The effect of triamcinolone subacromial bursa injection versus naproxen therapy was compared in a randomized, double-blind , placebo-con trolled study of 100 patients who had painful shoulders. Outcome was compared using degree of active abduction, pain, limitation of function, and a clinical index that combined equally weighted measures of all of these. In a timeadjusted analysis, triamcinolone was superior to placebo in all clinical variables. Naproxen was superior to placebo in all variables except pain. Triamcinolone was superior to naproxen in the relief of pain (P = 0.04) and the clinical index (P = 0.04). Multiple linear regression analysis showed that naproxen and triamcinolone treatment accounted for only 16% of the variation in outcome, compared with 44% accounted for by the clinical index prior to treatment. Thus, patients with a poor pretreatment clinical index (those with the most room for improvement) were least likely to improve. We conclude that both triamcinolone (P = 0.00005) and naproxen (P = 0.02) are superior to placebo in the treatment of the painful shoulder.The painful shoulder is a common, usually temporarily disabling condition secondary to supraspinatus tendinitis and/or subacromial bursitis. There is no proven best treatment for it. Corticosteroid injection into the tendon or bursa, commonly accepted by rheumatologists and orthopedic surgeons to be effective, has not, in past studies, been shown to affect range of motion in the shoulder.In this double-blind, placebo-controlled study, 100 patients were examined to determine the therapeutic effect of an oral nonsteroidal antiinflammatory drug (NSAID; naproxen, 500 mg twice a day) and a local injection of corticosteroid (triamcinolone, 40 mg), alone or in combination. PATIENTS AND METHODS Patients.Of the 100 patients entered into the study, 56 were from the University of California, San Francisco, Screening and Rheumatology Clinics (UCSF) and 44 patients were from the Veterans Administration Emergency and Rheumatology Clinics (VA), San Francisco. Criteria for entry into the study were the presence of at least 2 of the following 3 findings: painful abduction at any degree of motion, painful arc of movement from 45" to 120°, or tenderness over the insertion of the supraspinatus tendon. Biceps tendinitis was not an inclusion criterion. Patients were excluded for any of the following: significant glenohumeral arthritis, a supraspinatus injection during the preceding 3 months, a reason to suspect rotator cuff tear (weakness of arm elevation, a positive "drop arm sign," or a high-riding humerus visible on roentgenogram of the shoulder), contraindication to the use of NSAIDs (e.g., allergy, renal insufficiency, gastritis, or ulcer), or an allergy to lidocaine. No patient demonstrated a "frozen" shoulder, which we

Summary1. Natural resource agencies often rely on surveys of animal sign (e.g. scat, scent marks, tracks) for population assessment, with repeat surveys required to model and account for uncertain detection. Using river otter Lontra canadensis snow-track survey data as a motivating example, we develop a 3-level occupancy model with parameters that describe (i) site-level occupancy probabilities, (ii) otter movement (and thus, track availability) and (iii) recorded presence-absence of tracks (conditional on the availability of tracks for detection). 2. We incorporated several recent developments in occupancy modelling, including the presence of both false negatives and false positives, spatial and temporal correlation and repeated sampling across distinct observers. 3. We investigated optimal allocation of sampling effort (e.g. within and among snowfall events) using simulations. We also compared models that allowed site-level occupancy and track-laying processes to be spatially correlated with models that assumed independence among sites. 4. Both types of models (independence and spatial) performed well across a range of simulated parameter values, but the spatial model resulted in more accurate point estimates for detection parameters and credibility intervals with better coverage rates when data were spatially correlated. When applied to real data, the spatial model resulted in a higher estimate of the occupancy rate ðŴÞ than the baseline model (0AE82 vs. 0AE59). A minimum of 15-20 helicopter flights, distributed among at least three unique snow events, were needed to meet precision goals (standard errorŴ < 0Á05). 5. Synthesis and applications. We describe a flexible and robust occupancy modelling framework that accounts for heterogeneous detection rates in surveys of animal sign. The method allows for spatially correlated sites and should have broad relevance to surveys conducted by many natural resource agencies.

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Total path length, or search cost, for a rooted tree is defined as the sum of all root-to-node distances. Let Tn be the total path length for a random recursive tree of order n. Mahmoud [10] showed that Wn := (Tn − E[Tn])/n converges almost surely and in L2 to a nondegenerate limiting random variable W. Here we give recurrence relations for the moments of Wn and of W and show that Wn converges to W in Lp for each 0 < p < ∞. We confirm the conjecture that the distribution of W is not normal. We also show that the distribution of W is characterized among all distributions having zero mean and finite variance by the distributional identityformula herewhere [Escr ](x) := − x ln x − (1 minus; x) ln(1 − x) is the binary entropy function, U is a uniform (0, 1) random variable, W* and W have the same distribution, and U, W and W* are mutually independent. Finally, we derive an approximation for the distribution of W using a Pearson curve density estimator.