Cortical bone viscoelasticity and fixation strength of press-fit femoral stems: finite element model.

Many cementless implant designs rely upon a diaphyseal press-fit in conjunction with a porous coated implant surface to achieve primary or short term fixation, thereby constraining interface micromotion to such a level that bone ingrowth and consequent secondary or long-term fixation, i.e., osseointegration, can occur. Bone viscoelasticity, however, has been found to affect stem primary stability by reducing push-out load. In this investigation, an axisymmetric finite element model of a cylindrical stem and diaphyseal cortical bone section was created in order to parametrically evaluate the effect of bone viscoelasticity on stem push-out while controlling coefficient of friction (mu = 0.15, 0.40, and 1.00) and stem-bone diametral interference (delta = 0.01, 0.05, 0.10, and 0.50 mm). Based on results from a previous study, it was hypothesized that stem-bone interference (i.e., press-fit) would elicit a bone viscoelastic response which would reduce the initial fixation of the stem as measured by push-out load. Results indicate that for all examined combinations of mu and delta, bone viscoelastic behavior reduced the push-out load by a range of 2.6-82.6% due to stress relaxation of the bone. It was found that the push-out load increased with mu for each value of delta, but minimal increases in the push-out load (2.9-4.9%) were observed as delta was increased beyond 0.10 mm. Within the range of variables reported for this study, it was concluded that bone viscoelastic behavior, namely stress relaxation, has an asymptotic affect on stem contact pressure, which reduces stem push-out load. It was also found that higher levels of coefficient of friction are beneficial to primary fixation, and that an interference "threshold" exists beyond which no additional gains in push-out load are achieved.

Correlation of in vitro susceptibilities to newer quinolones of naturally occurring quinolone-resistant Neisseria gonorrhoeae strains with changes in GyrA and ParC.

The in vitro activities of ciprofloxacin, trovafloxacin, moxifloxacin, and grepafloxacin against 174 strains of Neisseria gonorrhoeae isolated in Sydney, Australia, were determined. The strains included 84 quinolone-less-sensitive and -resistant N. gonorrhoeae (QRNG) strains for which ciprofloxacin MICs were in the range of 0.12 to 16 microg/ml. The QRNG included strains isolated from patients whose infections were acquired in a number of countries, mostly in Southeast Asia. The gyrA and parC quinolone resistance-determining regions (QRDR) of 18 selected QRNG strains were sequenced, and the amino acid mutations observed were related to the MICs obtained. The activities of moxifloxacin and grepafloxacin against QRNG were comparable to that of ciprofloxacin. Trovafloxacin was more active than the other quinolones against some but not all of the QRNG strains. Increments in ciprofloxacin resistance occurred in a step-wise manner with point mutations initiated in gyrA resulting in amino acid alterations Ser91-to-Phe, Ser91-to-Tyr, Asp95-to-Gly, and Asp95-to-Asn. Single gyrA changes correlated with ciprofloxacin MICs in the range 0.12 to 1 microg/ml. The Ser91 changes in GyrA were associated with higher MICs and further QRDR changes. QRNG strains for which ciprofloxacin MICs were greater than 1 microg/ml had both gyrA and parC QRDR point mutations. ParC alterations were seen in these isolates only in the presence of GyrA changes and comprised amino acid changes Asp86-to-Asn, Ser87-to-Asn, Ser87-to-Arg, Ser88-to-Pro, Glu91-to-Lys, and Glu91-to-Gln. QRNG strains for which MICs were in the higher ranges had double GyrA mutations, but again only with accompanying ParC alterations. Not only did the nature and combination of GyrA and ParC changes influence the incremental increases in ciprofloxacin MICs, but they seemingly also altered the differential activity of trovafloxacin. Our findings suggest that the newer quinolones of the type examined are unlikely to be useful replacements for ciprofloxacin in the treatment of gonorrhea, particularly where ciprofloxacin MICs are high or where resistance is widespread.

The learning of first and second person pronouns in English: network models and analysis.

Although most English-speaking children master the correct use of first and second person pronouns by three years, some children show persistent reversal errors in which they refer to themselves as you and to others as me. Recently, such differences have been attributed to the relative availability of overheard speech during the learning process. The present study tested this proposal with feed-forward neural networks learning these pronouns. Network learning speed and analysis of their knowledge representations confirmed the importance of exposure to shifting reference provided by overheard speech. Errorless pronoun learning was linked to the amount of overheard speech, interactions with a greater number of speakers, and prior knowledge of the basic-level kind PERSON.

Failure of azithromycin therapy in gonorrhea and discorrelation with laboratory test parameters.

BACKGROUND: Azithromycin is efficacious in the treatment of chlamydial genital tract infection but less so in gonorrhea. However, MICs of azithromycin for gonococci from previously reported azithromycin treatment failures were consistently below the 'susceptible' MIC level of 2 mg/L. GOAL OF THIS STUDY: To examine gonococci not eliminated with 1 g azithromycin therapy to establish treatment outcome/MIC correlates in gonorrhea. STUDY DESIGN: The MICs and phenotypes of gonococci isolated from five cases of treatment failure after 1 g azithromycin therapy were determined and compared with the MICs of a systematic sample of routine isolates. RESULTS: Azithromycin MICs of gonococci from five cases of failed 1 g azithromycin treatment were 0.125 or 0.25 mg/L, well within the current 'susceptible' MIC range. None of the isolates were of the mtr phenotype. The MIC90 of a systematic sample of 219 gonococcal isolates was 0.25 mg/L. CONCLUSION: The antibiotic MIC/treatment outcome correlates that are usually found in gonorrhea do not apply for azithromycin. Current MIC criteria do not accurately define susceptibility or resistance of gonococci to azithromycin and by themselves do not predict the likely outcome of therapy. Pharmacokinetic factors may decrease the predictive value of MIC data.

Continuing evolution of the pattern of quinolone resistance in Neisseria gonorrhoeae isolated in Sydney, Australia.

BACKGROUND AND OBJECTIVES: Multiple phenotypes of quinolone-resistant Neisseria gonorrhoeae isolated in Sydney since 1984 originated in Asia and increased in number and level of resistance in 1995. GOAL: To study the origins, characteristics, and infection pattern of quinolone-resistant Neisseria gonorrhoeae in Sydney from 1995 to 1997 and to compare these results with prior findings. STUDY DESIGN: Quinolone minimal inhibitory concentrations, phenotype, and geographic source of quinolone-resistant Neisseria gonorrhoeae isolated in Sydney from 1995 to 1997 were analyzed. RESULTS: Two hundred nineteen episodes of infection with quinolone-resistant Neisseria gonorrhoeae from 2,236 gonococcal isolates occurred during 1995 through 1997. The rate of isolation of quinolone-resistant Neisseria gonorrhoeae increased significantly at the end of 1996 and was maintained through 1997. The increase resulted from sustained domestic transmission of a limited number of phenotypes in heterosexual patients. CONCLUSION: The pattern of isolation of quinolone-resistant Neisseria gonorrhoeae in Sydney changed from the sporadic isolation of multiple phenotypes of imported quinolone-resistant Neisseria gonorrhoeae to a higher rate of endemic disease caused by a few subtypes. Alterations in antibiotic treatment regimens in the affected patient group were required.

Neural network modeling of developmental effects in discrimination shifts.

This paper presents neural network simulations of developmental phenomena in discrimination shifts. The discrimination shift literature is reviewed in order to identify the empirical regularities. Leading theoretical accounts of the development of shift learning are reviewed, and the lack of a thorough account is highlighted. Recent unsuccessful neural network simulations of shift learning are also reviewed. New simulations, using the cascade-correlation algorithm, show that networks can capture the regularities of the discrimination shift literature better than existing psychological theories. Manipulation of the amount of training that networks receive, which affects depth of learning, simulates developmental phenomena. It is suggested that human developmental differences in shift learning arise from spontaneous overtraining by older participants, an interpretation consistent with the overtraining literature.

Quinolone-resistant Neisseria gonorrhoeae isolated in Sydney, Australia, 1991 to 1995.

BACKGROUND AND OBJECTIVES: Quinolone antibiotics are used widely for the treatment of gonorrhea, but resistant strains appeared in Sydney in 1984, treatment failure with high-dose regimens in 1991, and isolates with very high minimal inhibitory concentrations (MICs) (16 mg/l) in 1994. GOALS: To examine the frequency, source, and characteristics of Quinolone-resistant Neisseria gonorrhoeae (QRNG) in Sydney from 1991 to 1995 and to compare these data with those obtained from 1984 to 1990. STUDY DESIGN: The antibiotic sensitivity, auxotype-serovar class, and geographic source of QRNG isolated in Sydney from January 1, 1991 to June 30, 1995 were analyzed. RESULTS: One hundred seven QRNG were isolated from 97 patients from 1991 to 1995. The number, proportion, and MICs of QRNG increased slowly in the first 4 years of the study and rapidly in the last 6 months. Most QRNG were isolated from travelers entering Sydney from Asia. Twenty-seven different auxotype-serovar classes were detected including 6 auxotype-serovar classes in 14 isolates with high-level quinolone resistance (MIC, 16 mg/l). CONCLUSIONS: QRNG isolated in Sydney during the past decade originated in Asia as multiple gonococcal subtypes and increased substantially in numbers and levels of resistance in 1995.

Cognitive dissonance reduction as constraint satisfaction.

A constraint satisfaction neural network model (the consonance model) simulated data from the two major cognitive dissonance paradigms of insufficient justification and free choice. In several cases, the model fit the human data better than did cognitive dissonance theory. Superior fits were due to the inclusion of constraints that were not part of dissonance theory and to the increased precision inherent to this computational approach. Predictions generated by the model for a free choice between undesirable alternatives were confirmed in a new psychological experiment. The success of the consonance model underscores important, unforeseen similarities between what had been formerly regarded as the rather exotic process of dissonance reduction and a variety of other, more mundane psychological processes. Many of these processes can be understood as the progressive application of constraints supplied by beliefs and attitudes.

Strain characteristics and antibiotic susceptibility of isolates of Neisseria gonorrhoeae causing disseminated gonococcal infection in Australia. Members of the Australian Gonococcal Surveillance Programme.

The auxotype (A) and serovar (S) distribution and antibiotic and serum sensitivity of 22 strains of Neisseria gonorrhoeae isolated from blood and joints were determined. With one exception, these strains from disseminated gonococcal infections (DGI) belonged to one of 4 serovars of the IA serogroup and were resistant to killing by normal human serum. The auxotype distribution of these Australian strains differed significantly from that reported elsewhere in that 17 of the 22 isolates were proline requires, but none were of the AHU auxotype. This lack of the AHU auxotype in the DGI strains in Australia was explained by the virtual absence of AHU requirers in a sample of 1560 mucosal strains isolated in Sydney and Darwin from 1987 to 1990. The A/S distribution of these mucosal isolates also helped to account for the low (0.12) percentage of DGI strains in isolates examined by the Australian Gonococcal Surveillance Programme (AGSP) from 1981 to 1991, and the differences in the rates of DGI in Sydney (0.08%) and Darwin (0.87%). There was a relative lack of the IA serogroup strains which are mostly responsible for DGI in the mucosal isolates from Sydney (15% of all strains) but a higher proportion of these serovars (40%) in the Darwin sample. There were 46 cases of DGI in data from the AGSP, 29 of these being women. Seven of the cases diagnosed in Australia were infected with penicillinase-producing gonococci suggesting that antibiotics other than the penicillins should now be used for this condition in this region.

Characteristics of Neisseria gonorrhoeae isolated in Australia showing decreased sensitivity to quinolone antibiotics.

Forty three strains of Neisseria gonorrhoeae with decreased sensitivity to quinolone antibiotics were detected amongst 2141 Australian isolates of gonococci examined in the years 1984 to 1990. The strains examined belonged to 23 different auxotype/serovar classes, were generally more resistant to other antibiotics and, in the majority of cases, were isolated from travellers entering or returning to Australia from SE Asia. Quinolone-sensitive wild-type gonococci became less sensitive to these agents in vitro at a relatively high frequency when grown in the presence of quinolone concentrations at or around the MIC (Mean Inhibitory Concentration) of the antibiotic. Further increments in the levels of quinolone resistance of the already less-sensitive gonococci were also produced by this means, but high-level resistance to these agents was not observed. This suggests that mechanisms other than alterations in the DNA-gyrase of the organisms were responsible for the changes seen. Although spread of quinolone resistance in gonococci in Australia is unlikely to be rapid, if these antibiotics are used in therapy, treatment regimens with higher rather than lower dosages of quinolone antibiotics should be employed.

The infant's concept of agency: the distinction between social and nonsocial objects.

The primary purpose of this study was to examine young infants' discrimination between the abilities of social and nonsocial objects to serve as agents. Thirty-one infants between 8 months and 8 days old and 14 months and 19 days old were studied. The children's communicative skills were evaluated through frustration episodes in which a toy was taken away in order to elicit communicative behaviors toward the mother. Visual fixation time was compared for events in which an inanimate object moved independently and events in which a human being was the agent. Analysis of the magnitude of decrease of attending responses revealed that the older infants took longer to process anomalous events, whereas the younger infants manifested more interest for events in which an animate being played the role of agent. The findings suggest that infants can distinguish between the causal powers of social and nonsocial objects by the end of the first year.

Maltose-negative Neisseria meningitidis isolated from a case of male urethritis.

A maltose-negative strain of Neisseria meningitidis isolated from a male patient with urethritis was initially identified as a gonococcus on the basis of carbohydrate utilization tests. Additional investigations initiated because of atypical colony morphology and a negative superoxol reaction showed the isolate to be a meningococcus with defective maltose-phosphorylating capacity.

Concepts of potency and resistance in causal prediction.

This study examined the development of causal prediction using physical systems with effects of continuous magnitude. Accurately predicting the magnitude of an effect (ME) requires integration of information about the potency (P) of the causal agent and the resistance (R) of the effect. 10 5-year-olds, 10 9-year-olds, and 10 adults each viewed 36 instances of each of 2 causal mechanisms in which 6 levels of P were crossed with 6 levels of R. For every (P, R) pair, subjects were asked to predict ME. For one mechanism (the balance), an accurate combination of P and R would correspond to a subtraction model (ME = P-R), whereas for the other mechanism (the ramp), a division model (ME = P/R) would yield accurate predictions. Subjects' theoretical models of the roles of P and R were inferred from (a) correlations of their predictions with ideal answers, (b) multiple regression analyses, and (c) analysis of the number of categories P and R that each subject employed. Relative to older subjects, 5-year-olds treated P and R as having fewer categories of intensity. Although 5-year-olds did not generally achieve high correlations with ideal answers, many systematically used P and/or R to influence their predictions. Subjects used P and R more systematically on the balance problem than on the ramp problem. 9-year-olds employed the correct model (subtraction) on the balance problem but applied the subtraction model to the ramp problem as well. Adults converged on the correct models for each mechanism. The results are interpreted in terms of the progressive refinement of a rough, qualitative theory.

Psychology of computer use: X. Effect of learning Logo on children's problem-solving skills.

A natural experiment was used to determine whether learning the computer language Logo improves children's problem-solving strategies outside of the Logo context. 8-yr.-olds who learned Logo in school were found to use both debugging techniques and procedurality in their computer programming. They and a group of control children of the same age were pre- and posttested on a game requiring debugging skills (Mastermind) and another game requiring procedural skills (Tower of Hanoi). Boys, but not girls, trained in Logo showed an improvement in debugging skills relative to the control children. Improvement in procedural skills was not related to training in Logo. The results were discussed in terms of distance of transfer, degree of expertise, and the basis of sex differences in computer programming.