Visualizing Anatomy in Dental Morphology Education

Tooth morphology is a foundation course for all dental healthcare students including dentists, dental hygiene, dental therapy, and dental nursing students. This chapter explores the conventional and innovative teaching methods to deliver tooth morphology educational modules. The teaching tools are explored with a 2D and 3D lens, with a particular focus on visualization, student understanding, and engagement. Traditional methods of teaching tooth morphology must be complemented with innovative pedagogical approaches in order to maintain student's attention and accommodate their diverse learning methods. Teaching 3D anatomy enables students to visualize and spatially comprehend the link between various anatomical components. Online tests and quizzes motivate students and are also beneficial in preparing students for exams. Online self-examinations offering visualization with 3D teeth enable students to evaluate their knowledge and offers immediate feedback, which aids in the long-term retention of information. These tools can be as efficient as other teaching methods, allowing the students to study at their own pace and with repetition. The authors conclude that blended and innovative teaching methods should supplement student learning and not replace, traditional face-to-face educational methods.

1095 The Utility of Plasma Circulating Cell-Free Messenger RNA as A Biomarker of Glioma: A Pilot Study

Introduction

Research into the potential utility of plasma-derived circulating-cell-free nucleic acids as non-invasive adjuncts to radiological imaging has been occasioned by the invasive nature of brain tumour biopsy. Circulating-cell-free messenger RNAs are short fragments of RNA present in blood. The objective of this study was to determine whether significant differences exist in the plasma transcriptomic profile of glioma patients relative to differences in their tumour characteristics, and also whether any observed differences were representative of synchronously obtained glioma samples and TCGA glioma derived RNA.

Method

Blood samples were collected from twenty-nine patients prior to tumour resection. Plasma-ccfmRNA and glioma derived RNA were extracted and profiled.

Results

BCL2L1, CXCL5, GZMB, HLA-A, HLA-C, IRF1, MYD88, TGFB1, TLR2, and TP53 genes were significantly over-expressed in glioma (high-grade-glioma-HGG and low-grade-glioma-LGG) patients (p < 0.05, versus control). BCL2L1, GZMB and HLA-A genes were significantly over-expressed in HGG patients (p < 0.05, versus LGG patients). There was positive correlation between the magnitude of fold change of differentially expressed genes in plasma and glioma derived RNA (Spearman r = 0.6344, n = 14, p = 0.017), and with the mean FPKM of TCGA glioma derived RNA samples (Spearman r = 0.4614, n = 19, p = 0.047). There was positive correlation between glioma radiographic tumour burden and the magnitude of fold change of CSF3 gene (r = 0.9813, n = 20, p < 0.001).

Conclusions

We identified significant differential expression of genes involved in cancer inflammation and immunity among patients with different glioma grades, and we identified positive correlation between the plasma transcriptomic profile and tumour samples, and with TCGA glioma derived RNA.

O51 The utility of plasma circulating cell-free messenger RNA as a biomarker of glioma: a pilot study

Introduction

Research into the potential utility of plasma-derived circulating cell-free nucleic acids as non-invasive adjuncts to radiological imaging has been occasioned by the invasive nature of brain tumour biopsy. Circulating-cell-free messenger RNAs are short fragments of RNA present in blood. The objective of this study was to determine whether significant differences exist in the plasma transcriptomic profile of glioma patients relative to differences in their tumour characteristics, and also whether any observed differences were representative of synchronously obtained glioma samples and TCGA glioma derived RNA.

Method

Blood samples were collected from twenty-nine patients prior to tumour resection. Plasma ccfmRNA and glioma derived RNA were extracted and profiled.

Result

BCL2L1, CXCL5, GZMB, HLA-A, HLA-C, IRF1, MYD88, TGFB1, TLR2, and TP53 genes were significantly over-expressed in glioma (high-grade-glioma-HGG and low-grade-glioma-LGG) patients (P < 0.05, versus control). BCL2L1, GZMB and HLA-A genes were significantly over-expressed in HGG patients (P < 0.05, versus LGG patients). There was positive correlation between the magnitude of fold change of differentially expressed genes in plasma and glioma derived RNA (Spearman r = 0.6344, n = 14, P = 0.017), and with the mean FPKM of TCGA glioma derived RNA samples (Spearman r = 0.4614, n = 19, P = 0.047). There was positive correlation between glioma radiographic tumour burden and the magnitude of fold change of CSF3 gene (r = 0.9813, n = 20, P < 0.001).

Conclusion

We identified significant differential expression of genes involved in cancer inflammation and immunity among patients with different glioma grades, and we identified positive correlation between the plasma transcriptomic profile and tumour samples, and with TCGA glioma derived RNA.

Take-home Message

The plasma transcriptomic profile of glioma patients appears to be representative of synchronously obtained glioma samples.

O64: GENOMIC PROFILING USING CIRCULATING NUCLEIC ACIDS IN STAGE IV MELANOMA PATIENTS RECEIVING IMMUNOTHERAPY REVEALS A NOVEL GENE AMPLIFICATION LANDSCAPE AND ALLOWS FOR DETECTION OF ACTIONABLE GENE MUTATIONS

Introduction

Serial monitoring for disease progression and therapeutic efficacy at the molecular level in metastatic melanoma is hampered by a lack of reliable blood borne biomarkers. Molecular profiling of melanoma tumours is almost impractical in metastatic disease due to risks of procedure related morbidity and sampling inefficiency in representing tumour heterogeneity. Cell free DNA allows monitoring of molecular changes in melanoma over the course of immunotherapy. We investigated the utility of somatic mutation and gene amplification analyses in melanoma patients receiving immunotherapy.

Method

Cell free DNA was extracted from plasma using a QIAamp Circulating Nucleic Acid Kit (Qiagen). Pathway focused profiling of somatic mutation status was performed by ARMs PCR using QBiomarker Somatic Mutation PCR Arrays (Qiagen). Gene amplification analysis was performed by Real Time Quantitative PCR (Roche) using RT2 Profiler PCR Arrays (Qiagen).

Result

A total of twenty patients with stage IV melanoma receiving immunotherapy were enrolled in this study. The BRAF p.V600E mutation was detected in the cfDNA of 80% of BRAF positive patients. Cell free DNA was also profiled for a total of 84 genes of the cancer inflammation and immunity pathway. There was a significant difference in the copy numbers of several genes (CTLA-4, CXCL12, CXCL5, IDO1, TGFB, IFNG, IL4, PTGS2, AICDA, HLA-A, CCL4, ACKR3, TP53, MYC) between patients with progressive disease and therapeutic response (n=20, p < 0.05).

Conclusion

We postulate that cell free DNA pathway focused somatic mutation and gene amplification analyses may be useful in evaluating disease progression and therapeutic response.

Take-home message

Genomic analysis of circulating nucleic acids may be useful in evaluating disease progression and therapeutic response in metastatic melanoma.

O9: DETECTION OF RELEVANT GENE MUTATIONS IN GLIOMA USING PLASMA CELL FREE DNA

Background

Comprehensive molecular profiling of gliomas provide information essential for accurate biological classification beyond traditional histopathology. Genomic profiling utilizing tumour tissue samples inevitably involves obtaining tissues through potentially hazardous surgical procedures or stereotactic biopsies carrying risks of morbidity and mortality. Tissues from biopsies may also be insufficient or fail to capture a comprehensive picture of the tumours genetic profile due to tumour heterogeneity. In these contexts, complementary minimally invasive strategies are needed for molecular profiling of gliomas. Cell free DNA (cfDNA) has emerged as an easily accessible biomarker containing fragments of circulating tumour DNA (ctDNA) released into plasma through apoptosis. We explored its potential utility in genomic profiling of brain tumours.

Method

Plasma cfDNA from patients with radiographically suspected brain malignancies were extracted and quantified before planned surgical interventions. Cell free DNA was extracted using a QIAamp Circulating Nucleic Acid Kit (Qiagen), and was quantified (ng cfDNA/mL) using a DS-11 FX Spectrophotometer (DeNovix). Pathway focused profiling of somatic mutation status was performed using QBiomarker Somatic Mutation PCR Arrays for human brain cancers (Qiagen) through real time PCR (Roche).

Result

Somatic mutations in human brain cancer were evaluated in the following genes; BRAF, CTNNB1/beta-catenin, EGFR, IDH1, IDH2, KRAS, NF2, NRAS, PIK3CA, and PTEN. A total of 14 (70%) patients had greater than 1 somatic mutation detected in their plasma cfDNA.

Conclusion

We postulate that glioma derived circulating tumour DNA occur in plasma, and genomic analysis using cell free DNA may complement current methods of glioma genomic characterisation.

Take-home message

Glioma derived circulating tumour DNA occur in plasma.

Neuroanatomy of the spinal pathways: Evaluation of an interactive multimedia e-learning resource

This article was migrated. The article was marked as recommended. Introduction: A diminished number of young doctors opt for specialty neurology training and show reduced confidence in managing neurology patients and interlink difficulties in managing neurology patients with impaired understanding of neuroanatomy and associated clinical correlates. Aim: To evaluate an interactive e-resource for the neuroanatomy of the spinal pathways based on cognitive theories of multimedia learning in aiding medical students learn neuroanatomy. Methods: Using a single-blinded controlled experimental design, knowledge of the spinal pathways was assessed prior and after usage of the novel e-resource compared to control web resource. The perceived usefulness of the tool used was gauged using Likert-scale questionnaires. Results: Performance in the second assessment improved for all users but the learning gain of participants in the experimental groups was higher compared to participants who did not use e-resources. Likert-scale ratings revealed a significantly higher appreciation for the novel tool compared to the control tool when learning clinical correlates. Conclusions: Stronger correlations between the students' perception of the tool used and their second assessment scores suggest that students favored the instructional design of the novel e-tool which shows promising results in bridging the gap between neuroanatomy knowledge and its clinical application.

A Survey of tooth morphology teaching methods employed in the United Kingdom and Ireland

BACKGROUND

Tooth morphology is a central component of the dental curriculum and is applicable to all dental specialities. Traditional teaching methods are being supplemented with innovative strategies to tailor teaching and accommodate the learning styles of the recent generation of students.

METHODS

An online survey was compiled and distributed to the staff involved in teaching tooth morphology in the United Kingdom and Ireland to assess the importance of tooth morphology in the dentistry curriculum and the methodologies employed in teaching.

RESULTS

The results of the survey show that tooth morphology constitutes a small module in the dental curriculum. It is taught in the first 2 years of the dental curriculum but is applicable in the clinical years and throughout the dental career. Traditional teaching methods, lecture and practical, are being augmented with innovative teaching including e-learning via virtual learning environment, tooth atlas and e-books leading to blended learning. The majority of the schools teach both normal dental anatomy and morphologic variations of dental anatomy and utilise plastic teeth for practical and examination purposes. Learning the 3D aspects of tooth morphology was deemed important by most of the respondents who also agreed that tooth morphology is a difficult topic for the students.

CONCLUSION

Despite being core to the dental curriculum, overall minimal time is dedicated to the delivery of tooth morphology, creating a reliance on the student to learn the material. New forms of delivery including computer-assisted learning tools should help sustain learning and previously acquired knowledge.

Evaluation of an animation tool developed to supplement dental student study of the cranial nerves

INTRODUCTION

The structure/function of the cranial nerves is a core topic for dental students. However, due to the perceived complexity of the subject, it is often difficult for students to develop a comprehensive understanding of key concepts using textbooks and models. It is accepted that the acquisition of anatomical knowledge can be facilitated by visualisation of structures. This study aimed to develop and assess a novel cranial nerve animation as a supplemental learning aid for dental students.

MATERIALS AND METHODS

A multidisciplinary team of anatomists, neuroscientists and a computer scientist developed a novel animation depicting the cranial nerves. The animation was viewed by newly enrolled first-year dental students, graduate entry dental students (year 1) and dental hygiene students (year 1). A simple life scenario employing the use of the cranial nerves was developed using a cartoon-type animation with a viewing time of 3.58 minutes. The animation was developed with emphasis on a life scenario. The animation was placed online for 2 weeks with open access or viewed once in a controlled laboratory setting. Questionnaires were designed to assess the participants' attitude towards the animation and their knowledge of the cranial nerves before and after visualisation. This study was performed before the delivery of core lectures on the cranial nerves.

RESULTS

Our findings indicate that the use of the animation can act as a supplemental tool to improve student knowledge of the cranial nerves. Indeed, data indicate that a single viewing of the animation, in addition to 2-week access to the animation, can act as a supplemental learning tool to assist student understanding of the structure and function of cranial nerves. The animation significantly enhanced the student's opinion that their cranial nerve knowledge had improved. From a qualitative point of view, the students described the animation as an enjoyable and useful supplement to reading material/lectures and indicated that the animation was a useful tool in understanding the cranial nerves.

CONCLUSION

Overall, these findings indicate that an animation demonstrating the cranial nerves in a simple, everyday functional scenario may act as a learning aid in the study of cranial nerves.

Exposure of foetal neural progenitor cells to IL-1β impairs their proliferation and alters their differentiation - a role for maternal inflammation?

During pregnancy, activation of the maternal immune system results in inflammation in the foetal nervous system. The causative agents are pro-inflammatory cytokines like interleukin-1β (IL-1β), produced by the foetus. In this study, we examine the effect of IL-1β on the proliferation and differentiation of neural progenitor cells (NPCs) to better understand its potential effects on the developing brain. We find that the IL-1β receptor (IL-1R1) is expressed in the ventral mesencephalon of the developing brain. Furthermore, IL-1R1 is expressed on Nestin-positive, Sox-2-positive NPCs. IL-1β treatment reduced the numbers of proliferating NPCs, an effect prevented by the IL-1R1 receptor antagonist. LDH and MTT assays, and western blot analysis for cleaved caspase 3 and poly(ADP-ribose) polymerase, confirmed that this was not due to an increase in cell death but rather an induction of differentiation. To further study the effects of IL-1β on cell fate determination, we differentiated NPCs in the presence and absence of IL-1β. Il-1β promoted gliogenesis and inhibited neurogenesis, an effect that required p38-MAPK kinase signalling. In summary, these data show that exposure of NPCs to IL-1β affects their development. This necessitates an examination of the consequences that maternal immune system activation during pregnancy has on the cellular architecture of the developing brain.

DRD3 and DAT1 genes in schizophrenia: an association study

OBJECTIVE

To investigate the role of the dopamine receptor 3 (DRD3) and transporter 1 (DAT1) genes in schizophrenia or in modulating its phenotype.

METHODS

a Ser9Gly polymorphism in codon 9 of the DRD3 and a VNTR polymorphism in the DAT1genes were examined in two groups of schizophrenic patients, one of excellent neuroleptic responders (N=42) and one of nonresponders (N=64). A group of healthy volunteers screened for major psychiatric disorders was also included (N=89). In addition, age at onset of psychotic symptoms, attention performance and family loading for schizophrenia spectrum disorders were compared between patients with different genotypes in the DRD3 and DAT1 genes.

RESULTS

No significant differences in the allelic distribution of the DRD3 and DAT1 polymorphisms were detected between schizophrenic patients and controls. A trend toward an excess of DRD3 genotype Gly/Gly was observed in neuroleptic nonresponder schizophrenic patients compared to controls (chi(2)=3. 30, df=1, p=0.07). No significant differences in age at onset of psychotic symptoms, attention task performance or family loading for schizophrenia spectrum disorders were observed between groups with different DRD3 and DAT1 genotypes.

CONCLUSION

These results do not support the role of either of these genes in increasing susceptibility to schizophrenia or in modulating its phenotype in the studied population.

RARbeta involvement in enhancement of lung tumor cell immunogenicity revealed by array analysis

The retinoid receptors (RARs and RXRs) are mediators of the multiple effects of retinoic acid. Of these, the retinoic acid receptor beta2 (RARbeta2) has frequently been shown to be the principal mediator of the growth and tumor suppressive effects of retinoic acid; this gene is inactivated in many epithelial tumors and their derived cell lines. We have searched for genes that are regulated by this isoform and are potentially involved in tumor suppression. Using the Atlas human cDNA array I, we identified 27 genes (not counting RARbeta itself) that are regulated, directly or indirectly, by RARbeta2 when it is transfected into Calu-1, a lung tumor-derived line that does not normally express RARbeta. Several of the affected genes code for proteins whose functions would augment the process of apoptosis and/or the host's immune response. The latter group included ICAM-1 and MHC class I heavy chain, whose protein products play particularly important roles in the mounting of an effective anti-tumor response. We then confirmed by flow cytometry that the observed increases in message levels were reflected in increased cell surface protein levels for ICAM-1 and MHC class I in RARbeta2 transfectants of two RARbeta-deficient lines, Calu-1 and the epidermoid lung cancer-derived line SK-MES. Finally, we showed that RARbeta2 transfection of Calu-1 cells enhanced the heterologous CTL response in both the induction and the effector phases by up to threefold. These results support the hypothesis that down-regulation of these genes (and possibly others) in RARbeta-deficient tumor cells contributes to immune system evasion, and suggest a novel therapeutic approach for this disease.

RARbeta2 specificity in mediating RA inhibition of growth of lung cancer-derived cells

Retinoic acid receptor beta is the retinoid receptor most frequently associated with the growth suppressive effects of retinoic acid in various epithelial tumor-derived cell lines. In particular, it has been shown that transfection of RARbeta2 in epidermoid lung tumor cells could reduce their in vitro growth rate in the presence of retinoic acid and in vivo tumorigenicity. However, the question remained as to the isoform specificity of this effect. To investigate this, we transfected RARalpha1, RARbeta1 and RARbeta2 into the epidermoid lung cancer cell line Calu-1 and assessed the in vitro growth capacities of the transfected cells. The expression of the fetal RARbeta1 or overexpression of the ubiquitous RARalpha1 isoforms could not mimick the growth suppressive effect of RARbeta2. In addition we analyzed the expression of another RAR isoform, alpha2, in many tumor-derived lines and conclude from its expression pattern that RARalpha2 is unlikely to be involved in retinoic acid growth suppression of lung cancer. Overall our data suggest that the suppressive effect of RARbeta2 is isoform specific.

Analysis of 14 CAG repeat-containing genes in schizophrenia

Recently, it has been suggested that trinucleotide repeat-containing genes may be involved in the etiology of schizophrenia. This study was aimed at investigating putative associations between allelic variants or expansions of CAG repeat-containing genes (CAGrCG) and schizophrenia or its variability with respect to responsiveness to conventional neuroleptics. CAG repeat allelic variants of 14 expressed sequences were compared among three groups of subjects: neuroleptic-responder (R; n = 43) and neuroleptic-nonresponder (NR; n = 63) schizophrenic patients, and a control group (C; n = 122). No CAG expansions, in the range of those observed in neurodegenerative diseases, were identified in these 14 expressed sequences. The sizes of CAG repeat for the hGT1 gene were marginally different among the three groups of subjects (Kruskal-Wallis H (2, 456) = 10.48, Bonferroni corrected P = 0.047). Comparisons among the different groups indicated that neuroleptic responders have shorter alleles compared to controls (Mann-Whitney adjusted Z = -3.23, P = 0.0012). NR patients were not different from controls. These preliminary results suggest that the hGT1 gene, or a gene in its vicinity, may be involved in the etiology of schizophrenia or in modifying the disease phenotype with regard to outcome and/or neuroleptic responsiveness. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:694-699, 1999.

Lack of association between the hSKCa3 channel gene CAG polymorphism and schizophrenia

Genetic anticipation, a phenomenon characterized by increased severity of symptoms and earlier age at onset of a disease in successive generations, is believed to be present in schizophrenia. In several neurodegenerative diseases showing anticipation, the mutation causing the disease is an expanded trinucleotide repeat. Therefore, genes containing trinucleotide repeats prone to expansion have become a suitable family of candidate genes in schizophrenia. A human calcium-activated potassium channel gene (hSKCa3), possibly mapping to chromosome 22q11-13, a region previously linked to schizophrenia, was recently described. This gene contains two contiguous expressed CAG repeat stretches. Recently, long allelic variants of one of these CAG repeats were found to be overrepresented in schizophrenic patients compared to normal controls. In this study we attempted to replicate this result and to study the relationship between the length of this CAG repeat on the one hand and the severity and age at onset of the disease on the other hand. No association with the disease or correlation with the severity of schizophrenia was identified. In addition, hSKCa3 was mapped to chromosome 1. Our results do not support the involvement of this particular CAG repeat-containing gene in schizophrenia.

T102C polymorphism in the 5HT2A gene and schizophrenia: relation to phenotype and drug response variability

Although genes play a major role in the etiology of schizophrenia, no major genes involved in this disease have been identified. However, several genes with small effect have been reported, though inconsistently, to increase the risk for schizophrenia. Recently, the 5HT2A 2 allele (T102C polymorphism) was reported to be over-represented in patients with schizophrenia. Other reports have found an excess of allele 2(C) only in schizophrenic patients who are resistant to clozapine, not in those who respond to clozapine. In this study, the 5HT2A receptor allele 2 frequencies were compared between 2 groups of patients with schizophrenia (39 responders and 63 nonresponders) based on long-term outcome and response to typical neuroleptics. A control group of 90 healthy volunteers screened for mental disorders was also included. Genotype 2/2 tended to be more frequent in patients with schizophrenia with poor long-term outcome and poor response to typical neuroleptics (Bonferroni corrected p = 0.09). This difference was significant in men (Bonferroni corrected p = 0.054) but not in women. In addition, the age at first contact with psychiatric care was significantly younger in the patients with schizophrenia with genotype 2/2 than in patients with genotype 1/1. These result suggest that the 5HT2A-receptor gene may play a role in a subset of schizophrenia characterized by poor long-term outcome and poor response to neuroleptics.

Structure of the human retinoic acid receptor beta 1 gene

We report the isolation and characterization of genomic sequences coding for the 5' end of human retinoic acid receptor beta 1, a fetal RAR isoform which is also expressed in small cell lung cancers. Primer extension analysis revealed a principal transcription start site with a secondary site 23 bp further upstream in both SCLC and fetal tissues. The sequences isolated were CpG-rich between -60 and the 3' end of the first exon but there were no features like a TATA-box or an Inr element. In several important aspects, the human RAR beta 1 differs from its mouse counterpart. The 5'-UTR is 823 bp long and is encoded by four exons (vs two in the mouse giving a 477 bp UTR). The 5' end of the mouse cDNA has been mapped to a 67 bp CT repeat which is absent in our sequences. We were also unable to find evidence for a human isoform RAR beta 3 which is widely expressed in mouse tissues.

Dissociation of the antimicrobial activity of bacitracin USP from its renovascular effects

Bacitracin is a nephrotoxic antibiotic that has recently been shown to induce contractile effects in aortas isolated from rabbits by stimulating receptors for 5-hydroxytryptamine (5-HT). The possible renovascular actions of this antibiotic were investigated. Bacitracin USP increased the vascular resistance in a concentration-dependent manner (9 to 175 micrograms/ml) in rat kidneys perfused with a constant flow of Krebs solution. This was significantly inhibited by 5-HT antagonists, but only partially at the higher bacitracin concentration. An antagonist of the chemotactic peptide fMet-Leu-Phe failed to influence the pressor effect of bacitracin in rat kidneys. Indomethacin modestly reduced the effect of all potent pressor agents in the rat organ. Bacitracin USP was separated in several fractions by using C18 reverse-phase chromatography. Two distinct fractions were vasoconstrictive when infused in rat kidneys; both fractions were 5-HT mimetics. These peaks were different from the major antibiotic peak, bacitracin A, which was identified by using analytical high-pressure liquid chromatography, mass spectrometry, and inhibition of Micrococcus luteus growth. The less polar vasoactive peak corresponded to at least two minor peptides of the bacitracin family. The most abundant of these vasoactive peptides had no direct contractile effect on an aorta isolated from a rabbit, but a preliminary metabolic study in rat kidneys suggests that it is apparently transformed into a potent 5-HT agonist that is active on the aorta preparation. Bacitracin A, the major constituent of bacitracin with antimicrobial activity, had no vasoconstrictor effect in the test systems that we used; however, we did rule out the possibility that the renovascular stimulants found in the bacitracin mixture do not derive spontaneously or by biotransformation from the antibacterial forms of bacitracin.

Medication and programming in controlling the behavior of mentally retarded individuals in community settings

Behavioral outcomes of a behavioral-chemical intervention procedure on stereotypic and non-compliant behavior were evaluated. One group (n = 22) of community-based mentally retarded clients was initially on psychotropic medication (major tranquilizers). Their dosage was either increased, decreased, or kept the same following behavioral intervention. A second group (n = 19) was placed on psychotropic medication following behavioral intervention. A nonequivalent between-groups design was employed that permitted 36 outcome combinations involving Conditions X Subject X Group. The effects of behavioral intervention, the validity of drug-intervention decision rules, drug-intervention effects, and the validity of the behavioral-chemical intervention model were evaluated. Results indicated that the behavioral-chemical intervention produced expected and desirable behavioral change as well as reduced levels of psychotropic drug usage.