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BACKGROUND AND PURPOSE: Aside from basic Accreditation Council for Graduate Medical Education guidelines, few metrics are in place to monitor fellows' progress. The purpose of this study was to determine objective trends in neuroradiology fellowship training on-call performance during an academic year. MATERIALS AND METHODS: We retrospectively reviewed the number of cross-sectional neuroimaging studies dictated with complete reports by neuroradiology fellows during independent call. Monthly trends in total call cases, report turnaround times, relationships between volume and report turnaround times, and words addended to preliminary reports by attending neuroradiologists were evaluated with regression models. Monthly variation in frequencies of call-discrepancy macros were assessed via χ2 tests. Changes in frequencies of specific macro use between fellowship semesters were assessed via serial 2-sample tests of proportions. RESULTS: From 2012 to 2017, for 29 fellows, monthly median report turnaround times significantly decreased during the academic year: July (first month) = 79 minutes (95% CI, 71-86 minutes) and June (12th month) = 55 minutes (95% CI, 52-60 minutes; P value = .023). Monthly report turnaround times were inversely correlated with total volumes for CT (r = -0.70, F = 9.639, P value = .011) but not MR imaging. Words addended to preliminary reports, a surrogate measurement of report clarity, slightly improved and discrepancy rates decreased during the last 6 months of fellowship. A nadir for report turnaround times, discrepancy errors, and words addended to reports was seen in December and January. CONCLUSIONS: Progress through fellowship correlates with a decline in report turnaround times and discrepancy rates for cross-sectional neuroimaging call studies and slight improvement in indirect quantitative measurement of report clarity. These metrics can be tracked throughout the academic year, and the midyear would be a logical time point for programs to assess objective progress of fellows and address any deficiencies.

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In this clinical case series, we report our experience to date with neurologic complications of extracorporeal membrane oxygenation therapy for COVID-19 Acute Respiratory Distress Syndrome. We have found an unexpectedly increased rate of complications as demonstrated by neuroimaging compared with meta-analysis data in extracorporeal membrane oxygenation therapy for all Acute Respiratory Distress Syndrome etiologies over the past few decades and compared with the most recent baseline data describing the incidence of neurologic complication in all patients with COVID-19. For our 12-patient cohort, there was a rate of intracranial hemorrhage of 41.7%. Representative cases and images of devastating intracranial hemorrhage are presented. We hypothesize that the interplay between hematologic changes inherent to extracorporeal membrane oxygenation and inflammatory and coagulopathic changes that have begun to be elucidated as part of the COVID-19 disease process are responsible. Continued analysis of extracorporeal membrane oxygenation therapy in this disease paradigm is warranted.

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Attitudinal and behavioural change among gay men in Switzerland was measured between 1987 and 1990 to evaluate the effectiveness of AIDS prevention activities. The methodology used included a self-administered questionnaire published in Swiss gay magazines and distributed by gay organizations (N = 795 in 1987, N = 720 in 1990) and in-depth interviews with men recruited through advertisements and through the questionnaire (N = 42 in 1987, N = 24 in 1990). The two independent sampling procedures yielded similar samples with regard to socio-demographic characteristics, allowing comparisons to be made between the 1987 and 1990 data. Personal confrontation with AIDS (knowing someone who is HIV-positive, or who is ill or dead from AIDS) increased significantly during the period but more adequate ways of coping developed. Behavioural change towards safer sex began well before the first study. The majority of responding homosexuals have adapted their sexual behaviour to the new situation created by AIDS and generally maintain a protective behaviour. However, "exceptions" (condom rupture or episodes of non-protection) are not infrequent and should deserve more attention. Three indicators of sexual behaviour (number of sexual partners, anal sex and use of condom and oral sex with ejaculation), reported for the last 3 months before each study, exhibit few changes between 1987 and 1990: number of partners remained stable, unprotected oral sex decreased. Anal sex slightly increased, the use of condoms remaining stable. Sixty-seven percent of the sample knew their serostatus in 1990 (57% in 1987), and 13% of these stated that they were HIV+ (14% in 1987).

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Data about the use of pain relieving drugs in 411 patients, collected during 24 months are presented. The patients were interviewed personally by one of the authors during a selection process. Demographic data were obtained as well as information about headaches and other pains, duration of the disease, previous headache treatment, clinical characteristics of the headache and a diagnostic hypothesis was formulated. Regarding the use of medication the following factors were considered: amount and quality of medication taken, duration of disease, person responsible for the prescription and awareness of side effects. The results showed that 82% of the patients used substances for immediate relief to headache. Eighty per cent of these patients used commercial products without ergot derivatives, 9% with ergot derivatives and 12%, both. At the same time, 27% of the patients used 3 or more commercial products. The most frequently used substance was dipyrone. Several patients used, as PRD, substances without these properties. Forty eight per cent of the patients used PRD daily or more than once a day and 63% used them for over 90 days. Thirty two per cent of the patients used 5 or more doses of PRD during one single crisis of pain. Seventy four per cent of the patients used self-medication and 81% were not aware of side effects. The present data indicate that the use of PRD is high and chronic. The main implications of this fact and preventive measures are discussed.

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Data on the use of pain relieving drugs in 339 patients who used medication to relieve their headache are presented. One hundred sixty eight (49%) of them were considered as abusers based on Diamond and Dalessio's criteria modified by Saper. The most common form of abuse was the daily use of PRD, observed in 90 (54%) of the patients (criterion A) followed by: abuse by criterion A plus use of more than 100 doses of analgesic/month (criterion B) observed in 18 (11%) and finally criterion A plus daily use of compounds containing barbiturates or other tranquilizing drugs, in 18 (11%) of the patients. The abuse by psychotropic drugs was observed in 11 (7%) of the patients. The data suggest that the abuse of PRD is high and must be regarded as a public health problem.

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A study was designed to develop a measure of both acute and chronic effects of THC administration on memory in the rat. Errors in an 8-arm radial maze, before and after two delay intervals (5 s and 1 h, introduced between the fourth and the fifth arm choice), constituted the principal dependent measures. The first experiment involved testing the animals shortly after administration of 1.25 mg/kg THC. The drug did not affect performance in the pre-delay tests, although a significant effect was observed after the 5-s delay but not after 1-h delay. In the second experiment, 5 mg/kg THC or saline were administered 6 days/week for 90 days. Testing was conducted 18 h after each drug administration. During chronic administration the pre-delay performance did not differ between groups but the post-delay performance of the THC group deteriorated in a gradual manner, relative to their controls, in both the 5-s and 1-h delay conditions. After discontinuation of drug administration, the differences between groups reversed only after 30 days. The results provided evidence that both acute and chronic administration of THC affected working-memory in the radial arm maze test, although it did not interfere with the general cues of the task (reference memory). Chronic drug effects on memory were reversible after prolonged abstinence. Thus, the 8-arm radial maze task proved to be a useful measure of THC effects on memory and could be further used to investigate more thoroughly the mechanisms involved in such drug effects.(ABSTRACT TRUNCATED AT 250 WORDS)

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Interviews were conducted with 59 former intensive users of illicit drugs with no evidence of current social or behavioural dysfunction. Data were gathered by in-depth standardized interviews through which, past and current psychoactive substance use (including alcohol, tobacco and tranquillizers) were assessed. Special attention was given to the subjects' attributions as to what had caused the change in the drug use pattern. Events attributed for ending or substantially decreasing drug use were categorized as follows: 'physical-mental problems/disliked side effects' (27.1% of respondents), 'developmental/maturational/existential reasons' (27.1%), 'formal or informal drug treatment system' (11.8%), 'interpersonal reasons' (10.2%), 'job or school/performance lowering' (10.2%), 'religious/spiritual involvement' (6.8%), and 'legal/financial problems' (6.8%). The major finding was that only 7 out of the 59 respondents (11.8%) reported having ever been in any formal or informal drug treatment system.

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The effects of chronic ethanol administration were studied in rats receiving amygdaloid kindling. Daily ethanol administration 10 min prior to kindling stimulation delayed acquisition of kindling without affecting the electrical afterdischarge. For the lowest tested dose of ethanol (0.5 g/kg), this delay was restricted to kindling stages 1 and 2. For the higher doses of ethanol (1.0 and 1.5 g/kg) this delay became more severe and stages 3 and 4 were blocked. Ethanol produced a clear dose-related anticonvulsant effect upon kindled seizures. After repeated exposure to kindling stimulation and ethanol this anticonvulsant effect vanished. After a 15-day interval without stimulation or ethanol application kindled animals were insensitive to ethanol's anticonvulsant effect. In conclusion, it is suggested that the anticonvulsant effects of low ethanol doses are restricted to kindling stages 1 and 2 and that anticonvulsant effects of high ethanol doses are limited by tolerance and by the level of consolidation of the kindled seizure. Finally, we suggest that the anticonvulsant properties of ethanol are not due to its general depressant effect but to some rather specific action.

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1. The effect of acute ethanol on memory was studied in an eight-arm radial maze by interposing a 15-s or 1-h delay between the rat's fourth and fifth arm choices. 2. Ethanol (1.0 g/kg) was injected intraperitoneally 5 min prior to the first set of 4-arm choices, therefore being present since the acquisition of the trial-unique event. 3. The results showed 1) a decrease in choice accuracy only in the final 4 arm choices after the 1-h delay, and 2) that errors consisted of re-entries into arms chosen before the delay was imposed. The data further support the contention that ethanol impairs retention of working memory.

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Male Wistar rats were subjected to pilocarpine-induced status epilepticus and allowed to recover. After reaching the chronic state with spontaneous seizures they were tested in an 8-arm radial maze. During learning trials, epileptic rats made significantly more errors than controls. Even in the last trials epileptic rats did not improve their performance, indicating severe learning disability. These results suggest that spontaneous seizures after pilocarpine-induced status epilepticus are a useful model for studying the learning and memory impairment detected in some cases of symptomatic epilepsy.

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1. The effect of acute ethanol on memory was studied in an eight-arm radial maze by interposing a 15-s or 1-h delay between the rat's fourth and fifth arma choices. 2. Ethanol (1.0g/Kg) was injected intraperitoneally 5 min prior to the firsrt set of 4-arm choices, therefore being presrnt since the acquisition of the trial-unique event. 3. The results showed 1) a decrease in choice accuracu only in the final 4 arm choices after the 1-h delay, and 2) that errors consisted of re-entries into arms chosen before the delay was imposed. The data further support the contention that ethanol impairs retention of working memory

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Male Wistar rats were subjected to pilocarpine-induced status epilepticus and allowed to recor. After reaching the chronic state with spontaneous seizures they were tested in an 8-arm radial maze. during learning trials, epileptic rats made significantly more errors than controls. Even in the last trials epileptic rats did not improve their performance, indicating severe learning disability. These results suggest that spontaneous seizures after pilocarpine-induced status epilepticus are a useful model for studying the learning and memory detected in some cases of symptomatic epilepsy

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Locomotor activity was recorded after 5-30 mg/kg of cocaine in mice pretreated or not with a stimulant dose of ethanol (2.0 g/kg). The increase in locomotion induced by the association of cocaine plus ethanol was significantly larger when compared to either the group injected with only cocaine or only ethanol.

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Seventy-nine undergraduate social drinkers were the subjects in two studies. Both studies had two experimental sessions and followed a blind design. The subjects in experiment I (expectancy manipulation) were informed they would certainly receive an alcoholic beverage in one session, while in the other one they were told the beverage possibly contained alcohol. Thus, the different expectancy on the beverage content was evaluated. The volunteers in experiment II (attention demanding tasks) were submitted to attention tests in one session and in another one they were not. Thus, the assumption that tasks would motivate the subjects to stay more sober and rate themselves as less intoxicated was studied. Each subject received one of three alcohol doses (0.0; 0.4 or 0.6 g/kg): the same dose in both sessions of each experiment. Blood alcohol level (BAL), reaction time, and self-rating intoxication scores were recorded. The variables studied did not alter either BAL or reaction time values. The expectancy manipulation changed the self-rated intoxication with the lower alcohol dose (0.4 g/kg). So when doubt had been raised the subjects rated themselves as less intoxicated. However, this change was only found with a verbal scale. The attention demanding tasks manipulation did not change the self-rating evaluations. It is suggested that the tasks performed were not appropriate to motivate the subjects to stay sober. The differential sensitivity of the self-rating intoxication scales utilized, and the role of alcohol dose in the study of nonpharmacological variables are discussed.

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Mice from a randomly bred strain were divided into two groups according to their locomotor responses to ethanol (0.8-3.0 g/kg): in two thirds of the tested animals ethanol increased locomotor activity (ethanol activated-EA), whereas in the remaining one third it did not (ethanol non-activated-ENA). Both groups did not differ in their locomotor activity after saline administration. Furthermore, EA and ENA mice presented a similar increase in locomotor activity after challenge with 1.0 and 2.0 mg/kg d-amphetamine. Chronic exposure to ethanol increased the ethanol-induced locomotor activation in both EA and ENA groups. The possibility that the lack of responsiveness of ENA mice to ethanol's acute activating effect could be due to a higher sensitivity to the depressant effect of ethanol is discussed.

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The effects of 3, 6 and 48 mg/kg of the benzodiazepine receptor antagonist Ro 15-1788 on the ethanol-induced depressant action were evaluated in mice. These results support and extend previous findings in experimental animals and show that Ro 15-1788 in doses devoid of intrinsic effects, does not antagonize the motor impairment, hypnotic effect or lethality induced by ethanol.

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Data on the correlation between the degree of severity of the alcohol dependence syndrome, as evaluated through the Short Alcohol Dependence Data (SADD) questionnaire, and alterations of four biological state markers of alcohol abuse, namely gamma-glutamyltransferase (GGT), glutamate pyruvate transaminase (SGPT), glutamate oxalacetate transaminase (SGOT) and mean corpuscular volume (MCV), in a sample of 137 alcoholics, are presented. A significant increase in the proportion of altered GGT and SGOT results was found in those patients with higher scores in the SADD. The analysis of the correlation (Spearman coefficient) between the values of each biological test and the SADD scores showed only a significant, though low, positive correlation for SGOT (r = 0.29).

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The Short-Alcohol Dependence Data (SADD) and the Alcohol Dependence Scale (ADS) questionnaires, both designed to evaluate the degree of severity of alcohol dependence, were compared in a sample of 201 known alcoholics. Although a significant correlation was found between the scores obtained on the two scales (r = 0.61; P less than 0.01), respondents were classified differently by the two questionnaires (Kappa = 0.20). Subjects were generally considered less dependent by the ADS than by the SADD. Different possibilities that could explain the differential classification are discussed.

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Drinking habits was studied in a sample of 3114 students from a low socioeconomic level and aging from 9 to 18 years. Males and females were equally represented in the sample. The survey showed that 27% were non-drinkers, 54% experimental drinkers, 14% moderate regular drinkers and 5% excessive regular drinkers. The excessive regular drinkers reported a higher proportion of heavy alcohol consumption among close relatives, mainly fathers. Sex and age-related differences were found in the drinking pattern. Males as well as oldest students were over represented among the drinkers excepted for excessive regular drinkers where no age difference was detected. This finding (same proportion of excessive regular drinkers in all age groups) was discussed taking into account the possibility that the high drop out rates in Brazilian schools could be introducing a bias in the figures found for the oldest adolescent groups. Beliefs about drinking consequences and location where most drinking occurs were also studied.

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