Units of analysis and kinetic structure of behavioral repertoires

It is suggested that molar streams of behavior are constructed of various arrangements of three elementary constituents (elicited, evoked, and emitted response classes). An eight-cell taxonomy is elaborated as a framework for analyzing and synthesizing complex behavioral repertoires based on these functional units. It is proposed that the local force binding functional units into a smoothly articulated kinetic sequence arises from temporally arranged relative response probability relationships. Behavioral integration is thought to reflect the joint influence of the organism's hierarchy of relative response probabilities, fluctuating biological states, and the arrangement of environmental and behavioral events in time.

Response patterning on an avoidance schedule as a function of time-correlated stimuli

Control of avoidance response patterning by time-correlated stimuli was studied in rhesus monkeys. At several shock-shock = response-shock intervals, the intervals were divided into 8, 4, or 2 time segments by correlating, respectively, 1, 2, or 4 discrete lights of an eight-light display with each successive segment. A further condition examined response patterning when the avoidance interval was not segmented: all eight lights of the display were lit throughout the interval. Reversal of the order in which the lights were lit in sequence was also examined. Generally, increasing the number of lights lit at one time (decreasing the number of signalled time segments) increased response rates and shifted interresponse time distributions to the left. When the lights were lit one at a time, signalling eight discrete time segments of the interval, response rates were consistently low.

Complications of inguinoscrotal bladder hernias: a case series

Although the urinary bladder is involved in 1-4% of all inguinal hernias, extensive inguinoscrotal herniation of the bladder, termed scrotal cystocele, is very rare. Most small asymptomatic bladder hernias are commonly encountered and reduced successfully via the same incision during elective inguinal hernia repair. However, larger bladder herniations can be associated with bladder infarction or obstruction, which require urgent intervention to preserve renal function and reduce morbidity and mortality. We present two cases of elderly men presenting with significant scrotal cystocele complications which necessitated urgent surgical intervention. We compare and contrast the two cases and discuss the presentation, investigation, diagnosis and treatment of these pathophysiological conditions.

The relationship between compulsive behaviour and academic achievement across the three genetic subtypes of Prader-Willi syndrome

BACKGROUND

Prader-Willi syndrome (PWS) is a genetic syndrome associated with several physical, cognitive and behavioural characteristics. For many individuals with this syndrome, compulsive behaviour is often noted in both food and non-food situations. The focus of this paper is on the non-food-related compulsions in individuals with PWS and comparing differences across the three genetic subtypes of the syndrome.

METHODS

Compulsive behaviours in 73 people with PWS were assessed using the Yale-Brown Obsessive Compulsive Scale and the Compulsive Behavior Checklist. Compulsive behaviour and its relation to IQ and academic achievement also were evaluated. Phenotypic differences were characterized for the three most common genetic subtypes of the disorder: 16 individuals with the long Type I (TI) 15q deletion, 26 individuals with the short Type II (TII) 15q deletion and 31 individuals with maternal disomy 15.

RESULTS

There appeared to be important differences between the two deletion subtypes. Specifically, individuals with the TI deletion had more compulsions regarding personal cleanliness (i.e. excessive bathing/grooming), and their compulsions were more difficult to interrupt and interfered with social activities more than the other subtypes. Individuals with the TII deletion were more likely to have compulsions related to specific academic areas (i.e. rereading, erasing answers and counting objects or numbers).

CONCLUSIONS

These findings may help clinicians and researchers identify possible intervention strategies and supports based on the behavioural phenotype associated with genetic subtype in individuals with PWS.

Relationship of body mass index and other anthropometric measures and prostate specific antigen, NHANES 2001–2002

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Background: Obesity has been suggested to be a risk factor for prostate cancer. However, there has been limited information examining the relationship between body mass index (BMI) and other anthropometric measures such as triceps thickness (TT) and waist circumference (WC) and prostate specific antigen (PSA), a marker used in screening for prostate cancer. Methods: We analyzed data from the 2001–2002 National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey of a nationally representative sample of the non-institutionalized civilian US population. Participants in this study were limited to men aged 40 years and older without previously diagnosed prostate cancer (n = 1320). Weighted analyses were done overall and within three racial/ethnic groups [non-Hispanic whites (white), non-Hispanic blacks (black), or Mexican Americans (Mexican)]. BMI, TT, and WC were examined as both as a continuous and as a categorical variable. Three linear regression models were fit to determine the individual effect of BMI, TT, and WC on PSA within each racial/ethnic group after adjusting for age. Results: Among white men, the median PSA was 1.09 ng/mL [95% CI (0.96, 1.30)] for men with a normal BMI, 0.80 [95% CI (0.70, 0.94)] for overweight men, 0.83 [95% CI (0.74,0.95)] for obese men, and 0.74 [95% CI (0.56,1.22)] for severely obese men. Among black men, the median PSA for men was 0.83 [95% CI (0.70, 1.94)] and remained constant across BMI levels. Among Mexican men, the median PSA was 0.92 [95% CI (0.82, 1.23)] for men with a normal BMI, 0.91 [95% CI (0.81, 1.07) ] for overweight, 0.73 [95% CI (0.54,1.14)] for obese, and 0.59 [95% CI (0.39,1.06)] for severely obese men. In linear regression models controlling for age, a significant non-linear relationship was seen with BMI and PSA for both white (p = 0.010) and Mexican men (p < 0.001) but not for black men (p = 0.167). Increased TT was associated with decreasing PSA for black and Mexican men. Increased WC was associated with decreasing PSA for white and Mexican men. Conclusion: These data do suggest racial/ethnic differences of PSA across BMI categories as well as other anthropometric measures. This finding may help inform practitioners about the relationship of anthropometric measures on PSA levels.

No significant financial relationships to disclose.

Compulsive behavior in Prader-Willi syndrome: examining severity in early childhood

Prader-Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia and food preoccupations. Researchers indicate that individuals with PWS, including young children, exhibit food and non-food-related compulsions. Normative rituals are also often present among typically developing preschoolers. However, it is unclear how these behaviors affect the child. Although preschoolers with PWS exhibit more types of rituals than other populations, it is uncertain if the severity of these behaviors differs from the rituals experienced during normative development. Thus, the purpose of this research was to determine whether the ritualistic behaviors exhibited by preschoolers with PWS differ in severity from those exhibited during normative development. We also sought to identify whether non-food ritualistic behavior was related to the hyperphagia in PWS. Parents of 68 children with PWS, 86 typically developing children, and 57 children with developmental delays completed questionnaires on rituals and eating behavior. Children with PWS exhibited more severe ritualistic behavior than typically developing children but not other children with developmental delays. However, the severity of non-food-related rituals was related to the severity of eating behavior in PWS. We hypothesize that this link between hyperphagia and non-food-related compulsivity may share a common underlying neurobiological mechanism.

A measure of food seeking in individuals with Prader-Willi syndrome

BACKGROUND

Individuals with Prader-Willi syndrome (PWS), a chromosome 15 genetic disorder, often have a significant preoccupation with food and problem behaviour related to food seeking is often prevalent.

METHODS

In the present study, we compared how individuals with PWS responded on a survey regarding the acceptability of food in various locations that varied according to degree of appropriateness for human consumption (e.g. food on a plate, food in a garbage can). For a subgroup of participants, we observed how they actually responded when placed in a room with food items placed in the same locations depicted in the survey. In the first part of the study, three groups (25 typically developing individuals, 7 individuals with intellectual disability (ID), and 19 individuals with PWS) responded to a visual survey to determine the degree of acceptability of food items in various locations (e.g. on a table near a hairbrush, on the floor behind a toy box, in a trash can). In the second part of the study, these food items (popcorn, jelly beans) were placed in the 12 locations described above. Nine individuals diagnosed with PWS (deletion type) and three individuals with ID were given some break time in the room for 15 min. The amount of food consumed, the time spent food seeking, and time spent interacting with materials were measured.

RESULTS

Results of the survey indicated that the PWS group differed significantly with regard to how they responded on the survey from the typically developing group, but did not differ significantly from the ID group. Results of the food seeking observations indicated that only three individuals with PWS ate a significant number of items. The three individuals did not differ from the rest of the group according to IQ or compulsivity score; however, they had significantly lower body mass index (BMI) scores and were younger than the other participants.

CONCLUSIONS

The findings from the survey indicate that individuals with PWS are able to discriminate the appropriateness of eating items in more or less contaminated areas; however, the amount of time spent seeking food and the amount of food covertly consumed appeared to depend more directly on age and BMI.

Rectus sheath haematoma (RSH) mimicking acute intra-abdominal pathology

AIM

Rectus sheath haematoma (RSH) is a rare cause of acute abdomen. We present a case series of patients seen at Wanganui Hospital, North Island, New Zealand.

METHODS

A retrospective survey of patients developing RSH over a 2-year period (from 2002 to 2004) in our hospital was carried out.

RESULTS

Seven patients were identified with RSH (male:female ratio=6:1, age range=16-80 years). Six of the RSH were spontaneous and four out of these six were on anticoagulant therapy post-acute coronary event. Each presented with acute abdomen and all were missed on initial evaluation. Two were diagnosed initially as bowel obstruction, one as acute diverticulitis, one as incarcerated hernia, one as an ovarian mass, and another as non-specific abdominal pain. One patient had traumatic RSH with peritonitis secondary to accompanying jejunal perforation. The ultrasound pick-up rate was 50% of but computed tomography (CT) abdomen was 100% diagnostic. Five (70%) had a significant fall in haematocrit, requiring blood transfusion. All settled on conservative management, with one requiring admission to intensive care.

CONCLUSION

Clinical diagnosis of RSH is unreliable. CT imaging is the procedure of choice and should be promptly carried out especially in those on anticoagulant therapy for early diagnosis and proper management.

Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre, iron, calcium and grain foods?

OBJECTIVE

This survey was conducted to assess nutrient intakes and food consumption patterns of adults with coeliac disease who adhere to a strict gluten-free diet.

DESIGN

Three-day estimated self-reported food records were used to assess daily intakes of calories, percent daily calories from carbohydrates, dietary fibre, iron, calcium and grain food servings.

SUBJECTS

Volunteers for this survey were recruited through notices placed in coeliac disease support group newsletters, as well as a national magazine for persons with coeliac disease. Forty-seven volunteers met all criteria for participation and returned useable food records.

RESULTS

Group mean daily intake of nutrients by gender: Males (n = 8): 2882 calories; 55% carbohydrate; 24.3 g dietary fibre; 14.7 mg iron; 1288.8 mg calcium; 6.6 grain food servings. Females (n = 39): 1900 calories; 52% carbohydrate; 20.2 g dietary fibre; 11.0 mg iron; 884.7 mg calcium; 4.6 grain food servings. Recommended amounts of fibre, iron and calcium were consumed by 46, 44 and 31% of women and 88, 100 and 63% of men, respectively.

CONCLUSIONS

Nutrition therapy for coeliac disease has centred around food allowed/not allowed on a gluten-free diet. Emphasis also should be placed on the nutritional quality of the gluten-free diet, particularly as it concerns the iron, calcium and fibre consumption of women. The use of the estimated food record as the dietary survey method may have resulted in the under-reporting of energy intake. Due to the small sample size and possible bias of survey participants, the findings of this survey may not be representative of the larger coeliac community.

An assessment of mother-to-child HIV transmission prevention in 16 pilot antenatal clinics in Jamaica

OBJECTIVES

This study aims to determine the number and age distribution of pregnant women testing positive for HIV at 16 selected clinics in Jamaica between 2001 and 2002; the utilization of therapeutic interventions to minimize the risk of mother-to-child transmission (MTCT) and the current status of the HIV-exposed infants and, finally, the number of children who received testing for detection of HIV and to calculate the incidence of MTCT in these children.

METHODS

A retrospective study was carried out at sixteen pilot clinic sites by examining the patient records for all confirmed HIV-positive pregnant mothers and the resultant infants at these facilities for the period January 2001 to December 2002.

RESULTS

One hundred and twenty-three of 8116 pregnant women newly tested positive during the period January 2001 to December 2002; however, 176 HIV+ women delivered. Fifty-three (30%) knew their HIV status prior to participating in the programme. Sixty-two (1.4%) and 61 (1.6%) tested positive in 2001 and 2002, respectively. One hundred and ten (77%) and 113 (83%) mothers and infants, respectively, received ARV therapy, (92% - nevirapine, 8% - zidovudine). Twenty-three per cent of pregnant women received no ARV Forty-four (25.0%) of the 176 infants had a documented ELISA HIV test before eighteen months of age, none had a PCR test. The health status of 40 (23%) of these children was known: 30 (75%) were alive and well, five of whom did not receive any ARV, one (2.5%) was alive and ill and nine (22.5%) were reported dead, five of whom received ARV; 28.6% of infants who did not receive ARV were reported as either dead or ill compared to 13.8% of those receiving ARV CONCLUSION: Though the majority of pregnant women discovered their HIV status during pregnancy, a significant number got pregnant knowing that they were HIV+. The majority of mothers and infants received ARV but the follow-up and testing of infants was limited. Nevirapine is clearly protective in the prevention of MTCT of HIV and should be made universally accessible. All infants delivered to HIV+ mothers should be identified and tested for HIV.