Learning and attention reveal a general relationship between population activity and behavior

Prior studies have demonstrated that correlated variability changes with cognitive processes that improve perceptual performance. We tested whether correlated variability covaries with subjects' performance-whether performance improves quickly with attention or slowly with perceptual learning. We found a single, consistent relationship between correlated variability and behavioral performance, regardless of the time frame of correlated variability change. This correlated variability was oriented along the dimensions in population space used by the animal on a trial-by-trial basis to make decisions. That subjects' choices were predicted by specific dimensions that were aligned with the correlated variability axis clarifies long-standing paradoxes about the relationship between shared variability and behavior.

Expression of anxiety and depression in a case of subcortical motor aphasia

A decision tree and decimal rating scales were used for psychotherapy with a patient with post-stroke subcortical motor aphasia. These two methods used in combination were highly efficient in obtaining information about the patient's mood and issues of concern. The patient was able to report on changing levels of anxiety and depression. He was able to relate his emotional state to environmental or personal factors. Values as low as 1 and as high as 10 for anxiety and depression were reported by the patient during the course of 25 psychotherapy sessions. A Pearson correlation indicated that anxiety and depression varied independently.

Laser Mixing of Titanium on Silicon Carbide

We have used excimer laser surface processing to melt and mix single Ti layers into the surface of polycrystalline SiC substrates. The mixing of Ti into the surface is very rapid and efficient. Examination of Rutherford backscattering (RBS) data for different mixing conditions shows the formation of a preferred composition at the Ti-substrate interface which propagates from the interface with further mixing. Reconstruction of the RBS spectrum indicates that the composition of the layer is Ti45C37Si18. X-ray diffraction demonstrates the formation of Ti suicides and carbides in the surface region. Profiling of C in both mixed and uncoated samples by 6 MeV He+ scattering demonstrates that laser processing of the SiC does not cause major changes in the stoichiometry of the substrate material.

Fluorescamine as a terminating agent in solid phase peptide synthesis

Fluorescamine was shown to be an excellent terminating agent for blocking unreacted amino groups during solid phase peptide synthesis. A comparison of the termination efficiency of fluorescamine versus that of acetylation revealed that the former method gave superior products as assessed by peptide analysis, dansyl-amino end group determination and biological assay. In addition, fluorescamine terminated fragments were converted to non-fluorescent spirolactones during the deprotection stage. These spirolactones were stable to subsequent solid phase reaction conditions and were readily removed from the target peptide.

Complete remodelling of displaced fractures of the neck of the phalanx

Fractures of the neck of the phalanx of the finger are uncommon, but problematic, injuries in children. Displaced fractures may heal with malunion leading to loss of movement or angular deformity. Remodelling of the phalangeal neck is reported to be minimal because of the distance of the fracture from the physis. We report three displaced fractures in two children who presented late. The fractures were treated conservatively and remodelled completely. Both patients regained full movement of the fingers.

Herbal and complementary and alternative medicine therapies for liver disease. A focus on Chinese traditional medicine in hepatitis C virus

This article presents herbal and alternative therapies used in the treatment of liver disease, both as adjunctive or complementary treatment to Western pharmaceutical strategies, and as an alternative treatment in liver disease, particularly for Hepatitis C Virus. There is a special emphasis on traditional Chinese herbal medicine.

Use of a chinese herbal medicine for treatment of hiv-associated pathogen-negative diarrhea

Background: Diarrhea is a frequent problem among persons with advanced HIV disease. In the absence of treatable pathogens, symptomatic relief is all that is available for current therapy. As a result, many patients with HIV and chronic diarrhea have turned to herbal formulas for treatment. We assessed the effectiveness and safety of a Chinese herbal formulation (Source Qi) in reducing the number of stools per day related to HIV-associated, pathogen-negative diarrhea. Methods: Sixteen male patients received treatment with Source Qi in an 8-week, open-label study. Patients tested negative for cryptosporidium and other gastrointestinal pathogens, and had chronic diarrhea, defined as having three or more loose stools/day for >/=14 days (and no other treatable causes for diarrhea). Measurements of diarrhea included numbers of bowel movements/day, abnormal bowel movements/day, and liquid bowel movements/day. Subjects completed daily stool diaries an average of 2 weeks before and up to 8 weeks after starting Source Qi. Paired Wilcoxon tests compared the last week before treatment with each week of treatment. Results: There was a reduction in average number of stools/day in each week of treatment (-0.2 to -0.8), except week 1 (+0.1), with improvements in weeks 2-6 approaching or reaching statistical significance. Conclusions: A modest but sustained decrease in average number of stools/day was observed in patients with HIV-associated, pathogen-negative diarrhea. The entry criteria, 2-week run-in period, lack of benefit in week 1, and sustained benefit thereafter all suggest that the improvement was not due to bias.

Randomized, placebo-controlled trial of Chinese herb therapy for HIV-1-infected individuals

CONTEXT

Alternative medicine or complementary remedies that have not been scientifically tested are nonetheless widely used to treat chronic illnesses, particularly if curative options are limited.

OBJECTIVES

To assess the effectiveness of Chinese medicinal herbs in reducing symptoms and improving the quality of life of HIV-infected persons.

DESIGN

Prospective, placebo-controlled double-blind study.

SETTING

University-based HIV outpatient clinic.

PATIENTS

68 HIV-infected adults with CD4 cell counts <0.5 x 10(9)/L.

INTERVENTION

Participants were randomized to receive four daily doses of seven pills containing a standardized preparation of 35 Chinese herbs or placebo for 6 months.

MAIN OUTCOME MEASURES

Symptoms, HIV disease progression, HIV-1 RNA plasma viral loads, CD4 and CD8 cell counts, and scores on standard questionnaires for quality of life, depression, anxiety, and coping.

RESULTS

Intervention and placebo groups were equivalent at baseline regarding, respectively, previous antiretroviral therapy (74% versus 79%), median CD4 cell counts (0.20 x 10(9)/L versus 0.25 x 10(9)/L), and median HIV-1 plasma viral loads (35,612 copies/ml versus 52,027 copies/ml). At enrollment, none of the study subjects was seriously ill or depressed, and average coping and quality of life scores were in the normal range. In all, 53 (78%) participants completed the study. Patients taking Chinese herbs reported significantly more gastrointestinal disturbances (79% versus 38%; p = .003) than those receiving placebo. No therapy-related toxicities were observed. At completion of the study, no significant differences between the intervention and placebo groups were found regarding plasma viral loads, CD4 cell counts, symptoms, and psychometric parameters. HIV-1 RNA level was unchanged at study end. Among participants who were not on concomitant antiretroviral therapy, median CD4 cell counts declined by 0.05 x 10(9)/L in both the intervention and placebo groups.

CONCLUSIONS

This standardized formulation of Chinese herbs for HIV-infected individuals did not improve quality of life, clinical manifestations, plasma virus loads, or CD4 cell counts. The data suggest that this formulation of Chinese herbs is not effective when administered in a Western medicine setting.

Baseline relationships between psoriasis and psoriatic arthritis: analysis of 221 patients with active psoriatic arthritis. Department of Veterans Affairs Cooperative Study Group on Seronegative Spondyloarthropathies

OBJECTIVE

To determine differences in disease onset, extent, and manifestations of psoriasis among patients with active, inflammatory psoriatic arthritis (PsA), and to examine relationships that may exist between psoriasis and PsA.

METHODS

Baseline demographic, clinical, and laboratory data were analyzed from 221 patients enrolled in a multicenter cooperative study, and relationships between measures of psoriasis and PsA were determined.

RESULTS

Mean percentage of body surface area (BSA) affected by psoriasis was modest (12+/-17), and mean severity of erythema, induration, and scaling was moderate (4.9+/-2.1 on a 0-9 scale). Spanish Americans tended to have a higher mean percentage of BSA (18.5%) than Caucasians (11%; p = 0.067), as well as higher target lesion severity (5.55 vs. 4.84; p = 0.077). Patients with psoriatic nail disease (180/221, 81%) had significantly greater number of involved distal interphalangeal (DIP) joints (p = 0.004). There were no other significant associations of skin pattern or regional involvement with PsA.

CONCLUSION

Patients with active PsA have generally mild skin disease, and baseline relationships between psoriasis and PsA tend to be weak except for nail involvement and DIP joint activity.

Effectiveness of technical assistance in the development of psychiatric rehabilitation programs

Most mental health programs need technical assistance to develop effective psychiatric rehabilitation programs. This article discusses how psychiatric rehabilitation was introduced into three community mental health programs and describes the elements of a psychiatric rehabilitation program and the phases of a technical assistance process. A case study illustrates how technical assistance consultants can be trained to develop psychiatric rehabilitation programs. Barriers and facilitators to the technical assistance are discussed in the context of several other technical assistance studies.

Survey of hospital systems and common serious medication errors

The Institute for Safe Medication Practices and the University of Illinois at Chicago, College of Pharmacy, undertook a hospital survey of medical-surgical hospitals to determine systems-oriented factors that allow the highest level of medication safety. The study incorporated a peer-reviewed and pretested questionnaire, which focused on critical information necessary to yield quality data for comparison. Through analysis, it was shown that over one third of all medication errors reported in the survey involve just six categories--allergies, insulin, heparin, opiates, PCA devices, and potassium concentrates.

Individual and sex differences in speed of handwriting among high school students

A group of 153 high school students participated in a cursive handwriting task which required them to copy sentences as quickly as possible. The 78 girls performed significantly better than the 75 boys and a substantial range of speed for each sex was found. The results have implications for more demanding writing and composition processes. Handwriting speed has the potential to act as a limiting factor under some circumstances.

Stymied by seizures. When the clues point to the wrong path

Seizures have many causes, and physicians should try not to be shortsighted when an apparent cause seems to leap out. The key is being receptive to the fact that a less obvious source of seizures may exist. In this case, new-onset seizures believed consistent with illicit drug use proved to have an infectious cause.

Medication error prevention: profiling one of pharmacy's foremost advocacy efforts for advice on error prevention

Medication errors have become a growing concern with the increase in the number of critically ill patients, in the complexity of drug therapy and in the use of more potent, dangerous drugs. The Institute for Safe Medication Practices (ISMP), a nonprofit organization founded three years ago, is in the forefront of medication error prevention efforts. Working with practitioners, regulatory agencies, healthcare institutions, professional organizations and the pharmaceutical industry, both nationally and internationally, ISMP provides timely and accurate medication safety information through its educational programs, site-reviews, and ongoing publications. This article reviews the work of ISMP and offers recommendations for managers to begin error prevention strategies.

Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis. A Department of Veterans Affairs Cooperative Study

OBJECTIVE

To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective for the treatment of active ankylosing spondylitis (AS) that is not controlled with nonsteroidal antiinflammatory drug therapy.

METHODS

Two hundred sixty-four patients with AS were recruited from 15 clinics, randomized (double-blind) to SSZ or placebo treatment, and followed up for 36 weeks. Treatment response was based on morning stiffness, back pain, and physician and patient global assessments.

RESULTS

While longitudinal analysis revealed a trend favoring SSZ in the middle of treatment, no difference was seen at the end of treatment. Response rates were 38.2% for SSZ and 36.1% for placebo (P = 0.73). The Westergren erythrocyte sedimentation rate declined more with SSZ treatment than with placebo (P < 0.0001). AS patients with associated peripheral arthritis showed improvement that favored SSZ (P = 0.02). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints.

CONCLUSION

SSZ at a dosage of 2,000 mg/day does not seem to be more effective than placebo in the treatment of AS patients with chronic, longstanding disease. SSZ is well tolerated and may be more effective than placebo in the treatment of AS patients with peripheral joint involvement. This effect is more pronounced in treatment of the peripheral arthritis in this subgroup of AS patients.

Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis. A Department of Veterans Affairs Cooperative Study

OBJECTIVE

To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective for the treatment of active psoriatic arthritis (PsA) resistant to nonsteroidal antiinflammatory drug therapy.

METHODS

Two hundred twenty-one patients with PsA were recruited from 15 clinics, randomized (double-blind) to SSZ or placebo treatment, and followed up for 36 weeks. Treatment response was based on joint pain/ tenderness and swelling scores and physician and patient global assessments.

RESULTS

Longitudinal analysis revealed a trend favoring SSZ treatment (P = 0.13). At the end of treatment, response rates were 57.8% for SSZ compared with 44.6% for placebo (P = 0.05). The Westergren erythrocyte sedimentation rate declined more in the PsA patients taking SSZ than in those taking placebo (P < 0.0001). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints, including dyspepsia, nausea, vomiting, and diarrhea.

CONCLUSION

SSZ at a dosage of 2,000 mg/day is well tolerated and may be more effective than placebo in the treatment of patients with PsA.

Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome). A Department of Veterans Affairs Cooperative Study

OBJECTIVE

To determine whether sulfasalazine (SSZ) at a dosage of 2,000 mg/day is effective in the treatment of reactive arthritis (ReA) that has been unresponsive to nonsteroidal antiinflammatory drug (NSAID) therapy.

METHODS

One hundred thirty-four patients with ReA who had failed to respond to NSAIDs were recruited from 19 clinics, randomized (double-blind) to receive either SSZ or placebo, and followed up for 36 weeks. The definition of treatment response was based on joint pain/tenderness and swelling scores and physician and patient global assessments.

RESULTS

Longitudinal analysis revealed improvement in the patients taking SSZ compared with those taking placebo, which appeared at 4 weeks and continued through the trial (P = 0.02). At the end of treatment, response rates were 62.3% for SSZ treatment compared with 47.7% for placebo treatment. The Westergren erythrocyte sedimentation rate declined more with SSZ treatment than with placebo (P < 0.0001). Adverse reactions were fewer than expected and were mainly due to nonspecific gastrointestinal complaints.

CONCLUSION

SSZ at a dosage of 2,000 mg/day is well tolerated and effective in patients with chronically active ReA.

Ultraviolet irradiation in systemic lupus erythematosus: friend or foe?

The long established notion that UV irradiation is always harmful to patients with systemic lupus erythematosus has been challenged by some recent reports of benefit using a form of phototherapy with UV-A1. In the review we discuss the different types of UV radiation, the links between certain forms of such radiation and clinical manifestations and consider the mechanisms involved.

Pilot randomized controlled trial of Chinese herbal treatment for HIV-associated symptoms

We wished to determine the short-term safety and efficacy of a Chinese medicinal herb preparation in treating symptoms of human immunodeficiency virus (HIV) infection in a 12-week randomized, double-blind, placebo-controlled clinical trial in a University-affiliated acquired immunodeficiency syndrome (AIDS) clinic at a public general hospital. Thirty adults with symptomatic HIV infection, no previous AIDS-defining diagnosis, and CD4+ counts of 0.200-0.499 x 10(9)/L (200-499/mm3) received 28 tablets each day of either a standardized oral preparation of 31 Chinese herbs or a cellulose placebo. Primary outcome measures were changes in life satisfaction, perceived health, and number and severity of symptoms. Other outcomes included adherence, and changes in weight, CD4+ count, depression, anxiety, physical and social function, and mental health. Two placebo- and no herb-treated subjects had mild adverse events (AE). Subjects on both arms reported taking 94% of prescribed tablets. No differences between treatment groups reached the p < 0.05 level. Life satisfaction improved in herb-treated [+0.86, 95% confidence interval (CI): +0.29, +1.43] but not in placebo-treated subjects (+0.20, 95% CI -0.35, + 0.75). Number of symptoms was reduced in subjects receiving herbs (-2.2, 95% CI -4.1, -0.3) but not in those receiving placebo (-0.3, 95% CI -3.2, +2.7). There were trends toward greater improvements among herb-treated subjects on all symptom subscales except dermatologic. Believing that one was receiving herbs was strongly associated with reporting that the treatment had helped (p < 0.005), but not with changes in life satisfaction or symptoms. There were improvements in life satisfaction and symptoms among subjects receiving the herbal therapy. Whether Chinese herbs are effective in the management of symptomatic HIV infection can be adequately addressed only by larger trials of longer duration.

Preventing medication errors in cancer chemotherapy

Recommendations for preventing medication errors in cancer chemotherapy are made. Before a health care provider is granted privileges to prescribe, dispense, or administer antineoplastic agents, he or she should undergo a tailored educational program and possibly testing or certification. Appropriate reference materials should be developed. Each institution should develop a dose-verification process with as many independent checks as possible. A detailed checklist covering prescribing, transcribing, dispensing, and administration should be used. Oral orders are not acceptable. All doses should be calculated independently by the physician, the pharmacist, and the nurse. Dosage limits should be established and a review process set up for doses that exceed the limits. These limits should be entered into pharmacy computer systems, listed on preprinted order forms, stated on the product packaging, placed in strategic locations in the institution, and communicated to employees. The prescribing vocabulary must be standardized. Acronyms, abbreviations, and brand names must be avoided and steps taken to avoid other sources of confusion in the written orders, such as trailing zeros. Preprinted antineoplastic drug order forms containing checklists can help avoid errors. Manufacturers should be encouraged to avoid or eliminate ambiguities in drug names and dosing information. Patients must be educated about all aspects of their cancer chemotherapy, as patients represent a last line of defense against errors. An interdisciplinary team at each practice site should review every medication error reported. Pharmacists should be involved at all sites where antineoplastic agents are dispensed. Although it may not be possible to eliminate all medication errors in cancer chemotherapy, the risk can be minimized through specific steps. Because of their training and experience, pharmacists should take the lead in this effort.

Enthesopathy and atypical gouty arthritis following renal transplantation: a case control study

AIMS

To define associations and causative factors in a musculotendinous pain syndrome occurring after kidney transplantation.

METHODS

A case-control study was performed. Cases were identified clinically; transplant controls were matched for age, sex, date and type of transplant, and dialysis controls were matched for age, sex, and race.

RESULTS

All cases had enthesitis and five of seven later developed gouty arthritis. None of the controls had findings. The plasma uric acid was significantly greater in cases compared to both control groups.

CONCLUSIONS

A painful musculotendinous syndrome may occur after kidney transplantation. The development of gouty arthritis in five of the seven kidney transplant patients suffering from this syndrome and significant hyperuricemia compared with controls suggested an unusual pattern of gout arthropathy.

Orientation teaching tool to prevent medication error

Patients can be harmed and even killed when a medication error occurs. The following questions are based on actual errors which have been reported through the Medication Error Reporting Program (MERP). This teaching tool is intended as a take home test to make newly hired pharmacists aware of common medication errors. An informed practitioner is another layer of safety in decreasing the possibility of a medication error occurring.