Decrease In Frequency Of Attacks Research Articles

Predicting the Path of Insurgency: Data-Driven Strategies to Counter Boko Haram in Nigeria

Background While Boko Haram insurgency’s dangers are well documented, existing research lacks methods for effective monitoring and prediction, of their activities. This study addresses this gap by analyzing data from Nigerian Security Tracker website (https://www.cfr.org/nigeria/nigeria-security-tracker/p29483) from year 2011 to 2023 and geolocated information on Boko Haram activity. Methods The research employs a mixed-methods approach. It uses descriptive statistics to understand attack trends and time series models (ARIMA/SARIMA) to forecast future attacks. Additionally, control charts identify periods of heightened insurgency. Results The findings confirm the Northeast region, as the epicenter of Boko Haram activities. The average monthly attack rate was 18 incidents, leading to 682 deaths over 12 years. 2014 and 2015 witnessed the peak of the insurgency. The forecasting models suggest a potential decrease in attack frequency in the coming years, with an average of nine attacks per month. This predicted decline might be linked to intervention efforts. Control charts reveal periods where attacks surpassed expected levels, highlighting critical moments for intensified counter-insurgency measures. These periods include July 2012-May 2014 and June 2014-August 2015, with a period of regained control. Conclusion This research provides valuable insights for stakeholders working to fight against Boko Haram’s insurgency. It offers forecasting capabilities and identifies critical periods, potentially informing targeted interventions and improving overall counter-insurgency strategies.

Comparison of greater occipital nerve blockade with radiofrequency and steroid in chronic migraine

ObjectivesThe study aims to retrospectively compare steroid and radiofrequency treatments for the greater occipital nerve(GON) under ultrasound guidance in chronic migraine. MethodsMonthly average headache attack frequency, attack duration, visual analog scale(VAS) and the number of days analgesics were taken were recorded. Under ultrasound guidance, GON block was administered once a week for a total of four sessions. In the final session, 4 mg of dexamethasone was added to the local anesthetic for the steroid group (n:26). Pulsed radiofrequency (RF) treatment was applied to the RF group (n:25) just before the last session of the GON block. The pain course in the week following the procedure monthly average headache attack frequency, attack duration, VAS and the number of days analgesics were taken in a month were compared for both groups at 1–3–6 months. ResultsIn the first month, a statistically significant decrease in attack frequency was observed in the RF group. However, no statistically significant differences were found between the groups in other findings at different time intervals. A significant decrease headache attack duration,VAS, and the number of days analgesics were taken in a month was observed in both treatment groups. Both treatments were found to be effective, but the effect size of the treatment was higher in the RF group compared to the steroid group. ConclusionAlthough the results were better in the group receiving pulsed RF treatment, except for the attack frequency in the first month, no statistically significant superiority of one treatment method over the other was determined.

Research on privacy and secure storage protection of personalized medical data based on hybrid encryption

AbstractPersonalized medical data privacy and secure storage protection face serious challenges, especially in terms of data security and storage efficiency. Traditional encryption and storage solutions cannot meet the needs of modern medical data protection, which has led to an urgent need for new data protection strategies. Research personalized medical data privacy and secure storage protection based on hybrid encryption, in order to improve the security and efficiency of data storage. A hybrid encryption mechanism was proposed, which uses user attributes as keys for data encryption. The results show that the storage consumption of user attribute keys increases with the number of user attributes, but the consumption of hybrid encryption privacy storage technology is much smaller than that of traditional schemes. In the test, when the number of users increased to 30, the processing time first reached 1200 ms. During the increase in data volume, both test data and real data showed a brief decrease in attack frequency, but after the data volume reached 730–780, the attack frequency increased. It is worth noting that the performance of test data is better than that of real data. Personalized medical data privacy and secure storage protection based on hybrid encryption can not only effectively improve data security and reduce the risk of attack, but also greatly outperform traditional solutions in storage consumption and processing time. It has important practical significance for modern medical data storage protection.

Probiotic use in the prophylaxis of periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome: a retrospective cohort study.

Periodic fever, aphthousstomatitis, pharyngitis, and adenitis (PFAPA) syndrome is an autoinflammatory recurrent fever syndrome that mainly affects children. Probiotics are currently used to prevent upper respiratory tract infections and flares of diseases associated with immune dysregulation. We aimed to evaluate the response to probiotic treatment in PFAPA patients. Patients with PFAPA syndrome who received probiotics and were followed between July 2019 and July 2021 were included in this retrospective study. Demographic and clinical features and response to probiotics were assessed. Twenty out of 111 children with PFAPA syndrome (F/M:1) were included. The median (min-max) ages at symptoms onset and diagnosis were 24 (3-72) and 51.5 (11-120) months, respectively. All 20 patients received probiotics during the disease course. The probiotic preparation they received included a combination of two lactobacilli as Lactobacillus plantarum HEAL9 (Lp HEAL9) and Lactobacillus paracasei 8700:2 (Lpa 8700:2). The median age at probiotic onset was 60 (33-192) months, while the duration of probiotic use was 4.5 (3-19) months. All patients except one experienced a decrease in attack frequency with probiotic use. After probiotic treatment, the median number of episodes during 3 monthsdecreased from 3 to 1 (p < 0.001). Eight (40%) patients had no attacks during the 3months after probiotic initiation. And, 5 (45%) of 11 patients who had ≥ 1 attacks on probiotics mentioned that the attack severity decreased significantly after probiotic initiation. Our results suggest that probiotic strains Lactobacillus plantarum HEAL9 and Lactobacillus paracasei 8700:2 could be beneficial in PFAPA patients by decreasing the attack frequency.

Rationale and design for a randomized, single-center, double-blind, sham-controlled study of non-invasive vagus nerve stimulation for treatment of post-traumatic headache

ObjectiveEvaluate the efficacy and safety of non-invasive vagus nerve stimulation (nVNS) for the treatment of post-traumatic headache (PTH).BackgroundWorldwide, ∼69 million people per year sustain a traumatic brain injury (TBI), many of whom develop PTH. Clinicians often treat PTH with drugs approved for primary headache disorders, and many patients self-treat with over-the-counter agents but have inadequate pain relief. There has been little study of therapies for PTH, and safe, effective treatments are needed.Design/MethodsThis randomized, double-blind, sham-controlled, parallel-group pilot study is enrolling adults who present 1–4 weeks after a head injury, meet International Classification of Headache Disorders 3rd edition (ICHD-3) criteria for acute headache attributed to mild TBI, and have ≥2 headaches/week with a migraine or probable migraine phenotype. After a 2-week run-in period, subjects are randomly assigned (1:1 allocation) to receive daily preventive therapy and as-needed acute treatment with nVNS or a sham device. Preventive therapy consists of two 120-second stimulations 3 times daily. Acute treatment comprises 2 stimulations at headache onset and 2 stimulations 20 minutes after the start of initial treatment. Subjects are not to use acute rescue medication for 120 minutes post-treatment. One North American site will enroll ≤80 subjects. The expected duration is 12 months (enrollment, 9 months; participation, 14 weeks).ResultsThe primary effectiveness end point is decrease in pain (on a 7-point scale) 60 minutes post-treatment for all treated headache attacks. Secondary end points include decrease in the frequency of headache days between the run-in period and the last 2 weeks of the double-blind period and responder rates (ie, percentages of subjects with ≥50% decrease in attack frequency). The primary safety end point is the incidence of treatment-related serious adverse events.ConclusionsThis study will assess the efficacy and safety of nVNS as a novel therapy for PTH.

Sphenopalatine Ganglion (SPG): Stimulation Mechanism, Safety, and Efficacy.

To describe the history of and available data on sphenopalatine ganglion (SPG) neuromodulation in the treatment of headache up to the present. The SPG has been a therapeutic target to treat primary headache disorders for over 100 years. Multiple destructive lesions have also been tried with variable rate and duration of success. Neurostimulation of the SPG for cluster headache was first described in 2007. This is not a systematic review. The authors review the anatomy and pathophysiology of the SPG and cluster headache and the important clinical trials, relating a history of how SPG neuromodulation reached the current state of approval in the European Union (EU) and pivotal registration study for cluster headache in the US. The EU approved SPG stimulation for cluster headache with a CE Mark in February of 2012. Since then, several EU countries have elected to reimburse implantation for cluster headache, and over 300 patients have been implanted worldwide. Success rates for implanted SPG neuromodulation in the experimental phase of the European randomized controlled trial, in the open label extension trial, and in the registry of patients implanted outside of the trial remain at about two-thirds of patients implanted being responders, defined as being able to terminate at least 50% of attacks or having at least a 50% decrease in attack frequency or both. A US pivotal registration study is underway to confirm these results and obtain FDA approval for this treatment for cluster headache patients. Further studies in migraine are also underway.

Cluster headache and other TACs: Pathophysiology and neurostimulation options.

The trigeminal autonomic cephalalgias (TACs) are highly disabling primary headache disorders. There are several issues that remain unresolved in the understanding of the pathophysiology of the TACs, although activation of the trigeminal-autonomic reflex and ipsilateral hypothalamic activation both play a central role. The discovery of the central role of the hypothalamus led to its use as a therapeutic target. After the good results obtained with hypothalamic stimulation, other peripheral neuromodulation targets were tried in the management of refractory cluster headache (CH) and other TACs. This review is a summary both of CH pathophysiology and of efficacy of the different neuromodulation techniques. In chronic cluster headache (CCH) patients, hypothalamic deep brain stimulation (DBS) produced a decrease in attack frequency of more than 50% in 60% of patients. Occipital nerve stimulation (ONS) also elicited favorable outcomes with a reduction of more than 50% of attacks in around 70% of patients with medically intractable CCH. Stimulation of the sphenopalatine ganglion (SPG) with a miniaturized implanted stimulator produced a clinically significant improvement in 68% of patients (acute, preventive, or both). Vagus nerve stimulation (VNS) with a portable device used in conjunction with standard of care in CH patients resulted in a reduction in the number of attacks. DBS and ONS have been used successfully in some cases of other TACs, including hemicrania continua (HC) and short-lasting unilateral headache attacks (SUNHA). DBS has good results, but it is a more invasive technique and can generate serious adverse events. ONS has good results, but frequent and not serious adverse events. SPG stimulation (SPGS) is also efficacious in the acute and prophylactic treatment of refractory cluster headache. At this moment, ONS and SPG stimulation techniques are recommended as first line therapy in refractory cluster patients. New recent non-invasive approaches such as the non-invasive vagal nerve stimulator (nVNS) have shown efficacy in a few trials and could be an interesting alternative in the management of CH, but require more testing and positive randomized controlled trials.

Comparison of the efficacy of once- and twice-daily colchicine dosage in pediatric patients with familial Mediterranean fever--a randomized controlled noninferiority trial.

BackgroundIn this study, we examined the efficacy and safety of a once-daily dosage schema of colchicine compared with a twice-daily dosage schema in pediatric patients with familial Mediterranean fever (FMF).MethodsIn this 24-week, multicenter, randomized controlled noninferiority trial, pediatric patients newly diagnosed with FMF carrying a homozygous or compound heterozygous mutation and not receiving any treatment were included. Patients were randomly assigned using a block randomization method to receive treatment with a once- or twice-daily dosage. Clinical and laboratory characteristics and medication side effects were recorded and compared between groups. The study was carried out in compliance with Good Clinical Practice and the Consolidated Standards for Reporting of Trials (CONSORT) statement.ResultsA total of 92 patients were selected, and 79 patients completed the study. There were 42 patients in the once-daily dosage group and 37 in the twice-daily dosage group. The results indicated that the once-daily dosage was not inferior to the twice-daily dosage regarding decrease in attack frequency and duration as well as improvement in clinical findings and Mor severity scores. Alterations in laboratory findings indicating inflammation, such as erythrocyte sedimentation rate, C-reactive protein, and serum amyloid A, were similar in both groups. The rates of drug side effects were similar between the once- and twice-daily dosage groups, implying comparable safety of colchicine, with the exception of diarrhea, which was slightly higher in the once-daily dosage group.ConclusionsUsing colchicine with either a once- or twice-daily dosage provides similar clinical and laboratory improvements. Considering both efficacy and safety, colchicine can be prescribed with a once-daily dosage.Trial Registration IDClinicalTrials.gov identifier NCT02602028. Registered 5 November 2015.

Neuromodulation of the posterolateral hypothalamus for the treatment of chronic refractory cluster headache: Experience in five patients with a modified anatomical target

Deep brain stimulation (DBS) of the posterior hypothalamus has been found to be effective in the treatment of refractory chronic cluster headache (CCH). We report the long-term outcomes of five patients with refractory CCH on whom stimulation of a modified target of approximately 3 mm in radius, which included the posterolateral hypothalamus, the fasciculus mammillotegmentalis, the fasciculus mammillothalamicus and the fasciculus medialis telencephali, was performed. The stereotaxic coordinates were 4 mm from the third ventricle wall, 2 mm from behind the mid-intercommissural point and 5 mm from under the intercommissural line. All patients became pain-free for 1-2 weeks after the procedure, but then needed an average of 54 days to optimize stimulation parameters. After a mean follow-up of 33 months, two remain pain-free, two have an excellent response (>90% decrease in attack frequency) and in one the attacks have been reduced by half. There were no serious adverse events. Permanent myosis and euphoria/well-being feeling were seen in three patients. Other adverse events, such as diplopia, dizziness, global headache of cervical dystonia, were seen transiently related to an increase in stimulation parameters. Attacks reappeared transiently in two patients as a result of cable rupture and when the stimulator was disconnected. Our results supports the efficacy of DBS in very refractory CCH with a slightly modified hypothalamic target conceived to avoid the lateral ventricle wall so as to extend the stimulated brain area and to decrease the morbidity of potential haemorrhagic complications.

Meer grip op migraine 6 maanden na de gedragsmatige zelfmanagement training door lekentrainers met migraine

More control over migraine 6 months after the behavioural self-management training by lay trainers with migraine Despite the availability of evidence-based treatments for migraine many patients do not seek medical treatment. The primary aim of this study was to evaluate the changes at 6-month follow-up after a behavioural self-management training (SMT) provided by lay trainers with migraine to small groups at home. We previously demonstrated in a RCT the short-term effectiveness on headache improvement, though it was modest when compared with the efficacy of clinical psychologists. However, large effects for self-efficacy and perceived control over attack prevention were achieved. The present follow-up data showed that six months after SMT 42% could be categorized as responders (≥50% decrease in attack frequency), 42% did not change and 16% responded adversely. In the group as a whole (n=95) attack frequency significantly decreased from 3.0 attacks at baseline to 2.5 post-SMT and to 2.3 at 6-month follow-up (-23%, medium effect size .6). The strong improvements of perceived control over and self-confidence in attack prevention were maintained at follow-up. Disability and health status were not changed, however, quality of life significantly improved over time (p<.01). SMT was also more beneficial for patients who entered the training with a high attack frequency. In conclusion, home-based lay trainers with migraine can train small groups of fellow patients in behavioural techniques. At 6-month follow-up attack frequency and quality of life were modestly improved, and feelings of control and self-confidence remained strongly improved.

Lay Trainers With Migraine for a Home‐Based Behavioral Training: A 6‐Month Follow‐Up Study

To evaluate the changes at 6-month follow-up after a home-based behavioral training (BT) provided by lay trainers with migraine to small groups of fellow patients. The need for self-management programs and cost-effective treatments gave rise to this study. In a previous randomized controlled trial, we compared the BT group with a waitlist-control group, receiving usual care. The control group was trained directly after their waitlist period. The present study examined the follow-up results in both groups and measurements were held pre BT, post BT, and at 6-month follow-up. Six months after BT, 42% was categorized as responders (>or=-50% decrease in attack frequency), 42% did not change (-49 to 49%), and 16% responded adversely (>or=50% increase). In the group as a whole (n = 95), attack frequency significantly decreased from 3.0 attacks at baseline to 2.5 post BT and to 2.3 at 6-month follow-up (-23%, medium effect size 0.6). The strong improvements of perceived control over and self-confidence in attack prevention were maintained at follow-up. Disability and health status were unchanged but quality of life significantly improved over time (P = .007). BT was more beneficial for patients who entered the training with a high attack frequency. Linear regression analysis demonstrated that a stronger belief at baseline that the occurrence of migraine is due to chance (external control) significantly predicted a lower attack frequency at follow-up. Lay trainers with migraine can train small groups of fellow patients at home in behavioral attack prevention. At 6-month follow-up, attack frequency and quality of life were significantly but modestly improved and feelings of control and self-confidence remained strongly improved.

Success and failure of preventative migraine treatment with botulinum toxin type A: Association with a novel classification of migraine headache

Quite a few migraine patients have noticed a considerable decrease in attack frequency following BTX-A injections. Many migraineurs, however, do not experience such improvement. Is there a marker that would tease out prospective responders from non-responders? Patients experiencing a >75% reduction in attack frequency within 3 months of treatment were selected as responders. Patients who showed no change in attack frequency were selected as non-responders. The interviewer had no knowledge of the patient's response to BTX-A treatment before the interview was completed. Responders experienced significant drops in the number of attacks/month, attack duration, and headache intensity. Non-responders yielded identical values before and after treatment. There was one clear difference between the two groups: 92% of non-responders described their headache as exploding (extreme pressure inside the head), whereas 89% of the responders described their headache as imploding (extreme pressure outside the head) or ocular (extreme pressure behind the eyeball). Migraine with imploding or ocular headache is highly associated with successful prevention of attacks using BTX-A. However, migraine with exploding headache is highly associated with failure to block attacks using BTX-A.

8. Hereditary angioedema

Hereditary angioedema is an episodic swelling disorder with autosomal dominant inheritance. Attacks are characterized by brawny, self-limited, nonpruritic edema of the deep dermal layers of the skin that most often involve the hands and feet. They usually begin in childhood and become more severe after puberty. Patients also have episodic attacks of severe abdominal pain caused by edema of the gastrointestinal mucosa. Swelling attacks are life threatening when they involve the airway. Estrogens exacerbate attacks, and in some patients attacks are precipitated by trauma or psychologic stress. The disease is caused by a mutation in one of the 2 copies of the gene for the plasma protein C1 inhibitor, with the product of 1 gene unable to control generation of bradykinin. Eighty-five percent of patients have low antigenic levels of C1 inhibitor, and 15% have normal levels of poorly functioning protein. Most patients have decreased plasma complement protein C4 levels. Impeded androgens and, less frequently, epsilon-aminocaproic acid are currently the mainstays of chronic treatment. These agents or fresh frozen plasma are also used for prophylaxis. At this time, acute therapy is mostly supportive. There are currently ongoing multiple trials of new therapeutic agents. In half a century, a life-threatening disease has become one that is manageable and rarely causes death.

Effective prophylactic therapy for cyclic vomiting syndrome in children using amitriptyline or cyproheptadine.

To evaluate our experience using the antimigraine prophylactic drugs, amitriptyline and cyproheptadine, for the prophylactic management of cyclic vomiting syndrome (CVS) in children. Twenty-seven patients (16 males) ranging in age from 2 to 16 years at diagnosis, fulfilling the diagnostic criteria for CVS and treated prophylactically with either amitriptyline (22) or/and cyproheptadine (6) were identified through retrospective chart review. Individual patient data were corroborated by the attending physician and/or interviews with patients and families. Minimum follow-up time before entry into the study group was 5 months. Patients were stratified according to three treatment outcomes: 1) complete response-no attacks, 2) partial response-50% or greater reduction in frequency of attacks, and 3) no response-less than 50% decrease in frequency of attacks. Of the 22 patients treated with amitriptyline, 16 (73%) had a complete response while 4 (18%) had a partial response. Of the 6 patients treated with cyproheptadine, 4 (66%) had a complete response and 1 (17%) had a partial response. Thus, 91% of the amitriptyline group and 83% of the cyproheptadine group had at least a partial response to therapy. No patients experienced significant side effects to either medication. The antimigraine prophylactic drugs, amitriptyline and cyproheptadine, represent effective prophylactic agents for the management of CVS in the vast majority of patients fulfilling the diagnostic criteria for this syndrome.

Comparisons of Oral Propafenone and Sotalol as an Initial Treatment in Patients With Symptomatic Paroxysmal Atrial Fibrillation

The main goal of this study is to evaluate the safety and efficacy of propafenone versus sotalol as an initial choice of treatment in patients with symptomatic paroxysmal atrial fibrillation (AF), according to a double-blind randomized system. In the oral propafenone group (n = 41), 2 patients (5%) discontinued therapy because of gastrointestinal discomfort in 1 and dizziness in the other. Thirty-one (79%) of the 39 patients who continued the treatment had effective response to oral propafenone (>75% reduction of symptomatic arrhythmic attacks) on a mean dose of 663 ± 99 mg/day with a decrease in attack frequency from 10 ± 3 to 2 ± 1 times per week. In the oral sotalol group (n = 38), 4 patients (11%) discontinued treatment because of dizziness in 2 and symptomatic bradycardia in 2. Twenty-six of the 34 patients (76%) who continued the treatment had effective response to oral sotalol on a mean dose of 200 ± 57 mg/day with a decrease in attack frequency from 11 ± 3 to 2 ± 1 times per week. Comparisons of the results between propafenone and sotalol groups showed a similar incidence of intolerable (2 of 41 vs 4 of 38, p = 0.42) and tolerable side effects (10 of 39 vs 8 of 34, p = 1.0). The attack frequency at baseline (11 ± 3 vs 10 ± 4 times per week, p = 0.23) and after treatment (3 ± 1 vs 3 ± 2 times per week, p = 0.85) did not differ significantly between the 2 groups. The incidence of effective response to drugs was also similar (31 of 39 vs 26 of 34, p = 0.78). Furthermore, the decrease of symptom scores (−32 ± 8% vs −29 ± 7%, p = 0.18) and percentage decrease of ventricular rate (−15 ± 4% vs −18 ± 4%, p = 0.10) during AF were also similar between the 2 groups. In conclusion, oral propafenone and sotalol are equally effective and safe in preventing attacks and alleviating symptoms of paroxysmal AF.A double-blind randomized study protocol was designed to evaluate the safety and efficacy of propafenone versus sotalol as an initial choice of treatment in 79 patients with frequent attacks of symptomatic paroxysmal atrial fibrillation. The study result demonstrated that oral propafenone and sotalol were equally effective and safe in preventing attacks and alleviating symptoms of paroxysmal atrial fibrillation.

Spatiotemporal Patterns of White Shark (Carcharodon carcharias) Predation at the South Farallon Islands, California

Spatial and temporal records of 146 predatory attacks by white sharks (Carcharodon carcharias) on four species of pinnipeds, one bird, and one human at the South Farallon Islands, Central California, from late Aug. to early Dec. 198689 are presented. During each 3.5-mo period, attacks were (1) unevenly distributed in bouts separated by hiatuses in predation, (2) paired temporally within the same day, (3) at similar times and locations on consecutive days, and (4) all during daylight hours. Predation was observed most often within 450 m of shore, with a decrease in attack frequency with increasing depth. Within this high-risk zone, predation was concentrated near coastal departure and entry points of pinnipeds, and the predatory attack positions formed linear patterns leading away from the island. Consecutive predatory attacks were often near each other, yet at times alternated between localities on either side of the island.

Preliminary experience with endoscopic stent placement in benign pancreatic diseases

We treated 35 patients with endoscopic stent placement across the major or minor papilla in an attempt to relieve suspected partial obstruction to pancreatic duct drainage in patients with pancreatitis. The patients subsequently have been followed for periods ranging from 6 months to 3 years (mean, 14 months). Endoscopic stents were successfully placed across the minor papilla in 19 of 22 patients with pancreas divisum associated with acute recurrent pancreatitis (19) and severe abdominal pain (3). 17 patients had symptomatic improvement manifested by a decrease in frequency of attacks of pain and emergency admission. Stents were placed through the major papilla in 14 of 15 patients with recurrent pancreatitis related to a variety of causes. 8 of the 14 patients improved during the follow-up period, including 4 of 5 patients with alcoholic pancreatitis complicated by a segmental stricture.

Some Problems in the Study of Anuran Pairing Patterns

come to resemble one another. In some instances they do so closely, in others sufficiently only to recall an unpleasant experience by means of some striking feature which they possess in common. From treatments like that of Ford we feel that the message delivered is that a predator rapidly learns to avoid distasteful models, in principle after a single trial, and thereafter hardly ever touches a similar looking insect again. We therefore interpret Ford's assertion, that mullerian mimics all of which are protected, to mean that they are not attacked, i.e. gain full protection when predators have once come into contact with a mullerian mimic. Thus we have never claimed that the probability of a new instar of L. equestris being attacked when presented during trial 5 is equal to that of it being attacked when presented for the first time, and the point Paxton and Harvey make about the sample size used, making it impossible to detect a 25% decrease in attack frequency from trial 1 to 5, is of course correct. However, we do not agree with their claim that trial 4 does not make a suitable comparison with trial 5. On the contrary, we believe that the important comparison to be made is that between the two trials which mark the point where a switch in prey type occurs. Since our experiment was designed to give the birds' experience of the first prey type, and thus a possibility for avoidance learning during four consecutive trials, the relevant comparison to be made is that between trials 4 and 5. Finally, the null hypothesis relevant to our experiment is that the birds do not detect a difference between the two prey types. This null hypothesis could not have been rejected if the attack frequency had decreased or remained the same between trials 4 and 5. However, the statistically significant increase in attack frequency that we found in our experiment forces us to reject the null hypothesis and to conclude that the birds do perceive a difference between the two instars. In conclusion, judging from our data on attack frequencies, there is no evidence to indicate that the birds used in our experiments did generalize between adults and fifth instar larvae of L. equestris.

EPIPHARYNGITIS AND RHEUMATISM

Because many patients with epipharyngitis suffer from latent inflammation with few local symptoms, in spite of severe over-all body symptoms, we can find very little literature regarding observation and description of this inflammation.Several findings on epipharyngitis and relationship between rheumatism and epipharyngitis were investigated and mutual relationship was found between the treatment of epipharyngitis and the improvement of rheumatic symptoms.The cases are classified from Stage I to Stage IV according to Steinbrocker's classification.Six cases of Stage I improved in all their body symptoms as arthralgia improved. One of the 2 cases of Stage II improved somewhat but the other did not.Out of the 3 cases of Stage III, one case improved to a certain degree. Two cases out of the 3 with rheumatic fever improved and the other showed decrease in frequency of attacks.