Pilot study of a community pharmacist led program to treat hepatitis C virus among people who inject drugs.

Background: People who inject drugs (PWID) are a key population for treatment with direct-acting antiviral medications (DAAs) to eliminate hepatitis C virus (HCV). We developed a Pharmacist, Physician, and Patient Navigator Collaborative Care Model (PPP-CCM) for delivery of HCV treatment; this study describes clinical outcomes related to HCV treatment (initial evaluation, treatment initiation, completion, and cure), as well as patient satisfaction. Methods: We conducted a single-arm prospective pilot study of adult PWID living with HCV. Participants completed baseline and six-month follow-up surveys, and treatment and outcomes were abstracted from electronic health records. Primary outcome was linkage to pharmacist for HCV evaluation; secondary outcomes included DAA initiation, completion, and cure, as well as patient-reported satisfaction. Results: Of the 40 PWID enrolled, mean age was 43.6 years, 12 (30 %) were female, 20 (50 %) were non-white, and 15 (38 %) were unhoused. Thirty-eight (95 %) were successfully linked to the pharmacist for initial evaluation. Of those, 21/38 (55 %) initiated DAAs, and 16/21 (76 %) completed treatment. Among those completing treatment who had viral load data to document whether they achieved "sustained virologic response", i.e. cure, 10/11 (91 %) were found to be cured. There was high satisfaction with 100 % responding "agree or strongly agree" that they had a positive experience with the pharmacist. Conclusion: Nearly all participants in this pilot were successfully linked to the pharmacist for evaluation, and more than half were started on DAAs; results provide preliminary evidence of feasibility of pharmacist-led models of HCV treatment for PWID. Clinicaltrialsgov registration number: NCT04698629.

What causes the isolation effect?

Events that are incongruent with their prevailing context are usually very well remembered. This fact often is described as the distinctiveness effect in memory, an effect that has served as explanation not only of memory phenomena but also of various other phenomena, including social judgment. The core laboratory paradigm for studying distinctiveness in memory research has long been the isolation paradigm. This paradigm, sometimes attributed to H. von Restorff, yields better memory for an item categorically isolated from surrounding items than for the surrounding items and a proper control item. The authors offer an interpretation of the isolation effect based on the analysis of the processing of similarities and differences among the items. Two experiments provide evidence for this interpretation. The results are discussed in the context of current theories of distinctiveness effects in memory. An appeal is made for a different conceptualization of distinctiveness effects, one that treats distinctiveness as a discriminative process in memory that requires processing of both similarities and differences among items.

The influence of distinctive processing on retrieval-induced forgetting.

Recall of a portion of a previously experienced list benefits subsequent recall of that portion of the list but leads to poorer recall of nonpracticed items from the same set (Anderson, Bjork, & Bjork, 1994). One explanation for this retrieval-induced forgetting is that during practice of part of a set, the non-practiced items compete for recall and are suppressed; this suppression process inhibits later recall of the nonpracticed items. Two experiments were conducted to investigate the relationship between distinctive processing of the original set and retrieval-induced forgetting, on the assumption that distinctive processing reduces response competition. In the first experiment, distinctive processing induced by difference judgments among the studied items did reduce forgetting relative to a standard encoding task and a similarity judgment task. In fact, the difference judgment task completely eliminated retrieval-induced forgetting. In the second experiment, the similarity judgment task was analyzed in relation to a task assumed to foster associative integration (Anderson & McCulloch, 1999). Even though the similarity judgment met the requirements for associative integration, retrieval-induced forgetting persisted following similarity judgment. The results are consistent with the view that distinctive processing benefits memory within an organizational context (Hunt & McDaniel, 1993; Smith & Hunt, in press).

Is perceptual salience needed in explanations of the isolation effect?

The isolation effect is a well-known phenomenon that has a well-accepted explanation: An item that is isolated on a list becomes perceptually salient, which leads to extra rehearsal that enhances memory for the isolate. To evaluate this hypothesis, the authors isolated an item near the beginning of a list. Immediately after each item was presented for study, participants judged the likelihood of recalling the item. Although the isolation effect occurred, participants did not judge the isolate as being more memorable than the preceding item, suggesting that the isolate was not salient. In a second experiment, participants rehearsed items aloud. Isolation at the beginning of the list did not produce extra rehearsal. By contrast, isolation in the middle of the list produced extra rehearsal; however, even when the isolate did not receive extra rehearsal, an isolation effect was evident. Thus, salience and extra rehearsal are not necessary for producing an isolation effect.

Accessing the particular from the general: the power of distinctiveness in the context of organization.

Recall is inversely related to the number of items sharing a cue. The limiting case of unique cue-target relationships supports extremely high levels of recall, particularly when the cue is self-generated. This fact is incongruous with the importance assigned to the construct of organization in memory theory. Further, self-generated unique cue-target relationships tend to be idiosyncratic, implying that the power of unique cues should be limited to cases of self-cued memory. The experiments presented here suggest a role for organization that reconciles the fact of unique cue effectiveness with the importance of organization to memory. Two new findings are reported: Unique cue production enhances target encoding; and general cues can access particular encodings. The data are further tribute to the importance of simultaneous organizational and distinctive processing and recommend a new perspective on the function of organization in memory.

The subtlety of distinctiveness: What von Restorff really did.

The isolation effect is a well-known memory phenomenon whose discovery is frequently attributed to von Restorff (1933). If all but one item of a list are similar on some dimension, memory for the different item will be enhanced. Modern theory of the isolation effect emphasizes perceptual salience and accompanying differential attention to the isolated item as necessary for enhanced memory. In fact, von Restorff, whose paper is not available in English, presented evidence that perceptual salience is not necessary for the isolation effect. She further argued that the difference between the isolated and surrounding items is not sufficient to produce isolation effects but must be considered in the context of similarity. Von Restorff's reasoning and data have implications for the use of distinctiveness in contemporary memory research, where distinctiveness is sometimes defined as perceptual salience and sometimes as a theoretical process of discrimination. As a theoretical construct, distinctiveness is a useful description of the effects of differences even in the absence of perceptual salience, but distinctiveness must be used in conjunction with constructs referring to similarity to provide an adequate account of the isolation effect and probably any other memory phenomena.

Affective valence and memory in depression: dissociation of recall and fragment completion.

Depressed (n = 16) and nondepressed (n = 16) subjects' memory for affectively valenced words was assessed by an explicit test (free recall) and an implicit test (word fragment completion). Under free-recall instructions, depressed subjects recalled significantly more negatively valenced than positively valenced words, whereas the opposite pattern was observed in nondepressed control subjects. These results replicate those previously reported in the literature. The differential effect of word valence was absent, however, when memory was tested implicitly: Depressed and nondepressed subjects exhibited equivalent priming of positive and negative words. These data are discussed in terms of Williams, Watts, MacLeod, and Mathews's (1988) model of depression.

Perceptual identification, fragment completion, and free recall: concepts and data.

The effects of orthographically distinctive and orthographically common words were compared on tests of free recall, fragment completion, perceptual identification, and lexical decision. Orthographic distinctiveness is argued to effect data-driven processing and, in light of recent theory, should have little effect upon free recall but substantial effects upon fragment completion and perceptual identification. The results showed superior recall and fragment completion of orthographically distinctive words but more accurate perceptual identification of orthographically common words. Latency of lexical decision was longer for orthographically distinctive than for orthographically common words. The visual complexity of orthographically distinctive words may require more extensive sensory processing than is possible within the temporal constraints of perceptual identification tests. The effect of orthographic distinctiveness upon free recall reveals a certain inadequacy in the notion of transfer-appropriate processing.

A reexamination of the role of imagery in learning and memory.

Five experiments were conducted to examine whether the superior recall of concrete over abstract words might be better accounted for in terms of relative differences in the processing of relational and distinctive information rather than redundant verbal and imaginal memory codes. Concrete and abstract word pairs were presented in the standard paired-associated learning task or under conditions intended to affect the nature and extent of relational processing between pair members. Concreteness effects were attenuated or eliminated when relational processing was prevented at encoding (Experiments 3, 4, and 5) or when the use of encoded relations within pairs was prevented at recall (Experiments 1, 2, and 3). The results indicated the viability of an account of concreteness effects in paired-associate learning based on the joint functions of distinctive and relational information. They also remove theoretical constraints imposed on imagery theories by the incorrect assumption of a uniform presence of concreteness effects in memory for word lists.

How much "effort" should be devoted to memory?

We focus on the issue of whether cognitive effort is causally related to memory. We begin with a discussion of the concept of cognitive effort as derived from capacity models of attention. We then suggest that the theoretical analysis of memory may involve concepts from different levels of psychological analysis, and we draw a distinction between concepts that represent boundary conditions and sufficient cause. When applied to memory phenomena, attentional concepts serve only as a boundary--or limiting--function in memory theory. In contrast, concepts that represent memorial processes serve as a sufficient cause function. In some instances, cognitive effort appears to have been used as a sufficient cause concept, resulting in some confusion. A review of the literature reveals a haphazard correlation between indexes of cognitive effort and of memory performance. Alternatively, the application of cognitive effort or capacity to the memory performance of certain populations (clinical, children, and elderly) illustrates a potentially more appropriate use of the concept.

Adult age differences in memory for imagined and performed actions.

Young and older adults were presented a list of 24 descriptions of simple actions. For each list item, subjects were either instructed to perform the action or else were instructed to imagine themselves performing the action. On a surprise recall test, age differences were found for both performed and imagined actions as well as for source judgments (remembering which actions had been performed and which imagined). The latter effect, however, resulted from the near chance level of performance of a minority of the older adults; the performance of the majority of the older adults overlapped with that of the young adults on the source judgment task.

The generation effect and reality monitoring: evidence from dementia and normal aging.

The role of semantic memory activation in accounting for generation effects and reality monitoring was investigated in young and old normal adults and in patients with dementia of the Alzheimer's type (DAT). Both young and old normal adults demonstrated higher recall for internally generated information than for externally presented information, whereas the DAT patients failed to demonstrate a generation effect. Similarly, reality monitoring scores (discrimination between internal and external items) were high for both age groups of normals, but near chance levels for the DAT group. These results implicate semantic memory as an important factor in generation effects.

Associative processes and strategies in disjunctive reaction time.

Scaling analysis based on variable criterion theory has been applied to the c-reaction form of disjunctive RT. In addition to previously identified sensory growth functions, two associative processes have been identified and functions of time describing their growth have been obtained. Associative strength to the positive stimulus begins at about 200 msec, or after, and grows with initial positive and later negative acceleration. Associative inhibition to the negative stimulus begins earlier, shortly after the sensory detection functions, and grows rapidly with negative acceleration. Subjects may adopt strategies which emphasize the use of either of these associative processes. With the pure inhibitory strategy, they respond to the positive stimulus entirely on the basis of sensory detection, but associatively inhibit response to the negative stimulus. With either strategy, the speed-accuracy tradeoff was determined by the level of criterion adjustment.

The synthesis and pharmacology of some 1,4,5,6-tetrahydropyrimidines.

1. Several 1- and 2-substituted, and 1,2-disubstituted, 1,4,5,6-tetrahydropyrimidines have been prepared and their toxicological and pharmacological properties have been investigated.2. In general the compounds were neuromuscular blocking agents with the monosubstituted members of the series showing a depolarizing type of activity and the disubstituted compounds a non-depolarizing type.3. The toxicity to mice of some of the monosubstituted compounds was increased by pretreatment of the animals with SKF 525A, but the toxicity of the disubstituted compounds was unaffected.4. The results obtained with these compounds are not at variance with a suggestion made previously that nicotinic action at the neuromuscular junction can result from an interaction between drug and receptor at two points separated by about 4 A.