Hormonally impregnated intrauterine systems (IUSs), versus other forms of reversible contraceptives as effective methods of preventing pregnancy

OBJECTIVES

To assess the contraceptive efficacy, tolerability and acceptability of hormonally impregnated intrauterine systems (IUSs) in comparison to other reversible contraceptive methods.

SEARCH STRATEGY

Literature was identified through database searches, reference lists and individuals/organisations working in the field.

SELECTION CRITERIA

All randomised controlled trials comparing IUSs with other forms of reversible contraceptives and reporting on pre-determined outcomes in women of reproductive years. The primary outcomes were pregnancy due to method/user failure and continuation rate.

DATA COLLECTION AND ANALYSIS

The quality assessment of studies and data extraction were completed independently by two blinded reviewers. A quality checklist was designed to identify general methodological and contraceptive specific factors which could bias results. Events per women months and single decrement life table rates were extracted where possible for pregnancy, continuation, adverse events and reasons for discontinuation. Events per total number of women at follow up were collected for hormonal side effects and menstrual disturbance. When appropriate, data were pooled at the same points of follow up to calculate rate ratios in order to determine the relative effectiveness of one method compared to another. For the single decrement life table rates, the rate differences were pooled to determine the absolute difference in effectiveness of one method compared to another. Interventions were only combined if the contraceptive methods were similar. Non-hormonal IUDs were divided into three categories for the purpose of comparison with IUSs: IUDs >250mm2 (i.e. CuT 380A IUD and CuT 380 Ag IUD), IUDs <=250mm2 (i.e. Nova-T, Multiload, CuT 200 and CuT 220 IUDs) and non-medicated IUDs.

MAIN RESULTS

Nineteen RCTs comparing hormonally impregnated IUSs to a reversible contraceptive method met the inclusion criteria and it was possible to include eight of these in the meta-analyses, four comparing LNG-20 IUSs with non-hormonal IUDs, one comparing the LNG-20 IUS with Norplant-2 and three comparing Progestasert with non-hormonal IUDs. No significant difference was observed between the pregnancy rates for the LNG-20 users and those for the IUD >250mm2 users. However, women using the LNG-20 IUS were significantly less likely to become pregnant than those using the IUD <=250mm2. Women using the LNG-20 IUS were more likely to experience amenorrhoea and device expulsion than women using IUDs >250mm2. LNG-20 users were significantly more likely than all the IUD users to discontinue because of hormonal side effects and menstrual disturbance, which on further breakdown of the data was due to amenorrhoea. When the LNG-20 IUS was compared to Norplant-2, the LNG-20 users were significantly more likely to experience amenorrhoea and oligomenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. No other significant differences were observed. Progestasert users were significantly less likely to become pregnant and less likely to continue on the method than non-medicated IUD users after one year, but no significant differences was noted for these two outcomes when Progestasert users were compared to IUD<=250mm2 users. The only other significant differences found in the meta-analyses were that Progestasert users were less likely to expel the device and more likely to discontinue the method because of menstrual bleeding and pain than users of IUDs <=250mm2.

REVIEWER'S CONCLUSIONS

Current evidence suggests LNG-20 IUS users are no more or less likely to have unwanted pregnancies than IUD >250mm2 and Norplant-2 users. The LNG-20 IUS was more effective in preventing either intrauterine or extrauterine pregnancies than IUDs <=250mm2. The contraceptive effectiveness of Progestasert was significantly better than non-medicated IUDs, but no difference was observed when compared to IUDs<=250mm2. Continuation of LNG-20 IUS use was similar to continuation of the non-hormonal IUDs and Norplant-2. Amenorrhoea was the main reason for the discontinuation for the LNG-20 IUS and women should be informed of this prior to starting this method.

Economic evaluation of strategies for managing crying and sleeping problems

AIMS

To estimate the financial cost to the NHS of infant crying and sleeping problems in the first 12 weeks of age and to assess the cost effectiveness of behavioural and educational interventions aimed at reducing infant crying and sleeping problems relative to usual services.

METHODS

A cost burden analysis and cost effectiveness analysis were conducted using data from the Crying Or Sleeping Infants (COSI) Study, a three armed prospective randomised controlled trial that randomly allocated 610 mothers to a behavioural intervention (n = 205), an educational intervention (n = 202), or existing services (control, n = 203). Main outcome measures were annual total cost to the NHS of infant crying and sleeping problems in the first 12 weeks, and incremental cost per interruption free night gained for behavioural and educational interventions relative to control.

RESULTS

The annual total cost to the NHS of infant crying and sleeping problems in the first 12 weeks was 65 pound sterling million (US$104 million). Incremental costs per interruption free night gained for the behavioural intervention relative to control were 0.56 pound sterling (US$0.92). For the educational intervention relative to control they were 4.13 pound sterling (US$6.80).

CONCLUSIONS

The annual total cost to the NHS of infant crying and sleeping problems is substantial. In the cost effectiveness analysis, the behavioural intervention incurred a small additional cost and produced a small significant benefit at 11 and 12 weeks of age. The educational intervention incurred a small additional cost without producing a significant benefit.

Catchment management and the Great Barrier Reef

Pollution of coastal regions of the Great Barrier Reef is dominated by runoff from the adjacent catchment. Catchment land-use is dominated by beef grazing and cropping, largely sugarcane cultivation, with relatively minor urban development. Runoff of sediment, nutrients and pesticides is increasing and for nitrogen is now four times the natural amount discharged 150 years ago. Significant effects and potential threats are now evident on inshore reefs, seagrasses and marine animals. There is no effective legislation or processes in place to manage agricultural pollution. The Great Barrier Reef Marine Park Act does not provide effective jurisdiction on the catchment. Queensland legislation relies on voluntary codes and there is no assessment of the effectiveness of the codes. Integrated catchment management strategies, also voluntary, provide some positive outcomes but are of limited success. Pollutant loads are predicted to continue to increase and it is unlikely that current management regimes will prevent this. New mechanisms to prevent continued degradation of inshore ecosystems of the Great Barrier Reef World Heritage Area are urgently needed.

Emotion recognition in schizophrenia: further investigation of generalized versus specific deficit models

In this study, the authors examined the nature of emotion perception in schizophrenia. Two samples of people with schizophrenia, one receiving acute care for a recent exacerbation of symptoms and the other receiving extended care, were compared with a nonclinical control group on emotion perception and general perception measures. The nonclinical control group obtained the highest scores on all of the study measures, and the acutely ill group obtained the lowest scores. Furthermore, the acutely ill sample had a specific deficit in emotion perception that remained present after controlling for performance on the general perception tasks. Conversely, the deficits in emotion discrimination in the extended-care sample reflected generalized poor performance. Differences in performance on the emotion identification task between the 2 clinical groups were reduced when controlling for active symptoms.

Locomotion, respiratory physiology, and energetics of amphibious and terrestrial crabs

The transition from breathing air to breathing water requires physiological and morphological adaptations. The study of crustaceans in transitional habitats provides important information as to the nature of these adaptations. This article addresses the physiology of air breathing in amphibious and terrestrial crabs and their relative locomotor abilities. Potamonautes warreni is an apparently amphibious freshwater crab from southern Africa, Cardisoma hirtipes is an air-breathing gecarcinid crab with some dependency on freshwater, and Gecarcoidea natalis is an obligate air-breathing gecarcinid endemic to Christmas Island in the Indian Ocean. All three species have well-developed lungs but retain gills and show seasonally different activity patterns that, in the gercarcinids, especially G. natalis, include long-distance breeding migrations. The three species were better at breathing air than water, but P. warreni was the best at breathing water. Cardisoma hirtipes is essentially an obligate air breather and appears to experience facultative hypometabolism during immersion. Cardisoma hirtipes has a haemocyanin with a high affinity for O(2) that facilitates loading from air but makes 30% of the Hc bound O(2) inaccessible. The gecarcinids but not P. warreni show increased diffusion limitation for O(2) over the lung during exercise. Gecarcoidea natalis outperforms C. hirtipes by virtue of a unique haemolymph shunt from the lung into the gills. Paradoxically, it is modifications of the gills for aerial O(2) uptake in G. natalis that allow for relatively greater haemolymph oxygenation. Despite showing decreased arterial-venous DeltaPo(2), P. warreni increased the arterial-venous Delta[O(2)] with no recourse to anaerobiosis during 5 min exercise. In the short term, P. warreni is more adept at walking than C. hirtipes. The breeding migrations of C. hirtipes and G. natalis were completely aerobic, but G. natalis walk farther and probably faster. Seasonal changes in underlying metabolism of G. natalis are strongly implied, including variations in hyperglycaemic hormone, variable basal metabolic rates, and a diel alkalosis present only in migrating crabs. The persistent dependence on water for reproduction is a determining factor in the biology of air-breathing crabs. The annual migrations include costs other than locomotion, for example, burrow construction and intermale competition. Estimates of costs that consider walking alone will underestimate the metabolic and stored fuel requirements for successful reproduction.

Levonorgestrel-releasing (20 microgram/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives

OBJECTIVE

To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 microg per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age.

DESIGN

A systematic review and meta-analysis of randomised controlled trials.

IDENTIFICATION

Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field.

MAIN OUTCOME MEASURES

Unplanned pregnancy and continuation of contraceptive method.

RESULTS

Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhormonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380A intrauterine devices) and those < or = 250 mm3 (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices < or = 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm3. LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting.

CONCLUSIONS

The effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome.

Outcome after musculoskeletal trauma treated in a regional hospital

BACKGROUND

Trauma remains the leading cause of death and morbidity in the under-35-year-old population. The majority of reports assessing outcome after trauma emanate from North American Level I trauma centers. We sought to examine outcome after trauma treated in an Irish regional unit.

METHODS

All patients admitted over a 1-year period with an Injury Severity Score > or =9 were evaluated and 61 patients recruited to the study. Demographic data, medical history, and details of the mechanism and pattern of injury and treatment were collected. Patients' functional outcome was assessed using the Sickness Impact Profile (SIP), duration of hospital stay, and return to work.

RESULTS

Significant residual disability was noted (mean SIP 13.63+/-14.60). Thirty-seven percent of patients had not returned to work despite a mean follow-up of 18.36 months. Factors associated with a poor outcome include increasing age, a blue-collar occupation, lower limb fractures, comorbid conditions, and the presence of complications.

CONCLUSION

Optimizing primary care of the trauma victim may help to minimize consequent morbidity. A small group of patients suffer permanent disability, and vocational retraining opportunities should be made available to them.

Emotion recognition in schizophrenia: further investigation of generalized versus specific deficit models

In this study, the authors examined the nature of emotion perception in schizophrenia. Two samples of people with schizophrenia, one receiving acute care for a recent exacerbation of symptoms and the other receiving extended care, were compared with a nonclinical control group on emotion perception and general perception measures. The nonclinical control group obtained the highest scores on all of the study measures, and the acutely ill group obtained the lowest scores. Furthermore, the acutely ill sample had a specific deficit in emotion perception that remained present after controlling for performance on the general perception tasks. Conversely, the deficits in emotion discrimination in the extended-care sample reflected generalized poor performance. Differences in performance on the emotion identification task between the 2 clinical groups were reduced when controlling for active symptoms.

Swimming eliminates the weight gain and abdominal fat associated with ovariectomy in the retired breeder rat despite high-fat diet selection

The effects of swim-training on choice of dietary fat, carbohydrate or protein, weight gain, energy intake, and energy efficiency were examined in ovariectomized and sham-operated retired breeder rats. After a 3 week training period of increased duration, rats swam for 75 min per session (5 days per week) for 4 weeks. Ovariectomized rats gained more weight than sham rats, while swimming reduced weight gain and abdominal fat. As a percentage of total intake, macronutrient choices (weight and energy) were similar for all groups, ovariectomized animals consumed more food and more energy, compared with sham animals. All rats freely chose the majority of their food (g) as carbohydrate and the majority of energy (kJ) as fat. Results indicate that a moderate intensity training program of swimming prevented the weight gain following ovariectomy in older rats despite their excessive caloric intake of fat.

Respiratory gas transport, metabolic status, and locomotor capacity of the Christmas Island red crab Gecarcoidea natalis assessed in the field with respect to dichotomous seasonal activity levels

Red crabs, Gecarcoidea natalis, exhibit seasonal activity patterns: low activity during the dry season when they shelter in burrows to avoid dehydration, and high activity during the wet season. Red crabs were examined in situ in the rainforest of Christmas Island to determine if there were underlying seasonal differences in the capacity for exercise and associated metabolism. During both seasons, free-ranging (FR) crabs engaged in their normal activities and, together with crabs induced to exercise for 5 min, were sampled for haemolymph and muscle tissue. Respiratory gases in the haemolymph and key metabolites were measured to assess differences in metabolic status of FR and exercised crabs. Actively foraging FR crabs during the wet season exhibited a relative haemolymph hypoxia (2.9 kPa) and accumulated an extra 3 mmol. litre(-1) of CO(2) compared to the relatively inactive FR crabs during the dry season. Wet-season crabs appeared to be in a state of relative respiratory acidosis compared to dry-season animals. This hypercapnia may arise as a consequence of a relative hypoventilation in animals with a relatively higher metabolic rate during the wet season. Oxygenation of pulmonary and arterial haemolymph was similar and remained high after 5 min of exercise, indicating that the gills and lungs functioned similarly in gas exchange in both FR and exercised crabs. During exercise, venous O(2) reserves decreased and red crabs experienced a mixed respiratory/metabolic acidosis. Similar changes, after 5 min of enforced exercise, in metabolite concentrations, pH and respiratory gas status in the haemolymph during both sampling seasons suggest that the crabs maintain similar capacity to increase exercise during the wet and the dry seasons, despite the differences in underlying physiological status. This is important since after prolonged inactivity during the dry season, with the arrival of moonsoonal rains, red crabs must engage in their annual breeding migration.

Reversal of caffeine withdrawal by ingestion of a soft beverage

Followlng regular use, acute cessation of caffeine is associated with a characteristic withdrawal syndrome. Despite this, caffeine remains popular with its consumers. The aim of this study was to examine the physiologic and psychologic effects of small caffeine doses, administered in the form of a market-leading soft drink, on healthy women who were acutely withdrawn from caffeine. After 48-h abstinence and overnight fast, 11 healthy (22 to 40 years) female volunteers, all regular caffeine users (daily consumption 143 to 773 mg) consumed using a double-blind. randomized, controlled cross-over design either 2 tins of regular or caffeine-free Diet Coke. On both visits a Mars bar was eaten to prevent hypoglycaemia. Thus, the caffeine load was 76 or 10 mg respectively. Following ingestion of regular Diet Coke, there was a l0% fall in middle cerebral artery velocity (95% CI [6%-l4%], p < 0.005 versus caffeine free) and improvement in feelings of pleasure (p < 0.046) and energy (p < 0.037). Intellectual function (4-choice reaction time) was unaffected by caffeine status. On both visits, ingestion of Diet Coke induced a pressor response (maximum rise in systolic pressure +15+/- 2 mm Hg with caffeine and +l2 +/- 2 mm Hg with caffeine-free beverage, both p < 0.001 compared with baseline). In conclusion, in women acutely withdrawn from caffeine, ingestion of a popular soft beverage containing modest amounts of caffeine is associated with demonstrable physiologic and psychologic effects.

The immunogenicity of single and combination DNA vaccines against tuberculosis

DNA immunization is a promising new approach for the development of novel tuberculosis vaccines. In this study, the immune responses following the administration of single and combination tuberculosis DNA vaccines were evaluated. Single DNA vaccines encoding the MPT-63 and MPT-83 tuberculosis antigens evoked partial protection against an aerogenic challenge with M. tuberculosis Erdman in the mouse model of pulmonary tuberculosis. Immunization with a multivalent combination DNA vaccine (containing the ESAT-6, MPT-64, MPT-63, and KatG constructs) generated immune responses that indicated an absence of antigenic competition since antigen-specific cell-mediated and humoral responses were detected to each component of the mixture. More importantly, the combination vaccine elicited a strong protective response relative to the protection evoked by live BCG vaccine.

Utilization of docosahexaenoic acid from intravenous egg yolk phospholipid

Docosahexaenoic acid (DHA, 22:6n-3) is provided directly to human premature infants during parenteral nutrition from the egg yolk fraction of an intravenous fat emulsion. This study aimed to determine whether the high egg yolk phospholipid content of Intralipid 10% (IL 10%, Pharmacia, Uppsala, Sweden) relative to the standard emulsion Intralipid 20% (IL 20%, Pharmacia) could be a strategy to increase the delivery of DHA to the developing brain. Male, Large White piglets were randomly selected from sows 3 d after birth. Piglets were assigned to receive a 9-d continuous intravenous infusion commencing 5 d after birth of either Intralipid (IL) 10%, IL 20%, or Lipofundin S 20% (LFS; B. Braun, Melsungen, Germany). There were four piglets in each treatment group. IL 10% provides twice as much DHA as IL 20%, while LFS provides no DHA. Protein and other nutrients were provided enterally using a low-fat milk formula. After 9 d, animals were killed, and the fatty acid compositions of blood, liver, and cerebral cortex were analyzed. IL 10% infusion approximately doubled the amount of plasma phospholipid DHA (microg/mL of plasma) in comparison to IL 20%. However, red blood cells, liver, and cerebral cortex phospholipid DHA levels were indistinguishable between these two groups. LFS was associated with reduced levels of DHA in plasma, red blood cell and liver phospholipids in comparison to IL 20%. We conclude that infusion of additional phospholipid is an ineffective strategy for increasing DHA delivery to piglet tissues. This may be due to the formation of inert phospholipid particles in plasma. The data do not support the concept of using IL 10% as a means of providing additional DHA to premature human infants.

The association between chronic widespread pain and mental disorder: a population-based study

OBJECTIVE

Patients with chronic widespread pain (CWP) have been reported to have a greater prevalence of mental disorders and somatization than that found in the general population, but the true association between CWP and mental disorders is unknown. In this study, we investigated whether there is an increased prevalence of mental disorder in people with CWP from the general population. We also describe the psychiatric diagnoses associated with CWP.

METHODS

In a population-based case-control study, 1,953 subjects (75% of a random sample of individuals age 18-65 years) completed a questionnaire that included a pain assessment and the 12-item General Health Questionnaire (GHQ-12). Of 710 subjects scoring >1 on the GHQ-12, 301 were assessed further using a structured psychiatric interview and detailed assessment of medical records to identify cases of mental disorder, in accordance with criteria of the 10th edition of the International Classification of Diseases. The association between CWP and mental disorder was modeled using logistic regression, adjusting for possible confounders including age, sex, and nonresponders.

RESULTS

We estimated the overall population prevalence of mental illness to be 11.9%. The odds of having a mental disorder for subjects with versus those without CWP were 3.18 (95% confidence interval 1.97-5.11). Most subjects with mental disorders were diagnosed as having mood and anxiety disorders. Only 3 cases of somatoform disorders were identified, and all were associated with pain.

CONCLUSION

This study, although unable to demonstrate a cause-and-effect relationship, showed that 16.9% of those with CWP were estimated to have a psychiatric diagnosis, suggesting that these disorders should be identified and treated.

Chromosome analysis of workers occupationally exposed to radiation at the Sellafield nuclear facility

PURPOSE

To investigate the relationship between stable chromosome aberration frequency in peripheral blood lymphocytes and occupational cumulative radiation exposure.

MATERIALS AND METHODS

Cytogenetic analysis using G-banding was performed on peripheral blood lymphocyte cultures from 104 workers from the British Nuclear Fuels PLC facility at Sellafield, UK. The study group comprised 61 men with lifetime cumulative doses > 500 mSv, 39 men with minimal exposure (i.e. < 50 mSv) who formed a control group and 4 men with intermediate doses.

RESULTS

The slope of the dose-response, adjusted for smoking status, for translocations and insertions was 0.55+/-0.31 x 10(-2)/cell/Sv. Consideration of chromosome breakpoints for all aberrations combined in the radiation workers revealed an excess in the C group chromosomes and a deficit in the F group chromosomes with breakpoints being concentrated in the terminal regions whereas the distribution in the control group did not deviate from expectation.

CONCLUSIONS

The dose-response was not significantly different from the parallel FISH analysis (Tucker et al. 1997) and confirms that chronic radiation exposure appears to be substantially less effective at inducing stable chromosome aberrations in comparison with acute exposure.

Discovery of novel antifungal (1,3)-beta-D-glucan synthase inhibitors

The increasing incidence of life-threatening fungal infections has driven the search for new, broad-spectrum fungicidal agents that can be used for treatment and prophylaxis in immunocompromised patients. Natural-product inhibitors of cell wall (1,3)-beta-D-glucan synthase such as lipopeptide pneumocandins and echinocandins as well as the glycolipid papulacandins have been evaluated as potential therapeutics for the last two decades. As a result, MK-0991 (caspofungin acetate; Cancidas), a semisynthetic analogue of pneumocandin B(o), is being developed as a broad-spectrum parenteral agent for the treatment of aspergillosis and candidiasis. This and other lipopeptide antifungal agents have limited oral bioavailability. Thus, we have sought new chemical structures with the mode of action of lipopeptide antifungal agents but with the potential for oral absorption. Results of natural-product screening by a series of newly developed methods has led to the identification of four acidic terpenoid (1,3)-beta-D-glucan synthase inhibitors. Of the four compounds, the in vitro antifungal activity of one, enfumafungin, is comparable to that of L-733560, a close analogue of MK-0991. Like the lipopeptides, enfumafungin specifically inhibits glucan synthesis in whole cells and in (1,3)-beta-D-glucan synthase assays, alters the morphologies of yeasts and molds, and produces a unique response in Saccharomyces cerevisiae strains with point mutations in FKS1, the gene which encodes the large subunit of glucan synthase.

Adaptations to a terrestrial existence in the robber crab Birgus latro L. IX. Hormonal control of post-renal urine reprocessing and salt balance in the branchial chamber

The terrestrial robber crab Birgus latro L. regulates the composition of its final excretory product (termed P) depending on the availability of dietary salt by reabsorbing ions from urine passed over the gills. Laboratory and field-based studies investigated the nature of the mechanisms of control of this branchial ion uptake. B. latro were prepared such that their branchial chambers could be perfused with artificial urine, and the rate of ion transport from the artificial urine was determined. For B. latro acclimated to drinking fresh water, the rates of Na(+) and Cl(−) uptake were more than four times those of crabs drinking 70 % sea water. Crabs were injected with either saline carrier or the same solution containing either dopamine or dibutyryl cyclic AMP (db-cAMP) (final concentration 8.7×10(−)(7)mol l(−)(1)haemolymph). Dopamine and db-cAMP inhibited Na(+) and Cl(−) uptake in animals acclimated to fresh water and markedly reduced their gill Na(+)/K(+)-ATPase activity. Dopamine stimulated the production of cyclic AMP within the branchial epithelial cells. Dopamine, released from the pericardial organs, acts as a primary messenger, and cyclic AMP acts as a second messenger most likely promoting phosphorylation of membrane proteins. In contrast to aquatic brachyuran crabs, ion transport in B. latro, an anomuran, is controlled via an inhibitory effect. Terrestrial crabs normally have access to fresh water and must salvage salt from their urine, and a mechanism to down-regulate a normally active uptake system seems more appropriate to their ecology. Whether the control is stimulatory or inhibitory in the various air-breathing crabs may depend on the osmoregulatory abilities of their aquatic ancestors, but in either case has significant implications for the evolution of crustaceans to life on land. Further work must establish whether terrestrial brachyuran crabs are similar to B. latro and whether this crab is unique amongst the anomuran crabs.

Use of complementary and alternative medicine among Dominican emergency department patients

This small, pilot study examined presenting complaint, brief health history, use of complementary and alternative medicine (CAM), and sociodemographic characteristics, among patients attending the emergency department (ED) of a large urban hospital. The sample (n = 50) was primarily Dominican and of low socioeconomic status. Almost half had used CAM for their presenting complaint or another health problem during the past year, most commonly in the form of medicinal plants made into herbal teas. CAM users were more likely to be female, longer-term residents of the United States, and to have also used religious practices for health problems. Subjects who had used CAM for any problem other than the presenting complaint during the past year rated its effectiveness higher than subjects who had used CAM for their presenting complaint. In conclusion, it is likely that a significant proportion of Dominican ED patients use CAM, suggesting that they should be asked about their CAM use during triage.

Accelerated age-related decline in processing resources in schizophrenia: evidence from pupillary responses recorded during the span of apprehension task

Cognitive impairment in schizophrenia may be related to reduced availability of information-processing resources (resource limitations hypothesis). An abnormally accelerated age-related decline in processing resource availability may also occur in older patients with schizophrenia (neurodegeneration hypothesis). To test these hypotheses, pupillary responses were recorded as an index of processing resource availability during performance of the span of apprehension (SOA) task in 33 middle-aged and older patients with schizophrenia and 37 age-comparable nonpsychiatric participants. Consistent with the resource-limitations hypothesis, the patients with schizophrenia showed impaired detection accuracy and abnormally small pupillary responses (reduced resource allocation) only in the higher processing load SOA conditions. This pattern of results suggests that the patients depleted their available processing resources at lower processing loads than the nonpsychiatric participants. Consistent with the neurodegeneration hypothesis, cross-sectional analyses showed abnormally accelerated rates of age-related decline in SOA performance and pupillary responses in the patients with schizophrenia relative to age-comparable normal participants.