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INTRODUCTION: 'Count your drinks' is a protective behavioural strategy (PBS) that has been found to be effective in reducing alcohol consumption. Previous research has shown that females, older people and low-risk drinkers are more likely to use this strategy, but little is known about the attitudinal factors associated with engaging in drink counting. This information is important for developing effective interventions to encourage use of this PBS. The aim of this paper was to assess whether the following attitudinal factors are associated with frequency of enactment of the 'Count your drinks' PBS: (i) perceived ease of use; (ii) perceived effectiveness; (iii) personal relevance; and (iv) believability. METHODS: A total of 683 Australian drinkers completed an online survey assessing demographic variables, alcohol consumption, frequency of drink counting and attitudes to the 'Count your drinks' PBS. A hierarchical regression analysis was used to determine whether the attitudinal factors were associated with frequency of enactment after controlling for demographic and alcohol-related factors. RESULTS: Attitudes to the 'Count your drinks' PBS accounted for 28% of the variance in reported frequency of drink counting. Perceptions of personal relevance, ease of use and effectiveness were found to be significantly associated with frequency of enactment. DISCUSSION AND CONCLUSIONS: Interventions designed to encourage drinkers to count their drinks should aim to increase the perceived personal relevance, ease of use and effectiveness of this strategy.

This article analyzes popular and academic reviews of the book and film Going Clear: Scientology and the Prison of Belief in relation to scholarly debates over the status of “apostate” testimony in...

Background A long-term “earned media” marketing strategy deployed by the Christian ex-gay movement backfired and now generates mostly negative media against the movement. Analysis A governmental discourse analysis is used to examine media coverage representing conservative Christians struggling against unwanted same-sex desire. It does so in relation to Jurgen Habermas’ (2006) analysis of commercial media and Anna McCarthy’s (2007) notion of “neoliberal theatre of suffering.” Conclusion and implications Media coverage of the ex-gay debate showcases suffering as entertainment and does not achieve the full reasoned deliberation Habermas calls for in the public sphere. Nevertheless, it has not led to a paralysis of society’s ability to debate the issue of ex-gay “change.” Competing governmental perspectives still intersect and modify each other in ways that extend beyond mere commercialism. Contexte La strategie de marketing a long terme adoptee par le mouvement ex-gay chretien a echoue, et de nos jours elle recoit generalement une couverture mediatique negative. Analyse Une analyse de discours gouvernemental sert a examiner la couverture mediatique de chretiens conservateurs qui essaient de reprimer leur attirance pour des personnes du meme sexe. La demarche adoptee s’inspire de l’analyse des medias commerciaux effectuee par Jurgen Habermas et de l’idee de « theâtre neoliberal de la souffrance » formulee par Anna McCarthy. Conclusion et implications Dans les medias, la couverture du debat ex-gay exploite la souffrance a des fins de divertissement, ne permettant pas une deliberation raisonnable dans la sphere publique du type prone par Habermas. Neanmoins, cette couverture n’a pas paralyse la capacite qu’a la societe a debattre la question du « changement » ex-gay. Par exemple, des perspectives gouvernementales divergentes continuent a se croiser et se modifier de manieres qui depassent le simple commercialisme.

IntroductionAlcohol use and misuse are associated with substantial health and social issues in Australia and internationally. Pricing policy is considered as one of the most effective means to reduce risky drinking and related harms. This protocol paper describes a study that will model and estimate the effects, effectiveness and cost–benefit of alcohol pricing policy initiatives in reducing risky drinking, health and social harms, and health inequalities among subpopulations in Australia.Methods and analysisThe study is a modelling and epidemiological study using data from various resources, such as survey, previous literatures and response agencies. A number of statistical procedures will be undertaken to evaluate the impact of different alcohol pricing policy initiatives on various outcomes, including alcohol consumption in population subgroups, and health and social problems, and to measure health inequalities and cost-effectiveness of those proposed pricing policies, such as a 10% tax increase on all alcohol beverages or introduction of a minimum unit price.Ethics and disseminationThe ethics approval of this study was obtained from the College Human Ethics Sub-Committee of the La Trobe University on 9 November 2017 (Ref: S17-206). While examining the heterogeneous effects of price policy across population subgroups, this study will provide the first comprehensive estimates of the likely impacts of alcohol price changes on health inequalities. The study will also provide sophisticated economic analyses of the impact of price policy changes, which is critical information for policy makers and will assist policy makers in directing resources to a more efficient alcohol strategy. Results will be made available to communities and societies, health departments and other researchers.

Abstract: This article argues that Yann Martel's and Ang Lee's Life of Pi is a multicultural story of maternal cannibalism that resists discourses of cannibalism that assume only the excess of the Other can eat human flesh. Whereas on one level the main character's cannibalism is sublimated into a tale about a boy and four animals on a lifeboat, on a deeper level it is about a Hindu mother's Christian sacrifice that answers her son's Islamic prayers. Although psychoanalytic theory is used to unlock the maternal cannibalism underlying Pi's tale, the discourse of oedipal and pre-oedipal desire is rejected as discounting the specificity of Pi's adult trauma.

Background Alcohol-related harm is a substantial burden on the community in Australia and internationally, particularly harm related to risky drinking practices of young people in the night-time economy. This protocol paper describes a study that will report on the changes in a wide range of health and justice outcome measures associated with major policy changes in the state of Queensland, Australia. A key element includes trading hours restrictions for licensed premises to 2 am for the state and 3 am in Safe Night Precincts (SNPs). Other measures introduced include drinks restrictions after midnight, increased patron banning measures for repeat offenders, mandatory ID scanning of patrons in late-night venues, and education campaigns. Methods The primary aim of the study is to evaluate change in the levels of harm due to these policy changes using administrative data (e.g., police, hospital, ambulance, and court data). Other study elements will investigate the impact of the Policy by measuring foot traffic volume in SNPs, using ID scanner data to quantify the volume of people entering venues and measure the effectiveness of banning notices, using patron interviews to quantify the levels of pre-drinking, intoxication and illicit drug use within night-time economy districts, and to explore the impacts of the Policy on business and live music, and costs to the community. Discussion The information gathered through this project aims to evaluate the effectiveness of the Policy and to draw on these findings to inform future prevention and enforcement approaches by policy makers, police, and venue staff. Electronic supplementary material The online version of this article (10.1186/s12889-017-4811-9) contains supplementary material, which is available to authorized users.

Background: Functional status assessment is common in many cardiovascular diseases but it has undergone limited study in the setting of acute heart failure (AHF). Accordingly, we performed a pilot study of the feasibility of the six-minute walk test (6MWT) at the emergency department (ED) presentation and through the hospitalization in patients with AHF. Methods and Results: From November 2014 to February 2015, we conducted a multicenter, observational study of ED patients, aged 18–85 years, whose primary ED admission diagnosis was AHF. Other criteria for enrollment included a left ventricular ejection fraction ≤40%, systolic blood pressure between 90 and 170 mmHg, and verbal confirmation that the patient was able to walk >30 m at the baseline, prior to ED presentation. Study teams were uniformly trained to administer a 6MWT. Patients underwent a baseline 6MWT within 24 h of ED presentation (Day 1) and follow-up 6MWTs at 24 (Day 2), 48 (Day 3), and 120 h (Day 5). A total of 46 patients (65.2% male, 73.9% African American) had a day one mean walk distance of 137.3 ± 78 m, day 2 of 170.9 ± 100 m, and day 3 of 180.8 ± 98 m. The 6MWT demonstrated good reproducibility, as the distance walked on the first 6MWT on Day 3 was similar to the distance on the repeated 6MWT the same day. Conclusions: Our pilot study demonstrates the feasibility of the 6MWT as a functional status endpoint in AHF patients. A larger study in a more demographically diverse cohort of patients is necessary to confirm its utility and association with 30-day heart failure (HF) events.

The associations between mental health and addiction issues and relatively poor physical health outcomes have been well established over many decades. The situation in New Zealand is very similar to other relatively wealthy countries. People who experience mental health and addiction issues die much earlier than their counterparts in the general population, with a two to three times greater risk of premature death. Two-thirds of this premature mortality is due to preventable and treatable physical illness, particularly cardiovascular diseases and cancers (Cunningham et al, 2014). The reasons behind this disparity are complex and interrelated. They include factors relating directly to treatment such as the use of cardio metabolic effects of psychotropic medication, and greater exposure to known risk factors for chronic diseases such as smoking, obesity and a lack of exercise (Te Pou, 2014). However, more recent research has highlighted the role of the healthcare system in exacerbating this disparity, with diagnostic overshadowing being a significant issue along with the separation of mental health and addiction services and the workforce from general medicine, particularly primary care. Equally Well is a large and growing collaboration of people and organisations across the country committed to taking action to improve physical health outcomes. It is using the principles of collective impact to bring about change at both a system and service delivery level across the health and health-related sectors. An Equally Well consensus position paper, launched in September 2014, has already seen more than 70 organisations endorse it, formally acknowledging this health disparity and showing their commitment to taking action in their sphere of influence. Leaders in health policy and professional development, funding and planning, universities, primary care and mental health and addiction treatment services have agreed to work in partnership with people with lived experience of these challenges, to effect change. This presentation will provide an overview of the issues, supporting evidence and the solutions. It will cover up to date examples of how policy and strategy has been affected by this collaborative and highlight some of the best practice initiatives being undertake in New Zealand, particularly those that involve integrated care between specialist mental health and addiction services and primary care. This will be an opportunity to hear first hand how the Equally Well collaboration works to affect change at multiple levels by multiple people as well as to gain insights into the online discussion forum where wicked issues are discussed and examples of solutions shared. The aim will be that delegates leave inspired to take action in their sphere of influence. References : 1. Cunningham. R., Peterson. D., Sarfati. D. & Stanley. J. Premature mortality in adults using New Zealand psychiatric services. New Zealand Medical Journal(127) 31-41 2014 2. Te Pou, The physical health of people with a serious mental illness and/or addiction. An evidence review. Auckland: Te Pou o Te Whakaaro Nui. 2014

Integrated Family Health Centres became prominent in planning for future general practice in New Zealand particularly following the 2008 election. The Royal New Zealand College of General Practitioners (RNZCGP) is the organisation that trains and sets standards for general practitioners in New Zealand. In 2015 a question on integration was included in its annual workforce survey of members. The College sought to ascertain from general practitioners the nature and extent of integration currently existing with other health care providers. Integration with other doctors or with registered or enrolled nurses was specifically excluded as this is almost universal in NZ general practice. Respondents were asked “Do healthcare providers other than doctors and registered or enrolled nurses work in your practice, share your premises, share patient records with you or work with you in a virtual integrated practice? For example do you work with a Nurse Practitioner, Practice Assistant, Physician Assistant, Midwife, Pharmacist, Physiotherapist, Medical Laboratory Technician or Phlebotomist, Psychologist or Psychotherapist, Occupational Therapist, Dietician, Podiatrist, Speech Language Therapist, Social Worker, Counsellor or any other health related practitioner?" Those who said yes were then asked to select the relevant interactions in a matrix of fourteen professions and seven types of interaction. The survey was conducted in March and April 2015. A link to the electronic survey was emailed to 4576 fellows, members and associates of the College and the Division of Rural Hospital Medicine. We received 2486 usable responses giving a response rate of 54.3%. 2228 respondents stated that they were currently working in New Zealand in general practice. The age profile of respondents largely mirrored that of the recipients of the survey. Female respondents were slightly over represented among respondents comprising 47% of those emailed the survey but 53% of respondents. The majority of respondents (67%) indicated that they worked with other health care providers. Respondents from larger practices and rural practices were more likely to report doing so, as were younger GPs, recent graduates and GPEP 1 teachers. The most frequently reported relationship was with pharmacists. Thirty one percent (603) of the 1965 respondents who provided information on whether they “worked with other providers” reported that they worked with pharmacists in some way. Free-text entries in this question reveal that general practices are also integrating with a wide variety of provider types additional to those listed. The most frequent type of integration reported was working in the same building or premises (45% of all instances of integration) followed by working in the same practice (23%), sharing patient records (12%) and participating in joint practice meetings (7%). The pattern of responses indicated that some respondents had interpreted the question and in particular the types of interaction differently to what had been intended. This limited the conclusions that could be drawn from the data.

Alcohol consumption is behind only smoking and obesity among leading contributors to the burden of disease in Australia. For the first time in over a decade, Australian governments are developing a National Alcohol Strategy, and plan to finalise it in 2018. The draft contains evidence-based recommendations but lacks a framework for accountability, and the Commonwealth Minister of Health recently suggested that the alcohol industry help devise the final version. We recommend that the Government rely on advice from health experts for health policy, pre-specify outcome indicators, commit to modest activities initially, to develop momentum; and commission independent evaluation after 3 years.

Aims This paper examines the strategies and arguments used by segments of the alcohol industry to delay the introduction of mandatory health warning labels on alcohol containers in Australia. These strategies are compared with those used by the tobacco industry to delay the introduction of warning labels for cigarettes. Methods Submissions made by members of the alcohol industry to the Australian Government's review of labelling and Parliamentary Inquiry into Fetal Alcohol Spectrum Disorders were analysed. Results Segments of the alcohol industry have delayed the introduction of mandatory alcohol health warning labels in Australia by questioning the rationale and evidence base for labels; arguing that they will cause damage to public health and the economy; lobbying and seeking to influence government and political representatives including through monetary donations; and introducing its own voluntary labelling scheme. The arguments made by these organizations against the introduction of mandatory health warning labels for alcohol are flawed and their empirical basis is limited. Conclusion The Australian Government has delayed the introduction of mandatory alcohol health warning labels in Australia by 2 years, until at least December 2013. The campaigning of some parts of the alcohol industry appears to have been instrumental in this decision.

ABSTRACT INTRODUCTIONRepeat prescribing is an accepted part of general practice activities in New Zealand and in many developed countries. However, there has been little research on how this service is used in New Zealand, or on clinicians’ attitudes towards it. AIMTo discover the opinions of vocationally registered general practitioners (GPs) and general practice registrars regarding repeat prescribing, availability of practice policy and mechanisms for issuing such prescriptions. METHODSA survey was developed by an expert group and shared through the Royal New Zealand College of General Practitioners’ (the College) weekly newsletter, epulse, inviting members to participate in the survey. The survey was also emailed to registrars. RESULTSIn total, 144 vocationally registered GPs and 115 registrars responded (n=259), giving a response rate of 3.2% for GPs and 12.7% for registrars. Patient convenience and time efficiency for the practice were the most commonly cited reasons for repeat prescribing. Registrars had low awareness of practice policy on repeat prescribing and only one-quarter of practices had an orientation pack that contained advice on repeat prescribing. DISCUSSIONBetter practice systems are likely to improve the safety profile of repeat prescribing and should be addressed. There is substantial unwanted variability currently in these practice systems.

Proton transport (PT) plays an important role in many biological processes as well as in materials for renewable energy devices. Gaining insights into functional group requirements for PT would aid the design of new materials that provide enhanced proton conduction. In this report, we outline our efforts to understand the most probable proton conduction pathway in 1H-1,2,3-triazole systems. In triazole-based systems, both imidazole- and pyrazole-like pathways are possible. By systematically comparing structurally analogous polymers based on N-heterocycles and benz-N-heterocycles, we find that the imidazole-like pathway makes a significant contribution to the proton transfer in 1H-1,2,3-triazole systems, while the contribution from pyrazole-like pathway is negligible.

Polyacrylates containing a different number of 1H-1,2,3-triazole groups per repeat unit have been synthesized via conventional free radical polymerization. These polymers were characterized by nuclear magnetic resonance spectroscopy (NMR), gel permeation chromatography (GPC), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). Proton conductivity measurements were made using impedance spectroscopy. Introduction of more than one triazole per repeat unit did not result in an increase in conductivity as there was an accompanying increase in glass transition temperature (Tg). A maximum conductivity of 17.5 μS/cm was obtained at 200 °C under anhydrous condition. © 2008 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 47: 188–196, 2009

Purpose – The purpose of this paper is to present developments in designing out crime policy in Western Australia (WA) as a case study example, discussing the innovative designing out crime strategy, a systematic attempt at embedding such ideas within government policy.Design/methodology/approach – This paper reports on the systems approach adopted by the WA Government, which draws together three key themes of designing out crime, namely: the design of the built environment, the ongoing management of the built environment and the use of product design to reduce opportunities for crime. The systems perspective is underpinned by an evidence‐based approach across these three areas.Findings – Many existing international approaches to designing out crime are arguably limited, piecemeal and largely uncoordinated. This strategy represents a comprehensive and holistic policy commitment to designing out crime.Research limitations/implications – The effectiveness of this strategy is as yet unknown, but it arguably ...

This essay focuses on a transcription of a recording of ‘Creative from Guinea\', a piece composed and taught to me orally by Atsu Dagadu of Ghana. The transcription is innovative, combining West African drum language mnemonics and the Time Unit Box System in a hybrid transcription system which I devised. I drew on my experience as a student of drumming as well as a single recording in prioritising transcription decisions. The transcription draws attention to the structure and arrangement of ‘Creative\', and provides an accurate score for educational use to correct memory errors. I discuss transcription as facilitating internalisation and understanding, fitting together with transmission, memory and preservation of music. Journal of the Musical Arts in Africa Volume 4 2007, 55–70

To develop a national consensus statement to promote a pragmatic, appropriate and unified approach to seeking consent for medical student involvement in patient care. A modified Delphi technique was used to develop the consensus statement involving stakeholders. Feedback from consultation and each stakeholder helped to shape the final consensus statement. The consensus statement is a nationally-agreed statement concerning medical student involvement in patient care, which will be useful for medical students, health care professionals and patients.

Title: Giving voice to hope: music of Liberian refugees (2009) One compact disk and booklet. Production supervision by Barry Tonge, Michael Frishkopf, Nancy Hanneman, Ellis Pourbaix and Jennifer Woronuk.

Background For outpatient colonoscopy, the time required to intubate the cecum is variable. The aim of this study was to determine factors associated with cecal intubation time. Methods A total of 693 consecutive outpatient colonoscopies performed from January to October 2002 at a tertiary care medical center were studied prospectively. Data gathered included time required to reach the cecum; patient age, gender, and body mass index; history of abdominal surgery; quality of bowel preparation; presence/absence of diverticula; and endoscopist experience. Results Complete data were available for 587 patients. Mean age was 59 years, 48% were men, and mean body mass index was 28. Median cecal intubation time was 9 minutes. Linear regression analysis was performed. Cecal intubation time is prolonged by the following factors: older patient age, female gender, lower body mass index, poor bowel preparation, and lower endoscopist annual case volume. Conclusions This large, prospective study identified 5 factors that prolong the time required for cecal intubation at colonoscopy. These factors may be used to individualize scheduling of colonoscopy according to the time required.

One question of interdisciplinary education is how to encourage students to draw connections between disciplines and to engage in critical thinking. The authors developed a team-taught interdisciplinary course examining the history and literature of modern revolutions. The first time the course was given, students had difficulty making interdisciplinary connections and did not critically re-examine their assumptions. The authors restructured the course, re-thinking its emphasis, procedures, texts, and assignments, with substantial positive results. They also learned that teachers need to reassess their own ideology and teaching strategies to make interdisciplinary education effective.

We investigated whether moxifloxacin-induced QTc prolongations in Japanese and Caucasian healthy male volunteers were significantly different.A two period, randomized, crossover, ICH-E14-compliant thorough QT (TQT) study compared placebo-corrected changes in QTc interval from baseline (ΔΔQTc F) and concentration-effect relationships following administration of placebo and 400 mg moxifloxacin to 40 healthy male volunteers from each ethnic population. The point estimates of ΔΔQTc F for each population, and the difference between the two, were calculated at a geometric mean Cmax of moxifloxacin using a linear mixed effects model. The concentration-effect slopes of the two populations were also compared. Equivalence was concluded if the two-sided 90% confidence interval of the difference in ΔΔQTc F was contained within -5 ms to +5 ms limits and the ratio of the slopes was between 0.5 and 2.There were no statistically significant differences between the two populations studied, Japanese vs. Caucasians, respectively, for moxifloxacin Cmax (3.27 ± 0.6 vs. 2.98 ± 0.7 µg ml(-1) ), ΔΔQTc F (9.63 ± 1.15 vs. 11.46 ± 1.19 ms at Cmax of 3.07 µg ml(-1) ) and concentration-response slopes (2.58 ± 0.62 vs. 2.34 ± 0.64 ms per µg ml(-1) ). The difference in the two ΔΔQTc F of -1.8 (90% CI -4.6, 0.9) and the ratio of the two slopes (1.1; 90% CI 0.63, 1.82) were within pre-specified equivalence limits.Moxifloxacin-induced QTc prolongations did not differ significantly between the Japanese and Caucasian subjects. However, before our findings are more widely generalized, further studies in other populations and with other QT-prolonging drugs are needed to clarify whether inter-ethnic differences in QT sensitivity exist and whether ethnicity of the study population may affect the outcome of a TQT study.

This paper examines the strategies and arguments used by segments of the alcohol industry to delay the introduction of mandatory health warning labels on alcohol containers in Australia. These strategies are compared with those used by the tobacco industry to delay the introduction of warning labels for cigarettes.Submissions made by members of the alcohol industry to the Australian Government's review of labelling and Parliamentary Inquiry into Fetal Alcohol Spectrum Disorders were analysed.Segments of the alcohol industry have delayed the introduction of mandatory alcohol health warning labels in Australia by questioning the rationale and evidence base for labels; arguing that they will cause damage to public health and the economy; lobbying and seeking to influence government and political representatives including through monetary donations; and introducing its own voluntary labelling scheme. The arguments made by these organizations against the introduction of mandatory health warning labels for alcohol are flawed and their empirical basis is limited.The Australian Government has delayed the introduction of mandatory alcohol health warning labels in Australia by 2 years, until at least December 2013. The campaigning of some parts of the alcohol industry appears to have been instrumental in this decision.

Transporting protons is essential in several biological processes as well as in renewable energy devices, such as fuel cells. Although biological systems exhibit precise supramolecular organization of chemical functionalities on the nanoscale to effect highly efficient proton conduction, to achieve similar organization in artificial systems remains a daunting challenge. Here, we are concerned with transporting protons on a micron scale under anhydrous conditions, that is proton transfer unassisted by any solvent, especially water. We report that proton-conducting systems derived from facially amphiphilic polymers that exhibit organized supramolecular assemblies show a dramatic enhancement in anhydrous conductivity relative to analogous materials that lack the capacity for self-organization. We describe the design, synthesis and characterization of these macromolecules, and suggest that nanoscale organization of proton-conducting functionalities is a key consideration in obtaining efficient anhydrous proton transport. Efficient conduction of protons on a micrometre scale is critical for the development of fuel cell membranes — a key component of clean energy sources. Now, self-assembling amphiphilic polymers have been shown to provide a nanoscale organization of proton-conducting functionalities that dramatically increases anhydrous proton conductivity.

As network-enabled scholarship produces huge quantities of formal and informal research outputs in a variety of formats and varying levels of access, it is "enhanced" science that will facilitate the discovery, selection, and analysis of information that are a necessary part of the scientific research cycle particularly among interdisciplinary research communities. The national nanomanufacturing network (NNN) has developed a Web service, internano, to support the information needs of the nanomanufacturing community within this network-enabled research environment. Based on the clearinghouse concept, InterNano brings together heterogeneous resources and research outputs with networking and computational tools to enable discovery, facilitate selection of information, and encourage collaboration. With seventeen content features and services, internano's goal is not just to make information work within this community more efficient, but also to enable researchers to act on their discoveries within the same virtual framework.

The optimal regimen for discontinuing antiepileptic medications in children with epilepsy is unknown.We randomly assigned 149 children to either a six-week or a nine-month period of drug tapering, after which therapy was discontinued. Each group was composed of patients who had been seizure-free for either two or four years before drug tapering was begun. Most patients were receiving one antiepileptic drug; none were taking more than two. The children were evaluated periodically during and after the taper period. Sixteen patients were lost to follow-up before the beginning of the taper period. Proportional-hazards regression analysis was used to assess the risk of seizure recurrence among the remaining 133 patients.Seizures recurred in 53 patients (40 percent). The mean duration of follow-up was 39 months (range, 11 to 105) for the patients who did not have a recurrence of seizures. Neither the length of the taper period (six weeks vs. nine months, P = 0.38) nor the length of time the patients were free of seizures before the taper period was begun (two years vs. four years, P = 0.20) significantly influenced the risk of seizure recurrence. The presence of mental retardation (relative risk, 3.1, 95 percent confidence interval, 1.5 to 6.2) or spikes in the electroencephalogram at the time of tapering (relative risk, 1.9, 95 percent confidence interval, 1.0 to 3.4) increased the risk of seizure recurrence.The risk of seizure recurrence during drug tapering and after the discontinuation of antiepileptic drug therapy in children with epilepsy is not different whether the medications are tapered over a six-week or a nine-month period.

purpose: Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis are the most frequent pulmonary and central nervous system opportunistic infections associated with human immunodeficiency virus (HIV) infection. We designed a prospective study to compare the effects of aerosolized pentamidine and dapsone in the prophylaxis of these infections in HIV-infected persons with CD4+ lymphocyte counts less than 250/mm 3 . patients and methods: Two hundred seventy-eight patients seropositive for HIV who had acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex were randomly assigned to receive intermittent dapsone (100 mg twice weekly) or aerosolized pentamidine (100 mg every 2 weeks). The proportion of patients remaining free of PCP or toxoplasmosis was analyzed with the log-rank test as a function of time, as were the effects of zidovudine or prophylaxis on survival. results: Dapsone and aerosolized pentamidine demonstrated similar efficacy in the primary and secondary prophylaxis of PCP, with 15 (18%) failures among patients receiving dapsone compared to 15 (14%) among those receiving aerosolized pentamidine (p = 0.4), after a mean length of follow-up of 42 and 44 weeks, respectively. Dapsone was more effective in the primary prophylaxis of toxoplasmic encephalitis, with six toxoplasmic encephalitis events occurring among those receiving aerosolized pentamidine, compared to none among those taking dapsone (p = 0.01). Primary prophylaxis for PCP was more effective than secondary prophylaxis with either therapy. Zidovudine therapy did not prevent PCP yet prolonged the PCP-free interval for those in whom either prophylactic therapy failed. Kaplan-Meier estimates did not show a difference in survival between the patients receiving either therapy, yet zidovudine use was associated with improved survival, independent of race and risk factor (Cox proportional hazards model, p=0.001). The 1-month survival for patients developing PCP despite prophylaxis was better with those in whom dapsone failed than it was for those in whom aerosolized pentamidine failed (p = 0.08). conclusion: Dapsone is as effective as aerosolized pentamidine in preventing PCP and has the advantage of a lower cost, easier administration, and possibly an additional preventive effect against toxoplasmosis. Zidovudine prolongs the PCP-free interval for patients receiving prophylaxis, regardless of which prophylactic agent is used.