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Patients with Alzheimer's disease (AD) show varying degrees of awareness of their deficits. To examine the impact of this phenomenon upon the distress experienced by family caregivers of AD patients, we analyzed caregiver burden in relation to patient awareness of deficit in three different functional domains. The relationship of burden to selected sociodemographic variables was also explored. Results of multiple regression analyses suggested that caregiver burden was associated with impaired patient awareness of memory deficit independent of disease stage and dementia severity. The findings suggest that impaired awareness may be an important mediator of caregiver burden, a concern in the management of AD.

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A conceptual model of the morphological development of the riparian margins of newly cut river channels is presented, suggesting early feedbacks between vegetation growth and bank form. To test the model, observations of long and cross profiles, bank sediment and seed deposition, and bank vegetation development were collected over the first 2 years of river flows through a reach of the River Cole, West Midlands, UK. The newly created channel had a sinuous planform and varying asymmetric trapezoidal cross section in sympathy with the planform. No imposed bedforms or bank reseeding were included in the design. Over the 2 years, development of bedforms was rapid, with bed sediment sorting and bank profile adjustment occurring more steadily and progressively. Six classes of bank profile were identified by the end of the study period, illustrating close associations with sediment aggradation, vegetation colonization, and growth patterns. Vegetation colonization of the banks was seeded predominantly from local sources during the summer and from hydrochory (transport by the river) during the winter. Colonizing vegetation on the riverbanks appeared to act as a significant propagule source by the second summer and as an increasingly important roughness element, trapping both propagules and sediment, within the second year and providing early feedback into bank evolution. As a result, the time required for riparian margin development in the conceptual model was found to be considerably longer than observed in the study river. In addition, the role of surface wash/bank failure in modifying the bank profile and transporting seeds onto the upper bank face during the first year of bank development was found to be important in initiating rapid bank vegetation colonization and surface stabilization. This set of processes had not been incorporated in the initial conceptual model. In relation to channel restoration, this research illustrates that in small temperate rivers of modest energy the provision of an initial, sinuous corridor is sufficient to induce rapid development of fluvial features and vegetation cover without the need to construct bed forms or to seed the banks.

A randomized, double-blind, multicenter study in 181 afebrile cancer patients with ANC levels < 500/microL receiving myelosuppressive chemotherapy was undertaken to compare sargramostim (yeast-derived recombinant human granulocyte-macrophage colony-stimulating factor, RhuGM-CSF) and filgrastim (bacteria-derived recombinant human granulocyte colony-stimulating factor, RhuG-CSF) in the treatment of chemotherapy-induced myelosuppression. Patients received daily subcutaneous (SC) injections of either agent until ANC levels reached at least 1500/microL. There was no statistical difference between treatment groups in the mean number of days to reach an ANC of 500/microL, but the mean number of days to reach ANC levels of 1000/microL and 1500/microL was approximately one day less in patients receiving filgrastim. Fewer patients in the sargramostim arm were hospitalized, and they had a shorter mean length of hospitalization, mean duration of fever, and mean duration of i.v. antibiotic therapy compared with patients who received filgrastim. Both growth factors were well tolerated. No patient was readmitted to the hospital after growth factor was discontinued. Sargramostim and filgrastim have comparable efficacy and tolerability in the treatment of standard-dose chemotherapy-induced myelosuppression in community practice.

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