting that the captive population may be a reservoir of gene variants lost in situ.

Segmentation of whole cells and cell nuclei from 3-D optical microscope images using dynamic programming.

Communications between cells in large part drive tissue development and function, as well as disease-related processes such as tumorigenesis. Understanding the mechanistic bases of these processes necessitates quantifying specific molecules in adjacent cells or cell nuclei of intact tissue. However, a major restriction on such analyses is the lack of an efficient method that correctly segments each object (cell or nucleus) from 3-D images of an intact tissue specimen. We report a highly reliable and accurate semi-automatic algorithmic method for segmenting fluorescence-labeled cells or nuclei from 3-D tissue images. Segmentation begins with semi-automatic, 2-D object delineation in a user-selected plane, using dynamic programming (DP) to locate the border with an accumulated intensity per unit length greater that any other possible border around the same object. Then the two surfaces of the object in planes above and below the selected plane are found using an algorithm that combines DP and combinatorial searching. Following segmentation, any perceived errors can be interactively corrected. Segmentation accuracy is not significantly affected by intermittent labeling of object surfaces, diffuse surfaces, or spurious signals away from surfaces. The unique strength of the segmentation method was demonstrated on a variety of biological tissue samples where all cells, including irregularly shaped cells, were accurately segmented based on visual inspection.

Unreliability of triglyceride measurement to predict turbidity induced interference.

Lipaemic specimens are a common problem in clinical chemistry. Most laboratories will measure the concentration of triglycerides and then decide whether the analytical result is valid or not. There is a poor association between the concentration of triglycerides and an objective assessment of turbidity for visually turbid specimens. Extrapolation of triglyceride concentrations derived from the use of intravenous emulsions to visually turbid specimens found in clinical practice will overestimate the turbidity induced interference in assays (non-turbid interferences are probably the same). The evaluation of turbidity induced interference needs to be standardised using objective assessments of turbidity.

Phenology and density of balsam twig aphid, Mindarus abietinus Koch (Homoptera: Aphididae) in relation to bud break, shoot damage, and value of fir Christmas trees.

The balsam twig aphid, Mindarus abietinus Koch (Homoptera: Aphididae), is a major insect pest of balsam and Fraser fir grown for Christmas trees. Our objectives in this study were to 1) monitor the phenology of A. abietinus in fir plantations; 2) assess relationships among M. abietinus density, tree phenology, and damage to tree foliage; and 3) develop an esthetic injury level for M. abietinus on Christmas trees. We monitored phenology of M. abietinus and fir trees on three commercial Christmas tree plantations in central and northern Lower Michigan for 3 yr (1999-2001). Phenology of M. abietinus fundatrices and sexuparae was strongly correlated with accumulated degree-days (DD) base 10 degrees C. Fundatrices matured by approximately 83 DD(10 degrees C) and sexuparae were first observed at approximately 83-111 DD(10 degrees C). Trees that broke bud approximately 1 wk later than other trees in the same field escaped M. abietinus damage and shoot expansion rate in spring was generally positively correlated with M. abietinus damage. Retail customers surveyed at a choose-and-cut Christmas plantation in 2 yr did not consistently differentiate between similarly sized trees with no, light, and moderate M. abietinus damage, but heavy damage (>50% damaged shoots) did affect customer perception. Similarly, when wholesale grades were assigned, the high quality Grade 1 trees had up to 40% shoot damage, whereas Grade 2 trees had 32-62% shoot damage. Two trees ranked as unsaleable had sparse canopies and distorted needles on 42% to almost 100% of the shoots.

A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy.

PURPOSE: To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after 3 different treatments for clinically localized prostate cancer. METHODS AND MATERIALS: Ninety men with T1-T2 adenocarcinoma of the prostate were treated with curative intent between May 1998 and June 1999 and completed a quality-of-life Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire before treatment (T0) and 1 month (T1), 3 months (T3), and 12 months (T12) after treatment. Forty-four men were treated with permanent source interstitial brachytherapy (IB), 23 received external beam radiotherapy (EBRT), and 23 men were treated with radical prostatectomy (RP). The mean age of the entire study population was 65.9 years (median 67, range 42-79). The mean pretreatment prostate-specific antigen level of the entire study population was 6.81 ng/mL (median 6.25, range 1.33-19.6). The Gleason score was

Bottlenecks, drift and differentiation: the population structure and demographic history of sika deer (Cervus nippon) in the Japanese archipelago.

We assessed genetic differentiation and diversity in 14 populations of sika deer (Cervus nippon) from Japan and four populations of sika deer introduced to the UK, using nine microsatellite loci. We observed extreme levels of differentiation and significant differences in diversity between populations. Our results do not support morphological subspecies designations, but are consistent with previous mitochondrial DNA analyses which suggest the existence of two genetically distinct lineages of sika deer in Japan. The source of sika introduced to the UK was identified as Kyushu. The underlying structure of Japanese populations probably derives from drift in separate glacial refugia and male dispersal limited by distance. This structure has been perturbed by bottlenecks and habitat fragmentation, resulting from human activity from the mid-nineteenth century. Most current genetic differentiation and differences in diversity among populations probably result from recent drift. Coalescent model analysis suggests sika on each of the main Japanese islands have experienced different recent population histories. Hokkaido, which has large areas of continuous habitat, has maintained high levels of gene flow. In Honshu the population is highly fragmented and is likely to have been evolving by drift alone. In Kyushu there has been a balance between gene flow and drift but all the populations have experienced high levels of drift. Habitat fragment size was not significantly associated with genetic diversity in populations but there was a significant correlation between habitat fragment size and effective population size.

Induction of steady-state blood alcohol levels: application to the study of within-session alcohol tolerance in rats.

BACKGROUND: The study of within-session alcohol tolerance in the rat has been hampered by methodological difficulties related to the measurement of dependent variables at predictable blood alcohol concentrations (BAC) during a single session of alcohol exposure. This study characterizes a method for maintaining steady-state blood alcohol levels over several hours in the rat, referred to as the "alcohol clamp." METHODS: Wistar rats were implanted with an indwelling catheter in the carotid artery for blood sampling and another in the external jugular vein for alcohol infusion. To clamp BAC at a predetermined level, rats first were infused with a priming dose of alcohol to establish the desired or "target" BAC, followed by a continuous infusion of alcohol at a rate equal to that of alcohol metabolism in the rat. This maintained BAC at a constant level over time. BACs of 100, 200, or 300 mg% were maintained over several hours in separate groups of rats. The alcohol clamp was applied to the study of acute (within-session) alcohol tolerance in rats selectively bred for high and low alcohol drinking. Alcohol-induced hypothermia was used to index tolerance, and within-session alcohol tolerance was defined as a return of body temperature toward baseline during the course of the alcohol infusion while BAC was maintained at a constant level. RESULTS: The continuous alcohol infusion procedure maintained BAC in a steady state throughout the 3 hr alcohol infusion session at each of the three target BAC levels. Alcohol infusion induced a drop in body temperature, followed by a return of temperature toward baseline during the course of infusion, which indicated the development of within-session alcohol tolerance. CONCLUSIONS: The continuous alcohol infusion procedure (alcohol clamp) maintained BAC in a steady state, both within and between subjects, across a wide range of blood alcohol levels. The alcohol clamp appears to be a useful tool for subsequent studies of within-session alcohol tolerance in the rat.

Transrectal ultrasound and biopsy in the early diagnosis of prostate cancer.

BACKGROUND: Historically, the prostate was evaluated for cancer by simple digital rectal examination, and biopsy to obtain a tissue diagnosis of cancer was performed blindly. The advent of ultrasound technology offered a new way to evaluate the prostate, and biopsy techniques were soon developed to incorporate ultrasound guidance. METHODS: The authors review the role of transrectal ultrasound (TRUS) of the prostate and ultrasound-guided biopsy of the prostate in the diagnosis of prostate cancer. These techniques are traced from their origins to the current standards of care, with attention paid to developments and controversies in recent literature. RESULTS: Early experience with TRUS led to the description of "classic" sonographic findings of prostate cancer. To obtain a tissue diagnosis of cancer, these regions were initially targeted in ultrasound-guided biopsies. Concomitant with the development of TRUS, though, was the development of the prostate-specific antigen (PSA) assay. Over the past decade, there has been a profound stage migration due to earlier detection of prostate cancer. Most patients now diagnosed with prostate cancer have no palpable abnormality or specific sonographic findings. In response, ultrasound-guided biopsies have become more systematic, rather than lesion-specific, in nature. CONCLUSIONS: TRUS continues to play an important role in the evaluation of the prostate when malignancy is suspected. Although the optimal method of prostate biopsy is controversial, ultrasound is critical in ensuring accurate sampling of the gland.

Screening and intervention for illicit drug abuse: a national survey of primary care physicians and psychiatrists.

BACKGROUND: Illicit drug abuse causes much morbidity and mortality, yet little is known about physicians' screening and intervention practices regarding illicit drug abuse. METHODS: We mailed a survey to a national sample of 2000 practicing general internists, family physicians, obstetricians and gynecologists, and psychiatrists to assess their screening and intervention practices for illicit drug abuse. RESULTS: Of 1082 respondents (adjusted response rate, 57%), 68% reported that they regularly ask new outpatients about drug use. For diagnosed illicit drug abuse, 55% reported that they routinely offer formal treatment referral, but 15% reported that they do not intervene. In multivariate logistic regression models, more optimal screening and intervention practices were associated with psychiatry specialty, confidence in obtaining the history of drug use, optimism about the effectiveness of therapy, less concern that patients will object, and fewer perceived time constraints. CONCLUSIONS: Most physicians reported that they ask patients about illicit drug use, but a substantial minority inadequately intervene in diagnosed drug abuse. Initiatives to promote physician involvement in illicit drug abuse should include strategies to increase physicians' confidence in managing drug problems, engender optimism about the benefits of treatment, dispel concerns about patients' sensitivity regarding substance use, and address perceived time limitations.

First Report of Beech Bark Disease in Michigan.

Beech bark disease of American beech (Fagus grandifolia) is caused by the interaction of an introduced scale insect (Cryptococcus fagisuga) and the native fungus Nectria galligena, or N. coccinea var. faginata, which is thought to be introduced. Infestations of the insect precede development of the disease, and N. galligena is often found before N. coccinea var. faginata. Previously published records indicate that the beech scale extends as far west as eastern Ohio (2) and southern Ontario (Sajan, personal communication). The scale is now well established in several locations in both the Upper Peninsula (UP) and Lower Peninsula (LP) of Michigan. The scale insect has been found in beech stands throughout three counties (Oceana, Mason, and Muskegon) along the Lake Michigan shore in the LP, extending for at least 100 km from north to south, and occurring up to about 80 km inland. In the eastern UP, beech scale has been found in four counties (Alger, Chippewa, Luce, and Schoolcraft). The heaviest beech scale infestations are distributed around Ludington State Park in the west central LP and the Bass Lake Forest Campground in the eastern UP. The extent of the insect infestation suggests that it has been present in Michigan for many years, with anecdotal accounts placing the first observations of beech scale at Ludington State Park around 1990. These infection centers are distant from previously known beech scale infestations and are located in heavily used recreation areas, suggesting that the insect may have been transported by human activity. Perithecia of N. coccinea var. faginata were found in Ludington State Park in the LP at N 44° 1.951', W 86° 29.956' and perithecia of N. galligena were found at the Bass Lake site in the UP, at N 46° 27.748', W 85° 42.478'. The identity of the fungi collected from each location was confirmed by measurements of perithecium and ascospore morphology (1). Perithecia at both sites were scarce and difficult to find. Surveys planned for the summer and fall of 2001 will further delimit the occurrence and distribution of the pathogens involved in the disease in Michigan. To our knowledge, this is the first report of the beech scale and beech bark disease in Michigan, with N. galligena and N. coccinea var. faginata identified as the pathogens. References: (1) H. V. T. Cotter and R. O. Blanchard. Plant Dis. 65:332-334, 1981. (2) M. E. Mielke et al. Plant Dis. 69:905, 1985.

Pseudorabies virus induces apoptosis in tissue culture cells.

The process of cell death as a result of exposure to pseudorabies virus (PRV) in cultured cells was examined and specific features characteristic of apoptosis were observed. At early times of infection, externalization of membrane phospholipid phophatidylserine was detected by flow cytometry analysis. During the infection process, caspase 3-like protease activity was induced and the activity increased in a time dependent manner. Cellular DNA degradation was demonstrated by agarose gel electrophoresis. Morphologic changes of the nucleus that included chromatin condensation and margination to the periphery of the nucleus were evident in electron microscopy analysis. These biochemical and morphologic changes demonstrated that, during PRV replication, the host cell was induced to undergo apoptosis.

Are coagulation studies necessary before percutaneous nephrostomy?

PURPOSE: Performance of coagulation studies for patients undergoing percutaneous nephrostomy (PCN) has been advocated by some investigators. We performed a retrospective study to assess this practice. MATERIALS AND METHODS: The medical records of 180 patients subjected to PCN for various reasons between October 1991 and July 1998 were reviewed. This represents a subset of patients in whom PCN was performed by an experienced interventional radiologist at our institution. Patients were excluded if they had a history of active liver disease, hematologic or bleeding disorder, current use of heparin or warfarin, or platelet count <100,000. The remaining 160 patients were separated into two groups. Group 1 consisted of 153 patients with a normal prothrombin time (PT) and partial thromboplastin time (PTT). Group 2 comprised 7 patients with an abnormal PT or PTT. Demographic and laboratory data including PT, PTT, complete blood, and platelet counts were analyzed to determine if a hemorrhagic complication could be predicted by an abnormal PT or PTT. RESULTS: In group 1 the mean PT was 12.2 seconds and the mean PTT was 25.0 seconds; in group 2 the mean PT was 13.9 seconds and the mean PTT was 30.3 seconds. The hemorrhagic complication rates were not statistically different between the two patient cohorts (p = .203). Demographic and standard laboratory data were not predictive of abnormal coagulation parameters. CONCLUSIONS: Screening coagulation studies are unnecessary in the standard patient subjected to PCN.

Is there a learning curve in diagnosing urolithiasis with noncontrast helical computed tomography?

OBJECTIVE: To report one department's experience with helical computed tomographic (HCT) evaluation of patients with suspected renal colic to diagnose ureteral calculi; to determine whether there is a learning curve in performing HCT in this context; and to determine whether HCT for the evaluation of renal colic exposes patients to more radiation than the standard intravenous pyelography (IVP) combined with nephrotomography. METHODS: All patients presenting to the emergency department with flank or abdominal pain were evaluated with nonreformatted noncontrast HCT. To determine changes in diagnostic accuracy, patients were divided into 2 groups: those evaluated between September 1996 and January 1997 (group 1, 67 patients), and those seen from February to June 1997 (group 2, 53 patients). A radiation exposure study was performed using phantoms, and radiation exposure for HCT, IVP and nephrotomography was measured. RESULTS: Review of HCT scans to diagnose ureteral calculi had a sensitivity of 91.7%, specificity of 82.6%, and accuracy of 87.2% in group 1, and a sensitivity of 95.5%, specificity of 86.7%, and accuracy of 91.9% in group 2. Patients undergoing IVP with nephrotomography were exposed to an effective dose equivalent of 343 mrem (dSv) (for men) and 664 mrem (for women). The effective dose equivalent for an HCT scan was 180 mrem. CONCLUSION: HCT offers excellent, rapid diagnostic accuracy without the need for intravenous contrast medium and with a lower radiation exposure level than IVP in evaluating patients with acute flank pain. There is a small but real learning curve in evaluating patients with acute flank pain with HCT.

Thoracoabdominal radical nephrectomy: is a postoperative thoracostomy tube necessary?

OBJECTIVES: To report our results of patients undergoing thoracoabdominal radical nephrectomy without intraoperative placement of a thoracostomy tube. It has been routine in our hospital to not place a thoracostomy tube in patients undergoing thoracoabdominal radical nephrectomy since 1988. METHODS: We conducted a retrospective review of 47 thoracoabdominal radical nephrectomies performed from January 1988 through November 1998 at our institution. Of the 47 patients, 39 did not have a thoracostomy tube placed intraoperatively; the other 8 patients did. The development of all postoperative complications, length of hospital stay, and hospital charges were noted. RESULTS: No postoperative mortality was noted in our study. Of the 47 patients in the study, 20 patients had a total of 29 complications. The overall number of complications was not increased in the group without a thoracostomy tube compared with the group with a thoracostomy tube (P = 0.104). No patient treated without a thoracostomy tube required subsequent placement of a tube for persistent pneumothorax. The mean length of hospital stay in patients with a thoracostomy tube after radical nephrectomy was 9.14 +/- 2.65 days; in patients without a thoracostomy tube, the mean length of stay was 7.07 +/- 3.97 days (P = 0.071). CONCLUSIONS: In patients without parietal pleural injury, thoracoabdominal radical nephrectomy without the placement of a thoracostomy tube can be performed safely and effectively, with a low risk of postoperative complications and a decrease in the overall hospital stay and hospital charges.

A prospective analysis of patient-reported quality of life after prostate brachytherapy.

The purpose of this study was to prospectively assess the patient-reported quality of life (QOL) and changes in QOL during the first 3 months after prostate brachytherapy (PB). Seventy-four men treated with PB between September 1997 and December 1998 completed a QOL questionnaire (Functional Assessment of Cancer Therapy-Prostate [FACT-P]) and a measurement of urinary symptoms (International Prostate Symptom Score [IPSS]) before treatment (T0), 1 month (T1), and 3 months (T3) following PB. All participants were treated with (125)I alone. The mean score (and standard deviation) at T0, T1, and T3 FACT-P questionnaire are as follows: 139.2 (15.7), 125.4 (20.2), and 133.0 (18.2). For the global test across time, statistically significant differences were observed for the cumulative scores of FACT-P (P < .0001). Examination of the subscales within the FACT-P instrument demonstrated statistically significant changes over time for the following: physical well-being, functional well-being and the prostate cancer subscale. The mean score (and standard deviation) at T0, T1, and T3 for the IPSS questionnaire are as follows: 9.1 (5.9), 20.0 (7.8), and 16.6 (7.2). For the global test across time, statistically significant differences were observed for the IPSS scores (P < .0001). Clinically meaningful decreases in QOL are evident within weeks after PB. Moderate to severe urinary symptoms persist for at least 3 months following PB.

Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists.

OBJECTIVE: To describe adult primary care physicians' and psychiatrists' approach to alcohol screening and treatment, and to identify correlates of more optimal practices. DESIGN: Cross-sectional mailed survey. PARTICIPANTS: A national systematic sample of 2,000 physicians practicing general internal medicine, family medicine, obstetrics-gynecology, and psychiatry. MEASUREMENTS: Self-reported frequency of screening new outpatients, and treatment recommendations in patients with diagnosed alcohol problems, on 5-point Likert-type scales. MAIN RESULTS: Of the 853 respondent physicians (adjusted response rate, 57%), 88% usually or always ask new outpatients about alcohol use. When evaluating patients who drink, 47% regularly inquire about maximum amounts on an occasion, and 13% use formal alcohol screening tools. Only 82% routinely offer intervention to diagnosed problem drinkers. Psychiatrists had the most optimal practices; more consistent screening and intervention was also associated with greater confidence in alcohol history taking, familiarity with expert guidelines, and less concern that patients will object. CONCLUSIONS: Most primary care physicians and psychiatrists ask patients about alcohol use, but fewer use recommended screening protocols or offer formal treatment. A substantial minority of physicians miss the opportunity to intervene in alcohol problems. Efforts to improve physicians' screening and intervention for alcohol problems should address their confidence in their skills, familiarity with expert recommendations, and beliefs that patients object to their involvement