Deciding when to cross in front of an autonomous vehicle: How child and adult pedestrians respond to eHMI timing and vehicle kinematics

How autonomous vehicles (AVs) communicate their intentions to vulnerable road users (e.g., pedestrians) is a concern given the rapid growth and adoption of this technology. At present, little is known about how children respond to external Human Machine Interface (eHMI) signals from AVs. The current study examined how adults and children respond to the combination of explicit (eHMI signals) and implicit information (vehicle deceleration) to guide their road-crossing decisions. Children (8- to 12-year-olds) and adults made decisions about when to cross in front of a driverless car in an immersive virtual environment. The car sometimes stopped, either abruptly or gradually (manipulated within subjects), to allow participants to cross. When yielding, the car communicated its intent via a dome light that changed from red to green and varied in its timing onset (manipulated between subjects): early eHMI onset, late eHMI onset, or control (no eHMI). As expected, we found that both children and adults waited longer to enter the roadway when vehicles decelerated abruptly than gradually. However, adults responded to the early eHMI signal by crossing sooner when the cars decelerated either gradually or abruptly compared to the control condition. Children were heavily influenced by the late eHMI signal, crossing later when the eHMI signal appeared late and the vehicle decelerated either gradually or abruptly compared to the control condition. Unlike adults, children in the control condition behaved similarly to children in the early eHMI condition by crossing before the yielding vehicle came to a stop. Together, these findings suggest that early eHMI onset may lead to riskier behavior (initiating crossing well before a gradually decelerating vehicle comes to a stop), whereas late eHMI onset may lead to safer behavior (waiting for the eHMI signal to appear before initiating crossing). Without an eHMI signal, children show a concerning overreliance on gradual vehicle deceleration to judge yielding intent.

My assistive technology outcomes framework: rights-based outcome tools for consumers to 'measure what matters'

AT outcomes research is the systematic investigation of changes produced by AT in the lives of AT users and their environments. In contrast to focal outcome measures, My Assistive Technology Outcomes Framework (MyATOF) envisions an alternative starting point, co-designing a holistic and evidence-based set of outcome dimensions enabling AT users to quantify their own outcomes. International classification systems, research evidence, regulatory and service delivery frameworks underpin six optional tools: supports, outcomes, costs, rights, service delivery pathway and customer experience. Designed to empower the consumer-as-researcher and self-advocate, MyATOF has the potential to fill an identified gap in policy-relevant, consumer-focussed and consumer-directed outcome measurement in Australia and internationally. This paper presents the need for consumer-focussed measurement and articulates the conceptual foundations of MyATOF. The iterative development and results of MyATOF use-cases collected to date are presented. The paper concludes with next steps in using the Framework internationally, as well as its future development.

The injury patterns, management and outcomes of retroperitoneal haemorrhage caused by lumbar arterial bleeding at a Level-1 Trauma Centre: A 10-year retrospective review

PURPOSE

Haemorrhagic shock remains a leading preventable cause of death amongst trauma patients. Failure to identify retroperitoneal haemorrhage (RPH) can lead to irreversible haemorrhagic shock. The arteries of the middle retroperitoneal region (i.e., the 1st to 4th lumbar arteries) are complicit in haemorrhage into the retroperitoneal space. However, predictive injury patterns and subsequent management implications of haemorrhage secondary to bleeding of these arteries is lacking.

MATERIALS AND METHODS

We performed a retrospective cohort study of patients diagnosed with retroperitoneal haemorrhage who presented to our Level-1 Trauma Centre (2009-2019). We described the associated injuries, management and outcomes relating to haemorrhage of lumbar arteries (L1-4) from this cohort to assess risk and management priorities in non-cavitary haemorrhage compared to RPH due to other causes.

RESULTS

Haemorrhage of the lumbar arteries (LA) is associated with a higher proportion of lumbar transverse process (TP) fractures. Bleeding from branches of these vessels is associated with lower systolic blood pressure, increased incidence of massive transfusion, higher shock index, and a higher Injury Severity Score (ISS). A higher proportion of patients in the LA group underwent angioembolisation when compared to other causes of RPH.

CONCLUSION

This study highlights the injury patterns, particularly TP fractures, in the prediction, early detection and management of haemorrhage from the lumbar arteries (L1-4). Compared to other causes of RPH, bleeding of the LA responds to early, aggressive haemorrhage control through angioembolisation. These injuries are likely best treated in Level-1 or Level-2 trauma facilities that are equipped with angioembolisation facilities or hybrid theatres to facilitate early identification and management of thoracolumbar bleeds.

Cellular blue nevus tumor presenting as a submandibular lymph node in a 16-year-old

The cellular blue nevus tumor is a type of dendritic melanocytic nevus that is typically benign and exceedingly rare. The incidence of all blue nevi is about 1%, usually affecting the adult population and appearing on the extremities, sacrococcygeal or gluteal regions. There have only been a handful of case reports cited in the literature where cellular blue nevi present in the head and neck region, usually affecting the scalp and young adult population (7, 8). As such, it is exceedingly rare to encounter a cellular blue nevus tumor in the neck or infiltrating into neck lymph nodes. Here we report a rare case of a cellular blue nevus tumor presenting as a right neck mass in a pediatric 16-year-old patient, shown to invade into the submandibular lymph node and surrounding soft tissue. It is important to be aware of the cellular blue nevus tumor as a differential diagnosis in pediatric neck masses. Histological evaluation is necessary to determine tumor aggression and malignant potential which can guide further treatment in pediatric patients.

Regenerate bone fracture rate following femoral lengthening in paediatric patients

PURPOSE

Femoral lengthening using a circular or mono-lateral frame is a commonly used technique. Fracture at the site of the regenerate bone is a major concern especially following removal of the external fixator. This aim of this study was to assess the rate of fracture of the regenerate bone in this single surgeon series of paediatric patients and determine potential risk factors.

METHODS

Retrospective review of all the femoral lengthening performed by the senior author was performed. The medical and physiotherapy notes were reviewed. The gender, age at time of surgery, disease aetiology, total days in the external fixator and length of the new regenerate bone were recorded. Patients who sustained a regenerate fracture were identified.

RESULTS

A total of 176 femoral lengthening procedures were performed on 108 patients. Eight regenerate fractures occurred in seven patients (4.5%). The mechanism of injury was a fall in five cases and during physiotherapy in three cases. The regenerate fracture occurred a median number of nine days following removal of frame. There was no significant difference between gender, age at time of surgery, total time in external fixator between those who sustained a regenerate fracture and those patients who did not. A significant difference was noted between the amount of lengthening between the 'regenerate fracture group' and the 'no fracture group' (50 mm vs 38 mm, respectively; p = 0.029). There was no association between disease aetiology and risk of regenerate fracture.

CONCLUSIONS

Femoral lengthening of more than 50 mm increases the risk of a fracture at the regenerate site regardless of the disease aetiology. We recommend avoidance of aggressive physiotherapy for the initial four weeks following external fixator removal.

Efficacy and safety of etanercept in moderate-to-severe asthma: a randomised, controlled trial

Increased tumour necrosis factor-α levels have been observed in bronchial biopsies and induced sputum from subjects with severe asthma. We investigated etanercept (ETN) as a therapeutic option for treating moderate-to-severe persistent asthma. In this 12-week, randomised, double-blind, placebo-controlled, phase 2 trial, subjects (n=132) with moderate-to-severe persistent asthma received subcutaneous injections of 25 mg ETN or placebo twice weekly, and were evaluated at baseline, and at weeks 2, 4, 8 and 12. The primary end-point was the change from baseline to week 12 in pre-bronchodilator forced expiratory volume in 1 s (FEV1)% predicted. Secondary end-points included morning peak expiratory flow, FEV1% pred, Asthma Control Questionnaire (5-item version), asthma exacerbations, provocative concentration of methacholine causing a 20% decrease in FEV1, and the Asthma Quality of Life Questionnaire. No significant differences were observed between ETN and placebo for any of the efficacy end-points. ETN treatment was well tolerated, with no unexpected safety findings observed during the study. Clinical efficacy of ETN was not shown in subjects with moderate-to-severe persistent asthma over 12 weeks. However, ETN treatment was a well-tolerated therapy. Studies in specific subsets of patients with asthma with longer-term follow-up may be needed to fully evaluate the clinical efficacy of ETN in this population.

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) plasma concentrations in residents of Paritutu, New Zealand: evidence of historical exposure

An assessment of community exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) was undertaken in Paritutu, New Zealand. The suburb lies adjacent to an agrichemical facility that produced 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), between 1962 and 1987. Soil TCDD measurements from 73 nearby addresses demonstrated a pattern of TCDD deposition consistent with an aerial plume following the prevailing local wind patterns and the agrichemical plant as the point source. Blood samples were taken from 52 volunteers having lived for three or more years in Paritutu between 1962 and 1987. Candidate selection focused primarily on individuals who were most likely to show elevated TCDD blood lipid levels when compared to age and gender stratified national average blood concentrations, and secondarily on individuals that provided additional information about specific exposure periods, potential exposures of younger age groups, and specific dietary patterns. A multipathway exposure model was used to estimate serum TCDD levels in each participant. Age and gender-specific TCDD elimination kinetics were also considered. Historical TCDD environmental concentrations were back-calculated from soil concentrations at each residence assuming TCDD releases occurred pre-dominantly between 1962 and 1975. Serum was analysed for chlorinated dibenzodioxins and dibenzofurans, and a subset was analysed for dioxin-like polychlorinated biphenyls. TCDD in serum lipid exceeded two standard deviations above national background levels for 14 participants, and 3 standard deviations for 10 participants. The highest TCDD lipid concentration was 33.3 ng/kg-lipid, or 11 times higher than the comparative 1997 national average. Elevated TCDD concentrations were observed primarily, but not exclusively, in the older study participants who had been in residence in Paritutu before 1968. The study demonstrated TCDD exposure in this community, occurring most likely through the aerial route, and most probably from fugitive emissions during manufacture.

Comparison of once-daily to twice-daily treatment with mometasone furoate dry powder inhaler

BACKGROUND

Once-daily dosing with an effective inhaled corticosteroid (ICS) would likely enhance compliance and, therefore, aid in the management of asthma.

OBJECTIVE

Several once-daily dosing regimens of mometasone furoate (MF) administered by dry powder inhaler (DPI) were compared with a twice-daily dosing regimen in 286 patients with mild to moderate persistent asthma who were previously being treated with ICS.

METHODS

During a 2-week open-label phase, patients received MF-DPI, 200 microg twice daily. They were then randomized to continue MF-DPI, 200 microg twice-daily treatment or to receive MF-DPI, 200 microg once daily in the morning (AM), 200 microg once daily in the evening (PM), 400 microg once daily AM, or placebo as part of the 12-week, double-blind phase. The primary efficacy variable was the mean change from the baseline to endpoint (last evaluable observation) for FEV1.

RESULTS

Once-daily MF-DPI, 400 microg, AM maintained FEV1, and morning peak expiratory flow rate, FVC, FEF25%-75%, and asthma symptom scores, at levels similar to those for MF-DPI, 200 microg twice daily and significantly better than placebo. Once-daily MF-DPI, 200 microg, PM was effective in maintaining pulmonary function, but was less effective on other efficacy measures. In comparison to the other MF-DPI groups, once-daily MF-DPI, 200 microg, AM was not as effective overall. The incidence of local adverse events, including oral candidiasis, was low with all dosages.

CONCLUSIONS

Once-daily MF-DPI, 400 microg, AM was as effective as MF-DPI, 200 microg twice daily, whereas once-daily MF-DPI, 200 microg, was more effective when administered in the evening compared with morning, for patients receiving ICS therapy. Once-daily dosing offers an effective and convenient treatment that could aid compliance in the treatment of asthma.

Inhaled mometasone furoate reduces oral prednisone requirements while improving respiratory function and health-related quality of life in patients with severe persistent asthma

BACKGROUND

Inhaled corticosteroid therapy in severe persistent asthma has been shown to reduce or eliminate oral corticosteroid (OCS) use while retaining effective asthma control.

OBJECTIVE

We sought to evaluate the ability of mometasone furoate (MF) delivered by means of dry powder inhaler to reduce daily oral prednisone requirements in OCS-dependent patients with severe persistent asthma.

METHODS

We performed a 12-week, double-blind, placebocontrolled trial (21 centers, 132 patients) comparing 2 doses of MF (400 and 800 microg administered twice daily) with placebo, followed by a 9-month open-label phase in which 128 patients received treatment with MF.

RESULTS

At the endpoint of the double-blind trial, MF 400 and 800 mg twice daily reduced daily OCS requirements by 46.0% and 23.9%, respectively, whereas placebo increased OCS requirements by 164.4% (P <.01). Oral steroids were eliminated in 40%, 37%, and 0% of patients in the MF 400 and 800 mg twice daily and placebo groups, respectively. Pulmonary function and quality of life significantly increased for MF-treated patients. Further reductions in OCS requirements were achieved with long-term MF treatment in the open-label phase.

CONCLUSION

MF inhaled orally as a dry powder is an effective alternative to systemic corticosteroids in patients with severe persistent asthma.

Validation of a pediatric asthma caregiver diary

BACKGROUND

Young children are generally not able to consistently and reliably perform tests of airway function, and normative values are not available. Reliable and valid measures of parental reporting of asthma symptoms and functioning are needed to determine the efficacy of asthma interventions.

OBJECTIVE

A pediatric asthma caregiver diary was developed and validated for use in interventional asthma studies.

METHODS

A 3-week prospective study of 125 caregiver parents and their children, aged 2 to 5 years, with persistent asthma was conducted. At baseline, children were classified as either stable (no change to anti-inflammatory therapy) or unstable (anti-inflammatory therapy added or increased).

RESULTS

A symptom scale and day without asthma symptoms (DWAS) were defined from pediatric asthma caregiver diary questions. The scale and DWAS statistically differentiated between the stable and unstable groups at week 1 and detected change between the 2 groups (P <.01). On average, caregivers reported low symptom scores. However, the frequency of DWAS was only 43% of days in the stable group and 22% in the unstable group.

CONCLUSION

The pediatric asthma caregiver diary scale and DWAS have acceptable measurement characteristics for use in clinical trials of children with asthma symptoms. The DWAS indicates an opportunity for improvement in asthma control in this population.

Dose-response evaluation of levalbuterol versus racemic albuterol in patients with asthma

Albuterol, in all marketed forms, is sold as a racemate, composed of a 50:50 mixture of (R)- and (S)-isomers. Racemic albuterol and the single isomer version (R)-albuterol (levalbuterol) were compared in a randomized, double-blind, dose-ranging five-way crossover study in patients (n = 20) with mild persistent to moderate persistent asthma. Placebo, racemic albuterol (2.50 mg), or levalbuterol (0.31, 0.63, or 1.25 mg) were delivered as single, nebulized doses to 5 male and 15 female nonsmoking patients with asthma aged 18-50 years. Serial pulmonary function was assessed at 15-min intervals and mean time to onset of activity and duration of improvement of forced expiratory volume in 1 sec (FEV1) were measured. In addition, blood chemistries, electrocardiogram (ECG) readings, and patient subjective assessment of adverse symptoms were recorded. Levalbuterol was found to provide significant bronchodilatory activity and was well tolerated. Levalbuterol 1.25 mg provided the greatest increase and duration in FEV1 improvement, whereas racemic albuterol (2.50 mg) and levalbuterol 0.63 mg provided comparable effects. The lower doses of levalbuterol were associated with a less marked effect on heart rate and potassium than racemic albuterol or high-dose levalbuterol. These data suggest that 0.63 mg levalbuterol provides bronchodilation equivalent to 2.50 mg racemic albuterol with less beta-mediated side effects.

Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients

BACKGROUND

Montelukast, a leukotriene receptor antagonist, improves parameters of asthma control including forced expiratory volume in one second (FEV(1)) when given orally to patients aged six years or older. This study was undertaken to compare the effect on FEV(1) of intravenous and oral montelukast and placebo during the 24 hour period following administration.

METHODS

Fifty one asthmatic patients (FEV(1) 40-80% predicted and > or =15% improvement after inhaled beta agonist) were enrolled in a double blind, single dose, three period, crossover study to receive intravenous montelukast (7 mg), oral montelukast (10 mg), or placebo in a randomised fashion. The primary end point was area under the curve (AUC)(0-24 h) of the percentage change from baseline in FEV(1). Additional end points were maximum percentage change in FEV(1) and percentage change at different time points.

RESULTS

Compared with placebo, intravenous and oral montelukast significantly increased the AUC(0-24 h) (means of 20.70%, 15.72%, and 7.75% for intravenous, oral and placebo, respectively; no statistical difference between intravenous and oral). The difference in least square means from placebo for intravenous montelukast was 13.27% (95% CI 7.07 to 19.46), p<0.001 and for oral montelukast was 7.44% (95% CI 1.20 to 13.68), p = 0.020. The maximum percentage change in FEV(1) was not significantly different for intravenous and oral montelukast (difference in least square means 6.78% (95% CI -0.59 to 14.15), p = 0.071). The mean percentage change in FEV(1) for intravenous montelukast was greater than for oral montelukast within the first hour (15.02% vs 4.67% at 15 min, p< or =0.001; 18.43% vs 12.90% at one hour, p<0.001 for intravenous and oral montelukast, respectively (placebo 3.05% at 15 minutes, 7.33% at one hour). Intravenous and oral montelukast were similar to placebo in the frequency of adverse events.

CONCLUSIONS

The onset of action for intravenous montelukast was faster than for oral montelukast and the improvement in airway function lasted over the 24 hour observation period for both treatments. Although not well understood, there was a trend toward a greater improvement in FEV(1) with intravenous than with oral montelukast. These findings suggest that leukotriene receptor antagonists should be investigated as a treatment for acute severe asthma.

Placebo-controlled, comparative study of the efficacy and safety of triamcinolone acetonide inhalation aerosol with the non-CFC propellant HFA-134a in patients with asthma. Azmacort HFA Clinical Study Group

BACKGROUND

Triamcinolone acetonide (TAA) inhalation aerosol (Azmacort Inhalation Aerosol), a well-established corticosteroid treatment for bronchial asthma, utilizes the chlorofluorocarbon (CFC) propellant P-12, which will be phased out because of environmental concerns. Two TAA aerosol formulations have been developed using a non-chlorofluorocarbon propellant, HFA-134a (Azmacort HFA Inhalation Aerosol delivering TAA 75 microg/puff or 225 microg/puff).

OBJECTIVE

This study compared the efficacy and safety of the new 225 microg/puff formulation (TAA-HFA 225) to the marketed TAA inhalation aerosol (TAA-CFC) and to placebo in adult patients with moderate-to-severe persistent asthma.

METHODS

After a 5-day to 21-day baseline period during which all patients received TAA-CFC 150 microg/day, 538 patients were randomized to one of the following treatment schedules: TAA-HFA 450, 900, or 1800 microg/day; TAA-CFC 450 or 900 microg/day; or placebo for 12 weeks.

RESULTS

All active treatment groups showed statistically significant improvement compared with placebo in pulmonary function (FEV1, FEF25-75%, morning and evening PEF), use of rescue albuterol, and asthma symptom scores. Improvements in all variables occurred within 1 week of treatment.

CONCLUSIONS

The TAA-HFA 225 exhibited similar safety and efficacy profiles to the two equivalent doses of TAA-CFC studied. Our findings indicate that TAA-HFA is a safe and effective replacement for the currently marketed CFC-containing product. The higher strength 225 microg/puff formulation provides effective control of asthma with fewer inhalations.

The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients

BACKGROUND

Limited dose-response information is available for nebulized beta2 -agonists, especially in young children.

OBJECTIVE

The purpose of this study was to determine the safety and efficacy of increasing doses of nebulized levalbuterol (Xopenex; the pure R-isomer of racemic albuterol) and racemic albuterol compared with placebo in the treatment of asthma in pediatric patients.

METHODS

In this randomized, double-blind, crossover study, children (aged 3 to 11 years) with asthma (resting FEV1 50% to 80% of predicted normal [Polgar's] values) were treated with either levalbuterol, racemic albuterol, or placebo. Eligible subjects underwent a screening visit followed by 4 treatment visits. At each treatment visit, serial pulmonary function tests were completed before and after the treatment; plasma was collected to determine enantiomer levels, and safety was evaluated.

RESULTS

Five 3- to 5-year-old patients and twenty-eight 6- to 11-year-old patients completed the study, and a total of 87 doses of levalbuterol were administered. In the 6- to 11-year-old group, all doses of levalbuterol were significantly greater than placebo in peak change and percent peak change in FEV1 and area under the FEV1 versus time curve (P <.05). The FEV1 values over the 8-hour study period were similar for levalbuterol 0.31 and 0.63 mg and racemic albuterol 2.5 mg and were greatest after levalbuterol 1.25 mg. Median plasma levels of R-albuterol depended on dose and were 0.4, 0.7, 1.2, and 1.0 after levalbuterol 0.31 mg, 0.63 mg, and 1.25 mg and racemic albuterol 2.5 mg, respectively. All patients in the 2.5-mg racemic albuterol arm had measurable plasma levels of S-albuterol, although S-albuterol levels were undetectable in most patients in the levalbuterol arms. In a few patients who received levalbuterol, S-albuterol levels were detected, which was likely because of the use of racemic albuterol as a concomitant medication. All active treatments were well tolerated. beta-Mediated changes in heart rate, potassium, and glucose were dose dependent for all active treatment groups.

CONCLUSION

Levalbuterol caused a significantly greater increase in FEV1 than placebo, and FEV1 values were comparable with or better than those observed with racemic albuterol. beta-Mediated side effects were lower for an equipotent dose of levalbuterol when compared with racemic albuterol. Treatment with levalbuterol resulted in plasma levels that were dose dependent and had an approximate correlation with pharmacodynamic parameters.

Sex differences in anterior commissure size in the rat

Earlier studies have shown that the corpus callosum of rats tends to be larger in males than in females. We report here that the anterior commissure of rats is also larger in males than in females. The sizes of the two commissures were positively correlated in both sexes, but significantly more so in females than in males. The anterior commissure size difference in rats reported here is opposite in direction from that reported elsewhere for humans, and we speculate that this may derive from differences in the relative proportions of the constituent fibers that make up the anterior commissure in the two species.

Septal lesions impair rats' Morris test performance but facilitate left-right response differentiation

Lesions in the septum impaired performance on the Morris test, a task in which the rat locates a hidden escape platform by use of fixed landmarks, but facilitated a water maze-based left-right response differentiation, a task in which the rat finds a hidden escape ramp by means of its internal sense of direction. These results are interpreted as supporting an allocentric/egocentric dichotomy with respect to navigation, and support the notion that rats approach spatial problems with a hierarchy of potential solutions in which allocentric solutions take precedence over egocentric ones. The septal lesions are inferred to disrupt the allocentric mapping system.

Fluticasone propionate improves quality of life in patients with asthma requiring oral corticosteroids

BACKGROUND

Fluticasone propionate is a potent inhaled corticosteroid that is effective in improving pulmonary function and symptoms in patients with asthma.

OBJECTIVE

To evaluate the effects of fluticasone propionate on quality of life in patients with severe asthma requiring oral corticosteroids.

METHODS

A total of 96 patients with severe asthma participated in a randomized, double-blind, placebo-controlled, parallel-group, oral steroid-sparing study. Patients received fluticasone propionate aerosol, 750 or 1000 micrograms bid, or placebo for 16 weeks; 91 of these patients continued in a 1-year open-label study, in which everyone initially received fluticasone propionate, 1000 micrograms bid. At regular intervals, patients completed the Medical Outcomes Study Short Form-36 (SF-36), a general health status questionnaire measuring eight dimensions of quality of life, plus one question on change in health from the previous year.

RESULTS

Compared with the US population, patients scored significantly lower at baseline for five of eight SF-36 dimensions (P < .01). After 16 weeks, patients receiving fluticasone propionate, 1000 micrograms, improved significantly (P < or = .02) in physical functioning, role-physical, general health, and change in health, compared with the placebo group. After 1 year of open-label treatment with fluticasone propionate, these improvements were maintained. SF-36 scores in the placebo group during the double-blind period either worsened or remained unchanged; however, when these patients were switched to fluticasone propionate during the open-label period, their SF-36 scores also improved. Forced expiratory volume in 1 second (FEV1) at the end of the double-blind period was positively correlated with mean quality of life scores on physical functioning, role-physical, vitality, social functioning, and change-in-health status.

CONCLUSION

Health-related quality of life improved in patients with severe asthma following 16 weeks of treatment with fluticasone propionate, 1000 micrograms bid. These improvements were maintained during subsequent fluticasone propionate treatment over a 1-year period.

Acute gram-negative urosepsis mimicking an acute hemolytic transfusion reaction

BACKGROUND

The acute hemolytic transfusion reaction (AHTR) is one of the most feared complications of blood transfusion. Over the years, several clinical conditions, as well as errors in blood component preparation and administration, that mimic AHTR have been identified. This report describes a novel variation on the theme of pseudo-AHTR.

CASE REPORT

A 47-year-old diabetic man with drug-induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion. The passage of bright red urine immediately after the transfusion virtually confirmed for the clinicians administering the transfusion that an AHTR had occurred. In the laboratory, the hematuria was shown to be due principally to red cells and not to free hemoglobin. Further posttransfusion work-up showed a urinary tract infection and overwhelming bacterial sepsis with Escherichia coli.

CONCLUSION

As a pseudo-AHTR, gram-negative bacterial sepsis of urinary tract origin may surpass other forms of sepsis. Urosepsis should be considered in the work-up of a suspected AHTR in a pancytopenic patient with a urinary tract infection.

Direction and Reliability of Head Tilt in Humans

It has been proposed that asymmetry in the inner ear underlies various manifestations of brain-behaviour asymmetry in the human. Specifically, Previc (1991) argued that an otolith imbalance manifests itself in an asymmetrical head posture, and later (1994) suggested that head tilt may be consonant with other measures of human laterality. The present study tested the reliability of head tilt across days and assessed its relationship with handedness, footedness, and eyedness. As in Previc's earlier studies, a majority of our subjects tilted rightward. Head tilt proved to be highly stable across days but was not correlated with the other laterality measures. These findings suggest that head tilt may reflect an underlying asymmetric substrate that appears not to be directly related to other measures of cerebral hemispheric dominance.

Preference of laboratory rats for potentially enriching stimulus objects

In an effort to identify suitable stimulus objects which could be placed into standard laboratory cages in order to provide rats with a degree of environmental enrichment, the preference of rats to spend time near 15 diverse objects was measured in a free-choice paradigm. Rats showed no preference for objects such as pipes and partitions which we had reasoned might satisfy a wall-hugging tendency. They also showed no preference for objects which we had reasoned to be potentially interesting as manipulanda. The rats did show reliable preferences for spending time with some, but not all, chewable objects. A block of wood predrilled with holes was the most attractive, and we cautiously recommend that researchers consider providing laboratory rats with such an object to allow them the opportunity to exercise a fundamental, species-typical behaviour-chewing.

Fluticasone propionate reduces oral prednisone use while it improves asthma control and quality of life

This study examined the ability of fluticasone propionate aerosol to reduce oral prednisone requirements in patients with severe asthma. Ninety-six patients dependent on oral prednisone were treated for 16 wk with placebo or fluticasone propionate aerosol (750 or 1,000 micrograms twice daily). Their dosage of oral prednisone was adjusted weekly according to predetermined criteria. A total of 69% and 88% of patients treated with fluticasone propionate 750 and 1,000 micrograms twice daily, respectively, compared with 3% of placebo-treated patients used no prednisone by the end of the study. In the fluticasone propionate groups, FEV1 and peak expiratory flow rates at the last evaluable visit/date improved and the number of night awakenings and symptomatic albuterol use declined relative to placebo values (p < 0.05). Patient-rated asthma symptoms improved in the groups receiving fluticasone propionate but not in the placebo group (p < 0.005). Fluticasone propionate aerosol was well-tolerated, and it improved some dimensions of health-related quality of life measured using a standard patient survey. Fluticasone propionate aerosol (750 or 1,000 micrograms twice daily) effectively and safely allowed most asthmatics dependent on oral corticosteroids to reduce or eliminate oral prednisone use while improving pulmonary function and quality of life.

Fluticasone propionate aerosol for the treatment of adults with mild to moderate asthma. The Fluticasone Propionate Asthma Study Group

BACKGROUND

Recent emphasis on the control of airway inflammation in asthma highlights the need for safe and effective antiinflammatory agents. Fluticasone propionate is one of the most potent antiinflammatory corticosteroids developed to date.

OBJECTIVE

This study assessed the safety and efficacy of fluticasone propionate aerosol in the treatment of mild to moderate asthma.

METHODS

Fluticasone propionate aerosol (25, 100, or 500 micrograms twice daily) or placebo was given for as long as 8 weeks to adults with mild to moderate asthma in a randomized, double-blind, parallel-group study. Patients were removed from the study if they showed predefined signs of worsening asthma.

RESULTS

Sixty-three percent of placebo-treated patients and 23%, 13%, and 4% of patients treated with fluticasone propionate 25, 100, and 500 micrograms twice daily, respectively, were removed from the study. Mean forced expiratory volume in 1 second, forced vital capacity, and forced expiratory flow at midexpiratory phase at weekly visits throughout the study demonstrated that fluticasone propionate was more efficacious than placebo in maintaining asthma control. Measurements of peak expiratory flow and symptom scores significantly improved and nighttime awakenings and albuterol use to treat symptoms significantly declined in fluticasone propionate-treated groups relative to the placebo-treated group. Differences among fluticasone propionate groups for these variables were not statistically significant. Incidence and severity of adverse events were similar across groups. Fluticasone propionate did not affect morning or stimulated plasma cortisol concentrations, although slight, transient reductions in urinary free cortisol and urinary 17-hydroxy steroids occurred in the group receiving 500 micrograms fluticasone propionate twice daily.

CONCLUSION

These data indicate that fluticasone propionate provides safe and effective treatment for mild to moderate asthma.

Partial callosotomy and left-right response differentiation in the rat: Separate anterior and posterior facilitatory effects

Earlier research demonstrated that complete section of the corpus callosum in the rat reduced the number of trials required to acquire a left-right response differentiation (LRRD). This study was designed to investigate whether the facilitatory effect on LRRD could be produced by section of an anatomical subdivision of the callosum. Rats with sections of the anterior or posterior corpus callosum mastered the LRRD task faster than sham subjects, but more slowly than rats with total callosal section; section of the middle portion of the callosum had no such effect. The partial facilitatory effects of anterior and posterior callosotomy appear to be independent, and suggest that the callosal intermixing of lateral information, which contributes to left-right confusion, occurs at both the sensory and motor levels of processing.

Improved acquisition of left-right response differentiation in the rat following section of the corpus callosum

Split-brained rats learned a left-right response differentiation in a water maze significantly faster than rats with sham surgery. It is unlikely that this superiority resulted from improvement in performance variables since callosotomized rats did not differ significantly from sham operates in speed of acquisition of a brightness discrimination in the same apparatus. Additionally, callosotomy likewise had no effect on the acquisition of a water-maze task requiring consistent unilateral responses. The superiority of the callosotomized animals in forming the left-right response differentiation supports a hypothesis implicating the forebrain commissures in left-right confusion.

Failure of induced asymmetries to improve left-right response differentiation in the rat

Rats (and humans) appear to be able to distinguish between left and right by referring to an intrinsic asymmetry as a navigational aid; this suggests that experimentally induced asymmetries might also facilitate such a distinction. We assessed the effects of asymmetries produced by unilateral shaving, unilateral vibrissotomy, and asymmetrical cortical lesions on acquisition of a left-right response differentiation. None of the treatments improved performance relative to appropriate control treatments; the rats were evidently unable to use these induced asymmetries to form the lateral differentiation. The results are related to evidence provided in an earlier report (Noonan & Axelrod, 1989) that even some reliable intrinsic asymmetries cannot function as navigational aids.

The stability and interest consonance of lateral postural--motor biases in rats: results and implications

Each of six different tests of lateral postural-motor asymmetries was repeatedly administered to 126 rats. Directional reliability was found for rotatory swimming, open-field exploration, and stepping down from a beam. Neonatal posture, turn in an unbaited T maze, and orientation to tail pinch proved not to be reliable across days. The behavioral asymmetries in the open-field and step-down tests were directionally consonant with each other, but neither was related to the asymmetry exhibited in rotatory swimming, implying the existence of at least two independent asymmetrical neural substrates underlying the behaviors. Neither sample-wide directional biases nor major sex differences in bias were found. The sexes were, however, differentially influenced in direction on some tests by the number of males in their natal litters, implying a role for intrauterine exposure to androgens in predisposing rats toward some left- or right-biased behaviors.

Behavioral bias and left-right response differentiation in the rat

To examine the proposition that lateral asymmetry facilitates left-right response differentiation in rats, we examined the relationships between the strengths of several behavioral biases and the scores on a learning task requiring left-right response differentiation. No support was found for a simple model positing a monotonic relationship between any behavioral bias and the learning scores. However, performance showed a U-shaped relationship to one behavioral bias. This finding conforms to a curvilinear model in which rats at either extreme of asymmetry are disadvantaged, at low degrees of asymmetry by a lack of navigational reference, and at high degrees by resultant strong position habits; moderately asymmetrical rats have neither disadvantage and are best able to use the asymmetry as a reference in processing left-right information.

Earedness (ear choice in monaural tasks): its measurement and relationship to other lateral preferences

A total of 373 normal young adult subjects were distributed among 5 experiments measuring earedness. Handedness, eyedness and familial L-handedness were also indexed. Special care was taken to remove environmental asymmetries when determining ear preference when listening to sound from a suspended earphone, and from a stopwatch on a table, and for using a telephone symmetrically constructed and displayed. Ear preference was strongly influenced by seemingly minor environmental asymmetries and did not influence telephone habits, and must be considered a very weak lateral preference. Earedness was as concordant with handedness as eyedness was found to be; earedness was concordant with handedness in 74% of dextrals and 65% of sinistrals, but earedness was not related to eyedness. Earedness did not vary with putatively hemisphere-specific stimulus types (music, speech). Laterality of telephone use was jointly determined by handedness and the expectation of writing, not by earedness.

On the laterality of psychogenic somatic symptoms

Tabulation of cases reported in the literature of unilateral psychogenic somatic symptoms revealed that more symptoms were on the left side of the body than on the right; this result, although falling short of statistical significance, is consistent with recent reviews of hospital records by Stern and by Galin et al. A review of organic diseases and traumata for which lateral preferences have been reported, and a retrospective study of hospital emergency room records, provided no evidence for the hypothesis that the left-sided predominance of psychogenic symptoms is underlain by a generalized greater vulnerability of the left side to organic pathologies. The satus of three other explanations for the asymmetrical incidence of psychogenic symptoms is discussed.

Classification of random forms and distortions presented to the left or right visual field

Twenty right-handed undergraduate men were taught in free vision to categorize distortions of prototypic random forms and were then tested in a Go/No Go task with lateralized tachistoscopic presentations of previously sorted (old) distortions, new distortions, the prototypes, and unrelated forms. Accuracy of performance on positive items increased in the order New less than Old less than Prototype. More false alarms occurred to unrelated items in the right than in the left visual field, suggesting that the trace systems generated during training had different characteristics in the two hemispheres.