Sputum smear examination and time to diagnosis in patients with smear-negative pulmonary tuberculosis in the Pacific.

SETTING: National tuberculosis programmes (NTPs) in Kiribati and the Marshall Islands, 2006-2010. OBJECTIVE: To determine the proportion of all tuberculosis (TB) cases that were pulmonary smear-negative, and for these patients to determine how many sputum smears were examined and the time from sputum smear examination to registration. DESIGN: A retrospective cross-sectional study involving a record review of national TB and laboratory registers. RESULTS: Of 2420 TB cases identified, 709 (29%) were registered as smear-negative pulmonary TB. Of the 695 (98%) with information on smear examination, 222 (32%) had no smear recorded, 61 (9%) had one smear, 86 (12%) two smears and 326 (47%) three smears. Among the 473 patients who had at least one smear, 238 (50%) were registered before sputum examination, 131 (28%) within 1 week, 72 (15%) between 1 and 4 weeks, and 34 (7%) >4 weeks after sputum examination. CONCLUSION: NTPs in Kiribati and the Marshall Islands are diagnosing 29% of all TB patients as smear-negative pulmonary TB. Many patients do not have smears done or are registered before undergoing smear examination. Corrective measures are needed.

Complex interplays among population dynamics, environmental forcing, and exploitation in fisheries.

The patterns of variations in fisheries time series are known to result from a complex combination of species and fisheries dynamics all coupled with environmental forcing (including climate, trophic interactions, etc.). Disentangling the relative effects of these factors has been a major goal of fisheries science for both conceptual and management reasons. By examining the variability of 169 tuna and billfish time series of catch and catch per unit effort (CPUE) throughout the Atlantic as well as their linkage to the North Atlantic Oscillation (NAO), we find that the importance of these factors differed according to the spatial scale. At the scale of the entire Atlantic the patterns of variations are primarily spatially structured, whereas at a more regional scale the patterns of variations were primarily related to the fishing gear. Furthermore, the NAO appeared to also structure the patterns of variations of tuna time series, especially over the North Atlantic. We conclude that the patterns of variations in fisheries time series of tuna and billfish only poorly reflect the underlying dynamics of these fish populations; they appear to be shaped by several successive embedded processes, each interacting with each other. Our results emphasize the necessity for scientific data when investigating the population dynamics of large pelagic fishes, because CPUE fluctuations are not directly attributable to change in species' abundance.

Relationship of vitamin A deficiency, iron deficiency, and inflammation to anemia among preschool children in the Republic of the Marshall Islands.

INTRODUCTION: Although vitamin A deficiency, iron deficiency, and inflammation may contribute to anemia, their relative contribution to anemia has not been well characterized in preschool children in developing countries. OBJECTIVE: To characterize the contributions of vitamin A and iron deficiencies and inflammation to anemia among preschool children in the Republic of the Marshall Islands. SUBJECTS AND METHODS: A community-based survey, the Republic of the Marshall Islands Vitamin A Deficiency Study, was conducted among 919 preschool children. The relationship of vitamin A and iron status and markers of inflammation, tumor necrosis factor-alpha, alpha1-acid glycoprotein, and interleukin-10, to anemia were studied in a subsample of 367 children. RESULTS: Among the 367 children, the prevalence of anemia was 42.5%. The prevalence of severe vitamin A deficiency (serum vitamin A < 0.35 micromol/l) and iron deficiency (serum ferritin < 12 microg/dl) were 10.9 and 51.7%, respectively. The respective prevalence of iron deficiency anemia (hemoglobin < 110 g/l and iron deficiency), anemia with inflammation (anemia with TNF-alpha > 2 pg/ml and/or AGP > 1000 mg/l), and severe vitamin A deficiency combined with anemia was 26.7, 35.6, and 7.6%. In multivariate linear regression models that adjusted for age, sex, and inflammation, both iron deficiency (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.08-2.83, P = 0.023) and severe vitamin A deficiency (OR 4.85, 95% CI 2.14-10.9, P < 0.0001) were significantly associated with anemia. CONCLUSIONS: Both iron and vitamin A deficiencies were independent risk factors for anemia, but inflammation was not a significant risk factor for anemia among these preschool children.

Automatic orienting of visuospatial attention in Parkinson's disease.

The basal ganglia are involved in not only motor behavior, but also other more cognitive processes, such as attention. We tested Parkinson's disease (PD) patients in a task that measures reflexive orienting of spatial attention. Seven patients with idiopathic PD and eight control subjects performed a covert orienting task where spatial attention was directed by means of exogenous cues (luminance increments) with no predictive validity for target position. The subjects' task was to make a speeded saccade to a visual target, which appeared a variable time after onset of the cue either in the cued or an uncued spatial position. There was no overall difference between PD patients and control subjects in terms of the initial facilitation following reflexive cues, and later inhibition of return (IOR). However, PD patients differed from control subjects in two important respects. First, they were significantly faster than were control subjects on this reflexive visual-orienting task. Second, disease severity correlated with attentional performance; more advanced patients showed less initial facilitation but greater IOR. Thus PD patients show better performance on a reflexive saccade task and, for more advanced patients, greater IOR than control subjects. These findings are consistent with the possibility that reflexive attentional processes in PD patients may be more active.

Retinol binding protein as a surrogate measure for serum retinol: studies in vitamin A-deficient children from the Republic of the Marshall Islands.

BACKGROUND: Serum retinol is transported by retinol binding protein (RBP), which has one high-affinity binding site for retinol; consequently, the molar ratio of retinol to RBP in the circulation is approximately 1 to 1. In vitamin A deficiency (VAD), both serum retinol and RBP decline. However, the retinol-RBP relation has not been well studied in populations with a high incidence of severe VAD. OBJECTIVE: The purpose of this study was to determine whether RBP is a good surrogate for serum retinol at the very low retinol concentrations encountered in VAD. DESIGN: The stoichiometric relation between retinol and RBP was studied in 239 Marshallese children: 65 with severe VAD (< or = 0.35 micromol retinol/L), 94 with moderate VAD (0.36-0.70 micromol retinol/L), and 80 with vitamin A sufficiency (> 0.70 micromol retinol/L). RESULTS: Excellent correlation between retinol and RBP (r = 0.94) was observed across all retinol concentrations. Severe VAD was predicted with 96% sensitivity and 91% specificity on the basis of an RBP cutoff of < or = 0.48 micromol/L, whereas moderate VAD was predicted with 87% sensitivity and 98% specificity on the basis of an RBP cutoff of < or = 0.70 micromol/L. CONCLUSIONS: The use of RBP results in the classification of essentially the same children with VAD as does retinol, and RBP is an excellent surrogate for serum retinol. Considering the relative ease of measuring RBP with immunodiagnostic kits compared with that of serum retinol by HPLC, the use of RBP concentrations to assess VAD may be particularly advantageous in field settings. Consequently, measuring RBP concentrations may be a practical alternative to measuring serum retinol in population surveys assessing the prevalence of VAD.

Schizotypal traits, attention and eye movements.

1. Subjects demonstrating high, average, or low schizotypal traits participated in saccade tasks of eye movements and attention including: a simple saccade task, an antisaccade task, and/or a cued saccade task measuring both facilitatory effects of cuing and inhibition of return (IOR). 2. Subjects were recruited based on their scores on the Rust Inventory of Schizotypal Cognitions (RISC) and then were given Raine's Schizotypal Personality Questionnaire (SPQ) (1991). 3. Subjects scoring high in schizotypy demonstrated increased errors on the voluntary eye movement task (antisaccade task) (p<0.05). Performance on the reflexive saccade task was not impaired in high compared to low schizotypals, but may have been enhanced as demonstrated by a negative correlation between scores on the SPQ and performance on this task. For the cued saccade task, there were no overall differences in cueing effects between schizotypal groups, however there was a laterality difference between low versus high scoring schizotypal subjects. 4. These results indicate distinct differences in tasks of overt orienting (saccade and antisaccade tasks) and covert orienting tasks (cued saccade task). The patterns of performance by our schizotypy subjects, including impaired voluntary saccade, enhanced reflexive saccade, and lateralized performance on the cued saccade task, are consistent with the performance of schizophrenic patient populations. Thus, our study supports the previous findings of a physiological relationship between schizotypal personality and schizophrenia.

Inhibition of return in manual and saccadic response systems.

When nonpredictive exogenous visual cues are used to reflexively orient covert visual spatial attention, the initial early facilitation for detecting stimuli at cued versus uncued spatial locations develops into inhibition by 300 msec following the cue, a pattern referred to as inhibition of return (IOR). Experiments were carried out comparing the magnitude and time course for development of IOR effects when manual versus saccadic responses were required. The results showed that both manual and saccadic responses result in equivalent amounts of facilitation following initial exposure to a spatial cue. However, IOR developed more quickly for saccadic responses, such that, at certain cue-target SOAs, saccadic responses to targets were inhibited, whereas manual responses were still facilitated. The findings are interpreted in terms of a premotor theory of visual attention.

Control of voluntary and reflexive saccades in Parkinson's disease.

Eight patients with idiopathic Parkinson's disease (PD) were compared with a group of age-matched controls on both reflexive saccade and antisaccade tasks. While reflexive, visually guided saccades led to equivalent performance in both groups, PD patients were slower, made more errors, and showed reduced gain on antisaccades (AS). This is consistent with previous results showing that PD patients have no difficulty with reflexive saccades but show deficiencies in a number of voluntary saccade paradigms. Moreover, visual information in the form of landmarks improves AS performance more for PD patients than controls, a finding analogous to results seen with other motor acts such as target-directed pointing. Results are discussed in terms of a two-process model of attention and eye movements.

Selective attention to global and local structure of objects: alternative measures of nontarget processing.

When individuals are asked to report either the global or the local level of structure in a stimulus pattern located inside a relevant object, distractors located within an irrelevant object will interfere only if they are at the same level of structure as that of the target item (Briand, 1993; Paquet & Merikle, 1988). The basis of this level-specific filtering is unclear, as is the true level of semantic analysis for the ignored items. In the present series of experiments, multiple measures of nontarget processing were used to assess concurrent interference, negative priming, and a category effect supposedly reflecting a more abstract level of semantic analysis. These different indicants were assessed in three experiments in which form, color, or a spatial precue was used to direct attention to the relevant stimulus pattern. Overall, cuing by form produced poorer spatial selectivity, whereas spatial precues and color led to better selectivity. However, the three measures of nontarget processing were not equally affected by these manipulations, with global information showing more evidence for semantic analysis than for local analysis regardless of the type of selection cue used. The results suggest that inhibition is not the basis of target selection when ignored items are local, but that it may be used when global items are ignored.

Letter identification declines with increasing retinal eccentricity at the same rate for normal and dyslexic readers.

It has recently been claimed (Geiger & Lettvin, 1987; Perry, Dember, Warm, & Sacks, 1989) that the acuity/eccentricity function is flatter in dyslexics than in normal subjects, with dyslexics showing better performance in the periphery and worse performance at fixation. In these studies, all target letters were presented to the right of fixation, a procedural flaw inviting subjects to optimize performance by directing attention and/or gaze to the right of the designated fixation point. It is suggested that dyslexic and normal readers may differ in the degree to which they might adopt the optimal strategy in this situation. To overcome this problem, target letters were briefly presented at 16 randomly intermixed locations derived from the orthogonal combination of four eccentricities and four directions from fixation (above, below, right, left). The accuracy of letter identification declined with increasing eccentricity at the same rate for good and poor adult readers and dyslexic teenagers. This finding provides no support for the view that the acuity/eccentricity function might vary with and possibly cause differences in reading level.

Is Posner's "beam" the same as Treisman's "glue"?: On the relation between visual orienting and feature integration theory.

In the present study we investigated whether the visually allocated "beam" studied by Posner and others is the same visual attentional resource that performs the role of feature integration in Treisman's model. Subjects were cued to attend to a certain spatial location by a visual cue, and performance at expected and unexpected stimulus locations was compared. Subjects searched for a target letter (R) with distractor letters that either could give rise to illusory conjunctions (PQ) or could not (PB). Results from three separate experiments showed that orienting attention in response to central cues (endogenous orienting) showed similar effects for both conjunction and feature search. However, when attention was oriented with peripheral visual cues (exogenous orienting), conjunction search showed larger effects of attention than did feature search. It is suggested that the attentional systems that are oriented in response to central and peripheral cues may not be the same and that only the latter performs a role in feature integration. Possibilities for future research are discussed.