Age-at-first-admission of schizophrenia, bipolar disorder and major depression: Implications of heterogeneity

Age of onset is an important variable when considering the cause and course of mental illnesses. Given the debate about the relationship between psychotic disorders it would be useful to compare age-at-first-admission for ICD schizophrenia and for affective psychoses when the latter is differentiated into 'major depression' and 'bipolar disorder'. Data on age-at-first-admission for Australian-born individuals diagnosed with schizophrenia (ICD 295) or affective psychosis (ICD 296) were extracted from the Queensland Mental Health Statistics System -- a comprehensive, namelinked mental health register. Because the ICD 9 category 296.1 was used to code what is now called "major depressive episode', this group was differentiated from other 296 categorieswhich were considered bipolar disorders. Those receiving more than one diagnoses within these categories were excluded. All distributions show a wide age range of onset from early adolescence into the seventies and eighties. However the modal age-group for major depression ('60-69' for both sexes) is clearly different from bipolar disorder ('20-29' for males; '30- 39' for females), the latter distribution being more similar to the SCZ distribution (which had a model age-group of '20-29' for both sexes). While these distributions were similar for males and females, there were sex differences in the proportions within each diagnostic group: more males with schizophrenia, and more females with bipolar disorder and with major depression. Our results suggest heterogeneity within the affective psychoses as categorised by ICD 9, with bipolar disorder having an age-at-first-admission distribution more similar to schizophrenia than major depression. The Stanley Foundation supported this project.

Hemichordates and deuterostome evolution: robust molecular phylogenetic support for a hemichordate plus echinoderm clade

Hemichordates were traditionally allied to the chordates, but recent molecular analyses have suggested that hemichordates are a sister group to the echinoderms, a relationship that has important consequences for the interpretation of the evolution of deuterostome body plans. However, the molecular phylogenetic analyses to date have not provided robust support for the hemichordate + echinoderm clade. We use a maximum likelihood framework, including the parametric bootstrap, to reanalyze DNA data from complete mitochondrial genomes and nuclear 18S rRNA. This approach provides the first statistically significant support for the hemichordate + echinoderm clade from molecular data. This grouping implies that the ancestral deuterostome had features that included an adult with a pharynx and a dorsal nerve cord and an indirectly developing dipleurula-like larva.

Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study

Background and Purpose-Few community-based studies have examined the long-term survival and prognostic factors for death within 5 years after an acute first-ever stroke. This study aimed to determine the absolute and relative survival and the independent baseline prognostic Factors for death over the next 5 years among all individuals and among 30-day survivors after a first-ever stroke in a population of Perth, Western Australia. Methods-Between February 1989 and August 1990, all individuals with a suspected acute stroke or transient ischemic attack of the brain who were resident in a geographically defined region of Perth, Western Australia, with a population of 138 708 people, were registered prospectively and assessed according to standardized diagnostic criteria. Patients were followed up prospectively at 4 months, 12 months, and 5 years after the index event. Results-Three hundred seventy patients with first-ever stroke were registered, and 362 (98%) were followed up at 5 years, by which time 210 (58%) had died. In the first year after stroke the risk of death was 36.5% (95% CI, 31.5% to 41.4%), which was 10-fold (95% CI, 8.3% to 11.7%) higher than that expected among the general population of the same age and sex. The most common cause of death was the index stroke (64%). Between 1 and 5 years after stroke, the annual risk of death was approximately 10% per year, which was approximately 2-fold greater than expected, and the most common cause of death was cardiovascular disease (41%). The independent baseline factors among 30-day survivors that predicted death over 5 years were intermittent clandication (hazard ratio [WR], 1.9; 95% CI, 1.2 to 2.9), urinary incontinence (HR, 2.0; 95% CI, 1.3 to 3.0), previous transient ischemic attack (HR, 2.4; 95% CT, 1.3 to 4.1), and prestroke Barthel Index <20/20 (HR, 2.0, 95% CI, 1.3 to 3.2). Conclusions-One-year survivors of first-ever stroke continue to die over the next 4 years at a rate of approximately 10% per year, which is twice the rate expected among the general population of the same age and sex. The most common cause of death is cardiovascular disease. Long-term survival after stroke may be improved by early, active, and sustained implementation of effective strategies for preventing subsequent cardiovascular events.

Foraging and vein-cutting behaviour of Euploea core corinna (W.S. Macleay) (Lepidoptera : Nymphalidae) caterpillars feeding on latex-bearing leaves

Caterpillars of Euploea core corinna (W. S. Macleay) sever leaf veins prior to feeding on their latex-bearing host plants, which restricts the flow of latex at feeding sites. The severing of leaf veins by insects feeding on latex-bearing plants is commonly referred to as 'sabotaging' and is thought to be an evolved response by the insect to counter the negative effects of feeding on latex-rich leaves. Sabotaging behaviour is described for all instars of E. core corinna, with particular attention given to neonates. Vein cutting by neonate E. core corinna caterpillars can occur within 2 h of hatching, with most caterpillars establishing feeding sites within 10 h. Commonly, first instars cut an are-shaped row of leaf side-veins parallel to the leaf margin, but they may also cut the leaf mid-rib in a fashion similar to older instar larvae. From a sample of 50 E. core corinna larvae, representing all instars, we found that the diameters of the veins cut by caterpillars are closely correlated to larval head width (r=0.90). Through manipulative experiments, we demonstrate for the first time that sabotaging behaviour in neonate caterpillars imposes no detectable short-term physiological costs on those caterpillars.

Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990

Background and Purpose-Few reliable estimates of the long-term functional outcome after stroke are available. This population-based study aimed to describe disability, dependency, and related independent prognostic factors at 5 years after,a first-ever stroke in patients in Perth, Western Australia. Methods-All individuals with a suspected acute stroke who were resident in a geographically defined region (population, 138 708) of Perth, Western Australia, were registered prospectively and assessed according to standardized diagnostic criteria over a period of 18 months in 1989 to 1990. Patients were followed up prospectively at 4 and 12 months and 5 years after the index event. Results-There were 370 cases of first-ever stroke, and 277 patients survived to 30 days. Of these early survivors, 152 (55%) were alive at 5 years, and among those who were neither institutionalized (n=146) nor disabled (n=129) at the time of their stroke, 21 (14%) were institutionalized in a nursing home, and 47 (36%) were disabled. The most important predictors of death or disability at 5 years were increasing age, baseline disability defined by a Barthel Index score of <20/20 (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.7 to 14), moderate hemiparesis (OR, 2.7. 95% CI, 1.1 to 6.2), severe hemiparesis (OR, 4.5; 95% CI, 1.1 to 19), and recurrent stroke (OR, 9.4; 95% CI, 3.0 to 30). A low level of activity before the stroke was a significant predictor of institutionalization, and subsequent recurrent stroke was a consistent, independent predictor of institutionalization, disability, and death or institutionalization, increasing the odds of each of these 3 adverse outcomes by 5- to 15-fold. Conclusions-Among 30-day survivors of first-ever stroke, about half survive 5 years; of survivors, one third remain disabled, and I in 7 are in permanent institutional care. The major modifiable predictors of poor long-term outcome are a low level of activity before the stroke and subsequent recurrent stroke. Efforts to increase physical activity among the elderly and to prevent recurrent stroke in survivors of a first stroke are likely to reduce the long-term burden of cerebrovascular disease.

Variation in the dispersal potential of non-feeding invertebrate larvae: the desperate larva hypothesis and larval size

For many species of marine invertebrates, variability in larval settlement behaviour appears to be the rule rather than the exception. This variability has the potential to affect larval dispersal, because settlement behaviour will influence the length of time larvae are in the plankton. Despite the ubiquity and importance of this variability, relatively few sources of variation in larval settlement behaviour have been identified. One important factor that can affect larval settlement behaviour is the nutritional state of larvae. Non-feeding larvae often become less discriminating in their 'choice' of settlement substrate, i.e. more desperate to settle, when energetic reserves run low. We tested whether variation in larval size (and presumably in nutritional reserves) also affects the settlement behaviour of 3 species of colonial marine invertebrate larvae, the bryozoans Bugula neritina and Watersipora subtorquata and the ascidian Diplosoma listerianum. For all 3 species, larger larvae delayed settlement for longer in the absence of settlement cues, and settlement of Bugula neritina larvae was accelerated by the presence of settlement cues, independently of larval size. In the field, larger W subtorquata larvae also took longer to settle than smaller larvae and were more discriminating towards settlement surfaces. These differences in settlement time are likely to result in differences in the distance that larvae disperse in the field. We suggest that species that produce non-feeding larvae can affect the dispersal potential of their offspring by manipulating larval size and thus larval desperation.

Ten-year survival after first-ever stroke in the Perth Community Stroke Study

Background and Purpose-Very few studies have provided information regarding long-term prognosis after stroke. We aimed to determine the absolute and relative survival over 10 years among patients with first-ever stroke from a population-based study in Perth, Western Australia. Methods-For a 12-month period beginning February 1989, all individuals with a suspected acute stroke or transient ischemic attack who were resident in a geographically defined and representative region of Perth, Western Australia, were registered prospectively and assessed according to standardized diagnostic criteria. Patients with a definite first-ever stroke were followed up prospectively at 4 months, 12 months, 5 years, and 10 years after the index event. Results-A total of 251 patients with first-ever stroke were registered, and 244 (97%) were followed up at 10 years, by which time 197 (79%; 95% confidence interval [CI], 74 to 84) had died. The major causes of death were the direct effects of the initial stroke (27%; 95% CI, 21 to 33) and cardiovascular disease (26%; 95% CI, 20 to 32). Among 1-year survivors of stroke, the average annual case fatality was 4.8%, which was 2.3 (95% CI, 1.9 to 2.7) times greater than for the general population of the same age and sex. Conclusions-One in 5 patients with first-ever stroke survived to 10 years. The average annual case fatality was 4.8% between years 1 and 10 after stroke, which was twice that expected for the general population. Vascular disease is the major cause of death among long-term survivors of stroke.

Designing teams for first-of-a-kind, complex systems using the initial phases of cognitive work analysis: Case study

We present a technique for team design based on cognitive work analysis (CWA). We first develop a rationale for this technique by discussing the limitations of conventional approaches for team design in light of the special characteristics of first-of-a-kind, complex systems. We then introduce the CWA-based technique for team design and provide a case study of how we used this technique to design a team for a first-of-a-kind, complex military system during the early stages of its development. In addition to illustrating the CWA-based technique by example, the case study allows us to evaluate the technique. This case study demonstrates that the CWA-based technique for team design is both feasible and useful, although empirical validation of the technique is still necessary. Applications of this work include the design of teams for first-of-a-kind, complex systems in military, medical, and industrial domains.

Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study

Background and Purpose-Limited information exists on the long-term prognosis after first-ever stroke. We aimed to determine the absolute frequency of first recurrent stroke and disability and the relative frequency of recurrent stroke over 10 years after first-ever stroke in Perth, Western Australia. Methods-For a 12-month period beginning February 1989, all individuals with suspected acute stroke or transient ischemic attack who lived in a geographically defined and representative region of Perth were registered prospectively. Patients with a definite first-ever stroke were followed up 10 years after the index event. Results-Over 10 years of follow-up, the cumulative risk of a first recurrent stroke was 43% (95% confidence interval [CI], 34 to 51). After the first year after first-ever stroke, the average annual risk of recurrent stroke was approximate to4%. Case fatality at 30 days after first recurrent stroke was 41%, which was significantly greater than the case fatality at 30 days after first-ever stroke (22%) (P=0.003). For 30-day survivors of first-ever stroke, the 10-year cumulative risk of death or new institutionalization was 79% (95% CI, 73 to 85) and of death or new disability was 87% (95% CI, 81 to 92). Conclusions-Over 10 years of follow-up, the risk of first recurrent stroke is 6 times greater than the risk of first-ever stroke in the general population of the same age and sex, almost one half of survivors remain disabled, and one seventh require institutional care. Effective strategies for prevention of stroke need to be implemented early, monitored frequently, and maintained long term after first-ever stroke.

Azana atlantica, n.sp., with reduced mouthparts and two ocelli: first record of Azana for the Neotropical region (Diptera : Mycetophilidae : Sciophilinae)

A new Sciophilinae-Azana atlantica, sp. n. - is described from the Atlantic Forest in southeastern Brazil. The species has a number of distinctive apomorphic features, including loss of the mid ocellus, reduced mouthparts, Sc short and incomplete, first section of Rs missing, r-m elongated, longitudinal in position, aligned with the second section of Rs ( R(5)), unforked medial and cubital veins, R(4) missing, M(4) entirely absent, gonostyle triangular, with an inner row of elongated spines and a basal, digitiform inner projection. Some of these features are shared with other genera of the Azana-group of Sciophilinae. The shape of the scutum and the strong spines on the gonostyle make it clear that the species belongs in Azana, despite the features that are distinctive from the remaining species in the genus. There are ten species described in Azana to date, from United States, Europe, Sri Lanka, Canary Islands, tropical Africa and Baltic amber. This is the first Neotropical species belonging to the genus. The complete loss of M(4) and the separated gonocoxites suggest that Azana atlantica, sp. n. forms a monophyletic group with the Afrotropical species of the genus. Azana, Morganiella, Neoaphelomera, Neotrizygia, and Trizygia are shown to compose a small clade within the Azana-group of genera. The division of the genus into two subgenera - A. ( Azana) and A. ( Jugazana) - most probably renders A. ( Azana) paraphyletic and it is suggested that this should be for the time being abandoned.