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When a 13 member clinic group decided to opt out of medicare and set up a computerized billing system, they discovered many unforeseen problems. Cost of renting the program was one factor, unpaid accounts were another. The group eventually ended up opting back in to the medicare program. This article describes the experience and what the group learned from it.

Correspondence of the Minnesota Multiphasic Personality Inventory (MMPI) posttraumatic stress disorder (PTSD) subscale and the clinical scale decision rules reported by Keane, Malloy, and Fairbank (1984) with clinical diagnoses of PTSD was measured on a sample of 595 veterans. The measures demonstrated good sensitivity and selectivity, but the false-positive rate was high. It is suggested the MMPI measures be used to rule out, but not to establish, the diagnosis of PTSD. The construct validity of the PTSD subscale was supported by the finding of a higher mean score in combat than noncombat veterans.

The effects of different temperatures on the expression of autogenic development in unfed/mated Ornithodoros parkeri Cooley females were examined. High temperature (29 C) induced autogeny in lower, middle and higher weight classes (11-20, 21-30, 31-40 mg, respectively) with all females in the highest weight class and most in the middle weight class ovipositing within 51 days post-mate. At a lower temperature (21 C) autogenic development was not expressed by higher and middle weight females, whereas lower weight females exhibited similar degrees of autogeny at both temperatures. Results are discussed in relation to presumptive factors involved in the control and mediation of autogeny.

The present study employs allozyme electrophoresis to characterize and inter-relate 61 isolates of Naegleria. Diploidy was confirmed, with heterozygotes observed at 29 of the 33 loci established and in all but two isolates. With a single exception, isolates clustered at two levels of similarity, either below 21% or above 52%. It is argued that such a major discontinuity provides a sound biological basis for a species concept in Naegleria. On this basis the present species-level taxonomy does not reflect the genetic diversity of the genus. The study recognized 18 genetic groups of species rank. The subspecies N. australiensis italica deserves specific rank; additional thermophilic species not closely related to N. fowleri and N. lovaniensis are recognized; and N. gruberi as currently conceived is a complex of 10 species, at least five of which are represented in the formal culture collections. Most species are genetically too different for relationships to be elucidated by allozyme electrophoresis, supporting the view that some of the times of divergence within the genus are extremely ancient.

Explored similarities and differences among home and community adjustment ratings by clients, community informants, and psychiatrists. Minnesota Multiphasic Personality Inventories, and Personality Adjustment and Role Skills (PARS) scales (Ellsworth, 1975) were administered to 169 consecutively-admitted psychiatric patients. Psychiatrists rated each client on the Brief Psychiatric Rating Scales and 141 community informants rated client's home and community adjustment on the PARS. Simple, multiple, and canonical correlational analyses were performed with scores from these tests. Although clients, community informants, and psychiatrists agree when rating clients' symptomatology, nevertheless each person highlighted different aspects of adjustment. Moreover, "impression management" (as measured by subtle-obvious MMPI scales) emerged as influential. These two findings suggest that outcome assessment must be based not only on ratings from multiple perspectives but also outcome assessment must entertain possible biases among raters. Supplementary analyses indicated that outcome assessment for psychiatric clients can be improved by adding response style scales which evaluate dimensions of "sick" and "healthy" symptom presentation and by identifying interaction of diagnosis with ratings of home and community and adjustment.

The technique of allozyme electrophoresis was applied to species of Onchocerca from cattle to increase the number of enzyme loci established and therefore provide a genetic basis for a rational species-level taxonomy. Twenty-three enzyme loci were established and provided unequivocal genetic evidence for the taxonomic validity of Onchocerca gibsoni, O. gutturosa and O. lienalis. Furthermore, the diagnostic enzyme markers detected form the basis for identification of life-cycle stages, individuals and species and population structure analyses.

Reproductive interference between three species of reptile tick, Aponomma hydrosauri, Amblyomma albolimbatum and Amb. limbatum was investigated. Adults of two species attach together on the same lizard hosts in narrow overlap zones at parapatric boundaries between species, providing opportunities for interference. The possibility of reproductive interference was suggested because of similarities in the sexual communication systems.Three forms of interference were found in laboratory experiments. Firstly male movement to search for sexually receptive females was inhibited when females of two species were present on the same host, probably because of signal interference. Secondly, a nonspecific, short range attractant pheromone led males into non-conspecific courtship attempts which reduced the time for conspecific courtships. Thirdly Amb. albolimbatum males physically blocked the genitalia of female Ap. hydrosauri after unsuccessful non-conspecific courtship attempts. Field data showed this behaviour was common in both Amblyomma species after conspecific matings. Reproductive interference would reduce the fitness of each species in sympatry, and may contribute to the maintenance of the narrow parapatric boundaries.

A recent report by the Tuberculosis Chemotherapy Centre, Madras, showed that the response of patients to a year's domiciliary treatment for pulmonary tuberculosis with isoniazid plus p-aminosalicylic acid closely approached that of patients to a year's sanatorium treatment with the same combination of drugs. The present report summarizes the findings of a second year's study, carried out on those patients in the first-year study whose disease had attained bacteriological quiescence by the end of the year of combined chemotherapy. The main objects of this follow-up study were to determine (a) whether relapse in the second year was more frequent among the patients originally treated at home than among those originally treated in sanatorium, (b) whether a second year of antituberculosis chemotherapy, with isoniazid alone, would reduce the relapse rate and (c) the influence of residual cavitation at one year, the so-called "open negative" syndrome, on the results in the second year. During the second year all the patients were treated at home, either with isoniazid or with a placebo, calcium gluconate; in each case the medicine was administered by the patients themselves. It was found that there was very little difference in the relapse rates of the "home" and "sanatorium" groups, that a second year of treatment with isoniazid alone did not influence the likelihood of relapse, and that patients with the open negative syndrome fared slightly less well in the second year than patients without residual cavitation.

The authors present a report from the Tuberculosis Chemotherapy Centre, Madras, on the prevalence and attack rate of tuberculosis among close family contacts of tuberculous patients in South India undergoing domiciliary chemotherapy either with isoniazid plus PAS or with one of three regimens of isoniazid alone. The report gives (a) the prevalence of tuberculosis among the contacts at the time of diagnosis of the disease in the patients and (b) the incidence of tuberculosis in the contacts during the first year of treatment of the patients. The contacts were divided into four series, corresponding to the four chemotherapeutic regimens of the patients.The prevalence of active tuberculosis was found to be particularly high among children under five years of age, being 12.0% as compared with 7.6% for all age-groups combined. The incidence of active tuberculosis during the year of treatment of the patients was also found to be highest in the under five years' age-group-a further indication that child contacts are especially vulnerable to infection. The incidence was considerably higher in the first quarter of the year than in the other quarters, and it was lowest in the last quarter. This finding, together with the fact that the attack rates in the four contact series were not related either to the duration of bacteriological positivity in the patients or to the period of excretion of isoniazid-resistant organisms by the patients, suggests that the major risk to contacts in the first year results from exposure to the patient before treatment rather than from exposure during treatment. These results thus confirm the findings in an earlier study by the Centre of the contacts of patients in a controlled comparison of chemotherapy with isoniazid plus PAS at home and in sanatorium.

The authors present a second report from the Tuberculosis Chemotherapy Centre, Madras, on the incidence of tuberculosis in close family contacts of tuberculous patients. The patients initially received a year's chemotherapy either at home or in sanatorium in a controlled comparison of the merits of domiciliary as opposed to institutional treatment. The first report presented data relating to the prevalence and the attack rate of tuberculosis among the contacts during the first year of treatment of the index cases; this second report presents the attack rate for the 2-year period since the start of treatment for the index cases. During the second year all the index cases were managed at home, those with active disease, and half of those with quiescent disease, at the end of the first year receiving further chemotherapy. The findings of the 2-year study confirm those of the earlier study-namely, that the incidence of tuberculosis in the contacts of patients originally treated at home was no greater than that in the contacts of patients originally treated in sanatorium and that the major risk to the contacts resulted from exposure to the patient before diagnosis. As in the earlier report, the question of instituting chemoprophylaxis for the young contacts of tuberculous patients is discussed. The authors consider that close family contacts living in over-crowded, urban conditions in the developing countries are valuable groups for chemoprophylactic investigations.

The results of a study by the Tuberculosis Chemotherapy Centre, Madras, of the merits of home as compared with sanatorium treatment for pulmonary tuberculosis have indicated that treatment at home is satisfactory in the majority of cases. Before domiciliary chemotherapy can be introduced on a large scale, however, it must be established that it does not expose the patient's contacts to a special risk of infection, avoided by his isolation in a sanatorium. Accordingly, a further study was undertaken by the Centre to determine (a) the prevalence of tuberculosis among the family contacts of patients, and (b) the incidence of clinical tuberculosis and of tuberculous infections in the family contacts of the home and sanatorium groups of patients during the first year of treatment. The findings of this study indicate that the major risk for contacts lies in exposure to the infectious case before diagnosis, whether the patient subsequently remains at home or is isolated in a sanatorium appearing to have little importance, if the patients at home are treated with effective chemotherapy. Children under seven years of age proved to be particularly vulnerable to infection. The management of young contacts by chemoprophylaxis or by BCG vaccination, or by both measures, has been discussed.

It is well known that in the treatment of tuberculosis with isoniazid the complication of peripheral neuritis may arise. This complication is normally rare when small dosages of the drug are used, but a high incidence of the neuropathy has recently been observed in East Africa in a group of malnourished tuberculous patients receiving isoniazid in comparatively low dosage (4-6 mg/kg body-weight daily). The present paper reports on 20 cases of peripheral neuritis encountered in Madras, India, among 338 poorly nourished tuberculous patients during a trial of four isoniazid regimens, two of low and two of high dosage (3.9-5.5 and 7.8-9.6 mg/kg body-weight daily, respectively). Nineteen of the 20 cases occurred in the two groups of patients receiving the high dosage and these 19 patients were found to have a higher mean serum level of free isoniazid than the patients in the same groups who did not develop the complication. The authors consider that dosages of 7.8-9.6 mg/kg body-weight daily should not be used for the mass therapy of poorly nourished patients unless steps are taken to prevent the development of peripheral neuritis. Pyridoxine has been reported to be an effective preventive, but is too expensive for use on a large scale. This study indicates, however, that administration of the cheaper vitamin B complex might give satisfactory results and warrants further investigation.

This study from the Tuberculosis Chemotherapy Centre, Madras, compares patients infected with isoniazid-resistant tubercle bacilli ("R" patients) with those infected with isoniazid-sensitive tubercle bacilli ("S" patients) as regards, first, their pretreatment status and, secondly, their response to a year's chemotherapy, either with isoniazid plus p-aminosalicylic acid (PAS) or with isoniazid alone. With regard to the first comparison, there was, on admission to treatment, little difference between the R and S patients in terms of the extent of the radiographic lesion, the extent of cavitation or the bacterial content of the sputum, but there were major differences in the age and sex distributions, the R patients showing a greater preponderance of young males than the S patients. As to the second comparison, statistically significant differences in the bacteriological response to treatment of the S and the R patients were observed in both the isoniazid-plus-PAS and the isoniazid-alone series, the response of the S patients being much better than that of the R patients. When the response to treatment was assessed in terms of radiographic progress and weight changes, however, hardly any difference was observed between the progress of the S and the R patients. The reasons for the response in the R patients are discussed.

This study from the Tuberculosis Chemotherapy Centre, Madras, summarizes the progress during the second year of those patients in a 1-year comparison of four domiciliary chemotherapeutic regimens (isoniazid plus PAS and three regimens of isoniazid alone) whose pulmonary tuberculosis had attained bacteriological quiescence at the end of the year of chemotherapy. During the second year, about half of the patients received further chemotherapy, with isoniazid alone, and the remainder received a placebo, calcium gluconate. The main objects of the study were to determine the influence on the progress during the second year of (a) a second year of chemotherapy with isoniazid alone, (b) residual cavitation at the end of the first year, and (c) the chemotherapeutic regimen received during the first year, and to compare the results with those obtained in an earlier study by the Centre of the progress during the second year of patients with quiescent pulmonary tuberculosis after a year's chemotherapy with isoniazid plus PAS at home or in sanatorium.The results of the present study, which was planned on the same lines as the earlier one, showed that relapse in the second year was unrelated to the chemotherapeutic regimen received in the first year, and it was therefore permissible to amalgamate the findings in the two studies. The amalgamated results showed that the relapse rate in the second year was low (5.9%) and that a second year of treatment with isoniazid alone was of definite value for the patients with no residual cavitation at the end of the first year, but had no effect on the relapse rate of those with residual cavitation. The combined data from the two studies have thus clarified the position with regard to the effectiveness of isoniazid in preventing bacteriological relapse in patients without residual cavitation, slight evidence of which was apparent in the earlier study.

A controlled comparison by the Tuberculosis Chemotherapy Centre, Madras, of the merits of home as compared with sanatorium treatment for pulmonary tuberculosis showed that, at the end of a year of chemotherapy with isoniazid plus p-aminosalicylic acid (PAS), the response of the home patients closely approached that of the sanatorium patients. The present report reviews the progress of those patients in the controlled comparison whose disease had attained bacteriological quiescence by the end of the year of combined chemotherapy. During the second year, half of the patients received further chemotherapy, with isoniazid alone, and half received a placebo, calcium gluconate. During the third year, half of those who were treated with isoniazid in the second year and whose disease remained quiescent continued to receive that drug and all the remaining patients with quiescent disease received the placebo. In the second and third years all the patients were treated at home and administered the medicaments to themselves.It has been concluded from this follow-up study that in the second and third years there was relatively little difference between the progress of the patients whose disease attained quiescence following a year of domiciliary treatment with isoniazid plus PAS and that of those whose disease attained quiescence following a year's treatment with the same drugs in sanatorium; that a second or third year of further treatment with isoniazid alone gave no better results than a year of combined chemotherapy, followed by careful observation of the patient and further chemotherapy if relapse occurred; and that the relapse rate among the patients with residual cavitation at the end of the year of combined chemotherapy was slightly higher than that among the patients with no residual cavitation at the end of the first year.