Understanding systemic lupus erythematosus patients' desired outcomes and their perceptions of the risks and benefits of using corticosteroids.

Introduction The use of corticosteroids in systemic lupus erythematosus (SLE) patients requires difficult trade-offs between efficacy and risk of toxicity. This qualitative study examined SLE patients' most desired outcomes and their concerns with corticosteroid use in SLE treatment. Methods SLE patients with current/past experience with using corticosteroids were recruited from the clinics at the Johns Hopkins Lupus Center and the University of Maryland Medical Center. Five in-depth interviews ( N = 5) and four focus groups ( N = 15) were conducted during which discussions were transcribed and analyzed based on a grounded theory approach. Results We identified five major themes describing SLE patients' most desired outcomes: reduction in flares, maintenance of normal activities, minimization of treatment side effects, prevention of future organ damage, and finding a cure. Further, SLE patients reported these primary concerns with the adverse effects of corticosteroids: weight gain, organ damage (particularly bone-related damage), mood swings/irritability, sleep disturbances, and dental issues. Patients appeared to be more concerned with adverse effects that immediately affected their day-to-day lives. Conclusion Knowledge gained during this study better informs how patients view the benefits and risks of corticosteroids. This can facilitate discussions between physicians and patients as they work together to determine the appropriate use of corticosteroids.

Imaging Current-Induced Switching of Antiferromagnetic Domains in CuMnAs.

The magnetic order in antiferromagnetic materials is hard to control with external magnetic fields. Using x-ray magnetic linear dichroism microscopy, we show that staggered effective fields generated by electrical current can induce modification of the antiferromagnetic domain structure in microdevices fabricated from a tetragonal CuMnAs thin film. A clear correlation between the average domain orientation and the anisotropy of the electrical resistance is demonstrated, with both showing reproducible switching in response to orthogonally applied current pulses. However, the behavior is inhomogeneous at the submicron level, highlighting the complex nature of the switching process in multidomain antiferromagnetic films.

Avasopasem manganese (GC4419) protects against cisplatin-induced chronic kidney disease: An exploratory analysis of renal metrics from a randomized phase 2b clinical trial in head and neck cancer patients.

Head and neck squamous cell carcinoma (HNSCC) patients treated with high-dose cisplatin concurrently with radiotherapy (hdCis-RT) commonly suffer kidney injury leading to acute and chronic kidney disease (AKD and CKD, respectively). We conducted a retrospective analysis of renal function and kidney injury-related plasma biomarkers in a subset of HNSCC subjects receiving hdCis-RT in a double-blinded, placebo-controlled clinical trial (NCT02508389) evaluating the superoxide dismutase mimetic, avasopasem manganese (AVA), an investigational new drug. We found that 90 mg AVA treatment prevented a significant reduction in estimated glomerular filtration rate (eGFR) three months as well as six and twelve months after treatment compared to 30 mg AVA and placebo. Moreover, AVA treatment may have allowed renal repair in the first 22 days following cisplatin treatment as evidenced by an increase in epithelial growth factor (EGF), known to aid in renal recovery. An upward trend was also observed in plasma iron homeostasis proteins including total iron (Fe-blood) and iron saturation (Fe-saturation) in the 90 mg AVA group versus placebo. These data support the hypothesis that treatment with 90 mg AVA mitigates cisplatin-induced CKD by inhibiting hdCis-induced renal changes and promoting renal recovery.

Coherent terahertz sound amplification and spectral line narrowing in a stark ladder superlattice.

The bias voltage applied to a weakly coupled n-doped GaAs/AlAs superlattice increases the amplitude of the coherent hypersound oscillations generated by a femtosecond optical pulse. This bias-induced amplitude increase and experimentally observed spectral narrowing of the superlattice phonon mode with a frequency 441 GHz provides the evidence for hypersound amplification by stimulated emission of phonons in a system where the inversion of the electron populations for phonon-assisted transitions exists.

Multilevel information storage using magnetoelastic layer stacks.

The use of voltages to control magnetisation via the inverse magnetostriction effect in piezoelectric/ferromagnet heterostructures holds promise for ultra-low energy information storage technologies. Epitaxial galfenol, an alloy of iron and gallium, has been shown to be a highly suitable material for such devices because it possesses biaxial anisotropy and large magnetostriction. Here we experimentally investigate the properties of galfenol/spacer/galfenol structures in which the compositions of the galfenol layers are varied in order to produce different strengths of the magnetic anisotropy and magnetostriction constants. Based upon these layers, we propose and simulate the operation of an information storage device that can operate as an energy efficient multilevel memory cell.

Deterministic control of magnetic vortex wall chirality by electric field.

Concepts for information storage and logical processing based on magnetic domain walls have great potential for implementation in future information and communications technologies. To date, the need to apply power hungry magnetic fields or heat dissipating spin polarized currents to manipulate magnetic domain walls has limited the development of such technologies. The possibility of controlling magnetic domain walls using voltages offers an energy efficient route to overcome these limitations. Here we show that a voltage-induced uniaxial strain induces reversible deterministic switching of the chirality of a magnetic vortex wall. We discuss how this functionality will be applicable to schemes for information storage and logical processing, making a significant step towards the practical implementation of magnetic domain walls in energy efficient computing.

Effect of lithographically-induced strain relaxation on the magnetic domain configuration in microfabricated epitaxially grown Fe81Ga19.

We investigate the role of lithographically-induced strain relaxation in a micron-scaled device fabricated from epitaxial thin films of the magnetostrictive alloy Fe81Ga19. The strain relaxation due to lithographic patterning induces a magnetic anisotropy that competes with the magnetocrystalline and shape induced anisotropies to play a crucial role in stabilising a flux-closing domain pattern. We use magnetic imaging, micromagnetic calculations and linear elastic modelling to investigate a region close to the edges of an etched structure. This highly-strained edge region has a significant influence on the magnetic domain configuration due to an induced magnetic anisotropy resulting from the inverse magnetostriction effect. We investigate the competition between the strain-induced and shape-induced anisotropy energies, and the resultant stable domain configurations, as the width of the bar is reduced to the nanoscale range. Understanding this behaviour will be important when designing hybrid magneto-electric spintronic devices based on highly magnetostrictive materials.

Prescribing of psychotropic medication by primary care physicians and psychiatrists.

This study investigates the prescribing of psychotropic medications by primary care physicians and psychiatrists using the National Ambulatory Medical Care Survey database. Results indicate that primary care practitioners provide a larger percentage of psychotropic drug visits than psychiatrists in every psychotropic class except for those patients prescribed lithium. In addition, the two provider groups differed in the relative proportions of the classes of psychotropic drugs prescribed. Primary care physicians prescribed anxiolytics most frequently, while psychiatrists prescribed antidepressants most often. Finally, in all therapeutic classes, when a psychotropic medication was prescribed, psychiatrists typically provided a mental health diagnosis, while primary care physicians did not.

Expenditures for psychotropic medications in the United States in 1985.

OBJECTIVE: Psychotropic medications have seldom been included in estimates of the costs of mental health services. In the infrequent case that these costs have been assessed, they have been estimated by using national surveys of consumers of health services. The objective of this study was to estimate the costs of prescriptions for psychotropic medications in the United States in 1985 and to assess the difference with the most recent cost estimate from a health services survey (1977). METHOD: Study data were based on retail costs of psychotropic medications reported to the Pharmaceutical Data Service Alpha National Prescription and Sales Audit. The data come from a computerized survey panel of 2,250 pharmacies representative of the more than 14,000 pharmacies nationwide. The database includes all medication prescriptions filled, whether paid with cash or Medicaid or reimbursed by third-party payment. Analyses were limited to psychotropic medication prescriptions. RESULTS: In 1985, $1.45 billion was spent on outpatient psychotropic medications. Nearly $868 million (60% of the total) was spent on antianxiety and sedative-hypnotic medications, while approximately $263 million (18%) was spent on antipsychotic medications, $240 million (17%) on antidepressants, and $84 million (5%) on combination psychotropic medications. These expenditures were much higher than would have been expected given the most recent health services estimate of $513 million. CONCLUSIONS: These results demonstrate the substantial cost of psychotropic medications in 1985. The finding that the cost of psychotropic medications was so high, in contrast to the lower estimate from the 1977 survey, demonstrates the importance of obtaining more frequent cost estimates and basing future estimates on medication databases.

Prescribing of psychotropics in elderly nursing home patients.

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one-fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one-fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

The use of mental health measures in nursing home research.

To examine the quality of mental health research in nursing homes, 130 articles published in six geriatric specialty and health care delivery journals were reviewed. Thirty-nine (30%) articles used a mental health measure. Measures of cognitive function were most common, being used in 32 (25%) of the articles reviewed. Twenty-three (18%) studies measured abnormal mental experiences and 17 (13%) articles measured behavioral disorder. Many articles used measures or determinations with no established reliability. Twenty-six of the articles which used a mental health measure also used a measure of activities of daily living or physical function. Retrospective and prospective studies were similar in number. A minority of articles used control groups, random samples, or prepost measures while a majority (64%) identified an outcome measure. We conclude that nursing home research can be improved by the increased use of reliable measures of cognition and abnormal mental experiences and by the development of reliable measures of behavioral disorder. Study design can be improved by identifying a priori hypotheses and by the increased use of random sampling and control/comparison groups.

Race and the treatment of cytomegalovirus retinitis in a cohort of patients with acquired immunodeficiency syndrome.

This historical cohort study assessed the impact of race on critical factors in the diagnosis and drug treatment of cytomegalovirus (CMV) retinitis in acquired immunodeficiency syndrome (AIDS) patients over a 7-year period. The study subjects included 194 adult patients with a history of AIDS who were treated for CMV retinitis between September 1987 and September 1994. Abstracted inpatient hospital medical records and a statewide automated AIDS database were the primary sources of data. Patients were assessed for severity of CMV retinitis at diagnosis, time from initial CMV retinitis diagnosis to first treatment, survival from diagnosis of AIDS, and initiation of drug treatment for CMV retinitis. Results indicated a significant difference in the severity of CMV retinitis at diagnosis by race. Patients diagnosed with early disease were more likely to be white, whereas patients diagnosed with severe disease were more likely to be black. There was no difference in the type of CMV retinitis treatment or patient survival time after diagnosis, nor time to treatment once diagnosed by race. These results suggest that differences in survival may not be the result of discrimination against black patients and may be due more likely to practices associated with accessing medical treatment.

Effects of 5-Fluorouracil and 5-Fluorodeoxyuridine on Growth and Tumor-Inducing Ability of Agrobacterium tumefaciens.

Beardsley, Robert E. (Manhattan College, Bronx, N.Y.), and Jacques Lipetz Effects of 5-fluorouracil and 5-fluorodeoxyuridine on growth and tumor-inducing ability of Agrobacterium tumefaciens. J. Bacteriol. 92:346-348. 1966.-Agrobacterium tumefaciens B6, grown in the presence of 5-fluorouracil or 5-fluodeoxyuridine, exhibited a prolonged lag phase. The tumor-inducing ability of bacteria grown in the presence of these compounds was decreased even after exposures as short as 40 min. A positive correlation was found between the growth-inhibitory effects of these compounds and their effects on the tumor-inducing ability of the bacteria.

Pharmacist patient education: what strategies work?

Previous research reveals that pharmacist-coordinated patient education programs have been effective only if they go beyond providing information to patients. Effective programs must include strategies that assist and encourage patients to incorporate this new information into their life styles.

Agrobacterium tumefaciens Conn. 3. Effect of thermal shock on bacteria in relation to tumorinducing ability.

Stonier, Tom (Manhattan College, Bronx, N.Y.), Robert E. Beardsley, Lowell Parsons, and James McSharry. Agrobacterium tumefaciens Conn. III. Effect of thermal shock on bacteria in relation to tumor-inducing ability. J. Bacteriol. 91:266-269. 1966.-Bacteria heated to 42 C for 30 min exhibit a decrease in tumor-initiating ability without a detectable loss in viability. The thermal shock inhibits subsequent bacterial growth for up to 1.5 hr. As bacterial growth recovers, so does tumor-initiating ability. Respiration of the culture is somewhat increased by the heat treatment. The data suggest that living, actively respiring bacteria do not induce tumors unless they are also growing. The results also point to the necessity for excluding bacterial growth inhibition when interpreting data on the effect of various agents on tumor initiation.

Anticonvulsant serum levels are useful only if the physician appropriately uses them: an assessment of the impact of providing serum level data to physicians.

The ability to measure serum levels of anticonvulsants has been a significant advance in the treatment of epilepsy. This technique enables practitioners to monitor a patient's plasma concentration, to detect potential toxicity, and to assess compliance with the prescribed regimen. A retrospective study of 164 adults with epilepsy was conducted to evaluate how serum anticonvulsant determinations were used by physicians in their treatment of epilepsy. Results indicate that the availability of test results did not improve the degree of seizure control, nor did it diminish patient reports of toxicity. In 17% of therapeutic decisions, prescribers did not appear to use the blood levels appropriately in their therapeutic decision-making process. When physicians did appropriately utilize information from serum levels, the degree of seizure control improved significantly compared with when the prescribers did not use this information. The cost of determining serum levels of anticonvulsants is justified only if the information is appropriately utilized.

A drug self-administration program: a behavioral approach to patient education.

This study is an evaluation of an in-hospital patient education and drug self-administration program. The main goal of this patient education strategy was to increase appropriate drug use by patients after they were discharged from the hospital. Patients first learned about their medications from hospital staff, including pharmacists, and then gradually assumed the responsibility for self-administration of their drugs. Patients practices taking their medication while hospital staff monitored their actions, correcting inappropriate use and reinforcing correct use. Results showed that the program significantly increased both levels of drug knowledge and patient compliance when compared to a control group. An analysis of covariance revealed that improved compliance was attributable to both participation in the program and to the increase in drug knowledge. Patients were more satisfied with pharmacy services and perceived the pharmacist as being more knowledgeable about prescription drugs after interacting with pharmacists in this program. Analysis of patient locus of control revealed that internally oriented patients complied better after participating in the program than did externally oriented patients. In the control group, externally oriented patients complied better after receiving typical hospital care than did internally oriented patients. Thus, results imply that this behavioral approach benefited internally oriented patients.