Estimating the impact of alcohol consumption on survival for HIV+ individuals.

Alcohol consumption is associated with decreased antiretroviral adherence, and decreased adherence results in poorer outcomes. However the magnitude of alcohol's impact on survival is unknown. Our objective was to use a calibrated and validated simulation of HIV disease to estimate the impact of alcohol on survival. We incorporated clinical data describing the temporal and dose-response relationships between alcohol consumption and adherence in a large observational cohort (N=2,702). Individuals were categorized as nondrinkers (no alcohol consumption), hazardous drinkers (consume > or =5 standard drinks on drinking days), and nonhazardous drinkers (consume <5 standard drinks on drinking days). Our results showed that nonhazardous alcohol consumption decreased survival by more than 1 year if the frequency of consumption was once per week or greater, and by 3.3 years (from 21.7 years to 18.4 years) with daily consumption. Hazardous alcohol consumption decreased overall survival by more than 3 years if frequency of consumption was once per week or greater, and by 6.4 years (From 16.1 years to 9.7 years) with daily consumption. Our results suggest that alcohol is an underappreciated yet modifiable risk factor for poor survival among individuals with HIV.

Explaining variability in the relationship between antiretroviral adherence and HIV mutation accumulation.

OBJECTIVES: Determining the relationship between antiretroviral adherence and resistance accumulation is important for the design and evaluation of adherence interventions. Our objective was to explain heterogeneity observed in this relationship. METHODS: We first conducted a systematic review to locate published reports describing the relationship between adherence and resistance. We then used a validated computer simulation to simulate the patient populations in these reports, exploring the impact of changes in individual patient characteristics (age, CD4, viral load, prior antiretroviral experience) on the shape of the adherence-resistance (A-R) curve. RESULTS: The search identified 493 titles, of which 3 contained relevant primary data and 2 had sufficient follow-up for inclusion (HOMER and REACH cohorts). When simulating HOMER, the A-R curve had a high peak with a greatly increased hazard ratio (HR) of accumulating mutations at partial compared to complete adherence (simulation, HR 2.9; HOMER, HR 2.7). When simulating REACH, the A-R curve had a shallow peak with a slightly increased hazard of accumulating mutations at partial adherence (simulation, HR 1.2; REACH, HR 1.4). This heterogeneity was primarily attributable to differences in antiretroviral experience between the cohorts. CONCLUSIONS: Our computer simulation was able to explain much of the heterogeneity in observed A-R curves.

Physical abuse--physicians knowledge and reporting attitude in Israel.

UNLABELLED: The objective of this study was to assess knowledge and attitudes towards physical child abuse among pediatricians and family physicians in northern Israel. METHODS: An interview consisting of multiple choice questions and vignettes were employed. A stratified sample of 107 physicians from hospitals and community clinics and of different disciplines and educational cultural backgrounds was surveyed. RESULTS: Child abuse diagnosis was considered infrequently or not at all by 43% of the participants and a proportion of them were hesitant in their reporting intentions. A low consistency in the approach to diagnosis and management was found. Medical discipline, sex and age of the physician as well as level of knowledge and the family's socioeconomic status were not significantly related to reporting behaviors. A significant effect of medical training/cultural background (p = 0.01) and medical discipline (p = 0.04) on knowledge of child abuse were found. No relationship between knowledge and reporting behaviour was found. CONCLUSION: The results of this study are a reason for concern. A more active role of medical schools and health administrations in abuse-oriented education and training effort is required, particularly in societies in transition.

Asymmetric interactions in the processing of the visual dimensions of position, width, and contrast of bar stimuli.

The processing of different dimensions of a single stimulus may be either integral or separable. Dimensions are called integral if correlated variation of one improves discrimination on the basis of the other and random variation of one interferes with discrimination on the basis of the other. For separable dimensions on the other hand, subjects can attend to one dimension and disregard variations in the other. These discrimination tests were used to find the interactions between the processing of the visual dimensions of position, width, and contrast of a light bar stimulus. The relations between these dimensions were found to be asymmetric: judgments of position and width are independent of contrast variations, but variations in these dimensions influence contrast discriminations. Furthermore, position variations influence width judgements more than vice versa. The data were analyzed for repetition effects, and it was found that this model is not sufficient to explain all the interaction phenomena. The asymmetries found may be related to the different ways these dimensions are mapped onto cortical neuron responses.

Characteristics of the flux dimension cue in apparent motion correspondence.

It has been shown that element flux and size (but not luminance) serve as correspondence cues in the apparent motion visual system. Results are now presented of a study of the characteristics of the flux cue. It was found that flux rather than luminance is used by the system even when the size of the elements is greater than the size limit of Ricco's law. There were interactions between the apparent motion processing of the size and flux dimensions, beyond the obvious dependence of flux on size: positively correlated size and flux differences between elements have a greater effect on correspondence than do negatively correlated differences. Finally, when comparing the fluxes of different elements, the apparent motion system uses relative flux (above or below background) rather than absolute flux (relative to zero).

Gender differences in apparent motion perception.

Distance disparity is a strong cue to element correspondence in apparent motion. Using a 2-AFC paradigm we have previously shown that shape similarity also plays a role. We now demonstrate a small gender difference in these effects: women are more sensitive to distance disparity, whereas men are more sensitive to differences in shape. Furthermore, in the competing presence of a shape cue, women's sensitivity to distance decreases while men's sensitivity is unaffected. These observations may be related to putative gender differences in the 'form' and 'motion-spatial relations' cortical pathways.

On and off pathway contributions to apparent motion perception.

We studied the separability and/or interaction of the On and Off pathways in their role as inputs to visual motion perception. Using the long-range motion perception system, we asked if the motion system can use brightness polarity information, by testing whether correspondence is preferred between elements for which brightness polarity is preserved. We found such a preference, suggesting that brightness polarity information is indeed available to the motion system. However, under certain conditions motion is perceived even though the brightness polarity of apparent motion stimulus elements is reversed, indicating that the apparent motion system does integrate information from these two pathways. The source of the preference for maintaining polarity seems not to be the different brightnesses of the dark and bright stimulus elements, but the very fact that information must be integrated from different pathways. We relate the characteristics of the dependence of the motion perception on element contrast and contrast sign to those of previously reported visual evoked potential responses to brightness increments and decrements.

Size, flux and luminance effects in the apparent motion correspondence process.

The effects of the relative size, luminance, and total luminous flux of apparent motion visual stimulus disk elements are studied, using a competitive paradigm. These dimensions can only be studied in pairs and we find that all three pairs have significant correspondence process effects. A comparison of the magnitudes of the effects, however, suggests that size and flux are the dimensions relevant to apparent motion processing, while luminance may not contribute to the correspondence process. Pitting distance against these dimensions in apparent motion tasks, we were able to find effective equivalence scales among them. Finally, interactions were found between the processing of some of these dimensions. The most pronounced interaction effect is that the addition of the size dimension increases the noise in the processing of distance, while size processing is not affected by the addition of the distance cue.

Shape similarity and distance disparity as apparent motion correspondence cues.

Apparent motion is perceived when two spots of light are presented successively in different locations. When more than one element is present in each frame, there is a correspondence problem in matching the elements in one frame with those in the other. We report the effects of shape similarity and distance disparity on the correspondence process. Twenty subjects were tested using a 2-AFC design. We found that both shape and distance cues are used by the correspondence process: when distance is the only cue the motion which is usually perceived is that involving the shorter distance; when shape is the only cue the motion involving two elements of the same shape is preferred. We also studied the interaction between the two cues when both were present. Quantitative measures of the relative strengths of these effects and of their interaction are reported. A Signal Detection Theory model is used to analyze these apparent motion correspondence effects.

Overshadowing of responding on ratio and interval schedules by an independent predictor of reinforcement.

This experiment replicated previous demonstrations that interposing a brief stimulus between reinforced responses and the presentation of the reinforcer reduces responding maintained by intermittent reinforcement schedules. Furthermore, we could find no significant difference between the relative size of the reduction during training on ratio and interval schedules when the predictive significance of the response and stimulus was controlled by a yoking procedure.