No ψ-epistemic model can fully explain the indistinguishability of quantum states.

According to a recent no-go theorem [M. Pusey, J. Barrett and T. Rudolph, Nat. Phys. 8, 475 (2012)], models in which quantum states correspond to probability distributions over the values of some underlying physical variables must have the following feature: the distributions corresponding to distinct quantum states do not overlap. In such a model, it cannot coherently be maintained that the quantum state merely encodes information about underlying physical variables. The theorem, however, considers only models in which the physical variables corresponding to independently prepared systems are independent, and this has been used to challenge the conclusions of that work. Here we consider models that are defined for a single quantum system of dimension d, such that the independence condition does not arise, and derive an upper bound on the extent to which the probability distributions can overlap. In particular, models in which the quantum overlap between pure states is equal to the classical overlap between the corresponding probability distributions cannot reproduce the quantum predictions in any dimension d ≥ 3. Thus any ontological model for quantum theory must postulate some extra principle, such as a limitation on the measurability of physical variables, to explain the indistinguishability of quantum states. Moreover, we show that as d→∞, the ratio of classical and quantum overlaps goes to zero for a class of states. The result is noise tolerant, and an experiment is motivated to distinguish the class of models ruled out from quantum theory.

Opening up three quantum boxes causes classically undetectable wavefunction collapse.

One of the most striking features of quantum mechanics is the profound effect exerted by measurements alone. Sophisticated quantum control is now available in several experimental systems, exposing discrepancies between quantum and classical mechanics whenever measurement induces disturbance of the interrogated system. In practice, such discrepancies may frequently be explained as the back-action required by quantum mechanics adding quantum noise to a classical signal. Here, we implement the "three-box" quantum game [Aharonov Y, et al. (1991) J Phys A Math Gen 24(10):2315-2328] by using state-of-the-art control and measurement of the nitrogen vacancy center in diamond. In this protocol, the back-action of quantum measurements adds no detectable disturbance to the classical description of the game. Quantum and classical mechanics then make contradictory predictions for the same experimental procedure; however, classical observers are unable to invoke measurement-induced disturbance to explain the discrepancy. We quantify the residual disturbance of our measurements and obtain data that rule out any classical model by ≳7.8 standard deviations, allowing us to exclude the property of macroscopic state definiteness from our system. Our experiment is then equivalent to the test of quantum noncontextuality [Kochen S, Specker E (1967) J Math Mech 17(1):59-87] that successfully addresses the measurement detectability loophole.

The meniscal flounce: a valuable arthroscopic sign.

PURPOSE: The purpose of this study was to characterise the incidence and significance of the meniscal flounce. TYPE OF STUDY: Prospective Cohort Study. METHOD: A prospective study of 1088 consecutive knee arthroscopies. RESULTS: Intact menisci tended to have a flounce of characteristic size and position. The presence of this 'normal' flounce was closely correlated with an intact meniscus (p<0.0001). For the medial meniscus with a small flounce in zone 3 the sensitivity, specificity, and positive predictive value (PPV) for an intact medial meniscus were 68.5%; 92.9%; and 92.1% respectively. Conversely the presence of meniscal pathology correlated closely with either an absent or abnormal flounce (p<0.0001). The absence of a medial flounce had sensitivity, specificity, and PPV for a meniscal tear of 82.8%; 84.9%; and 81.9% respectively. CONCLUSIONS: The findings of this study are useful for arthroscopists especially when there is difficulty visualising all of the posterior half of the meniscus. In this situation the presence of a normal flounce is likely to signify an intact meniscus. However the presence of an abnormal or absent flounce may be the sign of an occult meniscal tear requiring better exposure.

Association of life events and psychological distress in family caregivers of dementia patients.

Relationships between life events and psychological distress were investigated for 197 dementia caregivers and 218 non-caregivers. Participants indicated which events on the Louisville Older Persons Events Scale they had experienced over the past six months. Life events were then classified as associated or unassociated with care-giving using differences in incidence rates between caregivers and non-caregivers. Primary care-giving stressors and associated life events were most predictive of psychological distress among caregivers. Among non-caregivers, unassociated negative life events were the strongest predictors of depression and life satisfaction. Implications for the assessment of life events and caregiver interventions are discussed.

Latent growth models of the longitudinal effects of dementia caregiving: a comparison of African American and White family caregivers.

Self-report measures of depression, physical health symptoms, and life satisfaction were collected over a 2-year period from 197 family caregivers of dementia patients and 218 noncaregivers (controls). Latent growth models were used to compare changes across time for African American and White caregivers, with gender, age, and socioeconomic status serving as covariates. Results indicated that White caregivers sustained higher levels of elevated depression and decreasing life satisfaction over time compared with African American caregivers. Both groups of caregivers reported increases in physical symptoms over time. These results indicate worsening difficulties over time for many White caregivers. African American caregivers show more resilience on measures of depression and life satisfaction but are still vulnerable to increases in physical symptoms over time. Implications for additional research and clinical intervention are discussed.

Psychosocial interventions for cancer: review and analysis using a three-tiered outcomes model.

This study describes a three-tiered measurement model for psychosocial interventions with cancer patients and compares this model to extant measurement strategies. Progress has been made toward demonstrating that psychosocial interventions reduce depression, anxiety, functional impairment, and symptoms. However, Chambless and Hollon (1998) note that the literature on psychosocial interventions for cancer fails to meet criteria for establishing treatment "efficacy" and does not address issues of cost-effectiveness. The lack of a timely model of clinical outcomes may be hindering demonstration of efficacy and wider implementation of these interventions. Outcomes assessed by 65 interventions were classified as Global Health Outcomes (medical endpoints, health-related quality of life (HRQOL), or resource utilization), Dimensions of HRQOL (distress, symptoms, functional ability, or interpersonal well-being), or Mechanisms of Action (evaluation of psychological or physiological processes). A total of 28% of reviewed studies assessed Global Outcomes, 82% assessed Dimensions of HRQOL, and 49% assessed Mechanisms of Action. While most studies assessed patients' symptoms and distress, measurements of resource utilization, HRQOL, and interpersonal HRQOL were under-reported. A greater emphasis on treatment costs, quality of life, and mediating/moderating processes associated with improvement in outcomes could inform decisions regarding allocation of health-care resources and lead to more widely available and efficient interventions for patients.

End of life care and reactions to death in African-American and white family caregivers of relatives with Alzheimer's disease.

Family caregivers for relatives with Alzheimer's Disease (AD) often experience significant stress-related problems in mental and physical health. Patients with AD often survive for protracted periods of time, placing an extensive burden of care on the caregiver prior to the patient's death. The present study addresses ethnic differences in the experience of AD caregivers around the time of their loved one's death, including life-sustaining treatment decisions and reactions to death. The results showed that, in our sample, more patients died in their homes than has been reported for deaths in the United States. African-American and White caregivers differed substantially in their reports of end of life care and subjective reactions to the death. Compared with White caregivers, African-American caregivers were less likely to make a decision to withhold treatment at the time of death, less likely to have their relative die in a nursing home, and reported less acceptance of the relative's death and greater perceived loss. Results suggest that death after AD caregiving deserves further study, and that ethnic differences in end of life care and bereavement may be of particular importance.

Longitudinal course of behavioral problems during Alzheimer's disease: linear versus curvilinear patterns of decline.

BACKGROUND: Patients with Alzheimer's Disease (AD) are commonly assumed to experience a linear decline in behavioral functioning that parallels progressive cognitive decline. However, some researchers have suggested that specific behavioral problems either decline at different rates or improve in late dementia. METHODS: The present analyses examined 150 AD patients at an initial assessment, 61 of whom were also evaluated annually on two additional occasions. Measures of cognitive impairment and behavioral problems were obtained. RESULTS: Cross-sectional results indicated curvilinear associations between dementia severity and certain behavioral problems (forgetful behaviors, and emotional and impulsive behaviors). Longitudinal analyses further indicated trends for curvilinear rates of behavioral disturbance across time, with some problem areas showing improvement as AD progresses through the most severe stages. CONCLUSIONS: Even though Alzheimer's disease is a progressive dementia characterized by increasing cognitive deterioration, it appears to be inaccurate to expect behavioral functioning to show the same linear decline across time.

Evaluating the relationship between pain presentation and health-related quality of life in outpatients with metastatic or recurrent neoplastic disease.

Because cancer pain can in many cases be intermittent, the presence or absence of pain in ambulatory care patients on any given clinic visit may not be an accurate characterization of the impact of pain on functioning or health-related quality of life (HRQOL). The purpose of this study was to describe the relationship between temporal aspects of pain presentation and HRQOL among 187 stage III/IV cancer patients using the Brief Pain Inventory and the EORTC QLQ-C30. A total of 43% of patients reported pain the previous week, with 22% reporting no pain at the time of assessment. Differences between three pain groups (No Pain, Past Pain, and Current Pain) were significant for global HRQOL and five dimensions of HRQOL. Severity of pain was also associated with each dimension of HRQOL. This study highlights the complex relationship between pain presentation and HRQOL. The findings support the continuing need for detailed pain assessments among cancer patients treated in ambulatory care settings. Specifically, standardized, self-report measures of cancer pain that include 'frequency' as well as severity may be the most accurate approach to capture the impact of pain on HRQOL.

Randomized study of peritonitis with conventional versus O-set techniques in continuous ambulatory peritoneal dialysis.

We performed a prospective randomized trial, comparing the incidence of peritonitis between a flush-disconnect (O-System, Baxter, Deerfield, IL) (OS) and a conventional (System II, Baxter) (CS) continuous ambulatory peritoneal dialysis (CAPD) method. Sixty consenting patients with no significant physical disabilities who commenced CAPD after May 1987 were entered and followed for a minimum of 12 months. Thirty were placed on the OS system and 30 were placed on CS. Age, gender, and time for training did not differ significantly. The period of observation for OS was 375 months; CS was observed for 430 months. OS patients experienced 28 episodes of peritonitis (13.4 months/patient/episode) compared with 88 (4.9 months/patient/episode) in CS (p less than 0.005). By 6 months, 32% of OS patients had had at least one episode of peritonitis, compared with 62% of CS patients; at 12 months, these figures rose to 48% for OS and 91% for CS (p less than 0.01) patients (Life Table Analysis). The median survival time to first peritonitis episode was 5.1 months in CS and 9.7 months in OS (p less than 0.01). Exit-site infections occurred in 14/30 (46%) of patients on OS and in 13/30 (43%) of CS patients. We conclude that the OS was associated with a significant reduction in the incidence of peritonitis.

Sympathetically maintained pain of the digits in porphyria cutanea tarda relieved by i.v. regional guanethidine.

A case of a sympathetically maintained pain of the tips of the fingers in a 39-year-old man with porphyria cutanea tarda is presented. Occupational vibrating trauma is the presumed cause. The successful treatment with intravenous regional guanethidine is reported.

The treatment of mesangial IgA nephropathy with cyclophosphamide, dipyridamole and warfarin: a two-year prospective trial.

Of 52 patients with mesangial IgA nephropathy, 25 were allocated to treatment with cyclophosphamide (6 months), and dipyridamole and warfarin (2 years) and 27 to no treatment in a randomized prospective 2-year study. At entry, the treated and untreated groups of patients did not differ in mean serum creatinines, urinary protein excretions, quantitative urinary erythrocyte counts or blood pressure readings. At the end of the trial mean (+/- SEM) serum creatinine values had gone from 0.12 +/- 0.01 to 0.13 +/- 0.01 mmol/l (p less than 0.05) in untreated patients and from 0.10 +/- 0.01 to 0.12 +/- 0.01 mmol/l (p less than 0.05) in treated patients. Mean (+/- SEM) log values of urinary erythrocyte (rbc) counts had not changed significantly from 5.47 +/- 0.09 to 5.21 +/- 0.14 log rbc/ml in untreated patients, from 5.45 +/- 0.11 to 5.49 +/- 0.19 log rbc/ml in treated patients. However, in treated patients, mean (+/- SEM) urinary protein excretions decreased from 1.67 +/- 0.35 to 1.15 +/- 0.31 g/24 h (p less than 0.01) whereas in untreated patients urinary protein was unchanged between initial values of 1.76 +/- 0.34 and follow-up at 1.89 +/- 0.45 g/24 h. No significant changes in blood pressure occurred in either group. This study supports the observation that treatment of IgA nephropathy with cyclophosphamide, dipyridamole and warfarin is associated with a reduction of urinary protein excretion but a significant effect on preservation of renal function, at least as determined by serum creatinine values, could not be confirmed over this two-year study.

Oral and transcutaneous pharmacologic agents in the treatment of impotence.

The pharmacologic treatment of erectile failure is now a reality. However, current agents have major drawbacks. Some require invasive administration, whereas others offer only marginal effect. The use of hormones should be limited to well-documented cases of endocrine dysfunction. Oral and transcutaneous agents remain experimental, but new drugs are under investigation and show early encouraging results.

Clinical and morphological aspects of the management of crescentic anti-glomerular basement membrane antibody (anti-GBM) nephritis/Goodpasture's syndrome.

Twenty-two patients with crescentic anti-GBM nephritis or Goodpasture's syndrome with renal impairment were reviewed. All patients were treated with a combination of plasma exchange and immunosuppression. Sixteen patients (73 per cent) showed improvement in renal function (greater than 30 per cent reduction in serum creatinine level) apparently in response to treatment, and nine patients (41 per cent) made long-term recoveries in renal function. The most important features carrying a bad prognosis were total anuria, and/or a very high percentage of glomeruli showing crescents (greater than 85 per cent) in the initial renal biopsy. Some patients with other so-called 'bad' prognostic features, including severely impaired renal function at presentation, oliguria and the need to institute dialysis had unexpected marked improvement in renal function and/or recovered renal function in the long term provided treatment with plasma exchange was begun promptly and maintained for a sufficient period to allow resolution of the disease process. Renal biopsies at the beginning and later proved to be an extremely valuable guide for the progress and outcome of the disease.

Protein composition of urinary casts from healthy subjects and patients with glomerulonephritis.

Urinary casts from 46 healthy volunteers and 60 patients with glomerulonephritis were examined for the presence of Tamm-Horsfall glycoprotein and other proteins. All samples gave immunofluorescence evidence of Tamm-Horsfall protein in casts. Casts from 59 of the patients but only three of the controls contained other proteins in addition (p less than 0.001). Immunoglobulins (IgG, IgM, IgA) were detected in casts from 53 of the patients but none of the healthy volunteers. Examination of urinary casts for immunoglobulins, complement, and fibrin provides a non-invasive method for distinguishing patients with active glomerular disease.

Nucleotide sequence of the lysozyme gene of bacteriophage T4. Analysis of mutations involving repeated sequences.

The nucleotide sequence of the lysozyme (e) gene of bacteriophage T4 and approximately 130 additional nucleotides on each side has been determined. The 5'-end of the gene for internal protein III appears to be located about 70 base-pairs from the 3'-end of the lysozyme gene. Nucleotide sequence analysis of mutant e genes confirmed that three identified hotspots of frameshift mutations are runs of five A nucleotides in the wild-type gene. The endpoints of two deletions are direct repeats of eight base-pairs in the wild-type gene. Two frameshift mutations with high reversion frequencies are duplications of five or seven base-pairs. The cloning and nucleotide sequence determination of the lysozyme gene will facilitate further study of the molecular biology of T4 lysozyme.

Studies on the Criollo goat of Northern Mexico: Part 1 - The effects of body weight on body components and carcass development.

Male Criollo castrate goats were reared on natural rangeland and also given some concentrate supplementation. They were slaughtered in groups of ten at 8, 12, 16 and 24 kg live weight. At slaughter the weights of body components were recorded and also carcass measurements and joint weights on the chilled left half of each carcass, which was then completely dissected into lean, fat and bone tissues. With increasing slaughter weight the proportion of internal body components minus gut contents, increased relative to the external components. In some of the goats from the higher slaughter weight groups the gut contents formed up to 26% of the total live weight. The dressing percentage based on empty body weight did not show an appreciable increase with increasing slaughter weight. The lean proportion in the carcass rose from 56% of the carcass weight in the 8 kg group to about 68% in the 24 kg group. The proportion of fat in the carcasses did not show any increase with increasing slaughter weight. The results indicate that, in terms of yield of lean meat and also edible offal, it is better not to slaughter castrate male Criollo goats before 24 kg live weight.

Studies on the Criollo goat of Northern Mexico: Part 2-Physical and chemical characteristics of the musculature.

Groups of castrate male Criollo goats were slaughtered at 12, 16, 20 and 24 kg liveweights after being reared on natural rangeland with concentrate supplementation. After slaughter the carcasses were chilled for 24 h at 2°C, and the total lean was dissected from the left halves of the carcasses. The total lean was subjected to a proximate analysis. M. biceps femoris and M. longissimus dorsi muscles were dissected out of the right halves of the carcasses. Various physical and chemical quality parameters, such as Warner-Bratzler shear values and tristimulus colour values, were measured on these muscles in addition to hydroxy proline analysis, for the estimation of collagen content. The moisture content of the total lean decreased steadily with increasing slaughter weight to a level of approximately 76% in the heaviest group. Ash and protein content tended to fall, with intramuscular fat increasing to approximately 16% of the wet tissue weight. The ultimate pH of the two muscles was high in all the slaughter groups, being usually higher than 6·0. Generally, shear values did not change between the slaughter groups in the two muscles. The data indicate that slaughtering castrate male Criollo goats at 24 kg instead of 8 kg does not exert deleterious effects on the parameters of physical and chemical quality investigated.