Evaluation of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Identification of Mycobacterium species, Nocardia species, and Other Aerobic Actinomycetes.

The value of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for the identification of bacteria and yeasts is well documented in the literature. Its utility for the identification of mycobacteria and Nocardia spp. has also been reported in a limited scope. In this work, we report the specificity of MALDI-TOF MS for the identification of 162 Mycobacterium species and subspecies, 53 Nocardia species, and 13 genera (totaling 43 species) of other aerobic actinomycetes using both the MALDI-TOF MS manufacturer's supplied database(s) and a custom database generated in our laboratory. The performance of a simplified processing and extraction procedure was also evaluated, and, similar to the results in an earlier literature report, our viability studies confirmed the ability of this process to inactivate Mycobacterium tuberculosis prior to analysis. Following library construction and the specificity study, the performance of MALDI-TOF MS was directly compared with that of 16S rRNA gene sequencing for the evaluation of 297 mycobacteria isolates, 148 Nocardia species isolates, and 61 other aerobic actinomycetes isolates under routine clinical laboratory working conditions over a 6-month period. MALDI-TOF MS is a valuable tool for the identification of these groups of organisms. Limitations in the databases and in the ability of MALDI-TOF MS to rapidly identify slowly growing mycobacteria are discussed.

Paleognathous carinate birds from the early tertiary of north america.

Fossils newly discovered in the Paleocene and early Eocene of western North America document some of the oldest birds known from nearly complete skeletons. These were medium-sized carinates with powers of sustained flight but which had a paleognathous palate like that of the flightless ostrich-like birds and the tinamous. The fossils provide additional evidence that the paleognathous palate is probably primitive and therefore should not be cited as a derived character state to define the ostrich-like birds as a monophyletic group.

Fossil counterparts of giant penguins from the north pacific.

New fossils of giant, flightless penguinlike birds have been found in late Oligocene and early Miocene rocks in Japan and in the state of Washington. These birds belong to the order Pelecaniformes, in the extinct family Plotopteridae, previously known by a single fragment of bone from California. Hindlimb and pelvic morphology is most similar to that of Recent anhingas, but the wing is paddlelike and remarkably convergent toward penguins and flightless auks. Both the Plotopteridae and the giant penguins became extinct by the middle Miocene, possibly because of competition from seals and porpoises.

Paleoenvironment of the earliest hominoids: new evidence from the oligocene avifauna of egypt.

Analysis of fossil birds from the Oligocene Jebel Qatrani Formation in the Fayum depression of Egypt, site of the oldest known hominoid primates, allows precise paleoenvironmental reconstruction of the climatic and biotic conditions that influenced some of the earliest stages of hominoid evolution. Unlike the fossil mammals of the Fayum, which belong largely to extinct groups, most of the birds are referable to living families, with some being close to modern genera. The avifauna consists mainly of aquatic species, with such forms as jacanas (Jacanidae) and shoebilled storks (Balaenicipitidae) indicating expanses of freshwater with dense floating vegetation. An avifauna closely analogous to that of the Fayum is found today only in a limited area of Uganda, north and west of Lake Victoria, a region of swampland bordered by forest and grasslands that presents marked faunal similarities to the environment inferred for the Egyptian Oligocene.

Fossil birds from the hawaiian islands: evidence for wholesale extinction by man before Western contact.

Thousands of fossil bird bones from the Hawaiian Islands collected since 1971 include remains of at least 39 species of land birds that are not known to have survived into the historic period; this more than doubles the number of endemic species of land birds previously known from the main islands. Bones were found in deposits of late Quaternary age; most are Holocene and many are contemporaneous with Polynesian culture. The loss of species of birds appears to be due to predation and destruction of lowland habitats by humans before the arrival of Europeans. Because the historically known fauna and flora of the Hawaiian Islands represent only afraction of natural species diversity, biogeographical inferences about natural processes based only on historically known taxa may be misleading or incorrect.

Unidirectional spread of secondary sexual plumage traits across an avian hybrid zone.

Theory predicts that traits under positive selection can rapidly cross a hybrid zone in spite of a substantial barrier to neutral gene flow between hybridizing taxa. An avian hybrid zone between Manacus candei (white-collared manakin) and M. vitellinus (golden-collared manakin) is reported here that displays an unusual pattern of noncoincident clines. Male secondary sexual traits of M. vitellinus have spread into populations that are genetically and morphometrically like M. candei. These birds have a lek breeding system in which male mating success is highly skewed, suggesting that sexual selection is driving male sexual traits across the zone.

Relationships of the extinct moa-nalos, flightless Hawaiian waterfowl, based on ancient DNA.

The extinct moa-nalos were very large, flightless waterfowl from the Hawaiian islands. We extracted, amplified and sequenced mitochondrial DNA from fossil moa-nalo bones to determine their systematic relationships and lend insight into their biogeographical history. The closest living relatives of these massive, goose-like birds are the familiar dabbling ducks (tribe Anatini). Moa-nalos, however, are not closely related to any one extant species, but represent an ancient lineage that colonized the Hawaiian islands and evolved flightlessness long before the emergence of the youngest island, Hawaii, from which they are absent. Ancient DNA yields a novel hypothesis for the relationships of these bizarre birds, whereas the evidence of phylogeny in morphological characters was obscured by the evolutionary transformation of a small, volant duck into a giant, terrestrial herbivore.

Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain.

STUDY DESIGN: The psychometric properties and clinical use of a battery of physical performance measures were tested on 44 patients with low back pain and 48 healthy, pain-free control subjects. OBJECTIVES: Reliability, validity, and clinical use of nine physical performance measures were evaluated. SUMMARY OF BACKGROUND DATA: Although physical performance measures have potential use in evaluation, treatment planning, and determination of treatment outcome, there is sparse systematic investigation of their reliability, validity, and clinical use. METHODS: Forty-four subjects with low back pain and 48 healthy pain-free subjects participated. The following physical performance measures were tested: distance walked in 5 minutes; 50-foot walk at fastest speed; 50-foot walk at preferred speed; 5 repetitions of a sit-to-stand task; 10 repetitions of a repeated trunk flexion task; timed up-and-go task; unloaded forward reach task; loaded forward reach task; and Sorensen fatigue test. Subjects were assessed twice on 2 days. RESULTS: All measures had excellent intertester reliability (intraclass correlation coefficient [ICC]1,1 > 0.95). Test-retest (within session) reliability was adequate for all measures (ICC1,1 > 0.83) except repeated trunk flexion (ICC1,1 > 0.45) in the low back pain group. Test-retest (day-to-day) reliability ranged between 0.59 and 0.88 in the low back pain group and between 0.46 and 0.76 in the control group. Day-to-day reliability improved when the averages of two trials of repeated trunk flexion and sit-to-stand were used (0.76-0.91 low back pain group and 0.62-0.89 control group). Results of a multivariate analysis of variance showed a significant effect of group (F10,65 = 3.52, P = 0.001). Results of univariate analyses showed significant group differences on all measures except the 50-foot walk at preferred speed and unloaded forward reach. Self-report of disability was moderately correlated with the performance tasks (r = 0.400 to -0.603). CONCLUSIONS: The results provide support for the use of these physical performance measures as a complement to patient self-report.

Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.

BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Comparison of the University of California-Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity.

BACKGROUND AND PURPOSE: Shoulder scales are often used to evaluate treatment efficacy, yet little is known about the psychometric properties of these scales. Only one scale has undergone psychometric scrutiny: the Shoulder Pain and Disability Index (SPADI). This study compared 2 shoulder measures-the University of California-Los Angeles (UCLA) Shoulder Scale and the Simple Shoulder Test (SST)-with the SPADI. SUBJECTS: One hundred ninety-two patients with shoulder disorders were recruited from one physician's office to complete the self-report sections of the 3 scales. METHODS: Cronbach alpha values and standard errors of measurement (SEM) were calculated for each of the multi-item subscales. Validity was examined through calculation of correlation coefficients among the 3 scales. Factor analysis was completed to assess the underlying constructs of the SPADI and the SST. RESULTS: Cronbach alpha values ranged from.85 to.95. The SEM values for the multi-item scales ranged from 4.75 to 11.65. Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale. The factor analysis of the SPADI revealed loading on 1 factor, whereas the SST loaded on 2 factors. CONCLUSION AND DISCUSSION: All scales demonstrated good internal consistency, suggesting that all items for each scale measure the same construct. However, the SEMs for all scales were high. Factor loading was inconsistent, suggesting that patients may not distinguish between pain and function.

Development of conduct problems and peer rejection in preschool children: a social systems analysis.

The development of impulsive-aggressive problem behavior and peer rejection was examined in sixty 4- to 5-year-old boys from low-income family backgrounds. Children's sociometric status and behavioral adjustment were assessed longitudinally at the beginning and end of the preschool year, and related to measures of peer interaction at three different points in time. Boys identified as socially rejected and aggressive in the beginning of the year were highly likely to be identified as such at the end of the year. Early in the preschool year, these children contributed to their own rejection by initiating socially aversive exchanges with peers. Although peers clearly perceived these problems, they did not reciprocate with counteraggression at first. However, as time passed, peers began to actively victimize these children, and most of the aggression on the part of victims became reactive in nature. Thus, the current findings strongly support a transactional model of the development of early peer rejection and conduct problems.

Emotional expressiveness during peer conflicts: a predictor of social maladjustment among high-risk preschoolers.

Preschool boys' emotional displays during conflicts with mixed-sex peers were related to individual differences in peer sociometric status and teacher ratings of disruptive behavior. Participants were 60 4- to 5-year old boys from low-income families who were videotaped with a small group of classmates in a Head Start preschool classroom. Conflicts were identified and emotional displays were coded from videotape. Results indicated that conflicts were more negative in emotional tone at the end than at the beginning of the year. Furthermore, children tended to mirror each others' emotional displays at the end but not the beginning of the preschool year. In addition, gleeful taunting, a form of emotional aggression, more strongly predicted negative peer nominations and teacher ratings than anger, suggesting that anger may be a more socially accepted form of emotional expression during conflicts among preschool-age children. Implications and directions for future research and interventions are discussed.

Assessment of peer rejection and externalizing behavior problems in preschool boys: a short-term longitudinal study.

We examined the longitudinal stability of measures of negative peer status and aggressive-disruptive behavior in preschool boys. Subjects were 53 white 4- to 5-year-old boys from low-income family backgrounds. Peer sociometric measures of rejection and behavioral deviance were assessed in the fall and spring of the preschool year. Complementary measures were also obtained from teachers at both assessment points. Half of the boys designated as rejected on the basis of peer nominations maintained this status at the end of the preschool year. Teachers and peers did not agree on their selections of socially rejected children, but had good agreement concerning the identification of children with externalizing-type behavior problems. Finally, teacher and peer classifications of aggressive-disruptive children were highly stable throughout the preschool year. These findings indicate that peer-rejected children can be identified at very young ages, and that preschoolers can be reliable informants about the social maladjustment of peers.

Early antecedents of childhood impulsivity: the role of parent-child interaction, cognitive competence, and temperament.

This prospective longitudinal investigation examined early mother-child interaction as a predictor of children's later self-control capabilities. Multimethod assessments of mother-child relationships, primarily focused on observed relationship qualities in the home, were conducted during the first 2 years and related to children's later impulse control capabilities. Child cognitive competence and temperament assessed during the 2nd year were also related to later impulsivity. Follow-up assessments of children's impulsivity were conducted at age 6 (N = 79), using a variety of laboratory measures. Findings indicated that responsive, cognitively stimulating parent-toddler interactions in the 2nd year modestly predicted later measures of cognitive nonimpulsivity and ability to delay gratification. Security of mother-infant attachment predicted the same outcomes, but only for boys and not for girls. Child cognitive competence in the 2nd year also consistently predicted children's later impulse control capabilities, although this was not true for measures of child temperament. Overall, the findings support a multidimensional and developmental conceptualization of the early antecedents of childhood impulsivity.

Early developmental precursors of externalizing behavior in middle childhood and adolescence.

This study examined the infancy- and toddler-age precursors of children's later externalizing problem behavior. Risk constructs included suboptimal patterns of observed caregiver-child interaction and the caregiver's perception of child difficultness and resistance to control. In addition, a novel dimension of caregiver-child relationship quality, the caregiver's perception of her toddler's unresponsiveness to her, was examined as a possible precursor of children's externalizing behavior. Externalizing problem outcomes were assessed throughout the school-age period and again at age 17, using multiple informants. As toddlers, children at risk for later externalizing behavior were perceived as difficult and resistant to control, and relationships with their caregivers were relatively low in warmth and affective enjoyment. Finally, the caregiver's perception of her toddler as emotionally unresponsive to her was a consistent predictor of later externalizing behavior, suggesting that negative maternal cognitions associated with child conduct problems may begin in toddlerhood. These predictive patterns were similar for boys and girls, and with minor exceptions, generalized across different subdimensions of externalizing problem behavior. Our findings underscore the importance of the infancy and toddler periods to children's long-term behavioral adjustment, and indicate the desirability of further research into the nature of caregivers' early perceptions of child unresponsiveness.

Measurement of impulsivity: construct coherence, longitudinal stability, and relationship with externalizing problems in middle childhood and adolescence.

This study focused on the assessment of impulsivity in nonreferred school-aged children. Children had been participants since infancy in the Bloomington Longitudinal Study. Individual differences in impulsivity were assessed in the laboratory when children were 6 (44 boys, 36 girls) and 8 (50 boys, 39 girls) years of age. Impulsivity constructs derived from these assessments were related to parent and teacher ratings of externalizing problems across the school-age period (ages 7-10) and to parent and self-ratings of these outcomes across adolescence (ages 14-17). Consistent with prior research, individual measures of impulsivity factor-analyzed into subdimensions reflecting children's executive control capabilities, delay of gratification, and ability or willingness to sustain attention and compliance during work tasks. Children's performance on the main interactive task index, inhibitory control, showed a signficant level of stability between ages 6 and 8. During the school-age years, children who performed impulsively on the laboratory measures were perceived by mothers and by teachers as more impulsive, inattentive, and overactive than others, affirming the external validity of the impulsivity constructs. Finally, impulsive behavior in the laboratory at ages 6 and 8 predicted maternal and self-ratings of externalizing problem behavior across adolescence, supporting the long-term predictive value of the laboratory-derived impulsivity measures.

Bedside musical care: applications in pregnancy, childbirth, and neonatal care.

Although music therapy in health care settings is not new, bringing live music to the bedside is a new way of extending the caring tradition of nursing practice. Bedside musical care is consistent with a philosophy of holistic nursing practice and can be used during pregnancy, childbirth, and in neonatal care. It is defined as live music at the bedside, which is part of a treatment plan to foster integrity, well-being, and health for varied populations across the life span.

Tender point sensitivity, range of motion, and perceived disability in subjects with neck pain.

STUDY DESIGN: Descriptive analysis of impairment and disability measures in subjects with neck pain. OBJECTIVES: To identify discrete tender points and overall pressure sensitivity and assess relationships among palpation tenderness, active cervical range of motion, visual analog scale pain scores, and Sickness Impact Profile disability scores. BACKGROUND: Palpation tenderness and cervical range of motion are used to evaluate patients with neck pain, but their ability to predict patient-perceived pain and disability is unknown. METHODS AND MEASURES: We studied 45 women and 15 men with neck pain (mean age, 35 +/- 7 years). Group 1 included 30 persons who had not sought treatment, and group 2 included 30 persons who had just been referred for treatment. RESULTS: Subjects demonstrated low mean pressure pain thresholds of tender points (2.3 +/- 1.3 kg). Regression analysis showed that only neck flexion predicted pain (R2 = 0.23), with decreased flexion associated with higher pain levels. Sickness Impact Profile total score was predicted by neck rotation (R2 = 0.31), group (R2 = 0.16), tender point pressure pain threshold (R2 = 0.04), and neck retraction (R2 = 0.03). Decreased neck rotation, neck retraction, and pressure pain thresholds were associated with higher disability. CONCLUSIONS: Neither palpation tenderness nor cervical range of motion were strong predictors of pain and disability in subjects with neck pain.

Ancillary service consumption by Military Health Service System special programs: implications for diagnosis related group resource allocation.

An analysis was conducted of consumption of ancillary services by medical treatment facility special programs within the Military Health Service System (MHSS). This workload would not receive explicit credit under the new weighted ambulatory visit/inpatient disposition workload credit system mandated by the National Defense Authorization Act for Fiscal Year 1987. Results indicated that ancillary workload consumption by facility special programs was substantial. When the weighted visit/disposition workload credit system is implemented throughout MHSS, appropriate adjustments must be made to reflect ancillary workload generated by MHSS facilities in support of direct patient care missions but lost under this type of credit system.