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Background: Generalised anxiety disorder (GAD) is a chronic and disabling condition with considerable personal and economic impact. Cognitive behavioural therapy (CBT) is a recommended psychological therapy for GAD; however, there are substantial barriers to accessing treatment. Digital CBT, in particular smartphone-delivered CBT, has the potential to improve accessibility and increase dissemination of CBT. Despite the emerging evidence of smartphone-based psychological interventions for reducing anxiety, effect size scores are typically smaller than in-person interventions, and there is a lack of research assessing the efficacy of smartphone-delivered digital interventions specifically for GAD.Methods: In the DeLTA trial (DigitaL Therapy for Anxiety), we plan to conduct a parallel-group superiority randomised controlled trial examining the efficacy of a novel smartphone-based digital CBT intervention for GAD compared to a waitlist control. We aim to recruit 242 adults (aged 18 years or above) with moderate-to-severe symptoms of GAD. This trial will be conducted entirely online and will involve assessments at baseline (week 0; immediately preceding randomisation), mid-intervention (week 3), post-intervention (week 6; primary end point) and follow-up (week 10). The primary objective is to evaluate the efficacy of the intervention on GAD symptom severity compared to a waitlist control at post-intervention. Secondary objectives are to examine between-group effects on GAD at follow-up, and to examine the following secondary outcomes at both post-intervention and follow-up: 1) worry; 2) depressive symptoms; 3) wellbeing; 4) quality of life; and 5) sleep difficulty.Discussion: This trial will report findings on the initial efficacy of a novel digital CBT intervention for GAD. Results have the potential to contribute towards the evidence base for digital CBT for GAD and increase the dissemination of CBT.Trial Registration: ISRCTN, ISRCTN12765810. Registered on 11 January 2019. [ABSTRACT FROM AUTHOR]

Objective: Computational human body models (HBMs) are nominally omnidirectional surrogates given their structural basis in human anatomy. As a result, such models are well suited for studies related to occupant safety in anticipated highly automated vehicles (HAVs). We utilize a well-validated HBM to study the head and neck kinematics in simulations of nontraditional occupant seating configurations.Methods: The GHBMC M50-O v. 4.4 HBM was gravity settled into a generic seat buck and situated in a seated posture. The model was simulated in angular increments of 15 degrees clockwise from forward facing to rear facing. A pulse of 17.0 kph (NASS median) was used in each to simulate a frontal impact for each of the 13 seating configurations. Belt anchor points were rotated with the seat; the airbag was appropriately powered based on delta-V, and was not used in rear-facing orientations. Neck forces and moments were calculated.Results: The 30-degree oblique case was found to result in the maximum neck load and sagittal moment, and thus Neck Injury Criteria (NIJ). Neck loads were minimized in the rear facing condition. The moments and loads, however, were greatest in the lateral seating configuration for these frontal crash simulations.Conclusions: In a recent policy statement on HAVs, the NHTSA indicated that vehicle manufacturers will be expected to provide countermeasures that will fully protect occupants given any planned seating or interior configurations. Furthermore, the agency indicated that virtual tests using human models could be used to demonstrate such efficacy. While the results presented are only appropriate for comparison within this study, they do indicate that human models provide reasonable biomechanical data for nontraditional occupant seating arrangements. [ABSTRACT FROM AUTHOR]

To protect and manage an intact neotropical carnivore guild, it is necessary to understand the relative importance of habitat selection and intraguild competition to the ecology of individual species. This study examined habitat use of four carnivores in the Mountain Pine Ridge Forest Reserve, Belize. We calculated photographic trap success (TS) rates for jaguars Panthera onca, pumas Puma concolor, ocelots Leopardus pardalis, grey foxes Urocyon cinereoargenteus, potential prey and humans at 47 remote camera stations spaced along roads and trails within the 139 km study site. At each station, we used manual habitat sampling in combination with geographic information systems to estimate habitat characteristics pertaining to vegetation cover. We used negative binomial models to analyse species-specific TS as a response to habitat (including vegetation and landscape variables, prey activity and human activity) and co-predator activity rates. Jaguars [TS=7.56±1.279 ( captures per 100 trap-nights (TN)] and grey foxes (31.5±6.073 captures per 100 TN) were commonly captured by cameras, while pumas (0.66±0.200 captures per 100 TN) and ocelots (0.55±0.209 captures per 100 TN) were rare. Model selection via Akaike's information criterion (AIC) revealed that models including habitat variables generally performed better than models including co-predator activity. Felid captures were positively associated with small bird TS and with the width or length of surrounding roads, while fox counts showed few habitat associations. Ocelot activity was positively related to jaguar captures, an effect probably explained by their shared preference for areas with more roads. Pumas were negatively related to human activity and jaguars showed a similar, though non-significant, trend, suggesting that these felids may be sensitive to human disturbance even within protected areas. Results suggest that these predators do not spatially partition habitat and that the jaguar could function as an umbrella species for smaller sympatric carnivores. [ABSTRACT FROM AUTHOR]

Background: One of the proposed mechanisms of trastuzumab-induced regression of human epidermal growth factor receptor 2-positive (HER2+) tumours includes facilitation of antibody-dependent cell-mediated cytotoxicity (ADCC). Granulocyte-macrophage colony-stimulating factor (GM-CSF) mediates ADCC. We presented our pilot study of adding GM-CSF to trastuzumab in patients with trastuzumab-resistant HER2+ metastatic breast cancer.Methods: Patients with HER2+ metastatic breast cancer that progressed after trastuzumab +/- chemotherapy were continued on trastuzumab 2 mg kg(-1) intravenous weekly and GM-CSF 250 μg m(-2) subcutaneous daily. Patients were assessed for response every 8 weeks. Treatment was continued until disease progression or intolerable toxicity.Results: Seventeen patients were evaluable (median age 48 years, range 27-75 years). The median number of metastatic sites was 2 (range 1-3); the most common site was the liver (n=10). The median number of prior regimens for metastatic disease was 2 (range 1-5). No objective disease response was observed, but five patients (29%) had stable disease for a median duration of 15.8 (range 10-53.9) weeks. The most common adverse event was rash at the injection site. No grade 4 or irreversible adverse event was seen.Conclusion: The addition of GM-CSF to trastuzumab alone had a modest clinical benefit and acceptable safety profile in heavily pretreated patients with trastuzumab-resistant HER2+ metastatic breast cancer. [ABSTRACT FROM AUTHOR]

We are constructing high-resolution, chromosomal ‘test’ maps for the entire pig genome using a 12,000-rad WG-RH panel (IMNpRH212,000-rad)to provide a scaffold for the rapid assembly of the porcine genome sequence. Here we present an initial, comparative map of human chromosome (HSA) 11 with pig chromosomes (SSC) 2p and 9p. Two sets of RH mapping vectors were used to construct the RH framework (FW) maps for SSC2p and SSC9p. One set of 590 markers, including 131 microsatellites (MSs), 364 genes/ESTs, and 95 BAC end sequences (BESs) was typed on the IMNpRH212,000-rad panel. A second set of 271 markers (28 MSs, 138 genes/ESTs, and 105 BESs) was typed on the IMpRH7,000-rad panel. The two data sets were merged into a single data-set of 655 markers of which 206 markers were typed on both panels. Two large linkage groups of 72 and 194 markers were assigned to SSC2p, and two linkage groups of 84 and 168 markers to SSC9p at a two-point LOD score of 10. A total of 126 and 114 FW markers were ordered with a likelihood ratio of 1000:1 to the SSC2p and SSC9p RH12,000-rad FW maps, respectively, with an accumulated map distance of 4046.5 cR12,000 and 1355.2 cR7,000 for SSC2p, and 4244.1 cR12,000 and 1802.5 cR7,000 for SSC9p. The kb/cR ratio in the IMNpRH212,000-rad FW maps was 15.8 for SSC2p, and 15.4 for SSC9p, while the ratio in the IMpRH7,000-rad FW maps was 47.1 and 36.3, respectively, or an ∼3.0-fold increase in map resolution in the IMNpRH12,000-rad panel over the IMpRH7,000-rad panel. The integrated IMNpRH12,000-rad andIMpRH7,000-rad maps as well as the genetic and BAC FPC maps provide an inclusive comparative map between SSC2p, SSC9p and HSA11 to close potential gaps between contigs prior to sequencing, and to identify regions where potential problems may arise in sequence assembly. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Two taste preference studies were conducted using six Holstein heifers in each experiment to determine preferences for no ionophore, lasalocid, or monensin in the diet. En Exp. 1, individually penned (approx. 5 mo old; 220 ± 14 kg BW) heifers were fed a basal total mixed ration containing 46% corn silage, 46% grass haylage, and 8% soybean meal (DM basis). There were five treatments (mg/kg BW-1·d-1): 0 ionophore (control), lasalocid (IL), 2 lasalocid (2L), 1 monensin (1M), or 2 monensin (2M). Jonophores were provided as part of the mineral mix that had been added to the control diet and through an ionophore grain by-product mix to make the 2L and 2M treatments. All five diets were offered for 7 d, with the first 2 d for adaptation and the last 5 d for measurement of feed intake. The most preferred diet was then removed and the study continued with the four remaining diets. The most preferred diets were again eliminated sequentially, so that only two diets remained on d 13 and 14. Each feeding segment ranking of treatment preferences was determined based on the weight of feed refused at the end of each feeding segment. In Exp. 2, six 6-wk-old heifers (75 ± 5 kg of BW) were individually fed either 0, 1L, or 1M in a study similar to Exp. 1, except that the most preferred diet was removed after 4 d, with the first day for adaptation and the last 3 d for measurement of feed intake. In Exp. 1, orthogonal contrasts indicated that heifers preferred the 1L and 2L diets over the IM and 2M diets. Preferences between diet concentrations of ionophores (1 and 2 mg/kg of BW; Exp. 1) and the control and ionophore treatments did not differ, nor was there an interaction between ionophores and their concentration. Dairy heifers previously fed lasalocid prefer lasalocid over monensin when given a choice; however, heifers without previous exposure to an ionophore did not indicate a preference (Exp. 2). [ABSTRACT FROM AUTHOR]

Studies have shown that the surface hydrology of a pasture system is influenced by its vegetative characteristics. As research continues on ways to prevent erosion and excessive nutrient loss from agricultural land, the effect that different forage species have on surface runoff requires further investigation. This study sought to evaluate the effect of five forage species at varying canopy heights (one day vs. six weeks growth post-harvest) on surface runoff and infiltration on 6.1 m x 6.1 m (20 x 20 ft) plots fertilized with poultry litter. The five forage species were: Alamo switchgrass (Panicum virgatum Carl Linnaeus), Caucasian bluestem (Bothriochloa caucasia (Trin.) C.E. Hubbard), Greenfield bermudagrass (Cynodon dactylon (L.) Christian Hendrik Persoon), Pete eastern gamagrass (Tripsacum dactyloides (L.) Carl Linnaeus), and Kentucky-31 tall fescue (Festuca arundinacea John H. Schreber). Poultry litter was surface-applied annually at 8.97 Mg ha-1 (4.0 ton/acre). Rainfall simulations (5.0 cm hr-1) (2.0 in hr-1) were used to produce runoff events during spring, summer, and fall to examine seasonal variations. Although there were no statistical differences in runoff volumes between cut canopy and full canopy covers within a single species, runoff volumes were reduced by full canopies, for all seasons, by an average of 18% for all species except bermudagrass. Comparisons of runoff volumes between the different species showed that tall fescue had significantly lesser (30 mm) runoff for three of the four runoff events. There were no differences in runoff between the other four species, for any runoff event. Infiltration was on average 19% greater in tall fescue plots for all runoff events, compared to the other four species. Neutron probe data supported these results, with tall fescue plots consistently having average profile volumetric water content from 3 to 5 m3 m-3 (9.8 to 16.4 ft3 ft-3) lower at the 20 and 35 cm (7.9 and 13.8 in) depths. Results of this study show that tall fescue, when directly compared to the other forages in this study, is more effective at reducing runoff volumes and increasing infiltration, thereby reducing edge of field loss in forage systems. [ABSTRACT FROM AUTHOR]

Bilayers consisting of two-dimensional (2D) electron and hole gases separated by a 10 nm thick AlGaAs barrier are formed by charge accumulation in epitaxially grown GaAs. Both vertical and lateral electric transport are measured in the millikelvin temperature range. The conductivity between the layers shows a sharp tunnel resonance at a density of 1.1×10^{10}  cm^{-2}, which is consistent with a Josephson-like enhanced tunnel conductance. The tunnel resonance disappears with increasing densities and the two 2D charge gases start to show 2D-Fermi-gas behavior. Interlayer interactions persist causing a positive drag voltage that is very large at small densities. The transition from the Josephson-like tunnel resonance to the Fermi-gas behavior is interpreted as a phase transition from an exciton gas in the Bose-Einstein-condensate state to a degenerate electron-hole Fermi gas.

Objectives: Clostridium difficile infection (CDI) is the most common cause of healthcare-associated infections in the United States. Despite well-established risk factors, little research has focused on use of these variables to identify a patient population at high risk for CDI to target with primary prevention strategies. A predictive index for healthcare-associated CDI could improve clinical care and guide research for primary prevention trials. Our objective was to develop a predictive index to identify patients at high risk for healthcare-associated CDI., Methods: We performed a secondary database analysis in a five-hospital health system in Houston, Texas. Our cohort consisted of 97 130 hospitalized patients admitted for more than 48 hours between October 2014 and September 2016. The derivation cohort consisted of the initial 80% of admissions (75 545 patients), with the remainder being used in the validation cohort., Results: CDI rates in the derivation and validation cohorts were 1.55% and 1.43%, respectively. Thirty-day predictors of CDI were increased number of high-risk antibiotics, Charlson comorbidity index score, age and receipt of a proton pump inhibitor. These variables were incorporated into a simple risk index with a score range of 0 to 10. The final model demonstrated good discrimination and calibration with the observed CDI incidence ranging from 0.1% to 20.4%., Conclusions: We developed a predictive index for 30-day risk of healthcare-associated CDI using readily available and clinically useful variables. This simple predictive risk index may be used to improve clinical decision making and resource allocation for CDI stewardship initiatives, and guide research design., (Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

The project described here seeks to answer questions regarding the role increased nitrogen (N) deposition is playing in enhanced carbon (C) sequestration in temperate mid-latitude forests, using detailed measurements from an AmeriFlux tower in southern Indiana (Morgan-Monroe State Forest, or MMSF). The measurements indicate an average atmosphere-surface N flux of approximately 6 mg-N m(-2) day(-1) during the 2000 growing season, with approximately 40% coming from dry deposition of ammonia (NH3), nitric acid (HNO3), and particle-bound N. Wet deposition and throughfall measurements indicate significant canopy uptake of N (particularly NH4+) at the site, leading to a net canopy exchange (NCE) of -6 kg-N ha(-1) for the growing season. These data are used in combination with data on the aboveground C:N ratio, litterfall flux, and soil net N mineralization rates to indicate the level of potential perturbation of C sequestration at this site.

Sleep patterns of 30 individuals with self-injurious behavior and mental retardation were compared with those of 30 matched controls residing in the same residential facility that did not self-injure. Individuals were recorded as asleep or awake during 30 min intervals for eight hours per night. The results of a Wilcoxon signed-ranks test (p < .05) indicated that individuals with self-injury slept significantly less than individuals without self-injury. chi2 analyses (p < .01) indicated significantly greater variability in the number of intervals recorded as asleep among individuals with self-injury than their matched controls. These results are congruent with previous findings of sleep disturbance among persons with mental retardation and behavior problems. The possibility of neurochemical dysregulation in sleep disturbance among individuals with daytime self-injury is discussed.

For many mothers living with HIV/AIDS, whether, when, and how to disclose their HIV diagnosis to their children and arranging for future care are important although agonizing issues. Due to the increasing number of children who lose their mothers to AIDS and the dearth of empirical information about them, these issues are increasingly important to research. This study of 188 HIV-positive mothers and their 267 children of minor age in New York City revealed that only half the mothers had disclosed their HIV diagnosis to at least one of their children and only 57% had made formal plans for the children's care. As expected, older children were more likely to be informed than younger children. Contrary to some previous research, maternal disclosure was not related to ethnicity, advanced illness, improved psychological well-being, or greater or more satisfying social support resources. Implications for future research and provision of services to this group of women are discussed.

Purpose: To catalog ophthalmic findings in a cohort of patients with scleromyxedema., Methods: Thirty-five biopsy-proven patients with scleromyxedema evaluated at the Mayo Clinic in Rochester, Minnesota, from 1960 to 1991 were identified. Eye examinations were performed on 17 of the patients. Ophthalmic findings not attributable to other systemic or ocular disease were recorded., Results: The following abnormalities were considered secondary to scleromyxedema: corneal opacities (2 patients), thickened eyebrow or eyelid skin (4 patients), lagophthalmos (1 patient), and ectropion (2 patients). One patient who had concurrent polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome also had choroidal folds and papilledema. A corneal biopsy in one patient disclosed deposits of acid mucopolysaccharide, consistent with one of two previously published cases., Conclusion: A series of patients with scleromyxedema was reviewed. This systemic disorder infrequently may cause visually significant ophthalmic manifestations, including eyelid changes and corneal deposits. Further study is needed to characterize better the nature of the corneal opacities.

A review of the medical literature concerning the psychological, physical, and vocal effects of premenstrual syndrome reveals a wide range of significant effects for the female singer and a larger number of proposed treatments. A survey was conducted to evaluate the frequency and severity of 67 general physical and psychological symptoms and 20 vocal symptoms experienced by 104 female singers. The variables of age, menstrual history, voice type, and performing experience were examined. The average number of general symptoms was 33 and the average number of vocal symptoms three. The most frequently reported general symptom was abdominal bloating, while the most frequently reported vocal symptom was difficulty in singing high notes. The subjects reported that symptoms occurred with moderate regularity and severity. At age 35 symptoms decreased in number and severity.

Given recent conceptualizations of trichotillomania (TM) as a variant of obsessive compulsive disorder (OCD), clinician-rated measures of obsessive compulsive symptoms have been adapted for use in the assessment of TM. Although the reliability and validity of these instruments have been well-documented in patients with OCD, psychometric properties have not been examined systematically in patients with TM. Here, we evaluate the reliability and validity of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in a sample of 11 patients with a primary diagnosis of TM. Data addressed the utility of the Y-BOCS for evaluating symptoms of TM, and provided information regarding the proposed overlap between OCD and TM. Initial analyses suggested that interrater reliability, internal consistency, and test-retest reliability for the total score were adequate. However, the range of scores was somewhat restricted, and suggested in particular that interference in daily functioning from TM symptoms is quite low. Both internal consistency and test-retest reliability for the Target Behaviors subscale were inadequate, suggesting that this combined score is inappropriate for use with TM patients. Concurrent validity data using the total score were mixed, although the Y-BOCS did appear to be sensitive to change in TM symptoms over treatment. Implications for the use of the Y-BOCS with TM patients and hypothesized phenomenological differences between TM and OCD are discussed.

Trichotillomania (TM) recently has been conceptualized as a variant of obsessive-compulsive disorder (OCD). However, no systematic data have compared the clinical features of these two disorders. Here we report data from 8 TM and 13 OCD patients which suggest important clinical differences between groups. First, TM patients reported a significantly greater degree of pleasure during hair-pulling than OCD patients reported during performance of ritualistic behaviors. Second, TM was accompanied by significantly fewer associated obsessive-compulsive symptoms. Third, the groups differed with regard to other clinical features including anxiety, depression, and personality characteristics. We conclude that TM is not conceptualized best as a variant of OCD.

A number of studies have failed to detect point mutations at codon 12 in the Ki-ras gene in melanocytic neoplasms. One recent study, however, has found a high percentage of Ki-ras codon 12 point mutations. In an effort to resolve this difference, the present study examined noncultured melanocytic lesions (i.e., 5 benign nevi, 10 dysplastic nevi, and 8 primary melanomas: 4 in situ and 4 invasive) for point mutations at codon 12 in the first exon of the Ki-ras proto-oncogene using polymerase chain reaction methodology with oligonucleotide hybridization and direct DNA sequencing. The results of this study indicates no detectable mutations in the 12th codon of the first exon of the Ki-ras gene in any premalignant or malignant melanocytic lesion examined.

This study is about enrichment of hemopoietic stem cell concentration in mouse bone marrow by use of a glass wool filtration technique. Maximum stem cell concentration was accomplished when filtration conditions were as follows: (1) support medium supplemented to 15% with fresh serum from syngeneic donors; (2) no incubation time allowed for cells on the columns; and (3) an operational temperature of 24 degrees C. With these conditions, stem cell concentrations were increased 5,4-fold relative to the concentration in untreated marrow.

The distal airways, defined anatomically as the region of the respiratory system including the terminal bronchioles through alveoli, were characterized in the guinea pig by means of light microscopy and by both scanning and transmission electron microscopy. The epithelium of the terminal bronchioles was comprised of two cell types. Ciliated cells were cuboidal and contained long thin microvili, ellipsoid mitochondria, and both rough and smooth endoplasmic reticulum. Nonciliated (Clara) cells were dome-shaped and usually protruded into the bronchiolar lumen. Numerous large mitochondria, granules of varying density, and crystalloid inclusions were notable in nonciliated cells. Respiratory bronchioles were characterized by a smooth-surfaced, low cuboidal epithelium. The cells in this region contained the crystalloid material found in terminal bronchioles, numerous large mitochondria, lysosomelike inclusions, and unusual tubular structures arranged in a matrix. The epithelium became progressively squamous toward the alveolar duct, where transition from bronchiolar cells to pneumocytes occurred. Transitional zones consisted of cells which, in addition to the above-mentioned structures, contained inclusions with internal laminations. These inclusions were structurally similar to the lamellar bodies observed in typical type II pneumocytes of the alveoli. The epithelium of both the alveolar ducts and alveoli was composed of type I and type II pneumocytes. Classical type I pneumocytes were squamous and very similar in cytoplasmic characteristics to the endothelial cells of the adjacent capillaries. Type II pneumocytes were characterized by the presence of lamellar bodies and numerous mitochondria.

The thymus exerts a potent influence on the development of I region self-recognition and antigen recognition by T cells. The mechanism by which the thymus acts on nascent T cells is unknown. It is assumed, however, that a cell interaction between the developing T cell and an la antigen-bearing cell in the thymus is involved. There are several candidates for the critical thymic cell; thymic epithelial, nurse, and antigen-presenting cells (APC) or dendritic cells. Because thymic epithelial cells derive from the third pharyngeal pouch and thymic APC derive from bone marrow, radiation-induced bone marrow chimeras allow the artificial creation of a chimeric thymus gland in which thymic epithelial cells and APC can be genetically different. We made radiation-induced bone marrow chimeras (F1 leads to P) using supralethal radiation doses (1200 R) and found bone marrow donor- (F1) type APC in the thymuses 3 wk after radiation. When such mice fully reconstitute their immune systems, their T cells behave as donor F1 phenotype T cells. Thus, the I region self-restriction and antigen-recognition repertoire of the T cells correlates with the genotype of the bone marrow-derived thymic APC, not the thymic epithelial cell.

While psychotherapists discuss amongst themselves and in supervision the struggles they experience face-to-face with their patients, empirical study of therapists' experience of psychotherapy has been scant and there has been little investigation of therapists' difficulties. We require tools for such investigation and in this initial report we describe the development of a taxonomy of situations that psychotherapists experience as difficult and indicate lines of research to which the taxonomy might be applied. We also suggest that our procedure might serve as a model of collective self-study for other groups of practitioner-researchers. Using accounts of our own difficulties as therapists, we constructed a consensual set of experimental categories that could be applied to describe them. These were designated as Therapist (T)-Incompetent, T-Damaging, T-Puzzled, T-Threatened, T-Out of Rapport, T's Personal Issues, Painful Reality/T's Ethical Dilemma (a combined category), T-Stuck, and T-Thwarted. We then employed a fresh set of 30 accounts, which were also drawn from our own experience but had not contributed to the development of the taxonomy, to study the taxonomy's reliability. Each of us rated the presence and predominance of the categories for each of the 30 accounts. Both presence and predominance of all nine categories in the taxonomy could be reliably identified, with about three raters required to ensure good reliability for all categories; alphas (for our group of seven raters) were in the range 0.88-0.95 for presence-absence and 0.83-0.94 for predominance. We conclude that the taxonomy is a serviceable tool for further investigation. We also show that we are discriminable from one another as therapists in terms of the kinds of difficulty we reported, differences amongst us conforming to what we know of one another's therapeutic practice. We note implications for the diagnostic use of the taxonomy in training and supervision.

Eleven case reports involving herpes zoster infection associated with alveolar bone necrosis and tooth loss were reviewed in order to develop a patient profile for this rare combination of physical findings. The clinical course of a 56-year-old white woman with herpes zoster infection of the fifth cranial nerve and related alveolar bone necrosis, tooth loss, and oroantral fistula development is reported. The etiology and management of herpes zoster infection associated with destructive oral sequelae are discussed.

The rapid proliferation of courses based on Keller's Personalized System of Instruction (PSI) calls for a prompt evaluation of the relative costs involved in PSI and more traditional forms of college instruction. To determine the cost in student time required by a course taught with PSI relative to lecture, students did their studying in a special Study Center where course materials could be used but not removed. Students in the PSI section spent an average of about 50% more time in the Study Center (46 hr) than did students in the lecture section (30 hr), but that difference was made up by the lecture students spending an average of 20 hr attending lectures. Thus, total preparation time was about the same. PSI students scored slightly higher on common course exams, and while college entrance exam scores correlated highly with course exam scores, Study Center time was reliably related to course exam score only for PSI students. An analysis of the study records of individual students revealed that PSI produced fairly regular patterns of study by all students, while lecture students varied greatly in their patterns.