Extra-group mating increases inbreeding risk in a cooperatively breeding bird.

In many cooperatively breeding species, females mate extra-group, the adaptive value of which remains poorly understood. One hypothesis posits that females employ extra-group mating to access mates whose genotypes are more dissimilar to their own than their social mates, so as to increase offspring heterozygosity. We test this hypothesis using life history and genetic data from 36 cooperatively breeding white-browed sparrow weaver (Plocepasser mahali) groups. Contrary to prediction, a dominant female's relatedness to her social mate did not drive extra-group mating decisions and, moreover, extra-group mating females were significantly more related to their extra-group sires than their social mates. Instead, dominant females were substantially more likely to mate extra-group when paired to a dominant male of low heterozygosity, and their extra-group mates (typically dominants themselves) were significantly more heterozygous than the males they cuckolded. The combined effects of mating with extra-group males of closer relatedness, but higher heterozygosity resulted in extra-group-sired offspring that were no more heterozygous than their within-group-sired half-siblings. Our findings are consistent with a role for male-male competition in driving extra-group mating and suggest that the local kin structure typical of cooperative breeders could counter potential benefits to females of mating extra-group by exposing them to a risk of inbreeding.

Peer review as a quality assurance mechanism in three pharmacist-run medication-refill clinics.

A peer-review system for monitoring pharmacists' practice in medication-refill clinics is described. Pharmacist practitioners trained in pharmacology, therapeutics, and physical assessment provide services in three medication-refill clinics associated with a 350-bed Department of Veterans Affairs (VA) medical center. The clinics serve patients who have exhausted their prescribed drugs before their next appointment with a physician. During a clinic visit, the pharmacist assesses the patient and the drug therapy and either consults an attending physician or writes new prescriptions. The pharmacist documents his or her activities in the medical record. The peer-review mechanism involves quarterly audits in which the chart notes written by the pharmacists are reviewed by other pharmacists. Five indicators of the quality of care are used in the peer reviews. The results are presented to the ambulatory-care and quality assurance pharmacy committees for analysis and discussion. The peer-review system has resulted in better compliance by the pharmacists with the quality indicators and clinic procedures, suggesting that the quality of care has also benefited. Peer review is used successfully to evaluate and monitor the care provided by pharmacists in medication-refill clinics associated with a VA medical center.

Respiratory syncytial virus infections on an adult medical ward.

Eleven cases of respiratory syncytial virus (RSV) infection occurred in acutely ill hospitalized adults over a 7-week period. Nosocomial illness was suspected in two patients. Because RSV can cause serious infections in immunocompromised adults with the potential for nosocomial spread, the following recommendations are indicated: (1) during the winter months, early recognition and diagnosis of RSV infections both in hospital staff and in patients should be encouraged; (2) infected hospital personnel should avoid patient contact when possible; (3) during outbreaks, careful attention must be paid to hand washing and gloving; and (4) a high level of vigilance for RSV infection should be maintained on units with immunocompromised patients. Increased awareness of the potential risks of RSV infection is needed on adult medical units.

A double-blind, vehicle-controlled study of clobetasol propionate 0.05% (Temovate) scalp application in the treatment of moderate to severe scalp psoriasis.

The efficacy and safety of clobetasol propionate 0.05% scalp application was evaluated in 378 patients with moderate to severe scalp psoriasis in a double-blind vehicle-controlled parallel group study. After 2 weeks of twice-daily applications, 81% receiving active drug versus 22% receiving vehicle had clearing of 50% or greater. Complete clearing was seen in 26% with active drug and 1% with vehicle. Local side effects were primarily burning or stinging in 11% and 10% of patients treated on an active or a vehicle regimen, respectively. The morning cortisol levels of 168 patients were checked at baseline and again after 2 weeks of drug therapy. Subnormal morning plasma cortisol values were seen in 5% of the patients receiving active drug and in 5% receiving vehicle; 13% of those taking active drug versus 5% taking vehicle had a 50% or greater decrease in morning cortisol at the 2-week visit compared with baseline values. Clobetasol propionate 0.05% scalp application appears to be a safe and an effective treatment for scalp psoriasis.

The Goeckerman regimen in two psoriasis day care centers.

Three hundred patients with severe psoriasis were treated with the Goeckerman regimen in two different day care centers. Each patient was personally evaluated and followed by us for a period of 1 year or longer in an effort to determine accurately clearing of the skin, side effects, and length of remission. The average duration of treatment to produce over 90% clearing of the skin was 18 days. Ninety percent of the patients remained clear for a minimum of 8 months, and 73% were clear for 1 year or longer. The average total body dosage of ultraviolet B (UVB) needed to clearing was 1.96 joules/cm2. Side effects were minimal, and there was no increase in skin cancer. The cost-effectiveness of the regimen in a day care center is comparable to psoralens and ultraviolet A (PUVA) therapy.

Psoriasis: current advances in etiology and treatment.

Psoriasis is a disease of major importance, the cause of which is unknown and treatment often difficult. However, research worldwide has intensified, and we now have an increased understanding of the events that lead to the production of a psoriatic lesion. Newer treatments and the revival of old therapies have increased the success rate in the management of this difficult disease but have also opened up new concerns regarding the safety of these modalities. This is a review of the current research on the etiology and treatment of psoriasis.

A congenital ichthyosiform syndrome with deafness and keratitis.

This is a report on two children with a syndrome characterized by an extensive congenital ichthyosiform eruption, neurosensory deafness, hypotrichosis, partial anhidrosis, and vascularization of the cornea. The facial involvement is distinctive. Other features are dystrophy of the nails and tight heel cords. Both children are of normal intelligence. The inheritance pattern is unknown.

Two tris urea mercaptoethanol extractable polypeptides found uniquely in scales of patients with psoriasis.

This study was designed to chemically characterize the principal structural proteins of psoriatic scales. Cornified cells were obtained from 40 patients with psoriasis, 21 patients with other scaly diseases, and 13 normal individuals. Cells were washed with Tris-HCl buffer and incubated in 8 M urea containing 2-mercaptoethanol (pH 9.0) at 30 degrees C for 7 hr. Extracted proteins were subjected to SDS polyacrylamide gel electrophoresis and protein patterns from normal and diseased scales were compared. The 67,000 dalton constituent of normal cornified cells could not be identified in protein from psoriatic scale and instead, a pair of polypeptides of approximately 54,000 and 57,000 daltons appeared. These extra bands were not found in protein extractions from other skin diseases, uninvolved skin of psoriasis patients, or normal skin. In order to analyze further normal and psoriatic scale proteins, the immunoreaction of rabbit antisera to human 67,000 dalton polypeptide with extracted psoriasis protein and with frozen biopsy sections, was studied using immunoprecipitation tests and indirect immunofluorescence microscopy. Both techniques demonstrated the existence of the 67,000 dalton protein in psoriasis, but as a minor component. These results indicate that additional unique urea mercaptoethanol soluble proteins are formed in psoriatic lesions, and this unusual protein synthesis may reflect the morphological changes in this disease.

A mechanobullous disease of the newborn. Bart's syndrome.

A patient had a unique mechanobullous disease (Bart's syndrome). The characteristic congenital localized skin defects, trauma-induced erosions, and nail deformities are present. The inheritance pattern appears to be autosomal dominant but, as in this report, isolated cases have been recognized. In a review of the other mechanobullous diseases, Bart's syndrome appears to present a distinctive clinical picture and course and has a favorable prognosis. The progressive spontaneous improvement emphasizes the importance of early recognition and conservative treatment.

Psoriasis: treatment with a tar gel.

Crude coal tar has long been an effective and safe form of therapy for psoriasis. However, as compounded in an ointment base it has many objectional features and usually is limited to hospital use. A new tar gel has been studied which appears to equal the effectiveness of crude coal tar, is convenient to apply, and is cosmetically acceptable. This new tar preparation is a valuable addition to the therapy of psoriasis.

Psoriasis day care centers.

With the rapidly mounting cost of medical care in hospitals, physicians must seek alternative forms of therapy for illnesses that could conceivably be treated by less confining methods. One appraoch to this problem is the Psoriasis Day Care Center, where psoriasis patients with extensive disease are treated during the day and allowed to return home at night. The advantages include reduced cost, accessibility for more patients, and superior therapeutic results. This day care center concept could be equally applicable to other diseases now routinely treated by complete hospitalization.