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First estimates of sex allocation patterns and body size-at-sexual maturity and at protogynous sex change are presented for the five major (including one endemic) species of parrotfishes of Hawaii. Median body size at initial maturation as a female (LM50) and at protogynous sex change from adult female to adult male (LΔ50) varied greatly among the five species. Estimates of LM50 were about 14, 17, 24, 34 and 35 cm fork length (LF) in palenose Scarus psittacus, Pacific bullethead Chlorurus spilurus, stareye Calotomus carolinus, spectacled Chlorurus perspicillatus and redlip parrotfish Scarus rubroviolaceus. Values of LΔ50 were c. 23, 27, 37, 46 and 47 cm LF in the respective species. Length at female maturation was proportional to maximum body size (Lmax) of the respective species, ranging from 50 to 72% and averaging 62% of Lmax across species. LΔ50 was also proportional to Lmax, ranging from 82 to 97% and averaging 92%. Males of both pairs of Scarus and Chlorurus spp. reported here are diandric. Only one of the five major species (C. carolinus) is functionally monandric, with either all or nearly all males secondarily derived from adult females. The broadly differing absolute body sizes at sexual maturation and at sex change among the five species have important implications for improving regulatory size limits for parrotfishes in the State of Hawaii, where parrotfish species have historically been managed based on a single minimum size limit of 30·5 cm LF. This study provides a model demonstration of why catch data for parrotfishes, and other size-structured reef-fish populations, should be recorded either by species or by functional size-groups of species that allow setting more meaningful minimum size limits.

The Workers' Compensation Board of British Columbia requested a retrospective analysis of all fishermen's deaths from immersion in water in British Columbia.To identify the underlying cause of drowning and make recommendations to improve safety in the fishing industry.Eighty-nine inshore and offshore fishing accidents were analysed. Where possible, deaths were classified into the four stages of cold-water immersion: cold shock, swimming failure, hypothermia and post-rescue collapse. Other factors that led up to the drowning were also identified.One hundred and thirty fishermen died from immersion between 1976 and 2002. One hundred and twenty-eight drownings were certified by the coroner as drowning or drowning/hypothermia and two were certified as cardiac event after immersion. The underlying causes of drownings were reclassified as: cold shock (5.4%), swimming failure (5.4%), hypothermia (5.4%), post-rescue collapse (0.8%), cardiac event (0.8%) and drowning/other (10%). In the remaining 72.2% of deaths, there was insufficient information to determine an underlying cause. All deaths occurred in water below 17.5 degrees C but 95% were in water less than 15 degrees C.Immersion in water below 15 degrees C is dangerous and this should be emphasized on marine survival courses. Accident investigators, coroners and pathologists need a common checklist to record vital data. A recommended format is included as Supplementary data available at Occupational Medicine Online. Fishermen should be educated about the dangers of sudden, unexpected immersion in cold water. Consideration should be given to making marine survival courses mandatory for fishermen.

Objective: The prevalence of cleft lip and/or palate (CL/P) in Northern Ireland (NI) was last reported for 1980 through 1990. This study was undertaken to update the prevalence of CL/P in NI for the 20-year period 1981 to 2000, to determine the pattern of prevalence, and to report the proportion of different cleft types and sex distribution. Design: Retrospective, population-based analysis. Patients/participants: All live born children with CL/P in NI from 1981 to 2000 were included. A total of 750 cases were identified. Resident births outside NI, stillbirths, abortuses, and children born with atypical orofacial clefts were excluded. Those with syndromes and submucous clefts were included in the study. Results: The overall prevalence of children born with CL/P within NI for the period 1981 to 2000 was 1.47 per 1000 live births, or 1:682. This was consistent with the findings reported by other U.K. studies. There were no significant changes in the prevalence rates over any 5-year period. No significant seasonality trends were noted. Clefts of the palate only were always in the majority. More boys than girls were affected by cleft lip with or without cleft palate. There was a significant left-sided predilection for unilateral clefting of the lip. Conclusions: There have been no significant changes in the birth prevalence of children born with CL/P or the distribution or laterality of cleft type in the NI population during the past 20 years.

This was to investigate what coping strategies are used by children, the efficacy of these strategies and the influences of age, gender, dental anxiety, pain experience and childhood caries prevalence (place of residence) upon the efficacy of the coping strategies used by Dutch (NL) children in The Netherlands and Northern Ireland (NI).Convenience samples of Dutch and NI children were taken and asked to fill out a coping questionnaire (Dental Cope Questionnaire) and an anxiety schedule (CFSS-DS). Data were entered onto a SPSS database and subjected to frequency distributions, Chi-square analysis, t-tests and analysis of variance.The children used a wide variety of coping strategies in dealing with pain in dentistry. The most frequently used and those reported to have the greatest efficacy by the children in this investigation were cognitively based strategies. Different strategies were used in relation to place of residence, age and level of dental anxiety. The variance in the number of strategies used was significantly explained by the experienced pain during dental treatment. The efficacy of the coping strategies used was significantly explained by level of dental anxiety.Dental coping strategies used by children seem to vary with age, dental anxiety and pain experience. This information can help dental practitioners to adjust his or her treatment to the child's emotional needs.

The dosage model provides a normative estimate of the overall pattern of patient improvement in psychotherapy. The phase model further specifies patterns of change in the domains of subjective well-being, symptom remediation, and functioning. The expected treatment response (ETR) approach uses patient characteristics to predict an expected path of progress for each patient. With repeated measures of mental health status, the treatment progress of an individual patient can be assessed against the patient's ETR to support decisions that would enhance the quality of a clinical service while it is being delivered.

Patient injuries are thought to have a substantial financial impact on the health care system, but recent studies have been limited to estimating the costs of adverse drug events in teaching hospitals. This analysis estimated the costs of all types of patient injuries from a representative sample of hospitals in Utah and Colorado. We detected 459 adverse events (of which 265 were preventable) by reviewing the medical records of 14,732 randomly selected 1992 discharges from 28 hospitals. The total costs (all results are discounted 1996 dollars) were $661,889,000 for adverse events, and $308,382,000 for preventable adverse events. Health care costs totaled $348,081,000 for all adverse events and $159,245,000 for the preventable adverse events. Fifty-seven percent of the adverse event health care costs, and 46% of the preventable adverse event costs were attributed to outpatient medical care. Surgical complications, adverse drug events, and delayed or incorrect diagnoses and therapies were the most expensive types of adverse events. The costs of adverse events were similar to the national costs of caring for people with HIV/AIDS, and totaled 4.8% of per capita health care expenditures in these states.

Patient profiling predicts improvement across psychotherapy sessions on the basis of intake clinical characteristics. Patients completed questionnaires before their 1st session and at other points during treatment. After using hierarchical linear modeling to calculate expected courses of improvement, 1/2 of the sample was divided into 1 of 2 groups: those whose treatment responses across sessions matched or exceeded their expected courses (75% of the sample) and those whose responses failed to match expectations. A discriminant function analysis indicated that the groups could be differentiated on the basis of intake characteristics; that is, patients with higher discriminant scores were more likely than those with low discriminant scores to have responded to psychotherapy as predicted. Successful cross-validation of the predictor weights was performed with the other 1/2 of the sample.

The acquisition of psychotherapy skillfulness is an important aspect of training programs in psychiatry and clinical psychology. Psychotherapy supervision is employed to teach and monitor the development of these clinical skills. The Supervisor Report (SR) is a questionnaire designed to systematically assess therapeutic behaviors and global psychotherapeutic skillfulness of therapists conducting psychodynamic psychotherapy. SRs were employed to examine changes in trainees' skillfulness over the course of training. T-tests were applied to evaluate differences between the average scores of trainees in the first half of their training compared to the last half of their training. Comparisons of the scores for Psychotherapeutic Techniques and assessments of Global Skillfulness were in the predicted direction: Trainees in the advanced portion of their training were rated as more skillful than at the beginning. This study provides some evidence that psychotherapy skillfulness is acquired over time in training.

Various disease states are associated with eosinophilia and the release of eosinophil peroxidase (EPO) into the microenvironment. The present study targets the effects of low levels of EPO on macrophage (M phi) phagocytosis and intracellular killing of Candida albicans as well as M phi oxidative activity measured as the luminescence product of luminol dioxygenation. Resident murine peritoneal M phi were exposed to various concentrations of EPO. Chemiluminescence data indicate that nanomolar concentrations of EPO markedly enhanced the dioxygenation activity (respiratory burst) of M phi. In other studies, the exposure of M phi to 0.17 microM EPO for 10 min. enhanced M phi-mediated candidacidal activity 10 fold. The above data indicate that EPO enhances certain M phi functions. Also the results illustrate a previously un-recognized interaction between eosinophils and M phi and implicate yet another possible role for EPO in host defenses against disease.

The intraoral antimicrobial activity of four commercial oral products-conventional NaF dentifrice (Crest), baking soda/peroxide/NaF dentifrice (Mentadent), essential oil mouthrinse (Listerine) and SnF2 dentifrice (Crest Plus Gum Care)-have been compared in three test regimens. Formulations were compared for their ability to suppress the regrowth and apical extension of dental plaque following toothbrushing during thirty hours of non-brushing where products were used as oral rinses (30-hour plaque regrowth model). Formulations were also compared for their ability to suppress the colony-forming units (cfu) of facultative anaerobic bacteria sampled from buccal gingival surfaces following use (Gingival Surface Microbial Index-GSMI model). Lastly, formulations were compared for effects in suppressing the glycolytic metabolic activity and regrowth activity of in vivo-treated dental plaques sampled at various periods following topical use and incubated under controlled ex vivo conditions (Plaque Glycolysis and Regrowth-PGRM model). In thirty-hour plaque regrowth testing, the rank ordered antimicrobial efficacy of formulations followed SnF2essential oilsNaF = water = baking soda/peroxide. In GSMI testing, all formulations were shown to suppress the cfu of facultative anaerobic bacteria relative to baseline, although SnF2 treatment was observed to reduce bacterial levels to a significantly greater degree than NaF dentifrice or baking soda/peroxide dentifrice up to two hours following brushing. In PGRM testing, the SnF2 dentifrice provided significant inhibition of bacterial metabolism and regrowth following topical application when compared with the NaF dentifrice as control. The baking soda/peroxide dentifrice provided no reduction in either bacterial metabolism or regrowth in PGRM. Previous studies had demonstrated modest effects for essential oil rinse in reducing PGRM plaque regrowth, with no effects for this treatment on plaque metabolism. Overall, these results demonstrate that SnF2 dentifrice provides substantial intraoral antimicrobial effects. The essential oil mouthrinse also exhibits significant intraoral antimicrobial effects, albeit apparently less than SnF2 dentifrice. The baking soda/peroxide dentifrice did not produce any antimicrobial effects following in vivo use compared with conventional dentifrice. These results provide mechanistic rationale for the chemotherapeutic efficacy of SnF2 and essential oil formulations in reducing gingivitis, while providing no support for the expectation of clinical efficacy for formulations containing baking soda and peroxide.

Using the psychotherapy dosage model in which effect was probability of recovery, this study compared treatment response rates for psychological symptoms. Symptom checklists were administered to 854 psychotherapy outpatients at intake and during treatment. Sixty-two symptoms were grouped into 3 classes on the basis of probit analysis results. Chronic distress symptoms demonstrated the fastest average response rate, whereas characterological symptoms demonstrated the slowest. Acute distress symptoms showed the highest average percentage of patients recovered across doses. A typical outpatient needed about a year of psychotherapy to have a 75% chance of symptomatic recovery. The model holds promise for establishing guidelines for the financing of psychotherapy.

A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis of 2 x 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.

Exogenous ochronosis resulting from the topical application of hydroquinone-containing bleaching creams has been reported to occur almost exclusively in black subjects, and only after use of high concentrations of hydroquinone (greater than 3 percent) for many years. A Mexican-American patient is described who experienced exogenous ochronosis after using 2 percent hydroquinone cream for less than six months.

Five hundred Black Rhodesian women given injections of 150 mg Depo-Provera every 3 months (group A) and 500 women given an injection of 450 mg Depo-Provera every 6 months (group B) were reviewed after 6 months. Group B had a significantly lower rate of defaulters. There was no significant difference between the groups with regard to weight gain, systolic and diastolic blood pressure increase, overall abnormal bleeding patterns and complaints of side-effects. Among those women who reported abnormal bleeding patterns, significantly more in group B had amenorrhoea. There was no significant increase of prolonged bleeding in group B. Among those women who complained of side-effects, significantly more in group B complained of headaches and a bloated abdomen. No pregnancies occurred in either group. The increased annual cost of the 450 mg injections, which was the main reason for women not accepting this regimen, is outweighed by convenience and reduced travel costs. Depo-Provera 450 mg given by 6-monthly injection is well tolerated and effective, and appears to be even more satisfactory as regards continued acceptance than 150 mg given every 3 months.

The authors have introduced an adjunctive procedure for correction of the osseous axial eversion of the first ray with hallux abducto valgus deformity. They believe that recurrence of bunion deformity is reduced with correction of this osseous abnormality. Consecutive illustrations are presented with recognition of the individual surgeon's ability to modify the procedure to allow for correction of deformities associated with hallux abducto valgus.

This study addressed whether the fact that the initial screening interview was with the treating therapist or with another clinician differentially affected engagement in treatment for those patients who actually entered psychotherapy. Patients (N = 418) accepted for individual psychotherapy were separated into two groups: (1) those who entered therapy with the same clinician who did the intake screening (same); and, (2) those who saw one clinician for intake screening and were subsequently assigned to another clinician for therapy (different). Chi-square was used to test the hypothesis that a greater proportion of patients who saw the same clinician from the beginning would complete at least 8 sessions of psychotherapy than would those who saw a different clinician. The results indicated that a greater proportion of patients who were assigned to therapy with the same clinician who conducted the initial screening evaluation returned for their next appointment. However, a greater proportion of patients who saw one clinician for intake screening and were assigned another clinician for therapy continued beyond eight sessions.

One context for understanding an adolescent's (or any other individual's) abnormal functioning is an appreciation of normal or modal functioning in the culture to which that adolescent belongs. After decades of research and clinical observation there is no consensus about what constitutes modal adolescent functioning in the United States. Much less is known about adolescent functioning in other cultures. Results were suggestive of large, cross-cultural differences in self-image among normal adolescents. In most areas American teenagers reported the best functioning while Bengali teenagers reported the worst. There were consistent gender differences in self-image across cultures, with adolescent girls showing poorer self-image than adolescent boys in many areas. Results are discussed from the point of view of difficulties in doing cross-cultural psychiatric research and the need for further research in this field.