Clarithromycin is a relatively new macrolide antibiotic with an action spectrum similar to that of erythromycin. Its main indications for use are for upper and lower respiratory and skin and soft tissue infections. Little is known about its safety in pregnancy, although animal reproductive studies found an increased rate of cardiovascular anomalies, cleft palate, and embryonic loss. Human data, limited to case reports and one small uncontrolled study, cannot allow evidence based counseling of pregnant women who were exposed to the drug before finding out they were pregnant. Pregnant women who had been counseled on the use of clarithromycin by five centers, were matched for age, smoking, and alcohol use with a control group of pregnant women who were exposed to nonteratogenic antibiotics. A total of 157 women were followed up. Of these, 122 were exposed to the drug in the first trimester. There were no significant differences found between the two groups in the rates of major and minor malformations; 2.3 versus 1.4% for major (p = 0.86) and 5.4 versus 4.9% for minor (p = 0.96). Spontaneous abortion rates in the exposed group was significantly different, higher (14%) than in the control group (7%) (p = 0.04). This first prospective controlled study of exposure to clarithromycin in pregnancy suggests that this agent does not increase the rate of major malformations above the baseline risk of 1-3%. The higher rate of reported spontaneous abortions, although still within the expected baseline rate, may warrant further study.

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This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

This study examines the changes over time in the personal incomes of nonresident fathers--whether divorced or nonmarital--in Wisconsin. Using data from the Wisconsin Court Record data base and the Wisconsin Department of Revenue, the authors examine the incomes of these fathers over the first seven years following a divorce or the initiation of a paternity suit. They also study separately the income patterns of initially poor nonresident fathers and fathers whose nonresident children receive welfare. The most important finding is that the incomes of nonmarital fathers, which typically are low in the beginning, increase dramatically over the years after paternity establishment--often to a level comparable with the incomes of divorced fathers. On the basis of their findings, the authors conclude that failing to establish child support obligations for nonresident fathers simply because their incomes are initially low does not appear justified.

Many species display alloparental care, where individuals care for offspring that are not their own, but usually the behavior is contingent on the individual receiving some direct or indirect benefit. In anemonefish, after removing the breeding male, non-breeders have been observed providing care for eggs they did not sire and which are not kin. Previously this behavior was interpreted as coerced by the female. The purpose of this study was to test the alternative hypothesis that the alloparental care occurs spontaneously without prodding by the female. Groups of Amphiprion ocellaris (male, female and non-breeder) were maintained in the laboratory and behavior monitored after removing the male and both the male and female. Non-breeders began to care for eggs after male removal and further increased parental care after male and female removal. Level of care was not as high as experienced males, but additional experiments showed performance increases with experience. In a separate experiment, non-breeders were placed alone in a novel aquarium and eggs from an established spawning pair were introduced. Approximately 30% of the fish displayed extensive fathering behavior within 90 min. Taken together, our results demonstrate that fathering behavior in A. ocellaris occurs spontaneously, independent of paternity or kinship. Alloparental care, where individuals care for offspring that are not their immediate descendants occurs with reasonable frequency in nature 1-6. However, usually the behavior is actively reinforced by the breeding individuals or contingent on their presence. For instance, in the cooperative breeding cichlid, Neolamprologus pulcher, unrelated subordinates assist the dominant pair in reproduction, otherwise they would be chased out of the territory by the larger breeding pair 5,7. Similarly, in anemonefish Amphiprion clarkii, subordinate, non-breeders care for eggs they did not sire and which are not kin, and the behavior is explained as being coerced by the presence of the dominant female 8. However, anemonefish have a peculiar life history which may have provided the right context for the appearance of unconditional, spontaneous fathering behavior independent of paternity or experience. Anemonefish, or clownfish, are an iconic group of coral reef fish, beloved by the aquarium hobby, and as such their life history has been studied for decades and extensively reviewed elsewhere 9,10. Anemonefish, such as A. clarkii, and especially A. ocellaris, typically live in small groups consisting of one alpha female and one beta male which reproduce together exclusively (i.e., genetic monogamy) plus zero to several gamma non-reproductive subordinates 11,12. The reproductively suppressed gamma individuals are sexually immature 13,14. However, they can rapidly acquire male reproductive potential if the male is removed 15. These gamma individuals are tolerated by the breeding pair and maintain their own dominance hierarchy below the breeders 16. They do not normally provide care towards the eggs and are usually cha...