Lunge filter feeding biomechanics constrain rorqual foraging ecology across scale.

Fundamental scaling relationships influence the physiology of vital rates, which in turn shape the ecology and evolution of organisms. For diving mammals, benefits conferred by large body size include reduced transport costs and enhanced breath-holding capacity, thereby increasing overall foraging efficiency. Rorqual whales feed by engulfing a large mass of prey-laden water at high speed and filtering it through baleen plates. However, as engulfment capacity increases with body length (engulfment volume∝body length3.57), the surface area of the baleen filter does not increase proportionally (baleen area∝body length1.82), and thus the filtration time of larger rorquals predictably increases as the baleen surface area must filter a disproportionally large amount of water. We predicted that filtration time should scale with body length to the power of 1.75 (filter time∝body length1.75). We tested this hypothesis on four rorqual species using multi-sensor tags with corresponding unoccupied aircraft systems-based body length estimates. We found that filter time scales with body length to the power of 1.79 (95% CI: 1.61-1.97). This result highlights a scale-dependent trade-off between engulfment capacity and baleen area that creates a biomechanical constraint to foraging through increased filtration time. Consequently, larger whales must target high-density prey patches commensurate to the gulp size to meet their increased energetic demands. If these optimal patches are absent, larger rorquals may experience reduced foraging efficiency compared with smaller whales if they do not match their engulfment capacity to the size of targeted prey aggregations.

A Randomized Clinical Trial Comparing Posterior Cruciate-Stabilizing vs Posterior Cruciate-Retaining Prostheses in Primary Total Knee Arthroplasty: 10-Year Follow-Up.

BACKGROUND: This 10-year follow-up compares health-related quality of life (HRQL) and reoperations in 100 subjects who were randomized to receive posterior cruciate ligament substituting (PS) or posterior cruciate ligament retaining (CR) total knee arthroplasty. We previously reported 2-year results. METHODS: Subjects were enrolled preoperatively and randomized at surgery. Subjects completed HRQL questionnaires at all evaluation points. Subjects were re-evaluated at 2 and 10 years with reoperations determined through regional medical record review and patient report. RESULTS: Over 10 years, 25 (25%) subjects died, 2 subjects were revised and withdrew, and 11 (11%) subjects were lost to follow-up. Of survivors, 62 of 75 (83%) were evaluated at 10 years. Twenty-eight (37%) subjects provided HRQL, radiographic, and reoperation status, 28 (37%) subjects completed HRQL evaluations and reoperation status only, and 6 (8%) subjects provided radiographic and reoperation follow-up. Both groups retained good HRQL between 2 and 10 years with no group differences noted (P > .35). One revision (CR subject), secondary to deep joint infection, occurred within 2 years with 1 further revision (PS subject) occurring at 3 years postoperatively. One subject (PS subject) required manipulation under anesthesia within 3 months of surgery. Four subjects required late patellar resurfacing (1 CR subject, 3 PS subjects) but were retained in the 10-year evaluation. Overall, reoperations were not significantly different between groups (P = .26). CONCLUSION: Over 10 years postoperatively, both the PS and CR total knee arthroplasty performed well with subjects reporting acceptable levels of HRQL up to 10 years postoperatively; low levels of revision or reoperation were reported in both groups.

A randomized trial of ceramic-on-ceramic bearing versus ceramic-on-crossfire-polyethylene bearing in total hip arthroplasty: five-year outcomes.

This study determined how ceramic-on-ceramic bearing THA affected joint-specific pain, function and stiffness in the first five postoperative years compared with ceramic-on-highly-crosslinked-polyethylene bearing THA. Subjects less than 61 years of age were randomized to ceramic-on-ceramic (CERAMIC) [n = 48] or ceramic-on-highly-crosslinked-polyethylene (POLYETHYLENE) [n = 44] bearing THA. Subjects were assessed using the Western Ontario McMaster Osteoarthritis Index (WOMAC) and the RAND 12-Item Health Survey (RAND-12) preoperatively, and at one and five years postoperatively. 92 subjects(50 (54%) males; average age = 52 (SD 6.6) years) were enrolled. 78 (85%) subjects returned five years postoperatively. All subjects reported improvements at one and five years in all measured indices with no group differences detected. Seven (8%) subjects experienced postoperative THA complications, none related to bearing surfaces; two subjects (POLYETHYLENE) required revision for instability. Both bearing surfaces provided excellent short-term results in younger subjects.

Interobserver reliability of the radiographic assessment of cement fixation in total hip arthroplasty.

BACKGROUND: The objective of this work is to evaluate the performance of a modified quantitative Barrack Cement grading in primary THA. Previous studies demonstrated both poor intraobserver and interobserver reliability which may be due to the qualitative nature of the scale. METHODS: Interobserver reliability of the Barrack Cement Grading System in its original format and then in combination with a quantitative measurement of implant/cement lengths was evaluated on 50 immediate post-operative radiographs of primary cemented arthroplasties. Intraobserver reliability was also assessed on a sub-sample of radiographs. Three evaluators with different skill levels and specialty participated: an arthroplasty surgeon, an orthopaedic resident and a radiologist. Reliability was measured using a weighted kappa coefficient for paired comparisons among the evaluators. RESULTS: Interobserver reliability was poor (κ < 0.10) for all pairings of the Barrack System. The modified quantitative system achieved slight (κ < 0.20) to poor reliability. Intraobserver reliability was dependent on the skill and specialty of the evaluator with maximal values achieved for the experienced arthroplasty surgeon using the modified quantitative system (κ = 0.62). CONCLUSION: Use of the modified scale may improve the reliability of ratings when used by individual experienced arthroplasty surgeons.

Shaped by Their Environment: Variation in Blue Whale Morphology across Three Productive Coastal Ecosystems.

Species ecology and life history patterns are often reflected in animal morphology. Blue whales are globally distributed, with distinct populations that feed in different productive coastal regions worldwide. Thus, they provide an opportunity to investigate how regional ecosystem characteristics may drive morphological differences within a species. Here, we compare physical and biological oceanography of three different blue whale foraging grounds: (1) Monterey Bay, California, USA; (2) the South Taranaki Bight (STB), Aotearoa New Zealand; and (3) the Corcovado Gulf, Chile. Additionally, we compare the morphology of blue whales from these regions using unoccupied aircraft imagery. Monterey Bay and the Corcovado Gulf are seasonally productive and support the migratory life history strategy of the Eastern North Pacific (ENP) and Chilean blue whale populations, respectively. In contrast, the New Zealand blue whale population remains in the less productive STB year-round. All three populations were indistinguishable in total body length. However, New Zealand blue whales were in significantly higher body condition despite lower regional productivity, potentially attributable to their non-migratory strategy that facilitates lower risk of spatiotemporal misalignment with more consistently available foraging opportunities. Alternatively, the migratory strategy of the ENP and Chilean populations may be successful when their presence on the foraging grounds temporally aligns with abundant prey availability. We document differences in skull and fluke morphology between populations, which may relate to different feeding behaviors adapted to region-specific prey and habitat characteristics. These morphological features may represent a trade-off between maneuverability for prey capture and efficient long-distance migration. As oceanographic patterns shift relative to long-term means under climate change, these blue whale populations may show different vulnerabilities due to differences in migratory phenology and feeding behavior between regions. Spanish abstract La ecología y patrones de historia de vida de las especies a menudo se reflejan en la morfología animal. Las ballenas azules están distribuidas globalmente, con poblaciones separadas que se alimentan en diferentes regiones costeras productivas de todo el mundo. Por lo tanto, brindan la oportunidad de investigar cómo las características regionales de los ecosistemas pueden impulsar diferencias morfológicas dentro de una especie. Aquí, comparamos la oceanografía física y biológica de tres zonas de alimentación diferentes de la ballena azul: (1) Bahía de Monterey, California, EE. UU., (2) Bahía del sur de Taranaki (BST), Nueva Zelanda, y (3) Golfo de Corcovado, Chile. Adicionalmente, comparamos la morfología de las ballenas azules de estas regiones utilizando imágenes de aeronaves no tripuladas. La Bahía de Monterey y el Golfo de Corcovado son estacionalmente productivos y apoyan la estrategia migratoria de la historia de vida de las poblaciones de ballena azul chilena y del Pacífico Norte Oriental (PNO), respectivamente. Por el contrario, la población de ballena azul de Nueva Zelanda permanece en la menos productiva BST durante todo el año. Las tres poblaciones eran indistinguibles en cuanto a la longitud corporal total. Sin embargo, las ballenas azules de Nueva Zelanda tenían una condición corporal significativamente mayor a pesar de una menor productividad regional, potencialmente atribuible a su estrategia no migratoria que facilita un menor riesgo de desalineación espaciotemporal con oportunidades de alimentación disponibles de manera más consistente. Alternativamente, la estrategia migratoria de las poblaciones de ballenas PNO y chilena puede tener éxito cuando su presencia en las zonas de alimentación se alinea temporalmente con la abundante disponibilidad de presas. Documentamos diferencias en la morfología del cráneo y la aleta caudal entre poblaciones, que pueden estar relacionadas con diferentes comportamientos de alimentación adaptados a las características de hábitat y presas específicas para cada región. Estas características morfológicas pueden representar una compensación entre la maniobrabilidad para la captura de presas y una migración eficiente a larga distancia. A medida que los patrones oceanográficos cambian en términos de mediano a largo plazo debido al cambio climático, estas poblaciones de ballenas azules pueden mostrar diferentes vulnerabilidades debido a diferencias en la fenología migratoria y el comportamiento de alimentación entre regiones.

Comparative effectiveness of alternative clinical pathways for primary hip and knee joint replacement patients: a pragmatic randomized, controlled trial.

OBJECTIVE: Total hip replacement (THR) and total knee replacement (TKR) (arthroplasty) surgery for end-stage osteoarthritis (OA) are ideal candidates for optimization through an algorithmic care pathway. Using a comparative effectiveness study design, we compared the effectiveness of a new clinical pathway (NCP) featuring central intake clinics, dedicated inpatient resources, care guidelines and efficiency benchmarks vs. the standard of care (SOC) for THR or TKR. METHODS: We compared patients undergoing primary THR and TKR who received surgery in NCP vs. SOC in a randomised controlled trial within the trial timeframe. 1,570 patients (1,066 SOC and 504 NCP patients) that underwent surgery within the study timeframe from urban and rural practice settings were included. The primary endpoint was improvement in Western Ontario and McMaster University osteoarthritis index (WOMAC) overall score over 12 months post-surgery. Secondary endpoints were improvements in the physical function (PF) and bodily pain (BP) domains of the Short Form 36 (SF-36). RESULTS: NCP patients had significantly greater improvements from baseline WOMAC scores compared to SOC patients after adjusting for covariates (treatment effect=2.56; 95% confidence interval (CI) [1.10-4.01]). SF-36 BP scores were significantly improved for both hip and knee patients in the NCP (treatment effect=3.01, 95% CI [0.70-5.32]), but SF-36 PF scores were not. Effects of the NCP were more pronounced in knee patients. CONCLUSION: While effect sizes were small compared with major effects of the surgery itself, an evidence-informed clinical pathway can improve health related quality of life (HRQoL) of hip and knee arthroplasty patients with degenerative joint disorder in routine clinical practice for up to 12 months post-operatively. CLINICALTRIALS.GOV IDENTIFIER: NCT00277186.

Variation in blubber cortisol levels in a recovering humpback whale population inhabiting a rapidly changing environment.

Glucocorticoids are regularly used as biomarkers of relative health for individuals and populations. Around the Western Antarctic Peninsula (WAP), baleen whales have and continue to experience threats, including commercial harvest, prey limitations and habitat change driven by rapid warming, and increased human presence via ecotourism. Here, we measured demographic variation and differences across the foraging season in blubber cortisol levels of humpback whales (Megaptera novaeangliae) over two years around the WAP. Cortisol concentrations were determined from 305 biopsy samples of unique individuals. We found no significant difference in the cortisol concentration between male and female whales. However, we observed significant differences across demographic groups of females and a significant decrease in the population across the feeding season. We also assessed whether COVID-19-related reductions in tourism in 2021 along the WAP correlated with lower cortisol levels across the population. The decline in vessel presence in 2021 was associated with a significant decrease in humpback whale blubber cortisol concentrations at the population level. Our findings provide critical contextual data on how these hormones vary naturally in a population over time, show direct associations between cortisol levels and human presence, and will enable comparisons among species experiencing different levels of human disturbance.

Decline of DDT residues in migratory songbirds.

Analyses of ten species of migratory songbirds killed when the birds flew into television towers in Florida showed a progressive decline in the concentration of DDT and its metabolites (DDD and DDE) in their fat depots for the period 1964 to 1973. This decline is apparently correlated with the decreased usage of DDT in the United States during the same time.

The Alberta Hip and Knee Replacement Project: a model for health technology assessment based on comparative effectiveness of clinical pathways.

BACKGROUND: The Alberta Hip and Knee Replacement Project developed a new evidence-based clinical pathway (NCP) for total hip (THR) and knee (TKR) replacement. The aim was to facilitate the delivery of services in a timely and cost-effective manner while achieving the highest quality of care for the patient across the full continuum of care from patient referral to an orthopedic surgeon through surgery, recovery, and rehabilitation. The purpose of this article is to provide an overview of the study design, rationale, and execution of this project as a model for health technology assessment based on comparative effectiveness of alternative clinical pathways. METHODS: A pragmatic randomized controlled trial study design was used to evaluate the NCP compared with the standard of care (SOC) for these procedures. The pragmatic study design was selected as a rigorous approach to produce high quality evidence suitable for informing decisions between relevant interventions in real clinical practice. The NCP was evaluated in three of the nine regional health authorities (RHAs) in Alberta with dedicated central intake clinics offering multidisciplinary care teams, constituting 80 percent of THR and TKR surgeries performed annually in Alberta. Patients were identified in the offices of twenty orthopedic surgeons who routinely performed THR or TKR surgeries. Evaluation outcome measures were based on the six dimensions of the Alberta Quality Matrix for Health (AQMH): acceptability, accessibility, appropriateness, effectiveness, efficiency and safety. Data were collected prospectively through patient self-completed questionnaires at baseline and 3 and 12 months after surgery, ambulatory and inpatient chart reviews, and electronic administrative data. RESULTS: The trial design was successful in establishing similar groups for rigorous evaluation. Of the 4,985 patients invited to participate, 69 percent of patients consented. A total of 3,434 patients were randomized: 1,712 to SOC and 1,722 to the NCP. The baseline characteristics of patients in the two study arms, including demographics, comorbidity as measured by CDS and exposure to pain medications, and health-related quality of life, as measured by Western Ontario and McMaster Universities Osteoarthritis Index and Short Form-36, were similar. CONCLUSIONS: The Alberta Hip and Knee Replacement Project demonstrates the feasibility and advantages of applying a pragmatic randomized controlled trial to ascertain comparative effectiveness. This is a model for health technology assessment that incorporates how clinical pathways can be effectively evaluated.

Why whales are big but not bigger: Physiological drivers and ecological limits in the age of ocean giants.

The largest animals are marine filter feeders, but the underlying mechanism of their large size remains unexplained. We measured feeding performance and prey quality to demonstrate how whale gigantism is driven by the interplay of prey abundance and harvesting mechanisms that increase prey capture rates and energy intake. The foraging efficiency of toothed whales that feed on single prey is constrained by the abundance of large prey, whereas filter-feeding baleen whales seasonally exploit vast swarms of small prey at high efficiencies. Given temporally and spatially aggregated prey, filter feeding provides an evolutionary pathway to extremes in body size that are not available to lineages that must feed on one prey at a time. Maximum size in filter feeders is likely constrained by prey availability across space and time.

Total joint arthroplasties: current concepts of patient outcomes after surgery.

Total hip and knee arthroplasties are effective surgical interventions for relieving hip pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all report gains or are satisfied after receiving total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis, and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no single patient-related or perioperative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.

Hydroxyapatite-coated tibial implants compared with cemented tibial fixation in primary total knee arthroplasty. A randomized trial of outcomes at five years.

BACKGROUND: Although excellent long-term results have been reported with cemented tibial fixation, cementless fixation as a means to improve the longevity of total knee prostheses continues to be of interest to clinicians. The purpose of this study was to compare outcomes between cementless tibial fixation with hydroxyapatite and cemented tibial fixation in the first five years following primary total knee arthroplasty. METHODS: We performed a prospective, randomized clinical trial that included eighty-one patients with noninflammatory knee arthritis who underwent primary total knee arthroplasty when they were less than seventy years of age. The subjects were randomized at the time of surgery to be treated with either cementless tibial fixation with hydroxyapatite or cemented tibial fixation. Evaluations were performed preoperatively and at six months, one year, and five years postoperatively by a physical therapist who was blinded to group allocation. Self-reported pain and function, the primary outcomes, were measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the RAND 36-Item Health Survey (RAND-36). Complications and revision rates were determined through a review of hospital records and at each patient evaluation. The Knee Society radiographic score was used to evaluate plain radiographs at each assessment. RESULTS: Seventy subjects (86%) completed the five-year assessment. Slightly more pain was reported in the hydroxyapatite group at six months as measured with both the WOMAC and the RAND-36, a difference that disappeared by one year postoperatively. No differences were seen in function, radiographic findings, or complications. No subject required revision of the tibial prosthesis during the study. CONCLUSIONS: At five years postoperatively, there is no difference between cementless tibial fixation with hydroxyapatite and cemented tibial fixation in terms of self-reported pain, function, health-related quality of life, postoperative complications, or radiographic scores.

Automated detection and enumeration of marine wildlife using unmanned aircraft systems (UAS) and thermal imagery.

Estimating animal populations is critical for wildlife management. Aerial surveys are used for generating population estimates, but can be hampered by cost, logistical complexity, and human risk. Additionally, human counts of organisms in aerial imagery can be tedious and subjective. Automated approaches show promise, but can be constrained by long setup times and difficulty discriminating animals in aggregations. We combine unmanned aircraft systems (UAS), thermal imagery and computer vision to improve traditional wildlife survey methods. During spring 2015, we flew fixed-wing UAS equipped with thermal sensors, imaging two grey seal (Halichoerus grypus) breeding colonies in eastern Canada. Human analysts counted and classified individual seals in imagery manually. Concurrently, an automated classification and detection algorithm discriminated seals based upon temperature, size, and shape of thermal signatures. Automated counts were within 95-98% of human estimates; at Saddle Island, the model estimated 894 seals compared to analyst counts of 913, and at Hay Island estimated 2188 seals compared to analysts' 2311. The algorithm improves upon shortcomings of computer vision by effectively recognizing seals in aggregations while keeping model setup time minimal. Our study illustrates how UAS, thermal imagery, and automated detection can be combined to efficiently collect population data critical to wildlife management.

Total joint arthroplasties: current concepts of patient outcomes after surgery.

Total hip and knee arthroplasties are effective surgical interventions for relieving pain and improving physical function caused by arthritis. Although the majority of patients substantially improve, not all reports gains or are satisfied after receiving a total joint arthroplasty. This article reviews the literature on patient outcomes after total hip and knee arthroplasties for osteoarthritis and the evidence pertaining to factors that affect these patient-centered outcomes. Mounting evidence suggests that no one patient-related or peri-operative factor clearly predicts the amount of pain relief or functional improvement that will occur following total hip or knee arthroplasty.

The effect of age on pain, function, and quality of life after total hip and knee arthroplasty.

BACKGROUND: As utilization rates for total joint arthroplasty increase, there is a hesitancy to perform this surgery on very old patients. The objective of this prospective study was to compare pain, functional, and health-related quality-of-life outcomes after total hip and total knee arthroplasty in an older patient group (> or =80 years) and a representative younger patient group (55-79 years). METHODS: In an inception community-based cohort within a Canadian health care system, 454 patients who received primary total hip arthroplasty (n = 197) or total knee arthroplasty (n = 257) were evaluated within a month prior to surgery and 6 months postoperatively. Pain, function, and health-related quality of life were evaluated with the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index and the 36-Item Short-Form Health Survey (SF-36). RESULTS: There were no age-related differences in joint pain, function, or quality-of-life measures preoperatively or 6 months postoperatively. Furthermore, after adjusting for potential confounding effects, age was not a significant determinant of pain or function. Although those in the older and younger groups had comparable numbers of comorbid conditions and complications, those in the older group were more likely to be transferred to a rehabilitation facility than younger patients. Regardless of age, patients did not achieve comparable overall physical health when matched with the general population for age and sex. CONCLUSIONS: With increasing life expectancy and elective surgery improving quality of life, age alone is not a factor that affects the outcome of joint arthroplasty and should not be a limiting factor when considering who should receive this surgery.

Stress management in the treatment of mild primary hypertension.

The use of simple relaxation-based stress management procedures in the treatment of mild primary hypertension has been the subject of extensive study. Stress management appears to lead to reliably greater reductions in pressure than a variety of control procedures. The mechanisms underlying these effects are obscure, and research has not identified which patients will benefit most from treatment. Preliminary data suggest that stress management may reduce the risk of coronary heart disease, but much research must be done if this is to be confirmed. It is suggested that such research should take into account the possibility that stress management may have beneficial effects on more than just hypertension-related aspects of the cardiovascular disease process.

Cardiac compression due to closure of the median sternotomy in open heart surgery.

Following open heart surgery, approximation of the median sternotomy can compress the heart and produce cardiac tamponade. A proposed new technique to eliminate this compression by sternal traction is presented.

The impact of regionalization on a surgery program in the Canadian health care system.

OBJECTIVE: To examine the impact of the regionalization of health care on the provision of surgical services in the Capital Health Region (Edmonton) of the province of Alberta. DESIGN: A 4-year retrospective descriptive analysis using data from the Canadian Institute for Health Information and from the Capital Health Region data banks. SETTING: To control health care costs, the provincially funded health care system in Alberta reformed its governance structure and service provision model. We studied community hospitals and an academic health sciences center. PATIENTS: All patients undergoing surgical care in the region. INTERVENTIONS: Regionalization of the organizational structure with the elimination of hospital boards, consolidation of services on specific sites within the regional system, and a major reduction in funding. OUTCOME MEASURES: Inpatient and day surgery procedure volumes, average length of hospital stay, relative value units, bed use, and mortality. RESULTS: The Capital Health Region has a population of 723,000 people, with 5 acute care institutions. Eighteen clinical programs now provide care through 2 referral hospitals and 3 community health centers. The reduction in operating dollars for this region was $167.1 million from fiscal years 1992-1993 to 1996-1997. Redistribution of surgical services occurred on July 1, 1995, resulting in an 18% inpatient bed reduction. Regionally, the number of acute care beds has declined from 2.25 to 1.47 per 1000 population (P < .001). Bed use has fallen from 637 to 442 inpatient days per 1000 population (P < .001). The surgery volume (1995-1996) was 44770 procedures (-3.1%). Redistribution of surgical services into high- and low-acuity settings has resulted in most surgeons working on 2 sites. Overall average length of hospital stay has decreased significantly (P < .001); however, it has increased, together with the average relative value units, in the institutions caring for patients with high-acuity surgical illnesses. Mortality remains unchanged. CONCLUSIONS: Regionalization and funding reductions within the surgical program in the Capital Health Region have resulted in a small reduction in surgical volumes. There have been major changes in service provision and the way surgeons practice.

Quality of life improvement in patents with osteoarthritis: the potential for office-based assessment.

OBJECTIVE: This study presents the initial findings from our evaluation of the Nottingham Health Profile, a short and simple quality of life instrument, to determine its ease and robustness as a routine office tool for evaluating changes in the quality of life for arthritis patients undergoing joint replacement. METHODS: Thirty-five patients awaiting total joint replacement surgery were asked to complete the Nottingham Health Profile at their pre-operative clinic. A post-joint replacement evaluation profile, with a self-addressed stamped envelope, was mailed to each participant 3-4 months post-surgery. The profile was self-administered on both occasions. RESULT: The follow-up response rate was 69%. The t-test for the paired difference of related populations was used to determine pre-test and post-test changes. Significant improvement was found in the profile's 6 subscales, with energy, pain, and physical mobility significant at the 0.001 level, emotion and social isolation significant at the 0.005 level, and sleep significant at the 0.05 level. The before and after comparison of the profile's global self-assessment of health was not significant. CONCLUSION: Preliminary findings suggest that the Nottingham Health Profile is a useful office tool for the routine assessment of intervention-related changes in quality of life. The instrument was easy to self-administer and was associated with a mail return response rate consistent with other investigations using the profile. Even with a small sample size, the profile rendered data consistent with large-scale research evaluations of changes in quality of life for joint replacement patients. The finding that patients' global health status measures did not change despite improvements in quality of life subscales indicates that the instrument reliably netted out the quality of life benefits of the arthritis-related intervention from the patients' total burden of illness.

Compounds interfering with ovum implantation and development. I. Alkaloids and antimetabolites.

PIP: The alkaloids ergocornine, vinblastine, and colcemide, with reported effects interfering with ovum implantation and development were investigated in the white New Zealand rabbit and the macaque monkey. 3 antimetabolites, 5-fluorouracil, 6-azauridine, and BW 57-323H, the 6 mercaptopurine derivative, were also investigated. Ergocornine was ineffective at the dosage employed (1.5-2.5 mg/kg) and vinblastine was teratogenic. Colcemide was administered in single doses ranging from .1-5 mg/kg. From Day 9 until term it was an extremely toxic agent to the developing fetus, death occurring within 2-4 hours after administration. At 5.0 mg/kg, 50% of the animals died from toxicity. Administration in the macaque monkey on Days 24, 45, 66, and 84 of pregnancy was without effect. 2-antimetabolites tested in the rabbit (5-fluorouracil and 6-azauridine) had little effect. BW 57-323H administered interperitoneally to pregnant rabbits resulted in complete litter destruction early in pregnancy, was teratogenic midpregnancy and ineffective in late pregnancy. This compound was without effect in macaques when administered on Days 28-30.^ieng