Genetic diversity, geographical range and origin of Bemisia tabaci (Hemiptera: Aleyrodidae) Indian Ocean Ms.

The whitefly Bemisia tabaci is a pest vector of begomoviruses on crops worldwide. Bemisia tabaci is composed of a complex of cryptic species which barely interbreed. An exception is the Ms from the South West Indian Ocean (SWIO), which crosses in low proportions with the exotic B. The Ms, together with B and Q is part of the same phylogenetic clad. To infer the genetic structure, the geographical range and putative origin of this putative species, microsatellite data and mitochondrial DNA (cytochrome oxydase I) sequences were analysed on an extensive sample set, including all the islands of the region and samples from mainland Africa. Only B and Ms populations were detected across these islands. The exotic B was found only on the islands of Réunion and Mauritius, whereas the Ms is found on all the SWIO islands. Very high isolation by distance was found for the Ms populations between islands of the SWIO, suggesting a long period of presence in this region. Ms populations from mainland Africa had a higher COI diversity than the Ms of the SWIO islands. This diversity is correlated with size and geological ages of the SWIO islands. The population genetic data obtained are in accordance with an origin of Ms in Africa, followed by its expansion and evolution across the SWIO islands prior to human arrival, confirming the status of Ms as indigenous in the SWIO islands.

Cost containment and quality of life. An experiment in compassion for physicians.

A review of emergency department visits during a 2-year period and before and after the liberation of physicians from a requirement of gatekeeping for some patients during the night showed no significant increases in the use or costs of services to our Medicaid enrollees for all but children under 6 years of age between 10 PM and midnight. We recommend that a more humane and practical view be taken of middle-of-the-night gatekeeping requirements for physicians functioning in managed-care environments. We also suggest, as many hospitals have already learned, that the costs of emergency department services for Medicaid patients can be reduced and that care may be enhanced by the offering of 24-hour urgent care services at or near the emergency department.

A survey of retirement planning by Texas psychiatrists.

Forty-six percent (274 of 600) of the members of the Texas Society of Psychiatric Physicians responded to a mailed survey that addressed retirement issues. Forty-seven percent of respondents were 60 to 69 years of age. Only 12% were female. Ninety-one percent were white, with 86% of respondents married. Only 24% of the sample (66 of 274) were retired at the time of the survey. Although engaged in more than one area of professional activity, 71% were involved in private practice, with 51% practicing in a private office. The major reasons for retiring were "a full life and ready to change pace" (52%) and "retired to pursue other interests" (25%). Twenty percent retired because of physical illness. A mixed financial package formed their retirement package, which included social security (80%), personal savings (73%), Keogh (64%), and state/US government monies (39%). Retired psychiatrists were interested in receiving additional information on successful patterns of retirement (21%), maintaining emotional and physical health (17%), and material on the problems and trials of retirement (15%). Leisure-time activities were varied, and most psychiatrists reported two to four activities. According to 39% of the sample, retirement should be discussed during medical school, 46% indicated that it should be discussed during residency training, and 80% selected Continuing Medical Education courses.

An outcomes analysis approach to utilization management: quality assessment of appropriateness of specialty referrals.

This report illustrates some methods by which to identify, guide, and develop acceptable levels of expected outcomes, defined as the validity or appropriateness of specialty referrals or procedures, through utilization management case studies and interventions. Outcomes variables may be used as standardized ongoing measures of cost-effectiveness and quality of health care services, focusing on appropriateness of utilization of specialty resources and health care technology. Community, regional, and national standards for such measures are currently being developed and evaluated for assessing the appropriateness of the use of health care technology. These standards for desired or expected outcomes need to become an integral part of utilization management as well as quality assessment and improvement, and are very helpful tools for developing specific interventions to be used for improving upon and documenting the cost-effective delivery of care within health services organizations.

Cost-effectiveness of case management: experiences of a university managed health care organization.

Effective, multifaceted, and short-term case management services can result in significant, quantifiable cost savings for managed Medicaid, Medicare, and other health care programs. Such savings clearly offset the administrative costs of support for case managers, social services departments, and utilization management services. This report reviews various case management models, the costs for case management staff and resource support, and a number of quantified ways in which a social service and utilization management team model saved significant dollars in a number of different service areas. This cost-benefit analysis financially justifies administrative support for case management services in the budgets of managed Medicaid programs. Case management is a cost-effective and quality of care management tool.

Cost and quality outcomes of comprehensive epilepsy monitoring review of referrals in a managed Medicaid program.

The proceedings of the National Institute of Health's "Consensus Development Conference on Epilepsy Surgery" was published in March 1990. In it, the conclusion was made that, while surgery for intractable epilepsy can stop or decrease documented seizures, "effects in overall health status and quality of life have not been adequately studied." Recommendations for standardized data collection for surgery in qualified, technologically-equipped centers included the need for follow-up studies of outcomes for at least five years. The University of Arizona's Epilepsy Center was established in 1984, and the Arizona Comprehensive Epilepsy Monitoring Program started at the University of Arizona Health Sciences Center in 1990. Patients from various payer sources have been managed, and many surgeries have been performed. This report focuses on patients covered under the state's managed Medicaid program for patients under a full-risk, capitated managed care contract with University Physicians. The Arizona Health Care Cost Containment System (AHCCCS) contracted with University Physicians, Inc., of the University of Arizona Health Sciences Center, for comprehensive health care services under a capitated payment mechanism from 1982 to 1992. Thereafter, University Physicians has provided services through subcontracts with other managed care organizations. This report focuses on this Medicaid population.

Pre-operative CT angiography and three-dimensional image post processing for deep inferior epigastric perforator flap breast reconstructive surgery.

Autologous breast reconstructive surgery with deep inferior epigastric artery (DIEA) perforator flaps has become the mainstay for breast reconstructive surgery. CT angiography and three-dimensional image post processing can depict the number, size, course and location of the DIEA perforating arteries for the pre-operative selection of the best artery to use for the tissue flap. Knowledge of the location and selection of the optimal perforating artery shortens operative times and decreases patient morbidity.

Terrestrial molluscs of Pemba Island, Zanzibar, Tanzania, and its status as an "oceanic" island.

Pemba is thought to have had a longer and/or stronger history of isolation than its better-known counterpart, Unguja. The extent to which the biota support this hypothesis of greater oceanicity have been debated. Here, Pemba's terrestrial mollusc ("land-snail") fauna is surveyed and reviewed for the first time. We find at best equivocal evidence for the following hallmarks of greater oceanicity: impoverishment, imbalance, and a high rate of endemism. At least 49 species are present, families are represented in typical proportions, and there are only between two and four island-endemic species - i.e. a 4% to 8% rate of endemism. For land-snails, isolation thus seems to have been short (Pleistocene) or, if longer, weak. Nevertheless, Pemba does host endemic and globally rare species. Forty-five percent of the species found, including most of these, is restricted to forest reserves, with Ngezi Forest Reserve particularly rich. A further 45% are able to tolerate the island's woody cultivated habitats. One new snail species (Cyclophoridae: Cyathopoma) and one new slug species (Urocyclidae: Dendrolimax pro tem.) are described. New data and illustrations are provided for other taxa.

Angiography in the diagnosis of renal scleroderma.

Three patients with different stages of renal scleroderma are presented, and the angiographic diagnosis of this disease is dicussed. No one pattern is specific, but the combination of findings is considered diagnostic of this disease. Pharmacoangiography is proposed for differential of renal scleroderma, and selective renal artery infusion of vasodilators is suggested as a potential means of therapy.

Antenatal ultrasonic demonstration of fetal bowel.

Although ultrasound evaluation of the adult gastrointestinal tract is largely impossible because of bowel gas, the fetal bowel is fluid-filled and therefore not subject to this limitation. In our experience, the fetal bowel pattern can be recognized and antenatal abnormalities detected.

Comparative costs of urgent care services in university-based clinical sites.

OBJECTIVE: To identify the most cost-effective utilization of resources for urgent care for a managed care Medicaid population at a university medical center. The null hypothesis was that there are no significant differences between the costs and types of services for patients with comparable urgent care problems who are seen in outpatient clinical settings compared with those seen in the central emergency department of a university medical center. DESIGN: Retrospective case study comparing patient visits and charges for three clinical urgent care locales by diagnosis, severity of illness, age group, time period in which seen, and reason for referral. SETTING: Ambulatory care and hospital emergency department facilities at a university medical center. PATIENTS: 1096 Medicaid patients who were enrolled in the university physicians' managed care plan. MAIN OUTCOME MEASURES: Diagnosis-specific comparisons of types of services and charges for patient visits. RESULTS: There were significantly higher charges for all urgent care diagnoses of patients treated in the emergency department compared with urgent care facilities; these costs were higher in all categories of charges. CONCLUSIONS: A variety of alternatives to use of the full emergency department are more cost-effective in providing urgent care services for Medicaid clients in a managed care setting.

Antenatal diagnosis of hydranencephaly by ultrasound: correlation with ventriculography and computed tomography.

A case of hydranencephaly was demonstrated antenatally by ultrasound and correlated with ventriculography and computed cranial tomography. Prenatal diagnosis of intracranial abnormalities by careful attention to intracranial anatomy is possible and can facilitate obstetrical management.

Echocardiographic observation of ventricular volume changes and swinging septal position in massive pericardial effusion.

Swinging interventricular septal position and ventricular volume changes associated with respiration were studied in a patient with massive uremic pericardial effusion and pulsus paradoxus. Inspiration was regularly associated with a posterior swinging septal position which dramatically increased right ventricular (RV) volume with a lesser change in left ventricular (LV) volume. Expiration was consistently accompanied by an anterior swing of septal position which nearly obliterated the RV with slight enlargement of the LV. The above changes produced a pendulum-like motion of the septal position as the patient breathed. This may reflect the ventricular volume changes that accompany respiration in severe pericardial effusion association with pulsus paradoxus.

Prostate cancer: comparison of digital rectal examination and transrectal ultrasound for screening.

A prostate cancer screening study of 315 asymptomatic men comparing digital rectal examination and transrectal ultrasound identified 23 cancers, for a detection rate of 7.3%. Of the cancers 17 (5.4%) were diagnosed by digital rectal examination. Contrary to the experience of others, this was a higher rate than achieved by transrectal ultrasound (14 cases or 4.4%). Systematic multiple needle biopsies of both lobes with ultrasound guidance were routinely performed. As a result of this technique 7 of 23 cancers (30%) were fortuitously diagnosed. In addition, only unilateral disease was suspected in 4 of 7 patients with bilateral disease on biopsy. Digital rectal examination and transrectal ultrasound identified the same number of patients with small (less than 1.5 cm.) cancers, contrary to other reports that found transrectal ultrasound to be superior. Digital rectal examination is considered an effective screening examination, equivalent to transrectal ultrasound and preferable because of lower cost. An algorithm for screening is outlined with digital rectal examination and prostate specific antigen determinations.

Prostate cancer: correlation of digital rectal examination, transrectal ultrasound and prostate specific antigen levels with tumor volumes in radical prostatectomy specimens.

Volume and distribution of prostatic carcinoma were measured in 30 radical prostatectomy specimens. Obtaining these data was facilitated by the use of whole tissue mounts. Similar measurements were obtained from preoperative transrectal ultrasound studies. With this information the ability of digital rectal examination and transrectal ultrasound to predict tumor burden was analyzed. It was concluded that both of these examinations are poor predictors of tumor volume, distribution and pathological stage. Preoperative prostate specific antigen levels were correlated with the pathological data. It appeared that prostate specific antigen levels of greater than 10 presage [corrected] tumor volumes of greater than 3 cc, and that levels of more than 50 are suggestive of stages C and D disease.