Smoking and schizophrenia: is symptom profile related to smoking and which antipsychotic medication is of benefit in reducing cigarette use?

Smoking rate is disproportionately high among patients with schizophrenia, resulting in significant morbidity and mortality. However, cigarette smoking has been reported to have beneficial effects on negative symptoms, extrapyramidal symptoms, cognitive functioning and mood symptoms. Therefore, smoking cessation may worsen disability in schizophrenia. The association between smoking and these key clinical parameters was examined. Additionally, severity of smoking across four different antipsychotic treatment groups was explored. One hundred and forty-six patients with schizophrenia were assessed for smoking using expired carbon monoxide and smoking history. They were administered the Positive and Negative Symptom Scale, The Extrapyramidal Symptom Rating Scale, the Barnes Akathisia Rating Scale, Reitans Trail-making Test (A and B) and General Health Questionnaire-28. There was no difference in the chlorpromazine equivalent dose of any of the medications studied. Atypical agents were associated with significantly lower levels of smoking when compared with typical medications. There was no difference in smoking severity between the individual atypical medications examined. Similarly, there were no significant differences between smoking and non-smoking groups with regard to Positive and Negative Symptom Scale, Extrapyramidal Symptom Rating Scale, Trail-making Test and General Health Questionnaire-28. However, there was a significant difference between these groups with the smoking group demonstrating less akathisia. Smoking is not associated with positive, negative cognitive and mood symptoms in schizophrenia. Smoking is associated with lower levels of antipsychotic induced akathisia. Clinicians should not be discouraged from helping patients stop smoking for fear of worsening symptoms. However, akathisia may emerge upon cessation of smoking. Switching patients from typical to atypical antipsychotics may assist patients with schizophrenia to give up smoking.

Psychotropic medication utilization in a child and adolescent mental health service

Objectives: This study aimed to identify rates and correlates of psychotropic drug utilization in children and adolescents in inpatient and outpatient settings. Methods: A retrospective chart review examined 122 inpatient and 126 outpatient charts from a metropolitan child and youth mental health service in Brisbane, Australia. Results: Inpatients received more psychotropic medication than outpatients (71% vs. 25%; p < 0.01). Patients receiving medication were older, had longer hospital admissions, and more complex presentations, including history of abuse or suicide attempts and more diagnoses (all p < 0.01). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently used drug class (44% inpatients; 14% outpatients), primarily indicated for mood disorders (31%). SSRIs and newer antidepressants (ADs) were used more frequently in patients with a high suicide risk (p < 0.01). Atypical antipsychotics (APs) were also used (inpatients 23%; outpatients 3%), primarily for behavioral disturbances. Half of those receiving medication (51%) received polypharmacy (> 1 concurrent drug), with up to four drugs used at one time. Rates of polypharmacy were highest among patients receiving antipsychotics. Conclusions: Use of psychotropic medication is frequent in this population. Future research should initially focus on inpatients and intensive treatment settings and examine both safety and efficacy of interventions for depression in young people, atypical antipsychotics for behavioral disturbances, and polypharmacy.

A ASCENSÃO CELESTIAL DE PAULO DE TARSO: ANÁLISE DE 2 CORÍNTIOS 12,1-10 A PARTIR DA HISTÓRIA DA RELIGIÃO E DA NEUROTEOLOGIA

O tema viagem celestial , bem familiar ao mundo mediterrâneo antigo fundamenta-se na crença de que o visionário pode cruzar a fronteira entre a humanidade e a divindade, uma característica constante na literatura apocalíptica. O misticismo judaico antigo era visto como uma importante dimensão dessa tradição, razão pela qual os místicos usaram o termo apocalipse para descrever a revelação de suas experiências. A ascensão de Paulo ao céu, recontada em 2 Cor 12,1-10, é o único relato de primeira mão e a melhor evidência para a prática extática de viagem celestial no judaísmo do primeiro século. De grande interesse nos estudos do Novo Testamento o texto tem sido abordado em forma temática que se estende desde o reconhecimento do apóstolo como agradável à divindade o que lhe rendeu tal feito heróico a uma experiência de punição pelos guardiões dos portões celestiais por não ter sido encontrado nele mérito para aproximar-se do lugar da presença de Deus. Por muito tempo os estudos que predominavam na academia eram os de aspectos teológicos da passagem, tais como o espinho na carne , a missão apostólica , os oponentes de Paulo , entre outros. A linguagem da passagem revela pontos importantes não considerados de forma conjunta para uma interpretação coerente do texto. O uso por parte do apóstolo de expressões do círculo místico-apocalíptico judaico, tais como foi arrebatado , Terceiro Céu , ouviu palavras inefáveis e um espinho na carne precisa ser investigado para a compreensão do que Paulo tinha em mente ao utilizar tais terminologias. Outro problema é a omissão do enfoque experimental descrito na passagem. O apóstolo revela que vivenciou tal experiência recontada em 2 Cor 12,1-10. Ao relatar o desconhecimento do status do seu corpo durante a ascensão ele evidencia sinais do estado alterado de consciência, aspecto não considerado nas análises tradicionais do texto. Esses problemas que são abordados nesta tese tomam como instrumentos da análise a História da Religião e o da Neuroteologia. Modelos foram construídos tentando demonstrar uma correlação entre a atividade cerebral e a experiência mística. Há que se destacar, nesse sentido, que o surgimento da neuroteologia ou neurologia espiritual constitui-se em um avanço na área da experiência religiosa. Pontos de difícil interpretação no texto paulino foram elucidados dentro dessa perspectiva. A proposta deste trabalho, portanto, foi construir um quadro contextual em que a experiência extática de Paulo pudesse ser analisada. O estudo possibilitou inferir que a abordagem interdisciplinar permite alcançar um cenário mais apropriado para a compreensão e interpretação do referido texto.

Quantum Information Processing with spin systems: from modeling to possible implementations

The physical implementation of quantum information processing is one of the major challenges of current research. In the last few years, several theoretical proposals and experimental demonstrations on a small number of qubits have been carried out, but a quantum computing architecture that is straightforwardly scalable, universal, and realizable with state-of-the-art technology is still lacking. In particular, a major ultimate objective is the construction of quantum simulators, yielding massively increased computational power in simulating quantum systems. Here we investigate promising routes towards the actual realization of a quantum computer, based on spin systems. The first one employs molecular nanomagnets with a doublet ground state to encode each qubit and exploits the wide chemical tunability of these systems to obtain the proper topology of inter-qubit interactions. Indeed, recent advances in coordination chemistry allow us to arrange these qubits in chains, with tailored interactions mediated by magnetic linkers. These act as switches of the effective qubit-qubit coupling, thus enabling the implementation of one- and two-qubit gates. Molecular qubits can be controlled either by uniform magnetic pulses, either by local electric fields. We introduce here two different schemes for quantum information processing with either global or local control of the inter-qubit interaction and demonstrate the high performance of these platforms by simulating the system time evolution with state-of-the-art parameters. The second architecture we propose is based on a hybrid spin-photon qubit encoding, which exploits the best characteristic of photons, whose mobility is exploited to efficiently establish long-range entanglement, and spin systems, which ensure long coherence times. The setup consists of spin ensembles coherently coupled to single photons within superconducting coplanar waveguide resonators. The tunability of the resonators frequency is exploited as the only manipulation tool to implement a universal set of quantum gates, by bringing the photons into/out of resonance with the spin transition. The time evolution of the system subject to the pulse sequence used to implement complex quantum algorithms has been simulated by numerically integrating the master equation for the system density matrix, thus including the harmful effects of decoherence. Finally a scheme to overcome the leakage of information due to inhomogeneous broadening of the spin ensemble is pointed out. Both the proposed setups are based on state-of-the-art technological achievements. By extensive numerical experiments we show that their performance is remarkably good, even for the implementation of long sequences of gates used to simulate interesting physical models. Therefore, the here examined systems are really promising buildingblocks of future scalable architectures and can be used for proof-of-principle experiments of quantum information processing and quantum simulation.

Theme and thematic patterns in Spanish and English history texts

The aim of this research project is to compare published history textbooks written for upper-secondary/tertiary study in the U.S. and Spain using Halliday's (1994) Theme/Rheme construct. The motivation for using the Theme/Rheme construct to analyze professional texts in the two languages is two-fold. First of all, while there exists a multitude of studies at the grammatical and phonological levels between the two languages, very little analysis has been carried out in comparison at the level of text, beyond that of comparing L1/L2 student writing. Secondly, thematic considerations allow the analyst to highlight areas of textual organization in a systematic way for purposes of comparison. The basic hypothesis tested here rests on the premise that similarity in the social function of the texts results in similar Theme choice and thematic patterning across languages, barring certain linguistic constraints. The corpus for this study consists of 20 texts: 10 from various history textbooks published in the U.S. and 10 from various history textbooks published in Spain. The texts chosen represent a variety of authors, in order to control for author style or preference. Three overall areas of analysis were carried out, representing Halliday's (1994) three metafunctions: the ideational, the interpersonal and the textual. The ideational analysis shows similarities across the two corpora in terms of participant roles and circumstances as Theme, with a slight difference in participants involved in material processes, which is shown to reflect a minor difference in the construal of the field of history in the two cultures. The textual analysis shows overall similarities with respect to text organization, and the interpersonal analysis shows overall similarities as regards the downplay of discrepant interpretations of historical events as well as a low frequency of interactive textual features, manifesting the informational focus of the texts. At the same time, differences in results amongst texts within each of the corpora demonstrate possible effect of subject matter, in many cases, and individual author style in others. Overall, the results confirm that similarity in content, but above all in purpose and audience, result in texts which show similarities in textual features, setting aside certain grammatical constraints.

Anticholinergic medication use and cognitive impairment in the older population:the Medical Research Council cognitive function and ageing study

OBJECTIVES: To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative. DESIGN: A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993. SETTING: Community-dwelling and institutionalized participants. PARTICIPANTS: Thirteen thousand four participants aged 65 and older. MEASUREMENTS: Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years. RESULTS: At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03–0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14–0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30–2.16; P<.001) and possible (OR=1.56; 95% CI=1.36–1.79; P<.001) anticholinergics. CONCLUSION: The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.

A review of the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries

Background: Currently, no review has been completed regarding the information-gathering process for the provision of medicines for self-medication in community pharmacies in developing countries. Objective: To review the rate of information gathering and the types of information gathered when patients present for self-medication requests. Methods: Six databases were searched for studies that described the rate of information gathering and/or the types of information gathered in the provision of medicines for self-medication in community pharmacies in developing countries. The types of information reported were classified as: signs and symptoms, patient identity, action taken, medications, medical history, and others. Results: Twenty-two studies met the inclusion criteria. Variations in the study populations, types of scenarios, research methods, and data reporting were observed. The reported rate of information gathering varied from 18% to 97%, depending on the research methods used. Information on signs and symptoms and patient identity was more frequently reported to be gathered compared with information on action taken, medications, and medical history. Conclusion: Evidence showed that the information-gathering process for the provision of medicines for self-medication via community pharmacies in developing countries is inconsistent. There is a need to determine the barriers to appropriate information-gathering practice as well as to develop strategies to implement effective information-gathering processes. It is also recommended that international and national pharmacy organizations, including pharmacy academics and pharmacy researchers, develop a consensus on the types of information that should be reported in the original studies. This will facilitate comparison across studies so that areas that need improvement can be identified. © 2013 Elsevier Inc.

The normal optic nerve variations in an optometric population:Possible ocular and systemic influences

Early detection of glaucoma relies on a detailed knowledge of how the normal optic nerve (ONH) varies within the population. The purpose of this study focused on two main areas; 1. To explore the optic nerve head appearance in the normal optometric population and compare the south Asian (principally Pakistani) with the European white population, correcting for possible ocular and non-ocular influences in a multiple regression model. The main findings were: • The optic discs of the South Asian (SA) and White European (WE) populations were not statistically different in size. The SA group possessed discs with increased cupping and thinner neuro-retinal rims (NRR) compared with the WE group. The SA group also demonstrated a more vertically oval shape than the WE population. These differences were significant at the p<0.01 level. • The upper limits of inter-eye asymmetry were: ≤0.2 for cup to disc area ratio, and 3mmHg for intra-ocular pressure (IOP) for both ethnic groups and this did not increase with age. IOP asymmetry did not vary with gender, ethnicity or a family history of glaucoma and was independent of ONH asymmetry. ONH and IOP asymmetry are therefore independent risk factors when screening for glaucoma for both ethnic groups. 2. To investigate the validity of the ISNT rule: inferior> superior> nasal> temporal NRR thickness in the optometric population. The main findings were: • As disc size increased the disc become rounder and less vertically oval in shape. Vertically oval discs had thicker superior and inferior NRRs and thinner nasal and temporal NRRs compared with rounder disc shapes due to cup shape being independent of disc shape. Vertically oval discs were therefore more likely to obey the ISNT rule than larger rounder discs. • The ISNT rule has a low adherence in our sample of normal eyes (5.7%). However, by removing the nasal sector to become the IST rule, 74.5% of normal eyes obeyed. SA eyes and female gender were more likely to obey the ISNT rule due to increased disc ovality. The IST rule is independent of disc shape and therefore more suitable for assessing discs from both ethnic backgrounds. Obeying the ISNT rule or IST rule was not related to disc or cup size.

A pilot study to evaluate the self-medication system for liver transplant patients at the Queen Elizabeth Hospital in Birmingham

Background and Objective: Medication non-compliance is a considerable obstacle in achievinga therapeutic goal, whichcan result in poorerhealthcare outcomes, increased expenditure, wastage and potential for medication resistance. The UK Government’s Audit Commission’s publication ‘A Spoonful of Sugar’1 addresses these issues and promotes self-medication systems as a possible solution. The self-medication system within the Liver Transplant Unit (LTU) was implemented to induct patients onto new post- transplantation medication regimes ready for discharge. The system involves initial consultations with both the Liver Transplant Pharmacist and Trans- plant Co-ordinator, supported with additional advice as and when necessary. Design: Following ethical approval, evaluation of the self-medication sys- tem for liver transplant patients was conducted between January and March 2004 via two methods: audit and structured post-transplantation interview. The audit enabled any discrepancies between current Hospital guidelines and Liver Transplant Unit (LTU) practices to be highlighted. Patient interviews generated a retrospective insight into patient acceptance of the self-medication system. Setting: LTU, Queen Elizabeth Hospital, Birmingham, England. Main Outcome Measures: LTU compliance with Hospital self-medication guidelines and patient insight into self-medication system. Results: A total of seven patients were audited. Findings illustrated that self- medication by transplant patients is a complex process which was not fully addressed by current Hospital self-medication guidelines. Twenty-three patients were interviewed, showing an overwhelming positive attitude to- wards participating in their own care and a high level of understanding towards their individual medication regimes. Following a drugs counselling session, 100% of patients understood why they were taking their medica- tion, and their doses, 95% understood how to take their medication and 85% were aware of potential side effects. Conclusions: From this pilot evaluation it can be stated that the LTU self-medication system is appreciated by patients and assists them in fully understanding their medication regimes. There appear to be no major defects in the system. However areas such as communication barriers and on-going internet education were illustrated as areas for possible future investigation. References: 1. Audit Commission. A spoonful of sugar – medicines management in NHS hospitals. London: Audit Commission; 2001.

Improving the description of the retinal vasculature and patient history taking for monitoring systemic hypertension

Systemic hypertension is an important public health concern. If optometrists are to perform a more active role in the detection and monitoring of high blood pressure (BP), there is a need to improve the consistency of describing the retinal vasculature and to assess patient's ability to correctly report the diagnosis of hypertension, its control and medication. One hundred and one patients aged >40 years were dilated and had fundus photography performed. BP was measured and a self-reported history of general health and current medication was compared with the records of their general practitioner (GP). The status of the retinal vasculature was quantified using a numeric scale by five clinicians and this was compared to the same evaluation performed with the aid of a basic pictorial grading scale. Image analysis was used to objectively measure the artery-to-vein (A/V) ratio and arterial reflex. Arteriolar tortuosity and calibre changes were found to be the most sensitive retinal signs of high BP. Using the grading scale to describe the retinal vasculature significantly improved inter- and intra-observer repeatability. Almost half the patients examined were on medication for high BP or cardiovascular disease. Patients' ability to give their complete medical history was poor, as was their ability to recall what medication they had been prescribed. GPs indicated it was useful to receive details of their patient's BP when it was >140/90 mmHg. The use of improved description of the retinal vasculature and stronger links between optometrists and GPs may enhance future patient care. © 2001 The College of Optometrists. Published by Elsevier Science Ltd. All rights reserved.

Investigating ocular allergy:can we determine a better measurement?

Objective: Ocular allergy is a broad group of allergic conditions involving inflammation of the conjunctiva and the most common forms are seasonal allergic conjunctivitis (SAC; 90% of cases) and perennial allergic conjunctivitis (PAC; 5% of cases). The main symptom is ocular itching caused by mast cell degranulation leading to the release of histamine and other mediators such as tryptase. Tryptase is a neutral protease that is selectively concentrated in the secretory granules of human mast cells and has been shown to be a sensitive and specific marker of type I hypersensitivity reaction. The objective was to ascertain the best assay method for determining the tryptase levels in tear samples and whether this can be used to determine the efficacy of non-pharmacological treatments compared to no treatment or their combined effect with anti-allergic medication for SAC and PAC. Method: Thirty patients with a history of SAC were recruited into a randomised blind study during winter months when all the patients were asymptomatic. Suitability was determined by skin prick and conjunctival provocation tests. Patients were randomly assigned to either a non-pharmacological or a pharmacological Intervention group and received each test condition assigned to their group in a randomly assigned order. Symptoms were provoked by exposure to pollen in an environmental test chamber where the temperature, humidity and grass pollen levels were set to a high pollen count day. Tear samples were taken set intervals during the visit and then processed by enzyme linked immunosorbent assay (ELISA) for the detection of tryptase levels. Preliminary results: Results are still being analysed but the preliminary optimisation experiments tested four different ELISA systems; two indirect assays and two capture ‹sandwich› assays. The results suggest that in both sandwich assay systems non-specific binding occurred which could not be easily overcome. The indirect assay systems both showed specific reactions, and the sensitivity achieved was greater with the monoclonal than the polyclonal antibody. Using these findings the indirect assay system was optimised to provide a standardised system for measuring tryptase. Initial trials using human tear samples displayed tryptase levels between 23.1 and 175.1 ng/ml; levels which fall within the anticipated range for patients with SAC. Further statistical work is needed to determine whether tryptase levels vary between the treatments 75.

A láthatatlan kéz – szemelvények egy metafora történetéből (The invisible hand - extracts from the history of a metaphor)

A láthatatlan kéz Adam Smith nyomán a közgazdaságtan legismertebb metaforája lett, de jelentősége és értelmezése máig megosztja a közgazdászokat és eszmetörténészeket. Az interpretációk skálája rendkívül széles: mértékadó közgazdászok szerint ez a közgazdaságtan alapeszméje, míg mások Smith ironikus tréfájának vélik. A tanulmány áttekinti a láthatatlan kéz Smith előtti használatát teológiai, politikai és irodalmi szövegekben és a hozzájuk kapcsolódó interpretációkat. Ezt követően bemutatja, hogyan alkalmazta Smith a nevezetes kifejezést a merkantilista politika ironikus és paradox kritikájaként, és miként került a 19. század végétől e metafora a Smith-olvasatokban központi helyre, majd miként vált kérdésessé ez a felfogás a 2008-as válság nyomán. ____ Adam Smith's phrase the invisible hand has become the best-known metaphor in economics, yet both its interpretation and its relevance are hotly debated by economists and intellectual historians. The range of opinions is wide: several leading economists view it as the founding idea in economics and social studies, some historians see it as an ironic jest by Smith. The study surveys the different uses of the metaphor in theological, political and literary texts before Smith and reconstructs the "invisible hand" passage in The Wealth of Nations as an ironic and paradoxical critique of mercantilist policy. A vast literature has emerged since the late 19th century treating the metaphor in various way, ranging from the description and justification of free markets to the claim that it is a purely fictitious mechanism. The critical approach to it has become stronger since the great recession of 2008.

Formal professional relationships between general practitioners and specialists: possible associations with patient health and pharmacy costs

This article investigates whether the strength of formal professional relationships between general practitioners (GPs) and specialists (SPs) affects either the health status of patients or their pharmacy costs. To this end, it measures the strength of formal professional relationships between GPs and SPs through the number of shared patients and proxies the patient health status by the number of comorbidities diagnosed and treated. In strong GP–SP relationships, the patient health status is expected to be high, due to efficient care coordination, and the pharmacy costs low, due to effective use of resources. To test these hypotheses and compare the characteristics of the strongest GP–SP connections with those of the weakest, this article concentrates on diabetes—a chronic condition where patient care coordination is likely important. Diabetes generates the largest shared patient cohort in Hungary, with the highest traffic of specialist medication prescriptions. This article finds that stronger ties result in lower pharmacy costs, but not in higher patient health statuses. Key points for decision makers • The number of shared patients may be used to measure the strength of formal professional relationships between general practitioners and specialists. • A large number of shared patients indicates a strong, collaborative tie between general practitioners and specialists, whereas a low number indicates a weak, fragmented tie. • Tie strength does not affect patient health—strong, collaborative ties between general practitioners and specialists do not involve better patient health than weak, fragmented ties. • Tie strength does affect pharmacy costs—strong, collaborative ties between general practitioners and specialists involve significantly lower pharmacy costs than weak, fragmented ties. • Pharmacy costs may be reduced by lowering patient care fragmentation through channelling a general practitioner’s patients to a small number of specialists and increasing collaboration between general practitioner and specialists. • Limited patient choice is financially more beneficial than complete freedom of choice, and no more detrimental to patient health.

A gyógyszerkiadás és a betegek egészségi állapota a háziorvosi és szakorvosi kapcsolatok függvényében = Formal professional relations between general practitioners and specialists. Possible links with patient health and pharmacy cost

Arra a kérdésre keressük a választ, hogy a szoros háziorvosi-szakorvosi szakmai kapcsolatoknak van-e hatásuk a betegek gyógyszerkiadására, illetve egészségi állapotára. Az orvosok közötti szakmai kapcsolatok szorosságát a közösen gondozott betegek száma alapján határoztuk meg, míg a betegek egészségügyi állapotát a diagnosztizált és kezelt társbetegségek számával mértük. Hipotézisünk egyrészt az volt, hogy a hatékonyabb koordinációnak köszönhetően a szoros kapcsolatban kezelt betegek jobb egészségi állapotúak, másrészt kezelésük az erőforrások hatékonyabb felhasználása miatt kisebb gyógyszerköltséggel jár. E két hipotézist a cukorbetegekre teszteltük. Azért esett erre a krónikus betegségre a választásunk, mert itt a háziorvosok és a szakorvosok együttműködése elsődleges fontosságú. Magyarországon a cukorbetegek esetében a legnagyobb a közösen kezelt betegek populációja, valamint itt a legmagasabb a szakorvosi javaslatra felírt háziorvosi receptek száma. Azt az eredményt kaptuk, hogy a szoros kapcsolatban kezelt betegek nem rendelkeznek sem jobb, sem rosszabb egészségi állapottal, miközben a kapcsolódó gyógyszerkiadásuk szignifikánsan alacsonyabb. ____ The article considers whether strong formal professional relations between GPs and specialists in shared care affect either the health of patients or the pharmacy costs they incur. The strength of such relations is measured by the number of shared patients; patient health is proxied by number of co-morbidities diagnosed and treated. The first hypothesis is that patients treated amid strong GP-specialist relations have better health status than those treated amid weak ones, due to enhanced efficiency of care coordination. The second is that patients treated in such strong relations incur lower pharmacy costs high numbers of shared patients are assumed to promote appropriate, effective use of resources. The article tests these hypotheses and compares the outcomes of the strongest and weakest GP-specialist relations through the example of diabetes, a chronic condition where patient-care coordination is important. Diabetes generates the largest shared patient cohort in Hungary, with the highest number of specialist medication prescriptions. This article finds that stronger ties result in significantly lower pharmacy costs, but not a higher patient health status.

Ecological correlates of successful colonization in the life history of the Cuban treefrog, {\it Osteopilus septentrionalis\/} (Anura: Hylidae)

Ten correlates of successful colonization were tested and met in the life history of the Cuban treefrog in Florida and the Caribbean. Like many successful colonizing species of animals, the Cuban treefrog was highly fecund; reproduction was possible at a small body size in males (27.0 mm) and females (45.0 mm), and large females could lay large clutches and eggs throughout the year. Generation times were short in this species thereby accelerating the colonization process. Tadpoles and post-metamorphic individuals could exploit a wide range of physical conditions with respect to weather conditions and structure of the habitat. The Cuban treefrog occupied the terrestrial-arboreal niche which was only marginally exploited by other species in Florida. Habitat preference of the Cuban treefrog was for mesophytic forests and disturbed areas, and both habitats were found in native and introduced ranges. The ability to coexist with man further enabled the Cuban treefrog to expand its geographic range. A broad diet enabled the Cuban treefrog to exploit a wide range of prey species and sizes thereby alleviating an important constraint to colonization success. The Cuban treefrog was gregarious and vagile, thereby accelerating the process of dispersal which is crucial to the colonization process. Thus, many features in its life history enabled the Cuban treefrog to rapidly disperse and colonize, often in high population densities, many kinds of sites in its native and introduced range. Conformity to these correlates by the Cuban treefrog ultimately provides predictive power regarding the future colonization of this tropical frog. ^