Sensitivity to eye gaze in prosopagnosic patients and monkeys with superior temporal sulcus ablation

Accuracy at perceiving frontal eye gaze was studied in monkeys and human subjects using a forced-choice detection task on paired photographs of a single human face. Monkeys learned the task readily, but after bilateral removal of the banks and floor of the superior temporal sulcus (STS) they failed to perform the task efficiently. This result is consistent with the conclusion, based on recordings from single cells in awake, behaving monkeys [Perret et al., Physiological Aspects of Clinical Neuro-ophthalmology, Chapman & Hall, London, 1988] that this region of the temporal lobe is important for coding information about eye-gaze of a confronting animal. Human subjects were given identical stimuli in a task where they were asked to detect "the face that is looking straight at you". Human performance is sensitive to the degree of angular deviation from the frontal gaze position, being poorest at small angular deviations from 0 degrees. This was also true of monkeys viewing these stimuli, pre- and post-operatively. Compared with normal controls, two humans prosopagnosics were impaired at this task. However the extent of impairment was different in the two patients. These findings are related to earlier reports (including those for patients with right-hemisphere damage without prosopagnosia), to normal performance with upright and inverted face photographs, and to notions of independent subsystems in face processing.     

A multinational investigation of the impact of subcutaneous sumatriptan. I: Design, methods and clinical findings

This report describes the design, methods and clinical results of a prospective sequential multinational (5 countries) study conducted to evaluate the effects of subcutaneous sumatriptan on health-related quality of life, workplace productivity, clinical parameters and patient satisfaction. Adult patients with moderate to severe migraine initially received customary therapy for migraine episodes for 12 weeks, followed by 24 weeks' treatment with self-administered subcutaneous sumatriptan 6 mg. Demographic, baseline, health-related quality of life and patient satisfaction rating data were collected during visits to the clinic. Data relating to migraine symptoms, migraine therapy, work productivity and non-work activity time were collected on diary cards filled out by the patients. 749 patients were recruited to the study and 637 received at least 1 dose of sumatriptan. Overall, 75.5% of migraines were successfully treated within 2 hours with sumatriptan compared with 31.9% with customary therapy; 36% of patients reported complete relief at 2 hours with sumatriptan treatment compared with 1% of patients receiving customary therapy. 69% of patients successfully treated 70% of their migraines with sumatriptan within 2 hours, compared with 12% of patients with customary therapy. No serious adverse events were reported; 50% of patients reported an adverse event during the 12-week customary therapy phase and 89% of patients during the 24-week sumatriptan phase. These clinical results, which are consistent with those reported in randomised blinded studies of subcutaneous sumatriptan, suggest that relief of migraine symptoms occurs more often, and in less time, in patients receiving subcutaneous sumatriptan rather than customary therapy as their primary medication.     

Effects of temporal cueing on residual visual discrimination in blindsight

We tested the ability of a blindsight patient, GY, to identify in which of two locations a target was presented in a spatial two-alternative forced choice paradigm (spatial 2AFC). On each trial the subject was asked to make a second manual response indicating whether he had had any awareness of an event occurring during the trial. A cue, presented at the fixation location, could signal the 0.4 s period over which the target appeared within the 10 s duration of each trial. Targets of three contrasts, 93, 43 and 22% were used. We found that GY's ability to discriminate the location of targets in his blind field remained significantly above chance, with and without cueing, for each contrast. Cueing, did, however, significantly improve his performance for low contrast targets. When he performed a similar task with near threshold contrast targets in his spared visual field his discrimination was at chance unless the presentation of targets was cued, despite his reporting more awareness for these stimuli than he did for low-contrast stimuli in his blind field. These results are compared with those previously reported in monkeys who received lesions to their visual cortices as infants or adults. We conclude that (1) GY's blindsight is qualitatively different from near-threshold normal vision. (2) In common with infant-lesioned monkeys his blindsight remains even in the absence of temporal cues. (3) Residual vision is subject to modulation by attentional processes, or arousal, associated with temporal cueing.     

Balancing the equation: The significance of professional and lay perceptions in the promotion of cervical screening amongst minority ethnic women

Studies of minority ethnic women and cancer screening have, in the past, suffered from many theoretical and methodological weaknesses. In addition, no attempts have been made to study the complexity of the issue involved in the intercultural context, or the possible contribution of women's experiences to low uptake rates. In order to further our understanding of the issues, an alternative approach, participatory action research (PAR), was adopted to identify factors that might have contributed to the persistently low participation of minority ethnic women in the cervical screening programme, and address them collaboratively. This paper presents the key findings of the ‘problem identification' phase of the project. Using mainly the focus-group method, it explores both smear takers' and minority ethnic women's perceptions and experiences of cervical screening. Data suggest that there was a divergence in perceptions held by these groups regarding cervical screening, which contributed to negative experiences for both groups. There is also clear evidence of dysfunctional clinical communication arising from these differing perceptions. Opportunistic screening at post-natal examination adopted by many general practices appeared to have perpetuated the perceptions that the majority of minority ethnic women held about the purpose of the smear test. Compounded by language differences, the majority of women who had undergone smear testing understood neither the purpose of screening programme nor the procedure of the test. This has clear implications for promoting regular uptake, and more importantly for informed consent and choice.     

The pathogenesis of the rheumatoid swan neck deformity.

Disappointment with the late results of intrinsic release for the rheumatoid "intrinsic-plus" hand has led to a re-appraisal of the role of intrinsic muscle contracture in the pathogenesis of the rheumatoid swan neck deformity. In cadaveric fingers, a properly placed suture typing the lateral band to the middle slip insertion causes a swan neck deformity. It is suggested that the usual "intrinsic-plus" hand and the fixed swan neck deformity of rheumatoid arthritis is caused by adhesions between the extensor tendons on the dorsum of the proximal interphalangeal joint, rather than by intrinsic muscle contracture and/or metacarpo-phalangeal dislocation.     

Psychosocial Factors Associated with Resilience in a National Community-Based Cohort of Australian Gay Men Living with HIV

HIV-positive gay men may experience multiple sources of adversity and stress, related both to their HIV diagnosis and sexual identity. Most of these men, however, do not experience mental health problems. Little is known about factors that help them achieve resilience in the face of life challenges. This study examined psychosocial factors associated with resilience in a national community-based sample of 357 Australian HIV-positive gay men. Resilience was measured using the Connor–Davidson Resilience Scale. Higher levels of resilience were linked with experiencing low or no internalized HIV-related stigma, having no previous history of mental health problems, and a number of socioeconomic indicators. In addition to providing a more complete picture of the mental health of HIV-positive gay men, findings from this study can be used to inform strength-based approaches to mental health prevention and support.     

Cost-effectiveness analysis of a hospital electronic medication management system

Objective To conduct a cost–effectiveness analysis of a hospital electronic medication management system (eMMS).Methods We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs.Results The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63–66 (US$56–59) per admission (A$97 740–$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially.Conclusion The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost–effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.     

Vasopeptidase inhibition with omapatrilat in chronic heart failure: acute and long-term hemodynamic and neurohumoral effects

OBJECTIVES: We investigated the acute and long-term hemodynamic and neurohumoral effects of the vasopeptidase inhibitor omapatrilat in human heart failure. BACKGROUND: Angiotensin-converting enzyme (ACE) inhibition constitutes a major advance in the treatment of chronic heart failure (CHF). Simultaneous inhibition of both neutral endopeptidase and ACE with omapatrilat may represent a new treatment strategy in CHF. METHODS: Three hundred and sixty-nine patients with symptomatic heart failure were randomized to double-blind treatment with omapatrilat (first 190 patients: 2.5 mg, 5 mg or 10 mg; last 179 patients: 2.5 mg, 20 mg or 40 mg once daily) for 12 weeks. RESULTS: Acutely, the 10 mg, 20 mg and 40 mg doses of omapatrilat produced greater reductions in pulmonary capillary wedge pressure (PCWP), systolic blood pressure (SBP) and systemic vascular resistance compared with 2.5 mg. Higher doses were associated with greater increases in vasodilator and natriuretic peptides, in addition to ACE inhibition. After 12 weeks, omapatrilat 20 mg and 40 mg showed greater falls from baseline in PCWP (40 mg: 0 h to 12 h average change -7.3 +/- 0.8 mm Hg) and SBP (40 mg: -11.7 +/- 1.7 mm Hg) than 2.5 mg (both p < 0.01 vs. 2.5 mg). The incidence of adverse experiences and patient withdrawal were similar in all groups. CONCLUSIONS: In CHF, the acute hemodynamic benefit seen with higher doses of omapatrilat was associated with increases in plasma vasodilator and natriuretic peptide levels in addition to ACE inhibition. After 12 weeks, the hemodynamic benefit was maintained. Omapatrilat may be a promising new agent in CHF.