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Background Many coronavirus disease 2019 (COVID‐19) survivors experience persistent symptoms, such as fatigue, dyspnea, and musculoskeletal pain. However, less is known about the impact of COVID‐19 on longer term functional outcomes. Objective To evaluate patient‐reported activity of daily living (ADL) function and fatigue symptoms 30 days after hospitalization for COVID‐19. Design Cross‐sectional study. Setting Tertiary care university hospital. Participants Adults 18 years or older hospitalized for COVID‐19 and survived to 30 days after discharge. Methods A standardized telephone questionnaire was administered 30 days after hospital discharge. Main Outcome Measures Ability to perform basic and instrumental ADLs and fatigue symptoms severity (Patient‐Reported Outcome Measurement Information System [PROMIS] Fatigue Short Form 7a) were assessed by self‐report. Results Participants (n = 55) were 22‐95 years old. Compared to pre‐COVID hospitalization, 52% developed new difficulty and 6% new dependence with performing basic ADLs (bADLs), 48% developed new difficulty and 11% new dependence with instrumental ADLs (iADLs), and 69% experienced a clinically significant worsening in their fatigue symptom severity. The average fatigue symptom severity T‐score before hospitalization was 44.2 ± 7.4 and after hospitalization was 54.5 ± 9.8. In exploratory multivariate analyses, each additional COVID symptom at presentation was associated with a predicted increase of 1.43 units (95% confidence interval [CI], 0.45–2.42) in the 30‐day fatigue symptom severity T‐score, each additional day of hospitalization was associated with an 1.2 times increased odds of worsening fatigue (95% CI, 0.98–1.5; p = .08), and each unit increase in baseline body mass index was associated with 0.8 times decreased odds of new bADL or iADL dependence at 30 days (95% CI, 0.65–0.99). Conclusions New functional impairments are common at 30 days after discharge among survivors of hospitalization for COVID‐19. Early rehabilitation, advance care planning, and referrals to appropriate therapies should be considered in postacute COVID‐19 care to maximize patients' functional outcomes. However, ongoing research is still needed regarding management of these patients.

Background Identification of novel risk factors for dementia in older adults could facilitate development of methods to identify patients most at risk and improve their cognitive outcomes. We aimed to determine whether lower appendicular lean mass (ALM), assessed by dual-energy x-ray absorptiometry (DXA), and lower grip strength are associated with a greater likelihood of incident dementia among older adults in the Health Aging and Body Composition Study (Health ABC). Methods Health ABC data from 1997 to 2008 were analyzed (n = 2 704). Baseline ALM to body mass index (BMI) ratio (ALMBMI) was assessed by DXA. Baseline grip strength was assessed by hand-held dynamometry. Incident dementia diagnosis was defined as either (i) dementia-related hospitalization plus a Modified Mini-Mental State Examination (3MS) score of ≤ 90; or (ii) record of prescription for anti-dementia medication; or (iii) decline of at least 1.5 SDs on the 3MS score compared to baseline. Cox proportional hazard models estimated associations of ALMBMI and grip strength with incident dementia over follow-up with and without adjusting for covariates, stratified by sex. Results Among older men, each standard deviation decrement in ALMBMI (adjusted hazard ratio [aHR]: 1.33; 95% confidence interval [CI]: 1.07, 1.65) or grip strength (aHR 1.22; 95% CI: 1.06, 1.41) was associated with increased likelihood of incident dementia. Conclusions Lower ALMBMI and grip strength may be important risk factors for the development of dementia among older men. How these factors may belong to a causal pathway of dementia must be elucidated in future work.

In this study, we introduce PIGEON—a novel statistical framework for quantifying and estimating polygenic gene-environment interaction (GxE) using a variance component analytical approach. Based on PIGEON, we outline the main objectives in GxE studies, demonstrate the flaws in existing GxE approaches, and introduce an innovative estimation procedure which only requires summary statistics as input. We demonstrate the statistical superiority of PIGEON through extensive theoretical and empirical analyses and showcase its performance in multiple analytic settings, including a quasi-experimental GxE study of health outcomes, gene-by-sex interaction for 530 traits, and gene-by-treatment interaction in a randomized clinical trial. Our results show that PIGEON provides an innovative solution to many long-standing challenges in GxE inference and may fundamentally reshape analytical strategies in future GxE studies.

There are an increasing number of individuals with long-term symptoms of coronavirus-19 disease (COVID-19); however, the prognosis for recovery of physical function and fatigue after COVID-19 is uncertain.To report the changes in functional recovery between 1 and 6 months after hospitalization of adults hospitalized for COVID-19 and explore the baseline factors associated with physical function recovery.A prospective cohort study.Tertiary care hospital.U.S. adult COVID-19 survivors.N/A.Telephone interviews assessed three outcome domains: basic and instrumental activities of daily living (ADLs) performance, fatigue, and general physical function (Health Assessment Questionnaire [HAQ]).The age of participants (n = 92) ranged from 22 to 95 years (54.3 ± 17.2). Across outcome domains, a majority (63%-67%) of participants developed new ADL impairment, fatigue, or worsening HAQ severity by 1 month. Of those, 50%-79% partially or fully recovered by 6 months, but 21%-50% did not recover at least partially. Fifteen to 30% developed new impairment between 1 and 6 months. For those without any improvement in ADL impairments at 6 months, lower socioeconomic status was significantly more common (p = .01) and age ≥ 65 (p = .06), trending toward being more common.In this cohort, a substantial proportion of the participants who developed new ADL impairment, worsening fatigue, or HAQ severity after hospitalization for COVID-19 did not recover at least partially by 6 months after discharge. Evaluating functional status 1 month after discharge may be important in understanding functional prognosis and recovery after hospitalization for COVID-19.

We used egg-mass counts to monitor populations of Lithobates sylvaticus (Wood Frog) and Ambystoma maculatum (Spotted Salamander) at 4 ponds located in central Vermont. We monitored numbers of egg-masses for 15 springs over the course of 20 years (2000–2020). Each year, the number of Wood Frog egg-masses at our breeding sites increased rapidly, over a period of close to 2 weeks. Spotted Salamanders deposited eggs beginning about a week later than the Wood Frogs, and the number of their egg-masses increased at our study sites over a period of up to 8 weeks. Consequently, when using egg-mass counts to determine presence/absence or to monitor populations, it is important to take the relative phenology of these 2 species into consideration.

Background Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with the development of hospital-associated ADL disability in older adults in the Health ABC Study. Methods Individuals hospitalized during the first 5 years of follow-up (n = 1 724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual-energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of prehospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability. Results Each standard deviation decrement in prehospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared with not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with the development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death. Conclusions Prehospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.

Older adults with cognitive impairment, including those with Alzheimer's disease and related dementias, are particularly at risk for hospitalization and hospital-associated disability. Understanding of key risk factors for hospital-associated disability is limited. Sarcopenia, age-related declines in muscle mass and strength, is common in older adults with cognitive impairment and may be an important risk factor for hospital-associated disability.Using data from the Health ABC Study, we examined associations of pre-hospitalization appendicular lean mass (ALM) and grip strength with the development of a new activity of daily living (ADL) disability at the next annual assessment after hospitalization.Grip strength, but not ALM, was negatively associated with increased risk of hospital-associated ADL disability, and this association was greater among those with cognitive impairment compared to those without.Lower grip strength may be an important risk factor for hospital-associated ADL disability in older adults, particularly those with cognitive impairment.

Author(s): Andrews, James S; Trupin, Laura; Wysham, Katherine D; Hough, Catherine L; Yelin, Edward H; Katz, Patricia P | Abstract: Objective:Reduced physical function and frailty are common in rheumatoid arthritis (RA). However, relationships between frailty and changes in physical function and disease activity over time in RA are unknown. We tested whether frailty is a risk factor for worsening patient-reported physical function and disease activity in RA. Methods:Adults from a longitudinal RA cohort (N = 124) participated. By using an established frailty definition, individuals with three or more of the following deficits were considered frail: 1) body mass index less than or equal to 18.5, 2) low grip strength, 3) severe fatigue, 4) slow 4-m walking speed, and 5) low physical activity. Individuals with one to two or zero deficits were considered "pre-frail" or "robust," respectively. Physical function and RA disease activity were assessed by the Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI), respectively, at baseline and follow-up 2 years later. Regression analyses modeled associations of frailty status with change in HAQ and RADAI scores between baseline and follow-up with and without controlling for covariates. Associations of individual frailty components with change in HAQ and RADAI scores were also examined. Results:Among adults with RA, baseline frailty status predicted significant increases, or worsening, in HAQ (β: 0.4; 95% confidence interval: 0.1-0.8; P l 0.01) but not RADAI scores (β: 0.5; 95% confidence interval: -0.4 to 1.5; P g 0.05) between baseline and follow-up in fully adjusted models. Fatigue was an important contributor to this effect. Conclusion:Frailty may be an important risk factor for reduced physical function over time in RA. Future studies should address whether interventions to reduce frailty improve physical function in RA.

Introduction: As of December 19th 2020, Coronavirus Disease 2019 (COVID-19) has resulted in approximately 17.6 million cases and 315,000 deaths in the United States. The hospitalization rate for COVID-19 in the US continues to rise and is currently around 295.8 hospitalizations per 100,000 population. Despite the increasing number of individuals who are contracting and recovering from this disease, little is known about their functional recovery. Understanding functional outcomes in these patients is critical to address their rehabilitation needs. The purpose of this study is to characterize the 30-day patient-reported functional outcomes of older and younger adults following acute hospitalization for COVID-19. Methods: A single-center prospective cohort study was performed from April to October 2020 of adult survivors of hospitalization for COVID-19 (n=28). A standardized telephone questionnaire was administered 30-days after hospital discharge to participants addressing their ability to perform basic activities of daily living (ADLs), instrumental ADLs, mobility, fatigue symptoms (Patient-Reported Outcomes Measurement Information Systems-PROMIS) and general disability (Health Assessment Questionnaire Disability Index - HAQ-DI). Results: Participants' were 23-95 years old. Twenty-one (75%) were less than 65 years old. Fifteen (54%) were female and 19 (68%) were white. Mean hospital length of stay was 11.3 days and 10 (36%) participants required ICU admission. Among adults aged 65 years developed new impairments and 29% new dependence. The most common new impairments in both age groups were transferring for basic ADLs and preparing meals and grocery shopping for instrumental ADLs. Seventy-one percent of older and 76% of younger adults experienced a decline in at least one mobility task (getting up from a chair, walking up 10 stairs, or walking mile). Seventy-six percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 5 points) in their PROMIS fatigue scores. Sixty-two percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 0.22 points) in their HAQ-DI scores. Conclusions: Among adults hospitalized with COVID-19, the majority experienced a decline in ≥1 functional task 30 days after discharge compared to pre-hospitalization. Younger adults had similar to worse impairment in physical functional outcomes than older adults. These results indicate all adults, regardless of age, are at risk for prolonged, clinically significant functional impairment following hospitalization for COVID-19.

Author(s): Andrews, James S; Gold, Laura S; Nevitt, Michael; Heagerty, Patrick J; Cawthon, Peggy M | Abstract: ObjectiveThe association of sarcopenia with development of knee osteoarthritis (OA) or knee pain in older adults is uncertain. We examined the relationship of grip strength and appendicular lean mass (ALM) with the likelihood of developing knee OA and knee pain in older adults in the Health ABC (Health, Aging, and Body Composition) Study.MethodsALM and grip strength were assessed at baseline by dual-energy x-ray absorptiometry and handheld dynamometry, respectively. Incident clinically diagnosed, symptomatic knee OA, defined as new participant report of physician-diagnosed knee OA and concurrent frequent knee pain, and incident frequent knee pain over 5 years of follow-up were examined. Separate regression analyses, stratified by sex, modeled associations of baseline ALM and grip strength with the likelihood of incident clinically diagnosed, symptomatic knee OA and incident knee pain over follow-up, adjusting for covariates.ResultsAmong the 2779 subjects without OA at baseline, 95 men (6.9%) and 158 women (11.3%) developed clinically diagnosed, symptomatic knee OA, and, among the 2182 subjects without knee pain at baseline, 315 men (28.3%) and 385 women (36.1%) developed knee pain over follow-up. Among men only, each SD decrement of ALM was associated with decreasing likelihood of incident knee OA (odds ratio [OR] per SD decrement: 0.68; 95% confidence interval [CI]: 0.47-0.97), and each SD decrement of grip strength was associated with increasing likelihood of incident knee pain (OR per SD decrement: 1.20; 95% CI: 1.01-1.42).ConclusionIn older men, ALM and grip strength may be associated with the development of knee OA and knee pain, respectively.

The patient, a 55-year-old female presented with a recent onset of bilateral leg weakness and falls at home. Medical history was remarkable only for rosacea. Clinical examination revealed weakness of bilateral shoulder girdle muscles and bilateral hip flexor muscles. Her exam was otherwise normal. Creatine kinase levels were mildly elevated (475 [normal: 43-274 U/L]) and the C-reactive protein level was 63.9 (normal: 0-10 mg/dl). Myositis antibody panel, including HMG-CoA reductase antibody was negative. EMG/NCS revealed small, short duration motor units and early recruitment on needle EMG of the proximal left deltoid and left gluteus medius muscles without evidence of membrane instability.

Sarcoidosis is a systemic illness of unknown etiology, characterized histologically by the formation of noncaseating granulomata in the affected tissue. The most common sites of involvement include the pulmonary system; however, neurologic involvement may be seen as well, though typically presenting with systemic findings.1 Diagnosing sarcoidosis is challenging due to the lack of reliable serum or imaging markers and hence typically relies on tissue diagnosis.1 Although fluorodeoxyglucose positron emission tomography (FDG-PET) has been used in the diagnosis of sarcoidosis, its role is not well established.2–4 FDG-PET is an imaging technique wherein FDG, a glucose analogue, is introduced into the body, where it is metabolized with varied rates by different cells.2–4 Certain conditions, such as malignancy or inflammatory disease, demonstrate increased metabolism and therefore uptake of FDG, which is visualized by PET scan. We report a case of probable neurosarcoidosis presenting with an unusual pattern of FDG uptake without concomitant brain MRI findings.

Objective Cross-sectional studies have observed that muscle weakness is associated with worse physical function among women with systemic lupus erythematosus (SLE). The present study examines whether reduced upper and lower extremity muscle strength predict declines in function over time among adult women with SLE.

Reduced physical function and health-related quality of life are common in rheumatoid arthritis (RA), and further studies are needed that examine novel determinates of reduced physical function in RA. This study examines whether frailty, a state of increased vulnerability to stressors, is associated with differences in self-reported physical function among adults with RA. Adults from a longitudinal RA cohort (n=124) participated in the study. Using an established definition of frailty, individuals with three or more of the following physical deficits were classified as frail: (1) body mass index ≤18.5, (2) low grip strength (adjusted for sex and body mass index (BMI), measured by handheld dynamometer), (3) severe fatigue (measured by the Multidimensional Assessment of Fatigue), (4) slow 4-m walking speed (adjusted for sex and height), and (5) low physical activity (measured by the International Physical Activity Questionnaire). Individuals with one or two deficits were classified as "pre-frail" and those with no deficits as "robust." Self-reported physical function was assessed by the Health Assessment Questionnaire (HAQ) and the Valued Life Activities Difficulty scale. Regression analyses modeled associations of frailty category with HAQ and Valued Life Activities (VLA) Difficulty scores with and without controlling for age, sex, disease duration, C-reactive protein, use of oral steroids, and pain. Among adults with RA, being frail compared to being robust was associated with a 0.44 worse VLA score (p&nbsp

Objective In geriatric populations, frailty is associated with poor health outcomes, including mortality. Frailty has not been examined in lupus, although components of the phenotype seem relevant. Methods Women with lupus (n=152) participated in research visits in 2008–2009. Frailty was assessed by Fried9s frailty phenotype criteria: low weight/unintentional weight loss, slow gait (4-m walk using sex and height criteria), weakness (grip strength using gender and body mass index criteria), exhaustion (2 specific questions) and inactivity (from physical activity questionnaire). Women accumulating 3+ components were classified as ‘frail’, one or two components as ‘prefrail’, and none as ‘robust’. Physical function (36-item Short Form (SF-36) Physical Functioning subscale and Valued Life Activities disability scale), cognitive function (from a 12-test battery) and mortality were examined as outcomes. Mortality was determined as of December 2015. Multiple regression analyses examined concurrent and 2-year function controlling for age, lupus duration, race/ethnicity, glucocorticoid use, obesity, self-reported disease activity and damage and, for longitudinal analyses, baseline function. Mortality analyses controlled for age, lupus duration and baseline disease damage scores. Results Mean age was 48 (±12) years, mean lupus duration was 16 (±9) years. 20% of the sample was classified as frail and 50% as prefrail. Frail women had significantly worse physical functioning than both robust and prefrail women and were more likely to have cognitive impairment. Frail women were also more likely to experience declines in functioning and onset of cognitive impairment. Mortality rates were significantly higher in the frail group (frail 19.4%; prefrail 3.9%; robust 2.3%). Odds (95% CI) of death for frail women were elevated, even after adjusting for age, lupus duration and baseline disease damage (5.9 (0.6 to 57.1)). Conclusions Prevalence of frailty in this sample of women with lupus was higher than in samples of older adults. Frailty was associated with poor physical and cognitive function, functional declines and mortality.

Objective Limited data exist describing relationships between muscle strength, muscle mass, and physical disability among individuals with systemic lupus erythematosus (SLE). The present study examines the relationship of muscle strength and muscle mass with physical disability among adult women with SLE.

ObjectivesTo determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.DesignProspective cohort study.SettingThe 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.ParticipantsTwelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.MeasurementsParticipants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).ResultsAt baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P&nbsp

Aim We used diffusion tensor imaging to investigate the association between white-matter integrity and reading ability in a cohort of 28 children. Nineteen preterm children (14 males, five females; mean age 11y 11mo [SD 1y 10mo], mean gestational age 30.5wks (SD 3.2), mean birthweight was 1455g [SD 625]); and nine term children (five males, four females; mean age 12y 8mo [SD 2y 5mo], mean gestational age 39.6wks (SD 1.2), and mean birthweight 3877g [SD 473]). Method We tested whether fractional anisotropy in a left hemisphere temporoparietal region and in the corpus callosum correlates with birthweight and scores on the following three subtests of the Woodcock-Johnson III Tests of Achievement: word identification, word attack, and passage comprehension. Results Preterm children had lower reading scores than a comparison group for all reading subtests (p

Background Frailty is defined as “excess vulnerability to stressors, with reduced ability to maintain or regain homeostasis after a destabilizing event” 1 . Frailty is closely related to body composition and physical functioning, and is associated with increased risk of poor health outcomes including death. Serum inflammation is associated with differences in body composition and physical functioning in the general population and individuals with chronic disease. The ability of serum markers of inflammation to identify increased frailty among individuals with rheumatoid arthritis (RA) is unknown. Objectives We tested whether serum erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) are associated with increased risk of frailty among men and women with RA. Methods Participants were individuals in a longitudinal RA cohort. ESR and high sensitivity CRP were assessed from blood samples using standard clinical assays. Individuals with 3 or more of the following physical deficits were classified as frail 1 : 1) body mass index ≤18.5, 2) low grip strength (adjusted for sex and BMI, measured by handheld dynamometer), 3) severe fatigue (measured by the Fatigue Severity Inventory), 4) slow 4-meter walking speed (adjusted for sex and height), 5) low physical activity (measured by the International Physical Activity Questionnaire). Individuals with 1 or 2 deficits were classified as pre-frail, and those with no deficits as robust. 1 Multinomial logistic regression analyses controlling for age, sex, smoking status, RA disease duration, prednisone use, tumor necrosis factor inhibitor use, appendicular lean mass, and pain modeled the effects of ESR and CRP on severity of frailty. Results Of the 141 participants, 60% were female; mean age was 58 (±11) years, duration of RA was 19 (±11) years, ESR was 19 (±19) mm/h, and hsCRP was 5 (± 8) mg/L. Sixteen participants (11%) were frail, 86 (61%) pre-frail, 22 (16%) robust, and 17 (12%) were missing grip strength data. In adjusted models, higher ESR was associated with significantly increased risk of frailty (Table 1). Similar trends were observed between CRP and risk of frailty, but did not reach statistical significance in adjusted models. Conclusions Frailty and pre-frailty were common in our cohort of individuals with RA, with a greater prevalence than that of geriatric populations. ESR levels were associated with approximately twice the risk of being frail or pre-frail compared to being robust. CRP demonstrated similar effects on risk of frailty, though trends did not reach statistical significance. These findings underscore the burden of frailty among individuals with RA, and they may suggest a clinical role for serum ESR and CRP to identify individuals with RA at greatest risk of frailty. References Fried J Am Geriatr Soc 2001;56:M146 Disclosure of Interest None declared

We used diffusion tensor imaging to investigate the association between white-matter integrity and reading ability in a cohort of 28 children. Nineteen preterm children (14 males, five females; mean age 11 y 11 mo [SD 1 y 10 mo], mean gestational age 30.5 wks (SD 3.2), mean birthweight was 1455 g [SD 625]); and nine term children (five males, four females; mean age 12 y 8 mo [SD 2 y 5 mo], mean gestational age 39.6 wks (SD 1.2), and mean birthweight 3877 g [SD 473]).We tested whether fractional anisotropy in a left hemisphere temporoparietal region and in the corpus callosum correlates with birthweight and scores on the following three subtests of the Woodcock-Johnson III Tests of Achievement: word identification, word attack, and passage comprehension.Preterm children had lower reading scores than a comparison group for all reading subtests (p0.05). We found significant correlations between birthweight and fractional anisotropy in the whole corpus callosum (p=0.001), and between fractional anisotropy and reading skill in the genu (p=0.001) and body (p=0.001) of the corpus callosum. The correlation between reading skill and fractional anisotropy in a left temporoparietal region previously associated with reading disability was not significant (p=0.095).We conclude that perinatal white-matter injury of the central corpus callosum may have long-term developmental implications for reading performance.

We sought to compare the efficacy of 3 intravenous antiemetic medications in ED patients complaining of moderate to severe nausea. This randomized, placebo-controlled, double-blind trial compares 1.25 mg droperidol, 10 mg metoclopramide, 10 mg prochlorperazine, and saline placebo. Adult ED patients complaining of nausea were eligible. Nausea was measured on a 100-mm visual analog scale at 0 and 30 minutes after treatment. A convenience sample of 100 patients was enrolled; 97 had complete data available for analysis. Of these, 22 patients received droperidol, 25 received metoclopramide, 24 received prochlorperazine, and 26 received placebo. Droperidol (-54.5 mm) was significantly better than metoclopramide (-40.2 mm) or prochlorperazine (-40.5 mm) at reducing nausea at 30 minutes (P = .04). There were no significant differences in rescue medication or patient satisfaction; however, droperidol had significantly higher akathisia (71.4% vs 23.5%) at 24-hour follow-up. When administered intravenously to adult patients with moderate to severe nausea, droperidol was more effective than metoclopramide or prochlorperazine but caused more extrapyramidal symptoms. Metoclopramide and prochlorperazine were not more effective than saline placebo. All patients improved over time and possibly with intravenous hydration.

The painted turtle, Chrysemys picta Schneider (family Emydidae), has been divided into four subspecies (with differing morphological characteristics), two of which intergrade in the northeastern United States. The intergradation of C. p. marginata (midland painted turtle) and C. p. picta (eastern painted turtle) has been well studied in some areas, but has been poorly studied in Vermont, an area that could contribute important information on this species and the process of intergradation. Turtles were trapped and released from three different watersheds in Vermont, and others were examined from collections at the Carnegie Museum of Natural History from within the center of the ranges of the two parent subspecies to investigate the hypotheses that Vermont's turtles are intergrades, and that the amount of influence from each subspecies differs with drainage in Vermont. For the external characteristics of scute disalignment, scute border width, and plastral figure, many of Vermont's turtles were det...