Women's attitudes to condoms and female-controlled means of protection against HIV and STDs in south-western Uganda

The consistent and correct use of the male condom makes it highly effective in both disease prevention and as a contraceptive method. However, it is also well recognized that its use is under men's control. Because of this vital limitation, there have been frequent calls for female-controlled methods of HIV prevention, particularly from women from sub-Saharan Africa. Here we report on data collected in focus-group discussions (FGDs) with women aged 17-54 in South-Western Uganda. A total of 138 women, from rural villages, urban family planning clinics and a truck-stop town, were recruited to participate in 18 FGDs on the male condom, the female condom and existing formulations of vaginal microbicidal products. Three themes emerged: (i) problems with men's control over the male condom, (ii) the importance of control over and secrecy about protective measures and (iii) sexual pleasure associated with different methods. We found that the female condom, while being perceived as an improvement over the male condom, was recognized as having limited value because of the need to agree its use prior to sex taking place. Other products were considered to be significantly better than the female condom; the sponge, in particular, was perceived as having advantages over every other product. Women like the fact that it could be inserted some time before, and left in place some time after, sexual intercourse, that it was effective for multiple instances of intercourse, and that men would be unaware that it was being employed. Female-controlled methods to prevent sexually transmitted infections, including HIV, and to increase reproductive choice, hold the promise of ceding some control over sexual and reproductive health to women.

A discrimination analysis of training-structure effects on stimulus equivalence outcomes

Experiments designed to establish stimulus equivalence classes frequently produce differential outcomes that may be attributable to training structure, defined as the order and arrangement of baseline conditional discrimination training trials. Several possible explanations for these differences have been suggested. Here we develop a hypothesis based on an analysis of the simple simultaneous and successive discriminations embedded in conditional discrimination training and testing within each of the training structures that are typically used in stimulus equivalence experiments. Our analysis shows that only the comparison-as-node (many-to-one) structure presents all the simple discriminations in training that are subsequently required for consistently positive outcomes on all tests for the properties of equivalence. The sample-as-node (one-to-many) training structure does not present all the simple discriminations required for positive outcomes on either the symmetry or combined transitivity and symmetry (equivalence) tests. The linear-series training structure presents all the simple discriminations required for consistently positive outcomes on tests for symmetry, but not for symmetry and transitivity combined (equivalence) or transitivity alone. Further, the difference in the number of simple discriminations presented in comparison-as-node training versus the other training structures is larger when the intended class size is greater than three or the number of classes is larger than two. We discuss the relevance of this analysis to interpretations of stimulus equivalence research, as well as some methodological and theoretical implications.

An update on radiation therapy in breast cancer

Radiation therapy plays an important role in the management of both invasive and noninvasive breast cancer. During the last 20 years, the availability of radiation therapy has made it possible to test the feasibility and safety of breast preservation after the diagnosis of early-stage breast cancer. This article summarizes some of the ongoing controversies concerning the use of radiation therapy in the multidisciplinary management of breast cancer.

An immunological assay for determination of baculovirus titers in 48 hours

Th baculovirus expression system is a system of choice for expressing eukaryotic proteins. Large amounts of biologically active material can be generated using this system by infecting insect cells with a baculovirus expressing the target protein. At several stages during the production of a baculovirus stock, it is necessary to titer the virus. Current methods have long time lines and are either technically difficult or are limited to viruses expressing a reporter gene. The new assay described here yields titers in 48 h, is easy to perform using 96-well plates, and is applicable to any Autographa californica nucleopolyhedrovirus-based recombinant baculovirus. This assay uses an antibody to a viral envelope glycoprotein to detect infected cells via immunostaining. The titer is determined by counting foci of infection under a light microscope. The required incubation period is shortened considerably because infected cells express viral antigens long before the macroscopic signs of infection scored in other assays become apparent. Titers determined using this immunological assay are comparable, both in value and variability, to those obtained using a traditional method, provided that the stocks have titers above 10(4) pfu/ml.

Family-oriented care during pediatric inter-hospital transport

We evaluated the family-oriented care and counseling provided by the BC Children's Hospital Transport Team paramedies. One hundred families were asked to rate: (1) how they would like paramedies to communicate with them under ideal conditions; and (2) what they actually experienced during their child's transport. There were no significant differences in parents' preferences under ideal circumstances and what they actually experienced in five of nine behavioural areas studied. Nineteen paramedies also rated their use of elements of family-oriented communication and the strategies they would recommend other teams use when interacting with families. The elements that paramedies reported using most frequently were rated highly by parents and produced positive feelings in the majority of families. The study indicates that effective counseling can be achieved in 'critical', time-limited situations but improvements can be made; and it supports the value of appropriate selection and training of transport team personnel in family-oriented critical care.

Proposed fellowship training program in international emergency medicine

Interest in international emergency medicine (EM) has grown steadily over the last ten years. This growth has been fueled by increased demand for emergency services abroad and the proliferation of emergency physicians (EPs) working in international relief and development. As a response, several academic EM programs have developed international EM fellowships for the purpose of providing formal training to EPs interested in international health. Although there have been preliminary articles describing fellowship curricula, to the authors' knowledge no recommendations have been proposed by national consensus that suggest emphasis or required components of a fellowship program. Therefore, a group of EPs interested in fellowship training convened for the purpose of developing goals and objectives for a postgraduate training program in international EM. To that end, this article proposes guidelines for a fellowship training program for international EM.

Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke

OBJECTIVE

To assess the efficacy of a programme of continuing self-directed exercises for people discharged home after a stroke, supervised once a week by therapists.

DESIGN

A randomized controlled trial of 100 patients discharged from hospital after a stroke, requiring ongoing therapy. The control group received outpatient or day hospital therapy; the experimental group were visited once a week by an occupational and/or physiotherapist who prescribed a programme of exercises and activities for the following week. Subjects were studied for the first three months after discharge from hospital.

SETTING

A district general hospital, or the homes of subjects randomized to the experimental group, in New Zealand.

MAIN OUTCOME MEASURES

(1) Characteristics of the groups, (2) gait speed, limb function, activities of daily living, (3) time with therapists, (4) mood of both subjects and caregivers, (5) anticipation of outcome at entry, compared with perceived outcome at exit.

RESULTS

No statistical differences between the control and experimental groups in characteristics, or in any outcomes measured, except that the contact time period, but not the number of visits, was longer in the experimental group (p = 0.003).

CONCLUSIONS

A supervised home-based programme is as effective as outpatient or day hospital therapy.

Characteristics of new referrals to twenty-seven lymphoedema treatment units

Lymphoedema affects 25-28% of patients who have undergone axillary surgery or radiotherapy in the treatment of cancer. The prevalence of primary lymphoedema or of lymphoedema secondary to non-cancer causes is unknown. In addition, basic demographic and disease characteristics of the lymphoedema population remain undocumented. We conducted a prospective survey to determine these characteristics. Lymphoedema treatment clinics in the UK were invited to participate at the British Lymphology Society 1996 Annual Conference. Twenty-seven clinics collected a standard data set for all new referrals in a 3-month period in 1997. The sample size was 603. The mean number of new referrals was 7.4 patients per unit per month. Eighty per cent of patients had cancer-related lymphoedema, and 86% of patients were female. Patients' mean age was 61.0 years. Thirty-seven per cent of the sample had suffered lymphoedema for less than 3 months, and 15% for 5 years or more. Patients with non-cancer related oedema had suffered the condition disproportionately longer than the cancer-related group (chi 2 = 102.2, P < 0.001). Sixty-six per cent of patients were reported as having lymphoedema at more than one site. Seventy-four per cent of all patients suffered unilateral limb oedema, and 23% bilateral limb oedema. Bilateral swelling was recorded for 67% of the non-cancer related group and 13% of the cancer related group (chi 2 = 153.4, P < 0.001). Median percentage excess volume (PCEV) for all patients with unilateral limb oedema was 16.4%. There was a positive relationship between PCEV and duration of the condition (H = 24.0, P < 0.001), and PCEV and non-cancer related lymphoedema (H = 10.5, P < 0.05). These results suggest that patients with non-cancer related lymphoedema and those with cancer-related lymphoedema form two distinct groups. The former present substantial management problems which are made more complex by late referral.

Effect of the menstrual cycle on endothelium-dependent vasodilation of the brachial artery in normal young women

In normal young women, endothelium-dependent, flow-mediated vasodilation is enhanced when serum estradiol levels are elevated and unopposed by elevated levels of progesterone.

Improved fluorescence and dual color detection with enhanced blue and green variants of the green fluorescent protein

The green fluorescent protein (GFP) from the jellyfish Aequorea victoria is a versatile reporter protein for monitoring gene expression and protein localization in a variety of systems. Applications using GFP reporters have expanded greatly due to the availability of mutants with altered spectral properties, including several blue emission variants, all of which contain the single point mutation Tyr-66 to His in the chromophore region of the protein. However, previously described "BFP" reporters have limited utility, primarily due to relatively dim fluorescence and low expression levels attained in higher eukaryotes with such variants. To improve upon these qualities, we have combined a blue emission mutant of GFP containing four point mutations (Phe-64 to Leu, Ser-65 to Thr, Tyr-66 to His, and Tyr-145 to Phe) with a synthetic gene sequence containing codons preferentially found in highly expressed human proteins. These mutations were chosen to optimize expression of properly folded fluorescent protein in mammalian cells cultured at 37 degreesC and to maximize signal intensity. The combination of improved fluorescence and higher expression levels yield an enhanced blue fluorescent protein that provides greater sensitivity and is suitable for dual color detection with green-emitting fluorophores.

Antimicrobial activity of antiseptic-coated orthopaedic devices

Antimicrobial coating of medical devices, including fracture fixation devices, has evolved as a potentially effective method for preventing device-related infections. We examined the in vitro antimicrobial activity of titanium cylinders coated with the antiseptic combination of chlorhexidine and chloroxylenol. The coated devices provided zones of inhibition against Staphylococcus epidermidis, S. aureus, Pseudomonas aeruginosa, Escherichia coli and Candida albicans, at baseline and up to 8 weeks after incubation of the coated cylinders in human serum at 37 degrees C. This durable antimicrobial activity was attributed to the relatively slow leaching of chlorhexidine and chloroxylenol from the coated cylinders as measured by high-performance liquid chromatography. These results suggest that antiseptic-coated orthopaedic devices may provide broad-spectrum and durable antimicrobial protection against device-related infection.

Structure and expression of several bean (Phaseolus vulgaris) nuclear transfer RNA genes: relevance to the process of tRNA import into plant mitochondria

Bean nuclear genes for tRNA(Pro), tRNA(Thr) and tRNA(Leu) were isolated. Expression of the tRNA(Pro) genes was demonstrated in vivo and sequence analysis suggested amplification of the tRNA(Pro) gene copy number through duplication of a gene cluster at the same locus of the bean genome. The two tRNA(Thr) genes isolated were actively transcribed and their transcripts processed in a HeLa cell system. In vivo expression tests of these genes and aminoacylation assays of the corresponding in vitro transcripts showed the presence of identity determinants in the anticodon of plant tRNA(Thr). The tRNA(Leu) gene was not expressed due to deviation from the consensus in the internal B-box promoter. The same sequence deviation also prevented aminoacylation of the corresponding in vitro transcript. This tRNA(Leu) however exists in plants and is synthesized from another gene with a consensus B-box promoter. Plant mitochondria import from the cytosol a number of nucleus-encoded tRNAs, including tRNA(Leu) and tRNA(Thr). From the available sequence data, we could not identify any conserved structural motif characteristic for the nucleus-encoded tRNAs imported into plant mitochondria, either in the tRNAs, or in the gene flanking sequences. These results suggest that recognition of tRNAs for import is idiosyncratic and likely to depend on protein/RNA interactions that are specific to each tRNA or each isoacceptor group.

PCR analysis of tissue samples from the 1979 Sverdlovsk anthrax victims: the presence of multiple Bacillus anthracis strains in different victims

An outbreak of human anthrax occurred in Sverdlovsk, Union of Soviet Socialists Republic (now Ekaterinburg, Russia) in April 1979. Officials attributed this to consumption of contaminated meat, but Western governments believed it resulted from inhalation of spores accidentally released from a nearby military research facility. Tissue samples from 11 victims were obtained and methods of efficiently extracting high-quality total DNA from these samples were developed. Extracted DNA was analyzed by using PCR to determine whether it contained Bacillus anthracis-specific sequences. Double PCR using "nested primers" increased sensitivity of the assay significantly. Tissue samples from 11 persons who died during the epidemic were examined. Results demonstrated that the entire complement of B. anthracis toxin and capsular antigen genes required for pathogenicity were present in tissues from each of these victims. Tissue from a vaccination site contained primarily nucleic acids from a live vaccine, although traces of genes from the infecting organisms were also present. PCR analysis using primers that detect the vrrA gene variable region on the B. anthracis chromosome demonstrated that at least four of the five known strain categories defined by this region were present in the tissue samples. Only one category is found in a single B. anthracis strain.

Visual identity matching and auditory-visual matching: a procedural note

After preliminary computerized training on visual-visual identity matching, a 5-year-old boy with autism (Sam) was given visual-visual and auditory-visual matching-to-sample tests with new stimuli. He did well in matching dictated name samples to 20 pictures, 26 printed upper case letters, and 9 single-digit numbers. In matching the visual stimuli (pictures, letters, or numbers) to themselves, however, he did not perform well. We then increased the number of picture comparisons per trial from two to three. In tests after this three-comparison training, Sam correctly matched on 95% of the original 20-stimulus, four-comparison, identity-matching test trials. He went on to demonstrate accurate identity matching of the numbers, letters, and new pictures. In identity-matching tests on the table top, he performed poorly until the stimulus array was made to resemble the stimulus arrangement on the computer. These findings showed that seemingly small procedural changes can influence performance and demonstrated that successful auditory-visual matching does not guarantee proficiency in visual-visual identity matching.

Effect of gemfibrozil +/- niacin +/- cholestyramine on endothelial function in patients with serum low-density lipoprotein cholesterol levels <160 mg/dl and high-density lipoprotein cholesterol levels <40 mg/dl

We studied endothelial function using the brachial artery ultrasound model in 100 subjects from the Armed Forces Regression Study, a placebo-controlled, angiographic regression trial in subjects with normal or modestly elevated low-density lipoprotein (LDL) cholesterol and low levels of high-density lipoprotein (HDL) cholesterol treated for 30 months with gemfibrozil and (if necessary) niacin and/or cholestyramine to raise HDL by 25% and lower LDL to < 110 mg/dl. Although the treatment group had highly significant improvements in LDL and HDL cholesterol, there was no difference between the 2 groups in flow-mediated dilation (treatment vs control 6.9 +/- 6.5% vs 6.3 +/- 7.3%) or nitroglycerin-induced dilation (12.4 +/- 9.6% vs 11.9 +/- 7.4%, all p = NS). Treatment and control subjects without a history of hypertension had flow-mediated dilation similar to that of a normal reference population (10.6 +/- 8.3% vs 8.4 +/- 4.5%), whereas subjects with a history of systemic hypertension had markedly impaired flow-mediated dilation that was not significantly improved with treatment (treatment vs control, 6.0 +/- 5.5% vs 4.3 +/- 5.9%, p = 0.2). Thus, nonhypertensive subjects with angiographic coronary disease and low HDL cholesterol had normal endothelial function in the brachial artery model. Patients with a history of hypertension had marked endothelial dysfunction despite blood pressure treated to normal levels, and this dysfunction is not attenuated by pharmacologic therapy for dyslipidemia.

Pediocin PD-1, a bactericidal antimicrobial peptide from Pediococcus damnosus NCFB 1832

Pediocin PD-1, produced by Pediococcus damnosus NCFB 1832, is inhibitory to several food spoilage bacteria and food-borne pathogens. However, pediocin PD-1 is not active against other Pediococcus spp. and differs in this respect to other pediocins produced by Pediococcus acidilactici and Pediococcus pentosaceus. Production of pediocin PD-1 starts during early growth and reaches-a plateau at the end of exponential growth. Pediocin PD-1 was partially purified and its size was determined by tricine-SDS-PAGE as approximately 3.5 kDa. The isoelectric point (pI) of pediocin PD-1 is approximately 3.5, as determined with the Rotofor electrofocusing cell (BioRad). Pediocin PD-1 is heat-resistant (10 min at 121 degrees C) and remains active after 30 min of incubation at pH 2-10. Pediocin PD-1 is resistant to treatment with pepsin, papain, alpha-chemotrypsin and trypsin, but not Proteinase K. Pediocin PD-1 is bactericidal against sensitive cells of Oenococcus oeni (previously Leuconostoc oenos).

What to do while things are changing

No longer able to support an entitlement culture, the business of health care is rapidly giving way to a culture of marketability. However, effective career management within a changing professional landscape doesn't have to be nightmare. Physician executives can learn to work with the dynamics and principles of change management to significantly reduce their error rate and increase their chances for success. Using change management strategies and tools effectively is the best way to transform any sense of urgency you may feel into energy, information, and action. This is the optimal time to create a better work environment for yourself, and become a better resource for the community you serve.

Location, DNA sequence and transcriptional analysis of the DNA polymerase gene of orf virus

Degenerate oligonucleotides representing conserved regions of various DNA polymerases hybridized to a region located 26 kb from the left end of the orf virus (OV) strain NZ-2 genome. DNA sequence analysis of this region revealed a 3024 bp open reading frame able to encode a protein with 56 percent amino acid identity to the DNA polymerase of vaccinia virus (VAC) and with significant homology to other DNA polymerases. Early transcripts derived from the open reading frame were detected in RNA purified from OV-infected cells, and 5' ends were mapped to a region 8-19 nt downstream from an A/T-rich sequence that resembles VAC early promoters. Unlike the VAC gene, the OV DNA polymerase makes almost exclusive use of G/C coding options. Attempts to substitute the activity of the OV DNA polymerase for its VAC counterpart were unsuccessful. This may indicate that the OV DNA polymerase is incompatible with VAC accessory proteins.

The good side after stroke: ipsilateral sensory-motor function needs careful assessment

Twenty subjects were examined 4-6 weeks after stroke to establish whether a sensory-motor ipsilateral deficit occurs early after stroke. Each underwent a timed test of repetitive side-to-side movement of both the upper and lower limbs ipsilateral to the cerebral infarct, and an assessment of motor disability using the Motor Assessment Scale. Results were compared with a group studied almost a year after their stroke, and with 41 age-matched healthy volunteers. There was a significantly worse performance (p < 0.005) on the right ipsilateral side, but not the left ipsilateral side, compared with normal volunteers, a finding similar to that of a group previously studied about a year after the stroke. There was no relationship between the severity of the motor deficit and performance of the side, possibly owing to reduction in cerebral activation as a result of a right hemispheric lesion. These observations have importance in rehabilitation and education as well as practical skills, including driving a car and maintaining balance.

Chromatographic fractionation and analysis by mass spectrometry of conjugated metabolites of bis(2-ethylhexyl)phthalate in urine

Mono(2-ethylhexyl)phthalate (MEHP), the primary metabolite of the plasticizer bis(2-ethylhexyl)phthalate (DEHP), was given to guinea pigs and mice and the methods for the isolation, separation and analysis of its metabolites in urine were developed. Following solid-phase extraction with octadecylsilane-bonded silica, individual metabolites were purified and separated using a combination of ion-exchange chromatography on lipophilic gels and reversed-phase high-performance liquid chromatography. Analysis of intact conjugates, as well as nonconjugated metabolites, was performed by fast atom bombardment mass spectrometry (FAB-MS) and, after derivatization, by gas chromatography-mass spectrometry. Enzymatic methods were used for further characterization. The study confirms glucuronidation as the major conjugation pathway for MEHP in the investigated species. Although less important quantitatively, glucosidation is shown to be an alternative conjugation pathway in mice. The methods developed were applied to a sample of urine from a hyperbilirubinemic newborn infant subjected to DEHP-exposure in conjunction with an exchange transfusion. It was demonstrated that metabolites of DEHP were excreted in amounts which could be analyzed by FAB-MS.

Coronary bypass surgery with internal-thoracic-artery grafts--effects on survival over a 15-year period

BACKGROUND

Aortocoronary bypass surgery has been performed most often with the patient's saphenous vein as the conduit. The internal-thoracic-artery graft, which has superior patency rates, has been shown to have clinical advantages, but it is not known how long these advantages persist.

METHODS

We identified all the patients in the registry of the Coronary Artery Surgery Study who had undergone first-time coronary-artery bypass grafting. Those with internal-thoracic-artery bypass grafts (749 patients) were compared with those with saphenous-vein bypass grafts only (4888 patients) with respect to survival over a 15-year follow-up period.

RESULTS

In a multivariate analysis to account for differences between the two groups, the presence of an internal-thoracic-artery graft was an independent predictor of improved survival and was associated with a relative risk of dying of 0.73 (95 percent confidence interval, 0.64 to 0.83). This improved survival was also observed in subgroups including patients 65 years of age or older, both men and women, and patients with impaired ventricular function. The survival curves of the two groups showed further separation over the years of follow-up, with a more marked downsloping after eight years in the curve for the group with saphenous-vein grafts only than in that for the group with internal-thoracic-artery grafts.

CONCLUSIONS

As compared with saphenous-vein coronary bypass grafts, internal-thoracic-artery grafts conferred a survival advantage throughout a 15-year follow-up period. The survival advantage increased with time, suggesting that the initial selection of the conduit was a more important factor in survival than problems appearing long after surgery, such as the progression of coronary disease.

Variation in ANA titres in Auckland

AIM

To determine the intralaboratory and interlaboratory variation in reported ANA titres in three Auckland laboratories, and to see if this has improved since a similar study was performed in 1981.

METHODS

Serum samples on 26 subjects with rheumatological symptoms were sent to the three laboratories on two separate days in 1993, and the presence and titre of ANA determined.

RESULTS

The number of titre dilutions by which duplicate samples differed within each laboratory has decreased since the previous study, and variation within each laboratory of greater than two dilutions was not observed. The correlation between the laboratories has improved since the previous study, particularly for Lab A vs. Lab B.

CONCLUSION

The ANA test, as expressed in titres, is more reproducible in Auckland laboratories than has been the case in the past.