Interpretation of tympanic membrane findings varies according to level of experience

The authors administered a written survey consisting of colour images of 28 tympanic membranes (TM) to four groups of examiners: 86 medical students, 68 paediatric residents, 62 paediatricians and seven expert otoscopists. For each image, examiners were asked to indicate whether redness or bulging of the TM was present and to assign a diagnosis. The odds of diagnosing acute otitis media (AOM) was examined according to perceived redness or bulging of the TM. Medical students and paediatricians attributed approximately equal importance to isolated redness and isolated bulging of the TM. In contrast, experts placed significantly greater importance on isolated bulging of the TM compared with isolated redness of the TM. The authors suggest that training curricula emphasize the strong association between a bulging TM and a diagnosis of AOM, while de-emphasizing the association between TM redness and AOM.

February 2010: a dramatic shift away from private fee-for-service plans in rural Medicare Advantage enrollment

In a reversal of recent trends, private fee-for-service (PFFS) enrollment fell dramatically in rural areas in early 2010. As a result, Medicare Advantage (MA) enrollment in rural areas (excluding other prepaid plans) fell slightly in early 2010 for the first time in years. The dramatic drop in PFFS enrollment was offset by increases in enrollment in preferred provider organization (PPO) and health maintenance organization (HMO) plans. Although PFFS enrollment has driven the rapid growth of the MA program in recent years, particularly in rural areas, the MA market share held by PFFS plans in rural areas fell significantly from 52% in December 2009 to 38% in February 2010. The decline was driven by some plans leaving the market and by underutilized and duplicative plans consolidating; factors contributing to this trend include slow growth in payment rates, legislative changes requiring PFFS plans to form provider networks by 2011, and significant increases in beneficiary premiums. Nationwide, enrollment in PPO and HMO plans grew, offsetting the decline in PFFS enrollment and contributing to a slight growth in total MA enrollment in 2010.

Validation of a Group Embedded Figures Test for young children

This paper describes the development and concurrent validation of a group-administered measure of field-dependence/independence for early elementary children. Following the procedure used to validate the Children's Group Embedded Figures Test (Level 2, 9 to 11 yr.), a validation study of a group test for younger children was undertaken with a second-grade sample (N = 77). The test was reliable (alpha = .84) and significantly related to both the individually administered Children's Embedded Figures Test (r = .56) and Portable Rod-and-frame Test (r = .57). This measure, designated the Children's Group Embedded Figures Test--Level 1, provides a promising research instrument for assessing cognitive style of young children.

Eosinophilopoietin. A circulating low molecular weight peptide-like substance which stimulates the production of eosinophils in mice

In earlier studies, methods were developed to raise specific antibodies in rabbits against purified suspensions of mouse or human eosinophils. On administration of antieosinophil serum (AES) to mice, the mature eosinophils in tissues, peripheral blood, and bone marrow were depleted, while the immature eosinophil pool in the bone marrow was observed to proliferate. The current investigations explore the generation of eosinophilopoietic factors during AES-induced eosinophilopenia. Mice received three injections of AES, one every other day. As the peripheral eosinophil counts started to recover after the last AES injection, the serum was collected and transferred to normal animals. Within 2 days the recipients showed an increase in peripheral blood as well as in bone marrow eosinophils. The rise in bone marrow eosinophils was due to newly formed cells as evidenced by increased uptake of [(3)H]thymidine. The generation of eosinophilopoietic activity was specifically related to depletion of eosinophils but not neutrophils. The eosinophilopoietic activity was: (a) dependent on the volume of serum transferred, (b) lost on dialysis, and (c) largely heat labile. The activity eluted as a low molecular weight substance on G-25 Sephadex and was digested by pronase but not by trypsin. Active fractions collected from G-25 columns were not chemotactic for the eosinophils in vitro. Thus, specific depletion of mature eosinophils generates a low molecular weight peptide which stimulates eosinophilopoiesis in vivo. It is suggested that this substance be named eosinophilopoietin.