Cost of counselling women who undergo mastectomy.

The psychiatric morbidity associated with mastectomy and brest cancer was substantially reduced by a specialist nurse who counselled women before and after surgery and monitored their progress. A controlled study was, therefore, carried out to determine what this cost. National Health Service costs were almost wholly covered by savings made because counselled subjects who developed psychiatric problems were recognised and treated much earlier than control patients. Counselled and control subjects suffered considerable financial losses, but these were offset in the counselled group by their relatives'' earlier return to work. Such counselling schemes are necessary and effective and may be implemented at little extra cost.     

The effect of various adjuncts on the surgical treatment of carpal tunnel syndrome secondary to chronic tenosynovitis.

A series of 22 patients with carpal tunnel syndrome secondary to chronic tenosynovitis was divided into two groups. The first group was treated by transverse carpal ligament release alone. The second group was treated by transverse carpal ligament release, external neurolysis of the median nerve, flexor synovectomy, and intraoperative corticosteroid instillation. Both groups were comparable preoperatively as to symptoms, signs, and electrophysiological data. At two years postoperatively there were no statistically significant differences in the symptoms, signs, and electrophysiological data in the two groups. The only difference was that patients undergoing release alone were able to return to work earlier than those patients who had the adjunctive procedures.     

A comparison of flexor tenosynovectomy, open carpal tunnel release, and open carpal tunnel release with flexor tenosynovectomy in the treatment of carpal tunnel syndrome

The purpose of this study was to identify the advantages and disadvantages of performing a flexor tenosynovectomy without dividing the transverse carpal ligament, an open carpal tunnel release, and an open carpal tunnel release with flexor tenosynovectomy in the treatment of carpal tunnel syndrome. From 1990 to 1998, a retrospective study was done in which a flexor tenosynovectomy was performed in 133 patients without division of the transverse carpal ligament and compared with 68 patients who had an open carpal tunnel release and 75 patients who had an open carpal tunnel release and flexor tenosynovectomy. Patients were followed up for an average period of 30 weeks with history and physical findings and nerve conduction velocities and for an average period of 2.6 years with telephone interviews. There was a 2.3 percent incidence of pillar pain in the flexor tenosynovectomy group, which may explain the earlier return to their regular jobs at an average time of 9.9 weeks, compared with 10.7 weeks for the carpal tunnel release group and 12.0 weeks for the carpal tunnel release/flexor tenosynovectomy group. The latter two groups had an incidence of pillar pain of 12.1 percent and 25.3 percent, respectively. Postoperative grip strength was statistically significantly improved in the flexor tenosynovectomy group compared with the other two groups, where adjustments were made for sex and preoperative grip strengths with standard error of adjusted means. In the flexor tenosynovectomy group, 20.6 percent of patients had a previous open or endoscopic carpal tunnel release with recurrent carpal tunnel syndrome, compared with 5.2 percent in the open carpal tunnel release group and 21.6 percent in the open carpal tunnel release with flexor tenosynovectomy group. Excisional biopsies of flexor tenosynovium in the flexor tenosynovectomy, open carpal tunnel release, and open carpal tunnel release with flexor tenosynovectomy groups revealed an incidence of fibrosis in 89.2 percent, 88.9 percent, and 87.7 percent of specimens, respectively. Edema was a frequent finding, but an active inflammatory response was seldom seen. The findings in this study indicate that because of a significant decrease in pillar pain, a flexor tenosynovectomy in the treatment of carpal tunnel syndrome would likely benefit workers who use the palm of the hand in heavy manual or highly repetitive work by allowing them to return to regular duty sooner.     

Male dwarf chameleons assess risk of courting large, aggressive females

Conflict between the sexes has traditionally been studied in terms of costs of mating to females and female resistance. However, courting can also be costly to males, especially when females are larger and aggressively resist copulation attempts. We examined male display intensity towards females in the Cape dwarf chameleon, Bradypodion pumilum, in which females are larger than males and very aggressive. We assessed whether aggressive female rejection imposes potential costs on males and whether males vary their display behaviour with intensity of female rejection, female size or relative size differences. Males persisted in courtship after initial female rejection in 84% of trials, and were bitten in 28% of trials. Attempted mounts were positively associated with males being bitten. Males reduced courtship with increased intensity of female rejection. Male courtship behaviour also varied with female size: males were more likely to court and approach smaller females, consistent with the hypothesis that larger females can inflict more damage. These results suggest that, in addition to assessing female willingness to mate, male dwarf chameleons may use courtship displays to assess potential costs of persistence, including costs associated with aggressive female rejection, weighed against potential reproductive pay-offs associated with forced copulation.     

Increased syllable rate during aggressive singing in a bird with complex and fast song

Sexual signals can comprise traits with multiple functions, and species with extreme phenotypes offer an opportunity to link function with signal evolution. This is the case in the serin Serinus serinus, a songbird with extremely fast syllable rate compared to related finches, and high sound frequency for its body size. Previous work on receiver responses showed that playback of artificially increased syllable rate is avoided and inhibits vocal responses, suggesting it is perceived as aggressive, while, on the contrary, higher sound frequency appears preferred by females. We tested whether senders also change these traits during aggressive singing, with a field playback experiment. Serin males responding aggressively by approaching the playback loudspeaker also increased syllable rate, while males responding less aggressively did not change syllable rate. Together with work on receiver responses, this suggests that aggressive signalling may have been an important selective pressure for the evolution of extremely fast syllable rate in this species. It is noteworthy that aggressive male serins still increase syllable rate, despite of their already elevated natural syllable rate. We found no changes in sound frequency when singing aggressively, which agrees with previous work that instead showed a female preference for high song frequency. We conclude that the evolution of extreme traits in serin song is best explained by multiple functions.     

THE EVOLUTION OF SELECTIVE AGGRESSION CONDITIONED ON ALLORECOGNITION SPECIFICITY

Many sessile cnidarians deploy specialized structures while competing aggressively for living space. The initiation of aggression is often contingent on the relatedness of the interacting contestants; clonemates and close kin generally behave passively toward one another, whereas more distant relatives generally behave aggressively. Behavioral specificity of this sort requires that there be 1) an allorecognition system that can discriminate among subtle differences in cell-surface determinants and 2) a highly polymorphic genetic system that provides specific labels of relatedness (haplotypes or allotypes). The evoutionary models analyzed in this paper show that a population of individuals that behave aggressively only against haplotypically distinct individuals (discriminating phenotypes) will not be evolutionarily stable in the face of either unconditionally aggressive or unconditionally nonaggressive phenotypes. Furthermore, even if the discriminating trait were somehow fixed, the rare recognition alleles necessary to confer allotypic specificity could not become established through natural selection. Thus, allotypic specificity is unlikely to be maintained by individual selection acting directly through aggressive behavior. Other selective mechanisms might account for the evolution of allorecognition specificity. Allotypic polymorphism could be maintained by pleiotropic mechanisms in which rare alleles are favored by natural selection acting either on gametic incompatibility, pathogen resistance, or somatic fusion, rather than aggressive behavior per se. However, these mechanisms do not explain the maintenance of selective aggression based on allotypic differences. Alternatively, if aggressive members of a clone indirectly enhance the reproductive output or survival of the entire clone (or close relatives), then kin selection acting directly through aggressive behavior could favor allorecognition specificity. Choosing among these alternatives will require the development of more sophisticated theory and empirical analyses of the costs and benefits of aggression.     

Comparison of partial excision with simple section of the transverse carpal ligament in the treatment of carpal tunnel syndrome

In the surgical treatment of carpal tunnel syndrome, debate has commonly focused on whether decompression should be performed by open or blind techniques. Contrarily, the goal of the present study was to determine whether instead of simple section, partial excision of the transverse carpal ligament has contributed to better results. Because complete healing of the transverse carpal ligament observed during reoperations has been reported elsewhere, the charts of 75 carpal tunnel syndrome patients who had been treated with open technique at Dokuz Eylül University were reviewed. Statistical analysis was performed using the Fisher's exact test and Student's t test when appropriate. Thirty-five patients had been treated with simple section of the transverse carpal ligament, whereas 40 had been treated with partial excision. Internal neurolysis was also performed in 19 of the patients, 11 of whom were treated with partial excision. The average follow-up time was 3.8 years. The comparisons regarding the overall operative outcomes did not show any significant difference between the two different techniques of releasing the transverse carpal ligament. In patients treated without neurolysis, results of partial excision of the transverse carpal ligament improved when compared with those of simple section, but this superiority was not statistically significant. There seemed to be statistically higher reoperation rates and worse outcomes after neurolysis (p < 0.05). Reoperation was required in eight patients (11 percent). Five of the patients who underwent reoperation had initially been treated with partial excision and neurolysis, whereas two had been treated with simple section and neurolysis. Another patient who had undergone reoperation had initially undergone only simple section. The mean time to return to work or daily activities did not differ between the types of applied technique for releasing the transverse carpal ligament. However, neurolysis lengthened these periods significantly when performed (p < 0.05). In the present study, partial excision of the transverse carpal ligament without adding neurolysis offered relatively better results than simple section. Verification of this finding endoscopically, if applicable, may improve the success rate of surgical therapy in patients with carpal tunnel syndrome.     

The effect of 6-benzylaminopurine (benzyladenine) on senescence and chocolate spot (Botrytis fabae) of winter beans (Viciafaba)

In laboratory trials on detached bean leaves, benzyladenine delayed both senescence and aggressive attack of chocolate spot disease. In field plots, over 80% of the aggressive spots were on senescent leaves and the distribution of aggressively attacked leaves was predictable from the distribution of senescent leaves. The total frequency of aggressively attacked leaves per shoot was apparently related to the frequency of senescent spotted leaves. Although benzyladenine significantly reduced leaf senescence in field plots sprayed in May, the senescent leaves were more frequently attacked aggressively. Wider plant spacing (14 in instead of 8 in) similarly increased the ratio of aggressive attack to senescence, and the individual fields retained until June the differences in infection earlier established by frost damage.     

Aggressive behavior and dominance hierarchies in female sable antelope,Hippotragus niger: Implications for captive management

Social interactions of adult female sable antelope, Hippotragus niger, were observed at the National Zoological Park's Conservation and Research Center. Aggressive behavior was quantified for two herds containing 8 and 11 females. Aggression was lowest at calving, and highest near the time of conception. Dominance hierarchies were strictly linear and stable over time. Dominance rank was highly correlated with age, with the oldest females achieving highest rank. High-ranking females initiated more aggression and were more likely to behave aggressively towards a newly introduced adult female. The newly introduced individual was the victim of prolonged, intense group chases and was permanently excluded from the herd. Low-ranking females directed more aggression at yearling herd members than did high-ranking females. Temporary absences by herd members resulted in long-lasting, substantial increases in received aggression upon their return. Because of their aggressive nature, sable antelope present a challenge to captive management. © 1993 Wiley-Liss, Inc.     

A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression

Controversy exists regarding the benefit of endoscopic carpal tunnel release versus open carpal tunnel release in terms of grip/pinch strength, scar tenderness, pain, return to work, reversible/irreversible nerve damage, and adverse effects. Although a number of randomized controlled trials and systematic reviews have been published on the subject, to date, no large definitive randomized controlled trial or meta-analysis has been performed comparing endoscopic to open carpal tunnel release. This meta-analysis was undertaken to address the effectiveness of endoscopic carpal tunnel release relative to open carpal tunnel release. Key outcome measures from 13 randomized controlled trials were extracted and statistically combined. Heterogeneity was observed in three of the outcomes (i.e., grip strength, pain, and return to work), but the causes of heterogeneity could not be explained because of insufficient detail in the reported studies. Using the Jadad et al. scale, nine of 13 studies were of low methodologic quality. The effect sizes were compared between the studies that were rated as high quality and the studies that were rated as low quality on the Jadad et al. scale. Similarly, the studies that were rated as high quality on the Gerritsen et al. scale were compared with those that were rated as low quality. No clinically significant difference in effect sizes was apparent between studies of high and low methodologic quality. This meta-analysis supports the conclusion that endoscopic carpal tunnel release is favored over the open carpal tunnel release in terms of a reduction in scar tenderness and increase in grip and pinch strength at a 12-week follow-up. With regard to symptom relief and return to work, the data are inconclusive. Irreversible nerve damage is uncommon in either technique; however, there is an increased susceptibility to reversible nerve injury that is three times as likely to occur with endoscopic carpal tunnel release than with open carpal tunnel release.     

A systematic review of reviews comparing the effectiveness of endoscopic and open carpal tunnel decompression

Controversy persists regarding the benefit of endoscopic carpal tunnel release compared with open carpal tunnel release for pain, numbness, strength, return to work and function, scar tenderness, and complications. For surgeons, a recommended first source of information on treatment effectiveness is a review of high-methodologic-quality articles. This review of reviews was undertaken to answer this clinical question regarding these outcomes. Cochrane, MEDLINE, EMBASE, CINAHL, and HealthSTAR databases were searched using the key words "endoscopic carpal tunnel," with limits "review or overview" and dates from 1989 to present. Five key journals were hand-searched. Any review with a reference to at least one randomized controlled trial that compared endoscopic carpal tunnel release to open carpal tunnel release was to be included. Two reviewers independently scanned titles and abstracts for potential relevance. Selection as relevant was confirmed through a review of full texts. Disagreements were resolved through discussion and consensus. The selected reviews were assessed for methodologic quality on the basis of the scale of Hoving et al. Of 48 articles initially identified, seven pertinent reviews were selected. Of these seven, three reviews of high methodologic quality concurred that there is no difference between the two techniques in symptom relief and that the evidence is conflicting for return to work and function. The risk of permanent median nerve injury does not differ between the techniques. The reviews indicated that the endoscopic carpal tunnel release technique is worse in terms of reversible nerve injury but superior in terms of grip strength and scar tenderness, at least in short-term follow-up. Several trials have not been incorporated in these reviews and statistical pooling has not been conducted. Further systematic review with meta-analysis may permit more definitive conclusions about the relative effectiveness of these two techniques, particularly with regard to return to work and function.     

The efficiency of strict reverse isolation and antimicrobial decontamination in remission induction therapy of acute leukemia

The efficiency of strict reverse isolation and antimicrobial decontamination in remission induction therapy of acute leukemia was studied retrospectively in 47 patients who were treated with a standardized aggressive chemotherapy of daunorubicin and cytosine arabinoside. Twenty-two patients were treated in strict reverse isolation with antimicrobial decontamination and 25 patients in the open ward without any measures against infections. In the patients in isolation the incidence of new infections per patient was 0.77 compared to 1.42 in the control group. The rate of complete remissions was 77% in the patients in isolation vs. 56% in the control patients.     

Progesterone modulates aggression in sex-role reversed female African black coucals

Testosterone is assumed to be the key hormone related to resource-defence aggression. While this role has been confirmed mostly in the context of reproduction in male vertebrates, the effect of testosterone on the expression of resource-defence aggression in female vertebrates is not so well established. Furthermore, laboratory work suggests that progesterone inhibits aggressive behaviour in females. In this study, we investigated the hormonal changes underlying territorial aggression in free-living female African black coucals, Centropus grillii (Aves; Cuculidae). Females of this sex-role reversed polyandrous bird species should be particularly prone to be affected by testosterone because they aggressively defend territories similar to males of other species. We show, however, that territorial aggression in female black coucals is modulated by progesterone. After aggressive territorial challenges female black coucals expressed lower levels of progesterone than unchallenged territorial females and females without territories, suggesting that progesterone may suppress territorial aggression and is downregulated during aggressive encounters. Indeed, females treated with physiological concentrations of progesterone were less aggressive than females with placebo implants. This is one of the first demonstrations of a corresponding hormone-behaviour interaction under challenged and experimental conditions in free-living females. We anticipate that our observation in a sex-role reversed species may provide a more general mechanism, by which progesterone--in interaction with testosterone--may regulate resource-defence aggression in female vertebrates.     

Benefits and Costs of Dominance in the Angelfish Centropyge bicolor

Social groups are often structured by dominance hierarchies in which subordinates consistently defer to dominants. High‐ranking individuals benefit by gaining inequitable access to resources, and often achieve higher reproductive success; but may also suffer costs associated with maintaining dominance. We used a large‐scale field study to investigate the benefits and costs of dominance in the angelfish Centropyge bicolor, a sequential hermaphrodite. Each haremic group contains a single linear body size‐based hierarchy with the male being most dominant, followed by several females in descending size order. Compared to their subordinate females, dominant males clearly benefited from disproportionately high spawning frequencies, but bore costs in lower foraging rates and greater aggressive defence of their large territories. Within the female hierarchy, more dominant individuals benefited from higher spawning frequencies and larger home ranges, but displayed neither higher foraging rates nor spawn order priority. However, dominance in females was also linked to aggressiveness, particularly towards immediate subordinates, suggesting that females were using energetically costly aggression to maintain their high rank. We further showed by experimentally removing dominant females that the linear hierarchy was also a social queue, with subordinates growing to inherit higher rank with its attendant benefits and costs when dominants disappeared. We suggest that in C. bicolor, the primary benefit of high rank is increased reproductive success in terms of current spawning frequency and the prospect of inheriting the male position in the near future, which may be traded off against the cost of aggressively defending rank and territory.     

Differential Response of Ant Colonies to Intruders: Attack Strategies Correlate With Potential Threat

Animals are often threatened by predators, parasites, or competitors, and attacks against these enemies are a common response, which can help to remove the danger. The costs of defense are complex and involve the risk of injury, the loss of energy/time, and the erroneous identification of a friend as a foe. Our goal was to study the specificity of defense strategies. We analyzed the aggressive responses of ant colonies by confronting them with workers of an unfamiliar congeneric species, a non‐nestmate conspecific, a co‐occurring congeneric competitor species, and a social parasite—a slave‐making ant. As expected, the latter species, which can inflict dramatic fitness losses to the colony, was treated with most aggression. A co‐occurring competitor was also attacked, but the ants used different behaviors in their responses to both enemies. While the slavemaker was attacked by biting and stinging and was approached with spread mandibles, the competitor was dragged, a behavioral strategy only possible if the defending ant is similar in size and strength to the opponent. Non‐nestmate conspecifics were treated aggressively as well, but less than the slavemaker and the co‐occurring competitor, presumably because they are less easily recognized as enemies. An unfamiliar congeneric species was rarely attacked. This first detailed study comparing the aggressive responses of ant colonies toward slave‐making ants to other species posing different threats indicates that the responses of ant colonies are adjusted to the risk each opponent poses to the colony.     

Sex and social costs of escaping in the striped plateau lizard Sceloporus virgatus

As a predator approaches, prey base decisions about when toflee on a balance between degree of predation risk and costsof escaping. Lost opportunities to perform activities that mayincrease fitness are major escape costs. Paramount among theseare chances to increase fitness by courting and mating and bydriving away sexual rivals. Because sexual selection imposesdifferent social demands on the sexes, social opportunitiescan have different consequences for males and females, but effectsof sex differences in social opportunity costs on escape behaviorare unknown. We conducted a field experiment showing that malestriped plateau lizards (Sceloporus virgatus) given the opportunityto court or perform aggressive behavior permit closer approachbefore fleeing, but females do not. Males allowed a simulatedpredator to approach closer before initiating escape if a tetheredmale or female rather than a control stimulus was introducedto them, but females initiated escape at similar distances inall conditions. For males, a trade-off between the greater predationrisk accepted before fleeing due to the likelihood of enhancingfitness by sexual or aggressive behavior accounts for closerapproach allowed in the presence of conspecifics. Mating opportunitiesare not limiting for females in most species and females oftenhave little to gain by interacting aggressively with other females.Therefore, presence of a conspecific male or female may notjustify taking greater risk. Results confirm the predictionof optimal escape theory that flight initiation decreases ascost of escaping increases. The sex difference in effect ofpresence of conspecifics on flight initiation distance is aconsequence of the sex difference in costs of escaping.     

Do Blackbirds Signal Motivation to Fight with Their Song?

Conflicts about resources can be solved with physical fights, but animals will in general try to avoid them due to the costs and risks associated with fighting. Fight outcome depends on the fighting ability as well as the motivation to fight, which means that individuals should try to assess both during a pre‐escalation phase. In the present study, we investigated whether blackbirds (Turdus merula) acoustically signal their motivation to fight with their advertisement song, which consists of a motif part with pure‐toned low frequency elements followed by a twitter part with more complex and higher‐pitched elements. We tested (1) whether the temporal and spectral characteristics of spontaneous songs broadcasted by a territorial male could predict its subsequent aggressive behaviour to a playback and (2) if the song of territorial males changed in case they responded aggressively to the playback. We found no effects in the temporal song structure, which contradicts results from a previous study involving playback experiments with blackbirds. We did however find an interesting pattern in the spectral characteristics of the twitter, since aggressively responding males significantly increased the twitter frequency after the playback. The post‐playback songs of aggressive responders were nevertheless indistinguishable from spontaneous pre‐playback songs of non‐aggressive responders. Therefore, we conclude that changes in twitter frequency, rather than absolute twitter frequencies, are advertising information about motivation to fight.     

Victims of Infanticide and Conspecific Bite Wounding in a Female-Dominant Primate: A Long-Term Study

The aggression animals receive from conspecifics varies between individuals across their lifetime. As poignantly evidenced by infanticide, for example, aggression can have dramatic fitness consequences. Nevertheless, we understand little about the sources of variation in received aggression, particularly in females. Using a female-dominant species renowned for aggressivity in both sexes, we tested for potential social, demographic, and genetic patterns in the frequency with which animals were wounded by conspecifics. Our study included 243 captive, ring-tailed lemurs (Lemur catta), followed from infancy to adulthood over a 35-year time span. We extracted injury, social, and life-history information from colony records and calculated neutral heterozygosity for a subset of animals, as an estimate of genetic diversity. Focusing on victims rather than aggressors, we used General Linear Models to explain bite-wound patterns at different life stages. In infancy, maternal age best predicted wounds received, as infants born to young mothers were the most frequent infanticide victims. In adulthood, sex best predicted wounds received, as males were three times more likely than females to be seriously injured. No relation emerged between wounds received and the other variables studied. Beyond the generally expected costs of adult male intrasexual aggression, we suggest possible additive costs associated with female-dominant societies – those suffered by young mothers engaged in aggressive disputes and those suffered by adult males aggressively targeted by both sexes. We propose that infanticide in lemurs may be a costly by-product of aggressively mediated, female social dominance. Accordingly, the benefits of female behavioral ‘masculinization’ accrued to females through priority of access to resources, may be partially offset by early costs in reproductive success. Understanding the factors that influence lifetime patterns of conspecific wounding is critical to evaluating the fitness costs associated with social living; however, these costs may vary substantially between societies.     

Aggression and Welfare in a Common Aquarium Fish,the Midas Cichlid

Many species of fishes are aggressive when placed in small aquaria. Aggression can negatively affect the welfare of those individuals toward whom it is directed. Animals may behave aggressively in order to defend resources such as food, shelter, mates, and offspring. The decision to defend depends on the distribution of resources and on ecological factors such as number of competitors, amount of available space, and amount of habitat complexity. This study tested the effects of these factors on aggression in a common aquarium fish, the Midas cichlid (Amphilophus citrinellus). The study found that time spent behaving aggressively was not associated with small-scale differences in group size or available space. Aggression was significantly lower in a large aquarium with a complex habitat. Aquaria of sizes typically used in the companion animal (pet) hobby did not provide optimal welfare for cichlids housed with aggressive conspecifics. The public should be aware that this and similar species require larger aquaria with complex habitat, which elicit more natural behavior.     

The Effects of Social Experience on Aggressive Behavior in the Green Anole Lizard (Anolis carolinensis)

To understand how context-specific aggression emerges from past experience, we examined how consecutive aggressive encounters influence aggressive behavior and stress responses of male green anole lizards ( Anolis carolinensis ). Animals were shown a video clip featuring an aggressively displaying conspecific male, which provoked aggressive responding, while control animals viewed a neutral video. After 5 d of interaction with the videos, both the subject and control groups were presented with a live conspecific. As a non-invasive assay of stress responses, we measured changes in body color and eyespot darkness, two features known to be strongly correlated with titers of stress hormones. Our results demonstrate that experience increased aggression in male anoles, but that increases in aggression to a repeated stimulus were transient. Tests with a novel conspecific indicate that the experienced animals remained aggressive when presented with novel stimuli. Although there were differences in the morphological indicators of the stress response between experimental and control groups during video presentations, there were no differences when presented with novel conspecifics. These data indicate that experience-dependent differences were not mediated by differences in the 'stressfulness' of aggressive interaction, as thought to be the case for animals in chronic subordinate/dominant dyads. We suggest that habituation and reinforcement interact to promote aggressive responding and to restrict it to novel individuals. Such context specificity is a hallmark of natural patterns of aggression in territorial species.