Antibiotics increase aggression behavior and aggression-related pheromones and receptors in Drosophila melanogaster

Aggression is a behavior common in most species; it is controlled by internal and external drivers, including hormones, environmental cues, and social interactions, and underlying pathways are understood in a broad range of species. To date, though, effects of gut microbiota on aggression in the context of gut-brain communication and social behavior have not been completely elucidated. We examine how manipulation of Drosophila melanogaster microbiota affects aggression as well as the pathways that underlie the behavior in this species. Male flies treated with antibiotics exhibited significantly more aggressive behaviors. Furthermore, they had higher levels of cVA and (Z)-9 Tricosene, pheromones associated with aggression in flies, as well as higher expression of the relevant pheromone receptors and transporters OR67d, OR83b, GR32a, and LUSH. These findings suggest that aggressive behavior is, at least in part, mediated by bacterial species in flies.

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Aggression increases in flies that lack a microbiome

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Monocolonization with specific bacteria can mediate this effect

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We observed differences in aggression-related pheromone expression levels

THU0054 NKTR-358, A NOVEL IL-2 CONJUGATE, STIMULATES HIGH LEVELS OF REGULATORY T CELLS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Impaired IL-2 production and dysfunction of regulatory T cells (Tregs) have been identified as key immunological defects leading to the breakdown of immune self-tolerance in SLE. Low-dose IL-2 can expand Tregs, but the effect is limited by a narrow therapeutic window for Treg selectivity. Furthermore, the short half-life of IL-2 necessitates frequent administration. NKTR-358 is a polyethylene glycol (PEG) conjugate of recombinant human IL-2 (aldesleukin sequence) and is differentiated from native IL-2 by its altered binding to the IL-2 receptor and prolonged biological activity. NKTR-358 resulted in marked and selective stimulation of Tregs when administered as a single SC injection to healthy volunteers.

Objectives:

This multiple ascending dose study assessed the safety, tolerability, pharmacokinetics (PK), and immune effects of NKTR-358 in patients with SLE after repeated administration of SC doses. The time course and extent of changes in numbers and percentages of Tregs, conventional CD4+ and CD8+ T cells, NK cells, and cytokine levels in peripheral blood were investigated.

Methods:

In this double-blind, multiple ascending dose study, patients with mild to moderate SLE received 3 SC doses q2w in 4 cohorts ranging from 3.0 to 24.0 µg/kg (9 active:3 placebo per cohort); patients were followed for a total of 79 days.

Results:

There were no dose-limiting toxicities, deaths, or clinically significant abnormalities in either vital signs or electrocardiograms. Adverse events attributed to NKTR-358 were primarily limited to mild (grade 1) injection site reactions. At the highest dose, one subject had transient and mild (grade 1) symptoms of a flu-like syndrome after administration, without associated elevated cytokine levels, and another subject had dosing stopped due to elevated eosinophil levels. No other individual at any dose level had systemic signs or symptoms known to be associated with IL-2 therapy. No anti-drug antibodies were detected. NKTR-358 demonstrated dose-proportional PK with repeated dosing; plasma levels peaked 3-6 days post-dose and declined with a terminal half-life of ~10-13 days.

The primary and consistent effect of NKTR-358 was seen on Tregs. In the four dose cohorts, dose-dependent and sustained increases in absolute numbers and percentages of circulating CD4+FoxP3+CD25brightTregs were observed. Treg levels remained elevated throughout the dosing period, peaking at Day 10 after the first administration of NKTR-358 and returning to baseline ~ 20-30 days following last administration. At 24.0 µg/kg, the mean peak increase in numbers of CD25brightTregs was 11-fold above baseline. In addition, there was an increase in Treg activation markers at doses ≥12.0 µg/kg. In contrast to effects on Tregs, no changes in percentages or numbers of conventional CD4+ or CD8+ T cells were observed at any dose tested. At the highest dose, there were low-level increases in the percentages and numbers of NK cells. Overall, NKTR-358 selectively induced Tregs, evidenced by a 12-fold increase in the mean peak Treg:CD8 ratio over baseline in the 24.0 µg/kg group.

Conclusion:

NKTR-358, an IL-2 conjugate Treg stimulator, was well tolerated when repeatedly administered (q2w) at doses up to 24 µg/kg. Its administration led to marked, selective, prolonged, and dose-dependent increases in circulating CD25brightTregs. This clinical study in SLE patients extends the previous results in healthy volunteers and provides strong support for continued testing of NKTR-358 as a new therapeutic in SLE and other inflammatory diseases.

Disclosure of Interests:

Suresh Siddhanti Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Christie Fanton Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Neha Dixit Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Lin Lu Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Vishala Chindalore Grant/research support from: Nektar Therapeutics for conducted studies, Speakers bureau: > 5 years ago, Robert Levin Grant/research support from: Payments for clinical research for industry-sponsored trials, Consultant of: Gilead, Exagen, Myriad Rheumatology, Speakers bureau: Sanofi/Genzyme, Regeneron, Bristol-Myers Squibb, AbbVie, Isam Diab: None declared, Richard Furie Grant/research support from: Nektar Therapeutics to Northwell Rheumatology to conduct this study, Consultant of: Nektar Therapeutics, Jonathan Zalevsky Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics, Brian Kotzin Shareholder of: Nektar Therapeutics, Employee of: Nektar Therapeutics

Relations among Nightmare Frequency and Ego Strength, Death Anxiety, and Sex of College Students

The present study was designed to investigate empirically the relationship between self-reports of nightmare frequency and ego strength and death anxiety in both men and women. In addition, the interrelations among these variables were assessed. 20 undergraduates with high frequencies of nightmares and 20 with low frequencies (10 men and 10 women per group) were administered the Barron Ego Strength Scale and a death anxiety scale. Significant differences were found between nightmare groups on the Barron scale for men and women but none on the death anxiety scale either by nightmare frequency or sex. A significant negative correlation of -.47 between death anxiety and ego strength was found for women and in one high frequency group. Women with high frequencies of nightmares showed the highest correlation, -.83. These data suggest that nightmare frequency may be a mediating factor in the relationship between ego strength, death anxiety, and sex of subject.

KidsBrainIT: A New Multi-centre, Multi-disciplinary, Multi-national Paediatric Brain Monitoring Collaboration

OBJECTIVES

Validated optimal cerebral perfusion pressure (CPP) treatment thresholds in children do not exist. To improve the intensive care unit (ICU) management of the paediatric traumatic brain injury (TBI) population, we are forming a new paediatric multi-centre collaboration to recruit standardised ICU data for running and reporting upon models for assessing autoregulation and optimal CCP (CPPopt).

MATERIALS AND METHODS

We are adapting the adult BrainIT group's approach to develop a new Paediatric Brain Monitoring and Information Technology Group (KidsBrainIT), which will include a repository to store prospectively collected high-resolution physiological, clinical, and outcome data. In the first phase of this project there are 7 UK Paediatric Intensive Care Units, 1 Spanish, 1 Belgium, and 1 Romanian Centre interested in participating. In subsequent phases, we plan to open recruitment to other centres both within Europe, US and abroad. We are collaborating with the Leuven Group and plan to use their LAx (low-frequency autoregulation index), DATACAR (dynamic adaptive target of active cerebral autoregulation), CPPopt and visualisation methodologies. We also plan to use the continuous diffuse optical monitoring and tomography technology developed in Barcelona as an acute surrogate end-point for optimising brain perfusion. This technology allows non-invasive continuous monitoring of deep tissue perfusion and oxygenation in adults but its clinical application in infants and children with TBI has not been studied previously.

RESULTS

We report on the current status of setting up this new collaboration and also on pilot analyses in two centres which are the basis of our rationale for the need for a prospective validation study of CPPopt in children. Specifically, we demonstrated that CPPopt varied with time for each patient during their paediatric intensive care unit (PICU) stay, and the median overall CPPopt levels for children aged 2-6 years, 7-11 years and 12-16 years were 68.83, 68.09, and 72.17 mmHg respectively. Among survivors and patients with favourable outcome (GOS 4 and 5), there were significantly higher proportions with CPP monitoring time within CPPopt (p = 0.04 and p = 0.01 respectively).

CONCLUSIONS

There is a need and an interest in forming a multi-centre PICU collaboration for acquiring data and performing analyses for determining validated CPPopt thresholds in the paediatric TBI population. KidsBrainIT is being formed to meet that need.

The Role of Improved Water Quality on Inflammatory Markers in Patients Undergoing Regular Dialysis

Hemodialysis utilizes large quantities of water for the preparation of dialysis fluid. Such water meets national standards and international standards but a considerable disparity exists between such standards with respect to microbiological purity. This study collated and retrospectively analyzed the impact of upgrading water systems from that specified in the US standards to those specified in European standards on clinical measures associated with inflammation in four metropolitan dialysis units for two periods. Two periods were compared, three months prior to and six months post upgrading the water treatment systems. The monthly total erythropoietin dosage and intravenous iron supplementation for each patient were also compared over these periods. Variables with significant pre-post differences were assessed using multivariate models to control for confounding factors.

The results indicated significant increases in hemoglobin, ferritin and TSat (all p < 0.0001) and albumin (p = 0.0001) were associated with improvement in water quality. Decreases in CRP and creatinine (both p < 0.0001) were also noted.

These findings suggest that the current regulations in the United States set the microbiological limits of water and dialysis fluid inappropriately high, and the limits should be revised downwards, since such an approach is reflected in improvement in markers of inflammation.

Sex-specific effect of intranasal vasopressin, but not oxytocin, on emotional recognition and perception in schizophrenia patients

Background

Impairments in social behavior and cognition, such as the ability to identify others’ emotional state, are important features in schizophrenia. Arginine vasopressin (AVP) and oxytocin (OXT) and are nonapeptides that influence social cognition and behavior. Previous studies have shown that the administration of intranasal AVP or OXT may affect the ability to recognize facial emotions. The primary objective of this study was to investigate the effects of a single dose of AVP or OXT on social cognition in patients with schizophrenia. The secondary objective of the study was to test for sex-specific effects of intranasal AVP and OXT administration on social cognition.

Methods

In this double-blind, placebo-control, cross-over study, 34 patients diagnosed with schizophrenia or schizo-affective disorder, received a dose of AVP, OXT or placebo in three separate meetings. Forty-five minutes after administration, subjects performed facial emotion recognition tasks.

Results

There were no significant main effects of hormone administration on the ability to recognize facial emotions between treatment conditions. However, AVP administration resulted in sex-specific differences in emotion recognition. Specifically, in men, AVP administration reduced the ability to recognize angry faces. In women, AVP administration reduced the ability to recognize sad faces and improved the ability to recognize fearful faces.

Conclusions

These findings indicate that intranasal AVP may affect the recognition of facial emotions differently in men and women. Thus, AVP may increase the differences between men and women on social cognition.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Safety, pharmacokinetics, and pharmacodynamics of RSLV-132, an RNase-Fc fusion protein in systemic lupus erythematosus: a randomized, double-blind, placebo-controlled study

Blood-borne RNA circulating in association with autoantibodies is a potent stimulator of interferon production and immune system activation. RSLV-132 is a novel fully human biologic Fc fusion protein that is comprised of human RNase fused to the Fc domain of human IgG1. The drug is designed to remain in circulation and digest extracellular RNA with the aim of preventing activation of the immune system via Toll-like receptors and the interferon pathway. The present study describes the first clinical study of nuclease therapy in 32 subjects with systemic lupus erythematosus. The drug was well tolerated with a very favorable safety profile. The approximately 19-day serum half-life potentially supports once monthly dosing. There were no subjects in the study that developed anti-RSLV-132 antibodies. Decreases in B-cell activating factor correlated with decreases in disease activity in a subset of patients.

Clinical Audit: Optimal Positioning of Endotracheal Tubes in Neonates

Background

The malposition of endotracheal tubes (ETTs) can be associated with endo-bronchial intubation or accidental extubation. A variety of methods have been reported for predicting insertional length (IL) including weight, nasal-tragus length (NTL) and sternal length (STL) measurements. In our unit no consistent predictor method was being used.

Aim

To audit the proportion of endotracheal tubes that required a significant position change after oral intubation. Our standard set was that the endotracheal tube should be in a satisfactory position in >80% of cases. If not met, practice would then be re-audited after a consistent predictor method had been implemented.

Methods

Data regarding changes in endotracheal tube position were collected. Significant position changes were defined as adjustments>0.5 cm.

Results

Twenty two babies were included in the initial audit, and only 73% of endotracheal tubes had a satisfactory position. Thirty six babies were included in the re-audit and when the nasal-tragus length predictor was used, 94% of endotracheal tubes had a satisfactory position, meeting the standard.

Conclusion

The nasal-tragus length predictor improved the accuracy of endotracheal tube positioning after oral intubation. It is a simple, fast, reproducible method and can be used in everyday practice to help avoid significant endotracheal tube malposition.

Comparative mortality risks of antipsychotic medications in community-dwelling older adults

BACKGROUND

All antipsychotic medications carry warnings of increased mortality for older adults, but little is known about comparative mortality risks between individual agents.

AIMS

To estimate the comparative mortality risks of commonly prescribed antipsychotic agents in older people living in the community.

METHOD

A retrospective, claims-based cohort study was conducted of people over 65 years old living in the community who had been newly prescribed risperidone, olanzapine, quetiapine, haloperidol, aripiprazole or ziprasidone (n = 136 393). Propensity score-adjusted Cox proportional hazards models assessed the 180-day mortality risk of each antipsychotic compared with risperidone.

RESULTS

Risperidone, olanzapine and haloperidol showed a dose-response relation in mortality risk. After controlling for propensity score and dose, mortality risk was found to be increased for haloperidol (hazard ratio (HR) = 1.18, 95% CI 1.06-1.33) and decreased for quetiapine (HR = 0.81, 95% CI 0.73-0.89) and olanzapine (HR = 0.82, 95% CI 0.74-0.90).

CONCLUSIONS

Significant variation in mortality risk across commonly prescribed antipsychotics suggests that antipsychotic selection and dosing may affect survival of older people living in the community.

Frailty and osteoporosis in older women--a prospective study

Despite sharing common risk factors and biological pathways, the relationship between frailty and osteoporosis (OP) is not clear. This prospective study has shown that frailty defined by the Vulnerable Elders Survey can predict a decrease in bone mineral density after 1 year. Thus, frail older women should be assessed for osteoporosis.

INTRODUCTION

Frailty and OP share common risk factors such as age, sarcopenia, lack of physical activity, low body weight, and smoking. Despite shared risk factors and biological pathways, the relationship between frailty and OP is not clear. The purpose of our prospective study was to examine this relationship in a community sample of older women.

METHODS

A sample of 235 community-dwelling women was assessed for demographic, medical, frailty and OP status at baseline, and after at least 1 year. Frailty was assessed using the Cardiovascular Health study (CHS) frailty phenotype and using the Vulnerable Elders Survey (VES-13). OP was measured using dual photon absorptiometry bone mineral density (BMD). Descriptive statistics and regression models were used.

RESULTS

At baseline, 235 women with a mean age of 77.6 (SD = 5.4), body mass index (BMI) of 28.3 (SD = 5.2) kg/m(2), and BMD of 0.7 (SD = 0.2) g/cm(2)were assessed. No correlation was found between BMD and the CHS (BMD spine, r = 0.009, p = 0.889; BMD hips, r = 0.050, p = 0.473) or the VES-13 (BMD spine, r = 0.034, p = 0.605; BMD hips, r = -0.042, p = 0.537) frailty scales. One hundred fifty-two (63.9 %) women were assessed after 1 year. In a regression model, women who were frail at baseline (VES-13) were found to have a statistically significantly lower hip and spine BMD at follow-up (controlling for BMI) than women who were non-frail at baseline (p = 0.0393, hip; p = 0.0069, spine).

CONCLUSIONS

Frailty status as defined by the VES-13 predicts a decrease in BMD after 1 year.

Effect of a water soluble derivative of fullerene C60 on the features neural progenitor cells in vitro

We studied the effect of a water soluble derivative of fullerene C60 on the behavior of cultured neural stem/progenitor cells. Addition of 20 nM of metal fullerenolate C60 (NaFL) into the cell culture increased the population of the cells almost twice in comparison with the control and also suppressed the formation of neurospheres. The obtained data allow us to suggest that NaFL has a positive effect on the proliferative activity of neural progenitors. The water-soluble fullerene nanostructures such as NaFL promoting the proliferation of neural stem cells might have numerous beneficent applications in cell biology and biotechnology.

Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study

OBJECTIVE

To assess risks of mortality associated with use of individual antipsychotic drugs in elderly residents in nursing homes.

DESIGN

Population based cohort study with linked data from Medicaid, Medicare, the Minimum Data Set, the National Death Index, and a national assessment of nursing home quality.

SETTING

Nursing homes in the United States.

PARTICIPANTS

75,445 new users of antipsychotic drugs (haloperidol, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone). All participants were aged ≥ 65, were eligible for Medicaid, and lived in a nursing home in 2001-5.

MAIN OUTCOME MEASURES

Cox proportional hazards models were used to compare 180 day risks of all cause and cause specific mortality by individual drug, with propensity score adjustment to control for potential confounders.

RESULTS

Compared with risperidone, users of haloperidol had an increased risk of mortality (hazard ratio 2.07, 95% confidence interval 1.89 to 2.26) and users of quetiapine a decreased risk (0.81, 0.75 to 0.88). The effects were strongest shortly after the start of treatment, remained after adjustment for dose, and were seen for all causes of death examined. No clinically meaningful differences were observed for the other drugs. There was no evidence that the effect measure modification in those with dementia or behavioural disturbances. There was a dose-response relation for all drugs except quetiapine.

CONCLUSIONS

Though these findings cannot prove causality, and we cannot rule out the possibility of residual confounding, they provide more evidence of the risk of using these drugs in older patients, reinforcing the concept that they should not be used in the absence of clear need. The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine.

Temporal trends in adherence to cardiovascular medications in elderly patients after hospitalization for heart failure

Although the complexity of treatment regimens for patients with heart failure (HF) has increased over time because of the increased availability of efficacious medications, little is known about temporal trends in adherence to treatment regimens in these patients. We assessed trends in adherence to angiotensin-system blockers (ABs), β-blockers (BBs), and spironolactone (SL) for HF in Medicare beneficiaries enrolled in two statewide pharmacy benefit programs from 1995 to 2004. The proportion of days covered (PDC) (%) was assessed after the first dispensing among users of an AB, BB, or SL. Proportions of full adherence (PDC >80%) did not change over time for ABs (54% in both 1996 and 2003) but increased slightly for BBs (from 47% in 1996 to 57% in 2003) and SL (from 31% in 1996 to 42% in 2003). Black race and dialysis treatment predicted poor adherence to any medications. Adherence to BBs and SL increased modestly over time, but overall nonadherence remained high.

Amnestic effect of cocaine after the termination of its stimulant action

The effects of cocaine on memory are controversial. Furthermore, the psychostimulant action of cocaine can be a critical issue in the interpretation of its effects on learning/memory models. The effects of a single administration of cocaine on memory were investigated during the presence of its motor stimulating effect or just after its termination. The plus-maze discriminative avoidance task (PM-DAT) was used because it provides simultaneous information about memory, anxiety and motor activity. In Experiment I, mice received saline, 7.5, 10, 15 or 30 mg/kg cocaine 5 min before the training session. In Experiment II, mice were trained 30 min after the injection of saline, 7.5, 10, 15 or 30 mg/kg cocaine. In Experiment III, mice received 30 mg/kg cocaine 30 min pre-training and pre-test. In Experiment IV, mice received 30 mg/kg cocaine immediately post-training. Tests were always conducted 24 h following the training session. Given 5 min before training, cocaine promoted a motor stimulant effect at the highest dose during the training session but did not impair memory. When cocaine was injected 30 min pre-training, the drug did not modify motor activity, but produced marked amnestic effects at all doses tested. This amnesia induced by cocaine given 30 min pre-training was not related to a state-dependent learning because it was not abolished by pre-test administration of the drug. Post-training cocaine administration did not induce memory deficits either. Our results suggest that the post-stimulant phase is the critical moment for cocaine-induced memory deficit in a discriminative task in mice.

Comparative gastrointestinal safety of weekly oral bisphosphonates

SUMMARY

Weekly bisphosphonates are the primary agents used to treat osteoporosis. Although these agents are generally well tolerated, serious gastrointestinal adverse events, including hospitalization for gastrointestinal bleed, may arise. We compared the gastrointestinal safety between weekly alendronate and weekly risedronate and found no important difference between new users of these agents.

INTRODUCTION

Weekly bisphosphonates are the primary agents prescribed for osteoporosis. We examined the comparative gastrointestinal safety between weekly bisphosphonates.

METHODS

We studied new users of weekly alendronate and weekly risedronate from June 2002 to August 2005 among enrollees in a state-wide pharmaceutical benefit program for seniors. Our primary outcome was hospitalization for upper gastrointestinal bleed. Secondary outcomes included outpatient diagnoses for upper gastrointestinal disease, symptoms, endoscopic procedures, use of gastroprotective agents, and switching between therapies. We used Cox proportional hazard models to compare outcomes between agents within 120 days of treatment initiation, adjusting for propensity score quintiles. We also examined composite safety outcomes and stratified results by age and prior gastrointestinal history.

RESULTS

A total of 10,420 new users were studied, mean age = 79 years (SD, 6.9), and 95% women. We observed 31 hospitalizations for upper gastrointestinal bleed (0.91 per 100 person-years) within 120 days of treatment initiation. Adjusting for covariates, there was no difference in hospitalization for upper gastrointestinal bleed among those treated with risedronate compared with alendronate (HR, 1.12; 95%CI, 0.55 to 2.28). Risedronate switching rates were lower; otherwise, no differences were observed for secondary or composite outcomes.

CONCLUSIONS

We found no important difference in gastrointestinal safety between weekly oral bisphosphonates.

Dealing with dental insurance

Dental insurance companies can have many different policies, with varying requirements depending on the company. This requires a tremendous amount of time on the part of dentists and their office teams to communicate with insurance companies, file all the proper data, acquire predetermination information when required and address a myriad of other factors. By managing this process carefully, practices can save time and labor expenses, especially if patients are well-educated regarding what their dental insurance covers and what it does not.

Improving women's health through modernization of our bioinformatics infrastructure

Our nationwide bioinformatics infrastructure used to detect important sex differences associated with medical product use is antiquated. The Food and Drug Administration (FDA) has embarked on an ambitious bioinformatics modernization effort that will improve our ability to assess the safety and effectiveness of new medical products. This, in turn, will improve our ability to detect important sex differences.

Uric acid lowering therapy: prescribing patterns in a large cohort of older adults

BACKGROUND

Uric acid lowering therapy (UALT) is considered a chronic treatment for gout. Relatively little is known about adherence to UALT.

METHODS

We assessed adherence with UALT over a 1-year study period among 9823 older adults enrolled in a pharmacy benefit program. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC <80% was considered poor adherence and its predictors were examined in multivariable logistic models.

RESULTS

The mean (SD) PDC was 54% (36%) with 64% of patients considered poorly compliant over the study period. A total of 56% had experienced an extended break in UALT. Predictors of poor adherence included younger age (odds ratio (OR) 1.50, 95% CI 1.33-1.69 for ages 65-74 compared with 85 and above) and African-American race (OR 1.86, 95% CI 1.52-2.27 compared with Caucasian race). Most patients (93%) received their initial UALT prescription from a non-specialist and this also predicted poor adherence (OR 1.15, 95% CI 0.96-1.38 compared with rheumatologists or nephrologists).

CONCLUSION

Adherence with UALT is poor. While uric acid levels were not measured in this study, poor adherence with UALT is likely to reduce attainment of goal uric acid levels.

Interpersonal communication

Interpersonal relationships are a critical factor in any service business. The stronger the relationship between the patient and the dental team, the better the patient will feel about the practice. He or she will assess dental recommendations much more carefully, and it certainly is possible that even referrals may increase. People love to talk with others about the positive experiences in their lives. Three simple questions can make a tremendous difference in how patients perceive a practice, whether they will trust the dentist and team, and what level of treatment they ultimately will accept. Dentists who want to provide the highest quality of care to as many patients as possible will have a greater chance of achieving this goal if interpersonal relationships in the practice are strong.

Drug-induced home cage conspecifics' behavior can potentiate behavioral sensitization in mice

The effect of home cage conspecifics' behavior on locomotor sensitization to amphetamine (AMP) or ethanol (ETOH) were investigated. Female mice were repeatedly treated with saline or AMP (2.0 mg/kg for 13 days--Experiment 1) or saline or ETOH (1.8 g/kg for 21 days--Experiment 2) in home cages where all the animals had the same treatment (homogeneous home cages--HOM-HC) or in home cages where half of the animals were drug-treated and half of them were saline-treated (heterogeneous home cages--HET-HC). Behavioral sensitization was evaluated by the quantification of open-field locomotor activity after AMP or ETOH challenge injection, respectively. In both experiments, behavioral sensitization was potentiated in HOM-HC maintained animals. These results suggest that the behavioral sensitization phenomenon can be modified by home cage conspecifics' behavior.

Conflict resolution

The sooner conflict is identified and confronted, the more quickly it can be resolved (and the sooner, the better). When this is accomplished calmly and objectively, many areas of conflict will be eliminated. Addressing conflict as it arises also sends a clear message to the team that the practice seeks resolution, not punishment or negative consequences. In addition, the dentist and the office manager need to lead by example by avoiding gossip and encouraging open communication. The goal is to go from a parent-child relationship with the dental team to an adult-adult relationship using this series of managerial conflict resolution steps.

Dealing with dental insurance

Dental insurance companies can have many different policies, with varying requirements depending on the company. This requires a tremendous amount of time on the part of dentists and their office teams to communicate with insurance companies, file all the proper data, acquire predetermination information when required and address a myriad of other factors. By managing this process carefully, practices can save time and labor expenses, especially if patients are well-educated regarding what their dental insurance covers and what it does not.

First Report of Meloidogyne partityla on Pecan in Florida

Pecan (Carya illinoensis (Wagenh.) K. Koch) is an important tree in the southern United States for commercial nut production and residential use. Meloidogyne partityla (pecan root-knot nematode) is only known to parasitize trees in the Juglandaceae including pecan, walnut, and hickory. In the United States, it has been reported on pecan in Texas, New Mexico, and Georgia and internationally in South Africa. Portions of a large pecan nursery in Madison County, Florida were infested with an unknown species of root-knot nematode. The pecan trees at this nursery are grafted onto rootstock and grown in the field until the trees are large enough to sell as bare-root transplant stock in several states including and adjoining Florida. Trees infected by the root-knot nematodes were stunted, had extensive galling and rotting of the root system, and pulled from the ground relatively easily compared with noninfected trees. Attempts to rear these nematodes on tomato in the greenhouse were unsuccessful. Young egg-laying females were isolated directly from pecan roots for speciation. Enzymes extracted from females were resolved with polyacrylamide gel electrophoresis [4% stacking (pH 6.8) and 8% separating gel (pH 8.8) with Tris-glycine buffer]. The esterase (Est) and malate dehydrogenase (Mdh) phenotypes of the unknown Meloidogyne sp. were consistent with those reported for M. partityla. In addition, specimens of M. partityla maintained by the USDA Southeastern Fruit and Tree Nut Research Laboratory in Byron, GA were obtained and their Est and Mdh phenotypes compared with the unknown Meloidogyne sp. under identical electrophoretic and enzyme staining protocols. The Est and Mdh phenotypes of the two isolates were identical. Therefore, we conclude that the root-knot nematodes infesting the pecan nursery in Florida are M. partityla. To our knowledge, this is the first report of this nematode in Florida and also the first report of this nematode from infected nursery stock. It is unknown how long the field has been infested but clearly, there is potential for spread of M. partityla to locations around Florida and bordering states. This nematode may be widespread throughout pecan-growing regions of the United States. References: (1) K. P. N. Kleynhans. Phytophylactica 18:103, 1986. (2) A. P. Nyczepir et al. Plant Dis. 86:441, 2002. (3) J. L. Starr et al. J. Nematol. 28:565, 1996. (4) S. H. Thomas et al. Plant Dis. 85:1030, 2001.

Consistency

Consistency is a reflection of having the right model, the right systems and the right implementation. As Vince Lombardi, the legendary coach of the Green Bay Packers, once said, "You don't do things right once in a while. You do them right all the time." To provide the ultimate level of patient care, reduce stress for the dentist and staff members and ensure high practice profitability, consistency is key.

Productive use of office time

Anything that takes the dentist away from patients must be addressed and, when appropriate, delegated to others. A practitioner's time is too precious to be doing tasks others can effectively and efficiently perform. Look first to staff members and then to advisers and outsource providers when deciding how to delegate various tasks. Once a practice begins to take administrative responsibilities away from the practitioner, chairside time will increase, patient care and customer service will be enhanced, and the practice will have greater growth potential.

Performance reviews

Performance reviews should be a consistent part of the management process. They should take place at approximately the same time every year and focus on improvement in a positive way. The performance review can be an energizing process, rather than a demoralizing one, and it truly can be an agent for positive development of team members.

Dental practice and dental insurance

The time has come for dentists to recognize that the dental insurers, as an outside factor, must be considered when designing a practice business model. The same efficiencies that would be well-placed in any business now need to be considered carefully in a dental practice to keep income from being reduced. Fortunately, there is a great deal of opportunity to increase practice efficiency and maintain or exceed the current level of financial performance.

Leadership and team building

Leadership is not something that can be done once. It's not a procedure that is performed and then you are all set. It is a way of thinking and acting--an hourly, daily and annual activity based on desire, skills, training and specific behaviors. Dentists who are willing to spend a small amount of time focused on leadership inevitably will build better teams with lower turnover and higher efficiency.

Measuring patient satisfaction

Many businesses use customer satisfaction surveys successfully. You may notice that you find one in almost every restaurant or hotel room. I do not think it is a coincidence that the hotel industry provides some of the finest customer service available. When it comes to providing excellent customer service, dental practices can learn from businesses that regularly assess customer satisfaction.

The challenge of esthetic dentistry and elective services

Many dentists would like to increase the number of esthetic and elective procedures they perform. What may be holding them back is the ability to communicate with, educate and motivate patients in the area of esthetic and elective dentistry. While implants, esthetic dentistry or elective dentistry is not for every patient, each of these areas has improved the quality of many people's lives, allowing the dental profession to continue to serve the public in the broadest possible way.

Practice progress

This column is not based on wishful thinking about how things should be, but rather is a candid look at the reality of everyday practice. Prioritization is critical. Each dentist should select three to five major initiatives that he or she would like to achieve and prioritize these accordingly. The best approach for most practices is to deal with each of these only one or two at a time. Consider scoring each priority on a scale of one to 10 (one being the lowest, 10 the highest), gauging its overall importance, its potential effect on the practice and whether it helps achieve preset practice goals.

Leverage in dentistry

Leverage is a powerful tool that can make a tremendous difference in the satisfaction and lifetime production of most dentists. Dentists typically do not use leverage properly, and as a result, the entire burden of the practice constantly falls on their shoulders. It is difficult for dentists to practice dentistry and handle administrative issues at the same time. Doing so leads to decreased production and increased stress. As an interesting exercise, try the following: take a stopwatch and time how long you are involved in direct patient care during the course of a day. Performing this exercise will be a true revelation in understanding the importance of leverage.

Is the dentist an entrepreneur?

Although dentists may have an entrepreneurial spirit, they are not true entrepreneurs. Simply by selecting dentistry as a profession, dentists have engaged in a business that has a high level of success and limited growth potential. By limited growth potential, I do not mean to imply that practices cannot be successful and create excellent lifestyles for dentists. As stated above, they will be limited in growth by the physical capacity of the dentist, the team and the facilities. There is a great deal of security in dental practice if basic management principles are followed and business systems are put in place. In my next column, I will continue to explore the similarities and differences between entrepreneurs and dentists, and how a dentist can take a practice through the multiple stages necessary to achieve the highest levels of dental practice success.

Evaluating your office staff

The most important assets in a dental practice are the people. We no longer live in an era in which an employee stays in the same job for decades. Change is inevitable and often comes at inopportune times. Evaluation gives the dentist the opportunity to identify key team members who will join the core team and train new staff members. Conversely, executive evaluation also demonstrates that there may not be a proper fit for a team member, if he or she cannot demonstrate the ability to grow and change with a practice despite support, training and career path development. As author Alvin Toffler noted, "The illiterate of the 21st century will not be those who cannot read or write, but those who cannot learn, unlearn and relearn."

Maximizing the physical use of the office

When referring to the physical plant in a dental practice, I am referring mainly to the use of dental chairs, because this is where dental practice production occurs. By maximizing the use of chairs or adding the necessary number of chairs to a practice, any office can grow and experience a proper patient flow. Since most offices have significantly high rates of no-shows, last-minute cancellations and overdue patients, the potential for growth is enormous. By using the schedule and chairs properly, the office has the opportunity to maximize production, create convenient appointments for patients and significantly increase practice profitability.

How home care is essential to ensuring successful orthodontic treatment outcomes

Patients can significantly affect the outcome of their orthodontic treatment. A practice committed to developing the right systems, scripts, and educational materials will experience a more satisfied patient, increased efficiencies, and higher profits. Educating and motivating patients to maintain their oral health and providing recommendations or dispensing of home care tools such as a power toothbrush increases patient compliance, positively impacts treatment outcomes, enhances customer service, and generates a new revenue stream for the practice. In a tight economy and a highly competitive orthodontic market, a power toothbrush can positively impact your marketing and case close rate. Treatment and fees being relatively equal, patients will tend to accept treatment from a practice that can demonstrate concern for the patients' overall oral health and greater value-added components to the orthodontic case. Power toothbrushes as part of a comprehensive orthodontic treatment provide a great differentiating marketing strategy.

Inventory control

By establishing clear inventory ordering targets and following the guidelines outlined in this column, the staff member handling the process will understand the high and low levels of inventory control and be able to maintain an accurate system. Inventory control represents approximately 6 to 8 percent of practice purchasing. The main goal of the advice in this column is not to reduce the cost, unless there is waste involved, but rather to establish a process that allows the practice to purchase supplies on a regular basis, avoid mistakes and maintain a steady expense level.