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Winds of change.

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Cost Control↗

The solar wind and hallucinations--a possible relation due to magnetic disturbances.

Data from the 19th century on hallucinations and magnetic disturbances were found to exhibit a direct and statistically significant correlation. The aa magnetic index over the period 1868-89 and concurrent visual hallucinatory activity were found to co-vary (Spearman coefficient = .64; P less than .05). Magnetic influences on the pineal hormone, melatonin, are suggested as a possible source of variation.

Hallucinations↗

Instruction in clinical pharmacology: changes in the wind.

We have presented some views on past, present and potential trends for teaching clinical pharmacology in the medical curriculum. Clinical pharmacology as subject matter in the medical curriculum has been operationally defined for our purposes as: (1) the application of fundamental principles of basic pharmacology to rational drug therapy in humans; and (2) the application of appropriate nuances of the human pharmacology of individual drugs to their use in particular disease states. In terms of improving the results of drug therapy, arguments were advanced for the importance of teaching clinical pharmacology at all levels in the medical curriculum and in postgraduate medical education. The introduction of so many new and potent pharmaceuticals over the past 25 years requires well educated and skilled medical practitioners adept and well versed in the fundamental principles of basic and applied pharmacology, so as to achieve the most prudent, effective and economically sound use of these drugs as possible. This creates a challenge to medical educators, particularly those involved in teaching clinical pharmacology, to devise innovative teaching techniques and curricular changes that foster these goals. In an attempt to address these challenges, we have reviewed some innovative teaching approaches and curricular reforms, both published and unpublished, that have already met with success, and we have also discussed some future trends in teaching both undergraduate and graduate physicians the fundamental principles of rational drug therapy. The challenges and issues involved in these future trends have been identified and will be addressed in subsequent articles in this journal. These will be concerned with teaching clinical pharmacology: (1) in basic medical pharmacology courses; (2) to upperclass medical students; and (3) in continuing medical education programs. Subsequent articles will also deal with new and innovative teaching modalities for clinical pharmacology and with the role of the drug industry in these modalities.

Education, Medical↗

Gompertzian mortality originates in the winding-down of the mitotic clock.

UNLABELLED: Gompertz' age-related exponential increase in mortality rate and the obdurately flat mortality trajectory of Drosophila are paradoxical notions for metazoan aging theory. A multiclonal model of Gompertzian organisms provides a resolution by assuming that (a) conception initiates a stochastic process producing a train of replications of fixed length (the Hayflick limit); (b) unique stem cells arise early on to generate multiple vital clones; (c) life continues until one such clone critically depletes its replicative potential. Lifespan is thus governed by the time it takes to reach the terminal branches of the mitotic tree. Although these times are not independent, asymptotic independence can be justified. This clears the way for asymptotic extreme-value theory to guarantee: (1) a non-increasing failure rate, under unlimited replicability; (2) an exponentially increasing failure rate, under limited replicability. However, to obtain an exact fit to the human force-of-mortality function also requires the inclusion of the phenomenon of mitotic deceleration (implemented with a lognormal model of replication). CONCLUSION: the sine qua non of Gompertzian mortality is cellular aging, expressed through these two mitotic phenomena. Conversely, those metazoa with unlimited cellular replicability, by staving off clonal failure would succumb only to catastrophic, age-independent events, yielding a constant mortality rate, the signature of a mitotic clock that does not run down.

Animals↗

The discovery of antidepressants: a winding path.

Modern treatment of mental depression started with the availability of monoamine oxidase (MAO) inhibitors and tricyclic antidepressants. These drugs also contributed to the early development of psychopharmacology. Attempts to improve the anti-tuberculous action of the hydrazine derivative isoniazid by developing derivatives thereof led to the synthesis of iproniazid. Its introduction as the first modern antidepressant was based on three unexpected actions of the drug: MAO-inhibition, 'reversal' of reserpine-induced sedation, and the presence of psychostimulation as a clinical side effect in man. However, the initial success of iproniazid and other MAO inhibitors, hydrazides and non-hydrazides, was curtailed by the occurrence of undesirable side effects such as potentiation of the blood-pressure elevating action of food amines. The tricyclic antidepressants were a development of the class of antihistamines, one of which, chlorpromazine, showed neuroleptic activity. A congener of this compound, imipramine, was discovered by clinical observation to have unexpected antidepressant effects. The clinical success of this drug (which is still in use) led to the development of a successful series of other tricyclic and non-tricyclic antidepressants. Progress in the elucidation of possible mechanisms of the action of the tricyclic compounds has helped this development. Recent advances in basic research have also induced a revival of MAO-inhibitors since, due to the discovery of MAO-subtypes, inhibitors with higher specificity and fewer undesirable side effects are now available.

Animals↗

Establishing systems of care in Germany: a long and winding road.

Since 1995/1996 a long-term care insurance (LTCI), which promised to develop new support structures, in particular for the group of potentially frail elderly people, has been implemented in Germany. It will be shown that this LTCI has undoubtedly improved the social situation of the persons in need of care, even if its scheme is only providing basic support with a ceiling in cash-benefits and benefits in-kind, and privileging home care by informal caregivers. But certain misdevelopments in the LTCI have shown that the present scheme requires further effort to cope with these negative effects and to elaborate new integrated models of care that bridge the still existent gap between medical and social support. This article points to long traditions of separating the social and medical dimensions in Germany which have also resulted in divided institutional arrangements. The current scheme of the LTCI, its organizational principles and its entitlements and benefits are outlined, which gives the opportunity to point out certain deficiencies, e.g., the still inappropriate provision for dementia care which is due to the dominant IADL-orientation of the medical assessment procedure and its implicit negligence of social care elements. The public debate about necessary improvements in benefits for the demented aged has already led to slight revisions of the LTCI, and will develop into a more comprehensive movement to path-bridging models of social and medical care in which the quality dimension will play a decisive role.

Aged↗

How to catch the wind: spider hairs specialized for sensing the movement of air.

Most arthropods are hairy creatures. Some of them have several hundreds of thousands of hairs on their exoskeleton which in the majority of cases serve mechanosensory functions. Filiform hairs or trichobothria, as they are called in the arachnids, respond to the slightest movement of the surrounding air. They have repeatedly been shown to be involved in the guidance of escape and prey capture behavior and are indeed among the most sensitive biosensors known to date. Accordingly, the mechanical interaction between the air and the hair which is deflected and thus adequately stimulated by viscous forces is very close and to a large extent follows principles known in fluid mechanics. Both the experimental and theoretical analysis of this interaction has reached considerable depth. Using spider trichobothria as the main example the present review article strives to explain in a simple way the main mechanical parameters to be considered and how hair morphology and mechanics bring about such remarkable sensitivity.

Air↗

Recurrent retinal vein occlusion after playing a wind instrument.

PURPOSE: To present a complication of repeated Valsalva maneuver. METHODS: Case report with serial intravenous fluorescein angiography and comprehensive workup for coagulopathies. RESULTS: After playing strenuous musical pieces, a solo trombonist suffered within 1 year three attacks of visual loss in the right eye; he had two attacks of inferior hemi-central retinal vein occlusion 2 months apart, followed by central retinal vein occlusion 10 months later. Final best spectacle-corrected visual acuity was 6/60. He ended his professional career, and no further attacks occurred in the following 10 years. CONCLUSION: Retinal vein occlusion with irreversible visual loss can occur after playing a strenuous piece of music on a high-resistance instrument.

Fluorescein Angiography↗