Phylogeography of stable fly (Diptera: Muscidae) estimated by diversity at ribosomal 16S and cytochrome oxidase I mitochondrial genes.

The blood-feeding cosmopolitan stable fly, Stomoxys calcitrans L. (Diptera: Muscidae), is thought to disperse rapidly and widely, and earlier studies of allozyme variation were consistent with high vagility in this species. The geographic origins of New World populations are unknown. Diversity at mitochondrial loci r16S and cytochrome oxidase I was examined in 277 stable flies from 11 countries, including five zoogeographical regions. Of 809 nucleotides, 174 were polymorphic and 133 were parsimony informative. Seventy-six haplotypes were found in frequencies consistent with the Wright-Fisher infinite allele model. None were shared among four or more zoogeographical regions. The null hypothesis of mutation neutrality was not rejected, thereby validating the observed distribution. Fifty-nine haplotypes were singular, eight were private and confined to the Old World, and three of 76 haplotypes were shared between the Old and New World. Only 19 haplotypes were found in the New World, 14 of which were singletons. Haplotype and nucleotide diversities were heterogeneous among countries and regions. The most diversity was observed in sub-Saharan Africa. Regional differentiation indices were C(RT) = 0.26 and N(RT) = 0.31, indicating populations were highly structured macrogeographically. Palearctic and New World flies were the least differentiated from each other. There were strong genetic similarities among populations in the Nearctic, Neotropical, and Palearctic regions, and it is most likely that New World populations were derived from the Palearctic after 1492 CE, in the colonial era.

A prospective clinical evaluation of an equation to predict daily lithium dose.

BACKGROUND: Conclusions about the usefulness of lithium dose-prediction equations are often based on retrospective evaluations, and the paucity of prospective tests is striking. METHOD: We prospectively evaluated the safety and accuracy of a lithium-dose prediction equation in a group of 29 psychiatric patients. Predicted doses were computed and rounded to the nearest multiple of 300 mg, and the respective doses of lithium carbonate were given either two or three times a day. On Day 4 or 5 following treatment initiation, morning blood samples were collected 8 to 12 hours after administration of the last dose. Patients were monitored carefully for signs of lithium toxicity. RESULTS: All 29 subjects achieved lithium concentrations between 0.5 and 1.3 mmol/L within 5 days of beginning treatment, and no participant showed any signs of lithium toxicity. CONCLUSION: The equation may be a safe, reasonable alternative to empiric dosing.

Thyroid stimulating hormone and prolactin responses to thyrotropin releasing hormone in nondepressed alcoholic inpatients.

Thyroid stimulating hormone (TSH) and prolactin (PRL) responses to thyrotropin releasing hormone (TRH) stimulation are sometimes blunted in alcoholic subjects; however, the mechanisms involved in these phenomena have not been established. We hypothesized that elevations in free thyroid concentrations might be related to these abnormal responses and then tested that hypothesis in a sample of nondepressed alcoholic inpatients (n = 21). Four alcoholic patients had delta max TSH responses that were < 7 mIU/l; three had PRL responses at or below 8 micrograms/l. Baseline TSH was the only significant predictor of peak TSH; however, free thyroxine (FT4) and baseline TSH both were significant predictors of peak PRL. The average baseline FT4 concentration in alcoholic patients was significantly higher than that in healthy control subjects (n = 10). Our data, thus, suggest that small elevations of FT4 play a role in the inhibition of TSH and PRL responses to TRH among nondepressed, abstinent alcoholic patients.

Light suppression of melatonin in unipolar depressed patients.

The effects of nocturnal light (500 lux) exposure on plasma melatonin were studied in seven men suffering from unipolar depression and in seven healthy men. Both groups showed significant declines in plasma melatonin concentrations during 1 hour's light exposure. Differential group declines were not detected.

The role of the Agency for Health Care Policy and Research (AHCPR) in improving outcomes of care.

This article describes the various outcomes programs supported by the Agency for Health Care Policy and Research (AHCPR). The mission of the agency is to generate and disseminate information that improves the delivery and quality of health care. The agency is charged with helping consumers, providers, purchasers, health plans, and policy makers meet the challenge of improving the quality of health care services while reducing spending. AHCPR has been recognized as funding the development of "gold standard" clinical practice guidelines and the source of unbiased, science-based information on what works and does not work in health care.

Spatial diversity in mitochondrial cytochrome c oxidase in house flies.

DNA sequence analysis at mitochondrial gene COI was surveyed in 293 house flies, Musca domestica Linneaus (Diptera: Muscidae), in 29 populations from North, Central and South America, Europe, Asia, Africa, and the Western Pacific. Nei's gene diversity index (H(S)) was 0.47, the chance that two randomly chosen flies have different COI haplotypes. Haplotype diversity was greater in the Old World (H(S) = 0.58) than the New World (H(S) = 0.31). The hierarchical partition of the total diversity indicated substantial differentiation at all levels (G(ST) = 0.30), and highly structured populations. All pairwise estimates of gene flow between zoogeographical regions were less than 0.70 reproducing females per generation. The results are compared to those of a similar study based on the single-strand conformation polymorphism method. Probable colonization scenarios for house flies into the New World are discussed and it is concluded that house flies are a recent addition to the fauna of the Western Hemisphere.

North American face flies Old World origins: mitochondrial evidence.

Analysis of a 513 base sequence of mitochondrial cytochrome oxidase I gene in Musca autumnalis De Geer (Diptera: Muscidae) from the U.S.A., England, Russia and Kazakhstan confirms that North American flies originated in Western Europe. Flies from the U.S.A., England and southern Russia shared most of their mitochondrial diversities, but face flies from Kazakhstan were substantially dissimilar, suggesting highly restricted gene flow and a species complex within the Palearctic.

Geographic differentiation in the house fly estimated by microsatellite and mitochondrial variation.

Gene flow over very large geographic scales has been investigated in few species. Examples include Drosophila melanogaster, Drosophila subobscura, Drosophila simulans, and the Mediterranean fruit fly (Ceratitis capitata). The cosmopolitan house fly, a highly vagile, fecund, colonizing species offers an additional exemplar. Genotypes at seven microsatellite loci were scored in 14 widely separated natural house fly populations from the Nearctic, neotropics, Afrotropics, Palearctic, and Asia. Allelic diversities and heterozygosities differed significantly among populations. Averaged over all populations, Weir and Cockerham's theta = 0.13 and RST = 0.20. Pairwise genetic distance measures were uncorrelated with geographic distance. Microsatellite frequencies were compared with mitochondrial data from 13 of the same populations in which theta = 0.35 and Nei's GST = 0.72. Mitochondrial variation indicated up to threefold greater indices of genetic differentiation than the microsatellites. We were unable to draw any biogeographical inferences from these results or from tree or network topologies constructed from the genetic data. It is likely that high microsatellite diversities, mutation rates, and homoplasy greatly compromised their usefulness in estimating gene flow. House fly colonization dynamics include a large number of primary and secondary colonizations coupled with substantial genetic drift, but no detectable bottlenecks.

Methodological challenges and innovations in patient outcomes research.

Between 1989 and 1992, the Agency for Health Care Policy and Research (AHCPR) awarded funding to 14 special projects known as Patient Outcomes Research Teams (PORTs). These large, complex projects form the centerpiece of the first generation of research under the Medical Treatment Effectiveness Program. In carrying out their individual 5-year research plans, and through collaborative work of six Inter-PORT Work Groups, PORTs have contributed to methodological advances related to their specific clinical focus and to outcomes research in general. Each of the PORTs has followed a standard research model, involving the application of: systematic literature review, measurement of outcomes, analysis of cost and claims data, decision analysis, and strategies for disseminating findings. This article reports what has been learned by individual PORTs, and by AHCPR, regarding the usefulness of each of these methodologies, both for the ongoing projects and for the next generation of effectiveness research. Example from individual PORTs and work groups illustrate some of the methodological gains that have been made in effectiveness research and provide a glimpse of the work that remains to be done.

The relationship between alexithymia and depressive symptoms in a sample of newly abstinent alcoholic inpatients.

The purpose of this investigation was to measure alexithymia in 90 newly abstinent alcoholism treatment candidates and to examine the relationship between alexithymia and depressive symptoms. Subjects completed the Schalling-Sifneos Personality Scale (SSPS) and the Beck Depression Inventory (BDI) at the time of application for care. The correlation between subjects' SSPS scores and their BDI scores was statistically significant (r = -0.398; p less than 0.001). Study participants with high BDI scores tended to be 'more alexithymic' than were those with low BDI scores. The authors conclude that alexithymia may serve as a defensive operation for alcoholic patients denying painful affect.

Evaluation of legal competency in patients with frontal lobe injury.

In recent decades, the relationship of the patients and health care provider has evolved into an informed, collaborative effort to recover from illness. The movement of patients from passive to active participants in treatment planning has caused an increasing need for patients to be competent, to successfully perform often complex analysis of available options, risks inherent in these options, and potential benefits of choosing one course of action over another. While competency is determined by the courts, the courts rely heavily on the opinions of health care providers with expertise regarding mental and emotional processes. Thus, knowledge of both legal standards of competency and of the mental and emotional processes which support competency have become increasingly important. Competency has been held to be comprised of perception and comprehension of a relevant body of information; memory and recall of relevant information well enough to support further mental evaluation of the information; the capacity to identify personal options implicit in the information and to logically deliberate among the available options based on relative potential risks and the benefits; and the capacity to make an enduring decision based on prior logical deliberation. The assessment of competency is even more difficult in the patient with executive dysfunction. Neuropsychological assessment, which is traditionally used to assess cognitive functioning, has not been as helpful in the quantification of the patient's ability to solve problems in a logical manner. This paper will outline the requisite steps in assessing competency and review the current data available on the neuropsychological assessment of frontal lobe dysfunction in competency determination.

Alexithymia: subscales and relationship to depression.

The purpose of this study was to determine the extent to which Toronto Alexithymia Scale (TAS) scores and derived subscale scores changed in a sample of newly abstinent alcoholic inpatients. Subjects completed the TAS and the Beck Depression Inventory (BDI) on the date of their application for care (Time 1) and at the end of their 3rd week in treatment (Time 2). Patients' mean BDI scores dropped significantly from Time 1 to Time 2; however, the expected concomitant drop in mean TAS scores did not occur. TAS subscales analysis suggests that the subscale associated with the ability to identify one's feelings and to distinguish them from bodily sensations may capture the alexithymia construct better by itself than when combined with the second 2 subscales, daydreaming and external thinking, to create the total TAS score.

Validation of the Toronto Alexithymia Scale with substance abusers.

The purposes of this paper were to complete factor and item analyses of the Toronto Alexithymia Scale (TAS) in a sample of mixed substance abusers and to examine the correlations between patients' TAS scores and other variables. Results indicate that the TAS is a reliable, valid measure of alexithymia for substance abusers. The factor structure we found is congruent with the theoretical construct and is similar to those published in the normative studies; coefficient alpha reliability was 0.68. Additionally, a high percentage of the subjects (50.4%) scored in the alexithymic range while 24% had scores in the nonalexithymic range. Patients' TAS scores were positively associated with Beck Depression Inventory scores, with a reported paternal history of alcoholism, and with attempted suicide; TAS scores were negatively associated with being Black.