The two-armed-bandit problem a decision theory approach to clinical trials.
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Biomedical subjects
Publications and source records attributed to C Hill.
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Mice chronically infected with the virus of lymphocytic choriomeningitis (LCM) develop immune complex glomerulonephritis. Others have shown that adoptive immunization of these mice by the i.p. injection of syngeneic immune spleen cells terminates the chronic viral carrier state. The present studies were designed to define the effector cell from the immune spleen responsible for adoptive immunization and to determine the effect of this procedure upon the immune complex nephritis which occurs in LCM carrier mice. The results indicate that the effector cell in adoptive immunization is a T-cell that functions directly as a killer cell when transferred to LCM carrier mice. Sixteen of nineteen adoptively immunized mice examined had less immune complex material deposited in their glomeruli than control unmanipulated litter mates. These data demonstrate that this animal model of immune complex glomerulonephritis is immunodeficient with respect to LCM virus-specific killer T-cells. Transfer of this cell population to the LCM carrier mouse diminishes the animal's viremia and improves its immune complex nephritis. In view of these observations, it is suggested that the rationale for the use of immunosuppressive therapy in spontaneously occurring glomerulonephritis should be carefully reconsidered.
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The life and the ideas of a mentally aberrant figure in mid-seventeenth century England are presented in relation to the sociocultural background of the time and the available clinical information. The material illustrates the need to draw on both sources when applying psychiatric concepts to particular historical epochs.
Phonocardiography previously has been limited in scope because the attained suboptimal signal-to-noise ratio has interfered with the sensitivity and clarity of recordings. A new system is described that reduces this problem by utilizing demodulation and synchronous averaging of the "envelop" of cardiac sounds. A limited survey of the differential diagnostic capabilities of this technique is presented for 80 patients having one of six common forms of pathological systolic murmurs and an 89 per cent diagnostic accuracy is demonstrated. This system promises to be a valuable noninvasive adjunct in cardiologic diagnosis research and education.
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Colicin E-resistant mutants were isolated in Escherichia coli K-12 which, although still apparently possessing the E receptor and adsorbing colicin, were nevertheless insensitive (refractory) to its effect. Eight phenotypic groups were obtained, but some mutants from three of these groups were all shown to map at gal, whereas a second refractory locus, giving resistance to E1 alone, mapped close to thy. It is suggested that the successful fixation of any of the three distinct colicins of group E may involve a dual role for the cell surface "receptor," the first for the binding of the protein and the second for the correct orientation of the bound molecule relative to the cytoplasmic membrane. The majority of the refractory mutants isolated may derive from changes in components concerned with the second of these receptor functions. Two groups of mutants, however, refractory to only E1 or E2, probably reflect changes in the intracellular transmission systems which specifically mediate the effects of these two colicins, the changes not allowing transmission through the cytoplasmic membrane to the respective targets of the colicins. The E1 adsorption site was shown to be distinct from that for E2 and E3, indicating an early separation of the colicin E transmission systems.
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It is standard practice in epidemiological studies to compare the observed mortality of a cohort to the mortality expected in a reference population of the same age and sex distributions computed from national statistics. The same methods can be used in a prognostic study where the effects on survival of potential prognostic factors are studied in a cohort of patients with a given disease. Writing the hazard function in the cohort as the product of the hazard function in the reference population and a function of some characteristics of the patients, one can derive simple estimates and statistical tests of the standardised mortality ratios (Breslow et al.). The study of a cohort of patients with thyroid cancer will provide an example.
OBJECTIVE: This paper describes the trends in tobacco sales and smoking prevalence in the French population, estimates the consequences of smoking on the mortality of this population, and discusses governmental actions: anti-tobacco campaigns, a ban on advertising, restriction of smoking in public places, and price increases. DATA SOURCES: Sales data were collected from the French tobacco monopoly, smoking prevalence data from surveys conducted by several institutes, and mortality statistics by cause from the Institut National de la Santé et de la Recherche Médicale. RESULTS: Tobacco sales increased from 3 g per adult per day at the beginning of the century to a maximum of 6.8 g in 1975, then decreased by 10% between 1991 and 1996. Since the early 1950s, the proportion of smokers has been on the decline in the male population and on the increase in the female population. In France, 60,000 deaths are attributable to tobacco smoking. These deaths represent 12% of the total mortality. The advertising ban has been enforced and the recent price increase has led to a drop in sales. CONCLUSIONS: The consequences of tobacco smoking on the health of the female French population will increase for another 30 years, because of the increase in female smoking observed in the recent past, whereas the epidemic is leveling off in the male population.
There have been repeated reports of a decrease in serotonin2A receptors in the frontal cortex from subjects with schizophrenia. Similarly, in rats treated with antipsychotic drugs, it has been shown that many antipsychotic drugs decrease cortical serotonin2A receptors, an affect not seen with the antipsychotic drug haloperidol. We therefore compared the density of serotonin2A receptors in frontal cortex from schizophrenic subjects treated with haloperidol, schizophrenic subjects treated with other antipsychotic drugs, and nonschizophrenic subjects. Independent of antipsychotic drug treatment, serotonin2A receptors were decreased in the frontal cortex from schizophrenic subjects. Importantly, the density of serotonin2A receptors was not different in schizophrenic subjects whether or not they had been treated with haloperidol. This study suggests that data obtained from treating rats with antipsychotic drugs cannot be simplistically extrapolated to studies on tissue obtained postmortem from schizophrenic subjects treated with the same drugs.