A multi-site, double-blind, placebo-controlled pilot clinical trial to evaluate the efficacy of buspirone as a relapse-prevention treatment for cocaine dependence

Objective—To evaluate the potential efficacy of buspirone as a relapse-prevention treatment for cocaine dependence. Method—A randomized, double-blind, placebo-controlled, 16-week pilot trial conducted at six clinical sites between August 2012 and June 2013. Adult crack cocaine users meeting DSM-IVTR criteria for current cocaine dependence scheduled to be in inpatient/residential substance use disorder (SUD) treatment for 12–19 days when randomized, and planning to enroll in local outpatient treatment through the end of the active treatment phase were randomized to buspirone titrated to 60 mg/day (n=35) or to placebo (n=27). All participants received psychosocial treatment as usually provided by the SUD treatment programs in which they were enrolled. Outcome measures included maximum days of continuous cocaine abstinence (primary), proportion of cocaine use days, and days-to-first-cocaine-use during the outpatient treatment phase (study weeks 4–15) as assessed by self-report and urine drug screens. Results—There were no significant treatment effects on maximum continuous days of cocaine abstinence or days to first cocaine use. In the females (n=23), there was a significant treatment-bytime interaction effect (X2 (1)=6.06, p=.01), reflecting an increase in cocaine use by the buspirone, relative to placebo, participants early in the outpatient treatment phase. A similar effect was not detected in the male participants (n=39; X2 (1)=0.14, p=.70). Conclusions—The results suggest that buspirone is unlikely to have a beneficial effect on preventing relapse to cocaine use and that buspirone for cocaine-dependent women may worsen their cocaine-use outcomes. Trial Registration—Clinical Trials.gov http://www.clinicaltrials.gov; Identifier: NCT0164115

Loss to Follow-Up from HIV Screening to ART Initiation in Rural China.

BackgroundPatients who are newly screened HIV positive by EIA are lost to follow-up due to complicated HIV testing procedures. Because this is the first step in care, it affects the entire continuum of care. This is a particular concern in rural China.Objective(s)To assess the routine HIV testing completeness and treatment initiation rates at 18 county-level general hospitals in rural Guangxi.MethodsWe reviewed original hospital HIV screening records. Investigators also engaged with hospital leaders and key personnel involved in HIV prevention activities to characterize in detail the routine care practices in place at each county.Results699 newly screened HIV-positive patients between January 1 and June 30, 2013 across the 18 hospitals were included in the study. The proportion of confirmatory testing across the 18 hospitals ranged from 14% to 87% (mean of 43%), and the proportion of newly diagnosed individuals successfully initiated antiretroviral treatment across the hospitals ranged from 3% to 67% (mean of 23%). The average interval within hospitals for individuals to receive the Western Blot (WB) and CD4 test results from HIV positive screening (i.e. achieving testing completion) ranged from 14-116 days (mean of 41.7 days) across the hospitals. The shortest interval from receiving a positive EIA screening test result to receiving WB and CD4 testing and counseling was 0 day and the longest was 260 days.ConclusionThe proportion of patients newly screened HIV positive that completed the necessary testing procedures for HIV confirmation and received ART was very low. Interventions are urgently needed to remove barriers so that HIV patients can have timely access to HIV/AIDS treatment and care in rural China

Impact of Allergic Reactions on Food-Specific IgE Concentrations and Skin Test Results

Although there is concern that food allergic reactions may negatively affect the natural history of food allergy, the impact of reactions on food-specific IgE (sIgE) or skin prick tests is unknown

Self-gravitating elastic bodies

Extended objects in GR are often modelled using distributional solutions of the Einstein equations with point-like sources, or as the limit of infinitesimally small "test" objects. In this note, I will consider models of finite self-gravitating extended objects, which make it possible to give a rigorous treatment of the initial value problem for (finite) extended objects.Comment: 16 pages. Based on a talk given at the 2013 WE-Heraeus seminar on "Equations of motion in relativistic gravity

Dynamical description of quantum computing: generic nonlocality of quantum noise

We develop dynamical non-Markovian description of quantum computing in weak coupling limit, in lowest order approximation. We show that long range memory of quantum reservoir produces strong interrelation between structure of noise and quantum algorithm, implying nonlocal attacks of noise. We then argue that the quantum error correction method fails to protect quantum computation against electromagnetic or phonon vacuum which exhibit $1/t^4$ memory. This shows that the implicit assumption of quantum error correction theory -- independence of noise and self-dynamics -- fails in long time regimes. We also use our approach to present {\it pure} decoherence and decoherence accompanied by dissipation in terms of spectral density of reservoir. The so-called {\it dynamical decoupling} method is discussed in this context. Finally, we propose {\it minimal decoherence model}, in which the only source of decoherence is vacuum. We optimize fidelity of quantum information processing under the trade-off between speed of gate and strength of decoherence.Comment: 12 pages, minor corrections, softened interpretation of the result

Exact time evolution and master equations for the damped harmonic oscillator

Using the exact path integral solution for the damped harmonic oscillator it is shown that in general there does not exist an exact dissipative Liouville operator describing the dynamics of the oscillator for arbitrary initial bath preparations. Exact non-stationary Liouville operators can be found only for particular preparations. Three physically meaningful examples are examined. An exact new master equation is derived for thermal initial conditions. Second, the Liouville operator governing the time-evolution of equilibrium correlations is obtained. Third, factorizing initial conditions are studied. Additionally, one can show that there are approximate Liouville operators independent of the initial preparation describing the long time dynamics under appropriate conditions. The general form of these approximate master equations is derived and the coefficients are determined for special cases of the bath spectral density including the Ohmic, Drude and weak coupling cases. The connection with earlier work is discussed.Comment: to be published in Phys. Rev.

Conducting clinical trials in sub-Saharan Africa: challenges and lessons learned from the Malawi Cryptosporidium study

Background An effective drug to treat cryptosporidial diarrhea in HIV-infected individuals is a global health priority. Promising drugs need to be evaluated in endemic areas which may be challenged by both lack of resources and experience to conduct International Committee of Harmonisation-Good Clinical Practice (ICH-GCP)-compliant clinical trials. Methods We present the challenges and lessons learned in implementing a phase 2A, randomized, double-blind, placebo-controlled trial of clofazimine, in treatment of cryptosporidiosis among HIV-infected adults at a single site in Malawi. Results Primary challenges are grouped under study initiation, study population, study implementation, and cultural issues. The lessons learned primarily deal with regulatory system and operational barriers, and recommendations can be applied to other human experimental trials in low- and middle-income countries, specifically in sub-Saharan Africa. Conclusion This study demonstrated that initiating and implementing human experimental trials in sub-Saharan Africa can be challenging. However, solutions exist and successful execution requires careful planning, ongoing evaluation, responsiveness to new developments, and oversight of all trial operations