Impartial third-party interventions in captive chimpanzees: a reflection of community concern

Because conflicts among social group members are inevitable, their management is crucial for group stability. The rarest and most interesting form of conflict management is policing, i.e., impartial interventions by bystanders, which is of considerable interest due to its potentially moral nature. Here, we provide descriptive and quantitative data on policing in captive chimpanzees. First, we report on a high rate of policing in one captive group characterized by recently introduced females and a rank reversal between two males. We explored the influence of various factors on the occurrence of policing. The results show that only the alpha and beta males acted as arbitrators using manifold tactics to control conflicts, and that their interventions strongly depended on conflict complexity. Secondly, we compared the policing patterns in three other captive chimpanzee groups. We found that although rare, policing was more prevalent at times of increased social instability, both high-ranking males and females performed policing, and conflicts of all sex-dyad combinations were policed. These results suggest that the primary function of policing is to increase group stability. It may thus reflect prosocial behaviour based upon "community concern." However, policing remains a rare behaviour and more data are needed to test the generality of this hypothesis.

Can captive orangutans (Pongo pygmaeus abelii) be coaxed into cumulative build-up of techniques?

While striking cultural variation in behavior from one site to another has been described in chimpanzees and orangutans, cumulative culture might be unique to humans. Captive chimpanzees were recently found to be rather conservative, sticking to the technique they had mastered, even after more effective alternatives were demonstrated. Behavioral flexibility in problem solving, in the sense of acquiring new solutions after having learned another one earlier, is a vital prerequisite for cumulative build-up of techniques. Here, we experimentally investigate whether captive orangutans show such flexibility, and if so, whether they show techniques that cumulatively build up (ratchet) on previous ones after conditions of the task are changed. We provided nine Sumatran orangutans (Pongo pygmaeus abelii) with two types of transparent tubes partly filled with syrup, along with potential tools such as sticks, twigs, wood wool and paper. In the first phase, the orangutans could reach inside the tubes with their hands (Regular Condition), but in the following phase, tubes had been made too narrow for their hands to fit in (Restricted Condition 1), or in addition the setup lacked their favorite materials (Restricted Condition 2). The orangutans showed high behavioral flexibility, applying nine different techniques under the regular condition in total. Individuals abandoned preferred techniques and switched to different techniques under restricted conditions when this was advantageous. We show for two of these techniques how they cumulatively built up on earlier ones. This suggests that the near-absence of cumulative culture in wild orangutans is not due to a lack of flexibility when existing solutions to tasks are made impossible.

Social learning and evolution: the cultural intelligence hypothesis

If social learning is more efficient than independent individual exploration, animals should learn vital cultural skills exclusively, and routine skills faster, through social learning, provided they actually use social learning preferentially. Animals with opportunities for social learning indeed do so. Moreover, more frequent opportunities for social learning should boost an individual's repertoire of learned skills. This prediction is confirmed by comparisons among wild great ape populations and by social deprivation and enculturation experiments. These findings shaped the cultural intelligence hypothesis, which complements the traditional benefit hypotheses for the evolution of intelligence by specifying the conditions in which these benefits can be reaped. The evolutionary version of the hypothesis argues that species with frequent opportunities for social learning should more readily respond to selection for a greater number of learned skills. Because improved social learning also improves asocial learning, the hypothesis predicts a positive interspecific correlation between social-learning performance and individual learning ability. Variation among primates supports this prediction. The hypothesis also predicts that more heavily cultural species should be more intelligent. Preliminary tests involving birds and mammals support this prediction too. The cultural intelligence hypothesis can also account for the unusual cognitive abilities of humans, as well as our unique mechanisms of skill transfer.

On the psychology of cooperation in humans and other primates: combining the natural history and experimental evidence of prosociality

In any given species, cooperation involves prosocial acts that usually return a fitness benefit to the actor. These acts are produced by a set of psychological rules, which will be similar in related species if they have a similar natural history of cooperation. Prosocial acts can be (i) reactive, i.e. in response to specific stimuli, or (ii) proactive, i.e. occur in the absence of such stimuli. We propose that reactive prosocial acts reflect sensitivity to (i) signals or signs of need and (ii) the presence and size of an audience, as modified by (iii) social distance to the partner or partners. We examine the evidence for these elements in humans and other animals, especially non-human primates, based on the natural history of cooperation, quantified in the context of food sharing, and various experimental paradigms. The comparison suggests that humans share with their closest living relatives reactive responses to signals of need, but differ in sensitivity to signs of need and cues of being watched, as well as in the presence of proactive prosociality. We discuss ultimate explanations for these derived features, in particular the adoption of cooperative breeding as well as concern for reputation and costly signalling during human evolution.

An evaluation of the geographic method for recognizing innovations in nature, using zoo orangutans

Innovation and social learning are the raw materials for traditions and culture. Of these two, innovation has received far less scrutiny, largely because of difficulties assessing the innovation status of behaviors. A recent attempt proposes recognition of innovations in natural populations based on assessment of the behavior's properties and its geographic and local prevalence. Here we examine the validity of this approach and the list of 43 potential innovations it generated for wild orangutans by extending the comparison to zoo orangutans. First, we created an inventory of the behavioral repertoire in the zoo population. Four of ten putative innovations recognized in the field and potentially present in captivity did not occur despite appropriate conditions, suggesting they are indeed innovations. Second, we experimentally produced relevant conditions to evaluate whether another five potential innovations could be elicited. Based on their continued absence or on their latencies relative to known behaviors, four of the potential innovations could be assessed as innovations and one as a modification. Because 53% of relevant innovations recognized in the field could be confirmed in this analysis, and another 27% assigned possible innovation status, we conclude that the geographic method for detecting innovation in the wild is valid. However, the experiments also yielded up to 13 additional innovations, suggesting that zoo orangutans are far more innovative than wild ones. We discuss the implications of this latter finding with regard to limiting factors for the expansion of cultural repertoires in wild orangutans.

Other-regarding preferences in a non-human primate: common marmosets provision food altruistically

Human cooperation is unparalleled in the animal world and rests on an altruistic concern for the welfare of genetically unrelated strangers. The evolutionary roots of human altruism, however, remain poorly understood. Recent evidence suggests a discontinuity between humans and other primates because individual chimpanzees do not spontaneously provide food to other group members, indicating a lack of concern for their welfare. Here, we demonstrate that common marmoset monkeys (Callithrix jacchus) do spontaneously provide food to nonreciprocating and genetically unrelated individuals, indicating that other-regarding preferences are not unique to humans and that their evolution did not require advanced cognitive abilities such as theory of mind. Because humans and marmosets are cooperative breeders and the only two primate taxa in which such unsolicited prosociality has been found, we conclude that these prosocial predispositions may emanate from cooperative breeding.

Adequacy of peritoneal dialysis

The National Kidney Foundation-Dialysis Outcomes Quality Initiatives guidelines have standardized many aspects of treating end-stage renal disease patients with peritoneal dialysis in an attempt to improve overall patient outcome. While recommending certain total solute clearance goals, the guidelines have also pointed out deficiencies in our knowledge base and precipitated many controversies. Some of these controversies have been resolved while others may have been interpreted wrongly, unnecessarily resulting in transfer of patients from peritoneal dialysis to hemodialysis due to "failure to meet adequacy targets" even when doing well clinically. This report reviews the rationale for the original guidelines and their subsequent modification. It also outlines a rational approach toward prescription modification based on peritoneal physiology. Specific solute clearance target goals discussed are the modifications for continuous ambulatory peritoneal dialysis (CAPD) and cycler peritoneal dialysis (CCPD), and a review of what solute clearance targets subsequent guidelines from other countries have used. Some examples are as follows: new guidelines suggest that solute clearance goals for creatine clearance should differ for low and low-average transporters than for high and high-average transporters (weekly clearance of 50 and 60 1/1.73 m(2), respectively) while Kt/V targets remain unchanged. Also discussed is the rationale for having the same target for patients on CCPD with a mid-day exchange as those for patients on CAPD. We are also reminded that solute clearance is only one aspect of "adequate" dialysis-blood pressure and volume control are equally important, and ways to maintain euvolemia and blood pressure control are discussed in the context of prescription management.

Incremental initiation of dialysis: one center's experience over a two-year period

OBJECTIVE

This pilot study describes our center's experience with peritoneal dialysis (PD) over the past 2 years using a "healthy start" dialysis protocol with an incremental approach to prescription management.

DESIGN

Nonrandomized, prospective pilot study.

SETTING

Single PD unit of a university teaching hospital.

PATIENTS

Thirteen PD patients who initiated dialysis at our center from April 1997 to June 1999.

METHODS

Patients initiating PD with residual renal Kt/V of 1.0 - 2.0/week were invited to participate. They were given an initial dialysis prescription so that total (residual renal + dialysis) weekly Kt/V exceeded 2.0. The dialysis prescription was "incrementally" increased as residual renal function (RRF) declined. Data collected for all patients included monthly serum chemistries, residual renal weekly Kt/V and creatinine clearance (CCr) at 1- to 2-month intervals, and peritoneal weekly Kt/V and CCr at 3-month intervals and 1 month after each prescription change.

RESULTS

To date, we have followed 13 patients on our incremental PD protocol for a total of 159.3 patient-months. Mean serum albumin concentration and mean normalized protein equivalent of nitrogen appearance (nPNA) were stable throughout the study. Mean total Kt/V and CCr remained above the recommended targets of 2.0/wk and 60 L/wk, respectively. Residual renal function declined rather slowly in our PD patients. One patient died from complications of aortic valve surgery and a second died from pneumonia. A third patient died from peritonitis. One patient required a new Tenckhoff catheter after catheter migration. Three patients were temporarily switched to hemodialysis after a hernia repair, a pleural leak, and elective native/transplant nephrectomies, respectively. Two patients were permanently switched to hemodialysis: one after an episode of peritonitis, the second after accidentally damaging his PD catheter.

CONCLUSIONS

Providing incremental dialysis to maintain adequate total small solute clearance has been technically feasible in our patient population. However, a larger than expected number of complications was seen in our study. Fortunately, complications were easier to manage due to the presence of RRF. Because this study was not designed to compare outcome with that observed after traditional initiation of dialysis, further large-scale studies are needed.

A multicenter study of noncompliance with continuous ambulatory peritoneal dialysis exchanges in US and Canadian patients

Recent evidence suggested that noncompliance (NC) with continuous ambulatory peritoneal dialysis (CAPD) exchanges may be more common in US than in Canadian dialysis centers. This issue was investigated using a questionnaire-based method in 656 CAPD patients at 14 centers in the United States and Canada. NC was defined as missing more than one exchange per week or more than two exchanges per month. Patients were ensured of the confidentiality of their individual results. Mean patient age was 56 +/- 16 years, 52% were women, and 39% had diabetes. The overall admitted rate of NC was 13%, with a rate of 18% in the United States and 7% in Canada (P < 0.001). NC was more common in younger patients (P < 0.0001), those without diabetes (P < 0.001), and employed patients (P < 0.05). It was also more common in black and Hispanic than in Asian and white patients (P < 0.001). NC was more common in patients prescribed more than four exchanges daily (P < 0.0001) but was not affected by dwell volume. On multiple regression analysis, the independent predictors of NC, in order of importance, were being prescribed more than four exchanges per day, black race, being employed, younger age, and not having diabetes. Being treated in a US unit did not quite achieve significance as a multivariate independent predictor. These findings suggest that NC is not uncommon in CAPD patients and is more frequent in US than in Canadian patients. However, country of residence is less powerful as a predictor of NC than a variety of other demographic and prescription factors.

Peritoneal dialysate fill-volumes and hernia development in a cohort of peritoneal dialysis patients

A retrospective case control study was performed on a cohort of 244 peritoneal dialysis patients followed over 5 years to determine whether dialysate fill-volume was associated with hernia development. The laboratory and clinical parameters of patients who developed hernias during this time period were compared with those of patients who did not develop hernias. Information on 27 patients who developed hernias was compared with that on 217 patients who did not develop hernias. Dialysate fill-volume was similar between groups (2.2 +/- .3 L for patients with hernias vs. 2.2 +/- .3 L for controls). Three patients with fill-volumes of 1.5 L developed hernias, and no patients with fill-volumes of 3 L developed hernias. Age, duration of time on dialysis, and body surface area were also similar between groups. This investigation could not find a relationship between fill-volume and hernia formation. From this study it would appear that physicians should not hesitate to increase fill-volume based on concerns of hernia development.

An international study of patient compliance with hemodialysis

CONTEXT

International differences in compliance of patients undergoing hemodialysis are poorly characterized and could contribute to international survival differences.

OBJECTIVE

To compare international differences in patient compliance with hemodialysis treatments.

DESIGN

A prospective observational study of patients undergoing hemodialysis in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996.

SETTING AND PATIENTS

Four dialysis centers in the southeastern United States with 415 patients undergoing hemodialysis, 1 center in Sweden with 84 patients, and 4 centers in Japan with 194 patients participated in the prospective observational study. In the cross-sectional survey, nurses and nephrologists from the United States (n = 49), Japan (n = 21), and Sweden (n = 16) responded to questions regarding the compliance of their patients undergoing hemodialysis.

MAIN OUTCOME MEASURES

Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments.

RESULTS

Of 415 US patients, 147 missed 699 treatments over a 6-month period (28.1 missed treatments per 100 patient-months or 2.3% of all prescribed treatments). During a 3-month period, there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 patient-months for patients from Sweden (P<.001). In the cross-sectional survey, the mean (SD) estimated percentage of patients missing a treatment per month was 4% (3%) for the United States, 0% for Japan, and 0.1% (3%) for Sweden (P<.001).

CONCLUSIONS

Noncompliance is much more common in US patients undergoing hemodialysis than Swedish and Japanese patients. The implications of these results for international differences in survival deserve further study.

Dialysis modality and delayed graft function after cadaveric renal transplantation

The purpose of this investigation was to compare outcomes in the immediate posttransplant period for hemodialysis (HD) and peritoneal (PD) dialysis patients who received cadaveric renal transplantation. Data were obtained from the United Network of Organ Sharing on all cadaveric graft recipients who were dialysis-dependent at the time of transplantation between April 1994 and December 1995. Baseline characteristics were compared between groups, and multivariate logistic regression was performed with outcome measures including urine production in the first 24 h posttransplantation (U24), requirement for dialysis in the first week posttransplant (FWDIAL), and treatment for acute rejection during the initial hospitalization. The odds of oliguria (not producing urine in the first 24 h) were 1.49 (1.28 to 1.74) times higher in HD versus PD patients. After adjustment for other comorbid conditions including age, gender, race, HLA mismatch, time on dialysis, panel-reactive antibodies, and cold and warm ischemia time, the odds of oliguria were 1.60 (1.14 to 2.25) times higher in black HD patients compared with PD patients and 1.29 (1.06 to 1.57) times higher in white HD patients. In a similar manner, after adjustment for significant comorbid conditions, the odds of requiring dialysis in the first week were 1.56 (1.22 to 2.0) times higher in black HD patients versus PD patients and 1.40 (1.21 to 1.60) times higher in white HD patients. The rate of acute rejection was similar during the first hospitalization. These results suggest that there is an association between hemodialysis and delayed graft function. Differences in biocompatibility between the two modalities could potentially be responsible.

Frequency and causes of discrepancy between Kt/V and creatinine clearance

This study examines the frequency of discrepancy between Kt/V urea and creatinine clearance (Ccr) measurements in patients on peritoneal dialysis (PD) and the reasons for this discrepancy.

DESIGN

Nonrandomized, retrospective data analysis.

SETTING

Single PD unit of a university teaching hospital.

PATIENTS

All adult patients receiving PD at our center from January 1995 to December 1996.

METHODS

Actual (a) and desired (d) body weight (BW) were used to calculate urea volume of distribution (V) and body surface area (BSA). Patients were divided into four groups based upon their total small solute clearances (Kt/V and Ccr, normalized by actual weight) and three additional groups based upon actual/desired (a/d) body weight ratio. An additional analysis was performed for the subset of anuric patients. Data collected for all patients included the following: total Kt, total Ccr, 4-hour dialysate/ plasma (D/P) creatinine, serum albumin concentration, duration of PD, actual body weight, age, and height.

RESULTS

Twenty-three percent of the clearance measurements in our study were discrepant, defined as having values for either Kt/V or Ccr (but not both) above the accepted targets of Kt/V > or = 2.0/wk and Ccr > or = 60 L/wk/ 1.73 m2. Patients with both values above target are more likely to have higher residual renal function. Patients who are significantly less than BWd and patients on PD for a longer time are more likely to have adequate Kt/V but not Ccr. Furthermore, patients who are less than 90% or greater than 110% of BWd have markedly different values for Kt/V and Ccr when BWa versus BWd values are used.

CONCLUSIONS

Kt/V and Ccr values are frequently discrepant; a number of factors affect these two measurements to varying degrees, including weight, degree of residual renal function, and duration of PD.

Measurement of continuous ambulatory peritoneal dialysis prescription adherence using a novel approach

OBJECTIVE

The purpose of the study was to test a novel approach to monitoring the adherence of continuous ambulatory peritoneal dialysis (CAPD) patients to their dialysis prescription.

DESIGN

A descriptive observational study was done in which exchange behaviors were monitored over a 2-week period of time.

SETTING

Patients were recruited from an outpatient dialysis center.

PARTICIPANTS

A convenience sample of patients undergoing CAPD at Piedmont Dialysis Center in Winston-Salem, North Carolina was recruited for the study. Of 31 CAPD patients, 20 (64.5%) agreed to participate.

MEASURES

Adherence of CAPD patients to their dialysis prescription was monitored using daily logs and an electronic monitoring device (the Medication Event Monitoring System, or MEMS; APREX, Menlo Park, California, U.S.A.). Patients recorded in their logs their exchange activities during the 2-week observation period. Concurrently, patients were instructed to deposit the pull tab from their dialysate bag into a MEMS bottle immediately after performing each exchange. The MEMS bottle was closed with a cap containing a computer chip that recorded the date and time each time the bottle was opened.

RESULTS

One individual's MEMS device malfunctioned and thus the data presented in this report are based upon the remaining 19 patients. A significant discrepancy was found between log data and MEMS data, with MEMS data indicating a greater number and percentage of missed exchanges. MEMS data indicated that some patients concentrated their exchange activities during the day, with shortened dwell times between exchanges. Three indices were developed for this study: a measure of the average time spent in noncompliance, and indices of consistency in the timing of exchanges within and between days. Patients who were defined as consistent had lower scores on the noncompliance index compared to patients defined as inconsistent (p = 0.015).

CONCLUSIONS

This study describes a methodology that may be useful in assessing adherence to the peritoneal dialysis regimen. Of particular significance is the ability to assess the timing of exchanges over the course of a day. Clinical implications are limited due to issues of data reliability and validity, the short-term nature of the study, the small sample, and the fact that clinical outcomes were not considered in this methodology study. Additional research is needed to further develop this data-collection approach.

Clinical experience: how much earlier should patients really start renal replacement therapy?

Data are needed to better determine the effect of initiation of dialysis on outcome. At present, it is unknown whether any of the previously reported improvements in survival "on" dialysis in patients who start "early" is solely due to lead time bias. Everyone involved with the care of ESRD patients must understand the concept of timely initiation, believe in it, and become fully educated about it. Incremental dialysis will require closer follow-up and proactive intervention. Protein restriction to prevent progression and timely initiation to prevent symptomatology are not mutually exclusive as noted by the MDRD experience. It is uncertain how much earlier the average ESRD patient would need to start dialysis. However, based on the MDRD experience, timely initiation of dialysis may likely only represent starting dialysis 4 to 5 mo sooner than the current approach to initiation in patients followed by nephrologists pre-ESRD. This "timely" initiation of dialysis would hopefully improve patient outcomes and in the long run be less costly. A multicentered, prospective, randomized trial is needed to better define the answers to these questions.

The Kidney Outcomes Prediction and Evaluation (KOPE) study: a prospective cohort investigation of patients undergoing hemodialysis. Study design and baseline characteristics

PURPOSE

The purpose of the Kidney Outcomes Prediction and Evaluation (KOPE) study, was to more fully characterize the end-stage renal disease (ESRD) population with respect to social, psychological, and clinical characteristics, and to prospectively study the biomedical, social, and psychological factors that influence a range of ESRD outcomes in a large observational study of black and white patients on hemodialysis. This paper focuses on the KOPE study design as well as characteristics of patients at baseline.

METHODS

KOPE was a prospective cohort investigation of patients treated at four dialysis centers in Forsyth County, North Carolina. Participants were interviewed at the dialysis centers, semi-annually over a 3 1/2 year period. Prevalent cases who were being treated with hemodialysis at the initiation of the study were enrolled into KOPE. Incident cases were subsequently enrolled as they presented to the participating units for hemodialysis. A total of 304 prevalent and 162 incident cases were enrolled into the study. The baseline health and sociodemographic characteristics of KOPE participants reported in this paper were obtained from medical records and Southeast Kidney Council data. Laboratory values taken within a 30-day interval around the baseline interview are also reported.

RESULTS

KOPE participants differ from national statistics on race, age, and gender. Differences between KOPE participants and patients living in the region, but who did not participate in the study, can be explained by our recruitment criteria.

CONCLUSIONS

KOPE will enable the characterization of the ESRD population, identification of factors related to poor outcomes, and identification of opportunities for interventions to prevent death and morbidity.