The Impaired Control Scale: confirmation of factor structure and psychometric properties for social drinkers and drinkers in alcohol treatment

AIMS

To examine (1). the structure of the Impaired Control Scale using confirmatory factor analytical techniques and (2). the internal consistency and validity of the ICS subscales.

DESIGN

Cross-sectional data were collected on alcohol-related variables using standard self-completion scales.

PARTICIPANTS

Three hundred and fifty-seven social drinkers (not in alcohol treatment) and 137 treatment drinkers (in alcohol treatment) who acknowledged experiencing impaired control over alcohol intake in the last 6 months. Impaired control was defined as drinking more than intended or more than one thinks one should.

MEASUREMENTS

Self-completion questionnaire consisting of demographic questions, Severity of Alcohol Dependence Data questionnaire (SADD), Impaired Control Scale (ICS) and three questions assessing alcohol consumption from the Alcohol Use Disorders Identification Test (AUDIT).

FINDINGS

This first confirmatory factor analytical study of the ICS found that all three parts of the ICS were unidimensional for both social and treatment drinkers. These results confirmed previous exploratory principal components analysis findings. The excellent validity and internal consistency of all three parts of the ICS found here also confirmed results of previous research into the scale.

CONCLUSIONS

The confirmation of the structure and psychometric properties of the ICS suggest that the scale is a reliable and valid instrument, with a predictable and stable factor structure, for use with both clinical and non-clinical samples.

Modeling tumor growth and irradiation response in vitro--a combination of high-performance computing and web-based technologies including VRML visualization

A simplified three-dimensional Monte Carlo simulation model of in vitro tumor growth and response to fractionated radiotherapeutic schemes is presented in this paper. The paper aims at both the optimization of radiotherapy and the provision of insight into the biological mechanisms involved in tumor development. The basics of the modeling philosophy of Duechting have been adopted and substantially extended. The main processes taken into account by the model are the transitions between the cell cycle phases, the diffusion of oxygen and glucose, and the cell survival probabilities following irradiation. Specific algorithms satisfactorily describing tumor expansion and shrinkage have been applied, whereas a novel approach to the modeling of the tumor response to irradiation has been proposed and implemented. High-performance computing systems in conjunction with Web technologies have coped with the particularly high computer memory and processing demands. A visualization system based on the MATLAB software package and the virtual-reality modeling language has been employed. Its utilization has led to a spectacular representation of both the external surface and the internal structure of the developing tumor. The simulation model has been applied to the special case of small cell lung carcinoma in vitro irradiated according to both the standard and accelerated fractionation schemes. A good qualitative agreement with laboratory experience has been observed in all cases. Accordingly, the hypothesis that advanced simulation models for the in silico testing of tumor irradiation schemes could substantially enhance the radiotherapy optimization process is further strengthened. Currently, our group is investigating extensions of the presented algorithms so that efficient descriptions of the corresponding clinical (in vivo) cases are achieved.

Acute laryngotracheitis in the rat induced by Sendai virus: the influx of six different types of immunocompetent cells into the laryngeal mucosa differs strongly between the subglottic and the glottic compartment

OBJECTIVES

Acute laryngotracheitis is a disease in which mainly the subglottic area is infected, whereas adjacent parts of the larynx, especially the narrow glottic fold, remain unaffected. The reason for the difference between these two directly adjacent regions is unknown. Therefore, in the present study the influx of dendritic cells, neutrophils, T and B lymphocytes, natural killer cells, and macrophages into the mucosa of different laryngeal compartments was investigated after Sendai virus infection in the rat. The aims were to study both the influx of immunocompetent cells and the adhesion of the pathogen and to correlate them to the different reactions of the laryngeal areas during pseudocroup.

METHODS

Acute laryngotracheitis was induced by intranasal application of Sendai virus in brown Norway rats. This virus is exclusively pneumotropic in rodents and belongs to the parainfluenza virus type 1, the main pathogen of acute laryngotracheitis in children. The numbers of dendritic cells, neutrophils, T and B lymphocytes, natural killer cells, and macrophages were determined in the supraglottic, glottic, subglottic, and tracheal mucosa on days 2, 5, 7, and 14 after virus application. Furthermore, the nucleoprotein of the virus and major histocompatibility complex (MHC) Class II expression were detected immunohistologically on the laryngeal epithelium.

RESULTS

All cell subsets entered the laryngeal mucosa during inflammation. The highest influx was detected among dendritic cells subglottically. This was accompanied by a strong virus adhesion and MHC Class II expression on the subglottic epithelium. In contrast, only a few immunocompetent cells entered the adjacent glottic mucosa, and on the glottic epithelium staining for virus nucleoprotein and MHC Class II expression was weak.

CONCLUSIONS

The inflammatory response of the laryngeal mucosa shows great regional differences in this animal model during experimental viral infection. The response was characterized by a strong subglottic and a weak glottic reaction. A possible reason for this difference might be region-specific viral adhesion on the epithelium of the laryngeal areas, as well as differences in MHC Class II expression. Thus, these data agree with the clinical observation during acute laryngotracheitis and may explain why the subglottic part of the larynx is affected preferentially during pseudocroup. The molecular mechanisms mediating the different reactions await clarification.

Analysis of thymectomy for myasthenia gravis in older patients: a 20-year single institution experience

BACKGROUND

Thymectomy has become recognized as an integral element in the care of the patient with myasthenia gravis. Although the number of elderly patients with myasthenia is substantial, little data exist demonstrating the efficacy and morbidity of thymectomy in this population.

STUDY DESIGN

We retrospectively analyzed 126 cervicomediastinal thymectomies performed at a single university hospital from 1980 to 1998. Patients 55 years or older were compared with those less than 55. Efficacy was measured by determining the change in Osserman score, the rate of remission during followup, and the reduction in medication requirements after thymectomy.

RESULTS

Older patients (n = 28) had similar Osserman scores (p = 0.8) and similar rates of complete and partial remission as the younger group (n = 98) at a mean +/- SEM followup of 58 +/- 5 months. The two groups did not differ in the number (p = 0.4) and doses of medications used to control myasthenic symptoms after operation. Older age was associated with an increased length of hospitalization (13.8 +/- 3.2 days versus 9.7 +/- 0.6 days, p = 0.05) and a higher incidence of reintubation, and longer ventilatory support (2.6 +/- 1.3 days versus 0.1 +/- 0.1 days, p = 0.001).

CONCLUSIONS

Increased age does not alter the outcomes of thymectomy for myasthenia gravis. Older patients can expect to have similar responses and require a similar number of postoperative medications as younger patients, but with a higher short-term morbidity.

Surgical outcomes of a randomized prospective trial involving patients with a proximal femoral fracture

BACKGROUND

An orthopaedic management/patient-focused care unit (OMPFCU) involving a dedicated orthopaedic-geriatrics liaison team was established at the Royal Brisbane Hospital in 1994 in an effort to safely accelerate rehabilitation of patients with proximal femoral fractures.

METHODS

The surgical outcomes of the patients were monitored in order to determine whether accelerated rehabilitation had any significant adverse effects on the surgical outcomes, measured by mortality, readmission to hospital, deep wound infection, fracture union delay, mobility and the revision surgery rate.

RESULTS

No significant difference was recorded in mortality and morbidity, deep wound infection and revision surgery rates between patients in the Royal Brisbane Hospital OMPFCU and those in standard care in the orthopaedic surgery wards.

CONCLUSION

Accelerated rehabilitation for patients with a proximal femoral fracture in a major teaching hospital can be accomplished safely.

A short history of nitroglycerine and nitric oxide in pharmacology and physiology

1. Nitroglycerine (NG) was discovered in 1847 by Ascanio Sobrero in Turin, following work with Theophile-Jules Pelouze. Sobrero first noted the 'violent headache' produced by minute quantities of NG on the tongue. 2. Constantin Hering, in 1849, tested NG in healthy volunteers, observing that headache was caused with 'such precision'. Hering pursued NG ('glonoine') as a homeopathic remedy for headache, believing that its use fell within the doctrine of 'like cures like'. 3. Alfred Nobel joined Pelouze in 1851 and recognized the potential of NG. He began manufacturing NG in Sweden, overcoming handling problems with his patent detonator. Nobel suffered acutely from angina and was later to refuse NG as a treatment. 4. During the mid-19th century, scientists in Britain took an interest in the newly discovered amyl nitrite, recognized as a powerful vasodilator. Lauder Brunton, the father of modern pharmacology, used the compound to relieve angina in 1867, noting the pharmacological resistance to repeated doses. 5. William Murrell first used NG for angina in 1876, although NG entered the British Pharmacopoeia as a remedy for hypertension. William Martindale, the pharmaceutical chemist, prepared '...a more stable and portable preparation': 1/100th of a grain in chocolate. 6. In the early 20th century, scientists worked on in vitro actions of nitrate-containing compounds although little progress was made towards understanding the cellular mode of action. 7. The NG industry flourished from 1900, exposing workers to high levels of organic nitrites; the phenomena of nitrate tolerance was recognized by the onset of 'Monday disease' and of nitrate-withdrawal/overcompensation by 'Sunday Heart Attacks'. 8. Ferid Murad discovered the release of nitric oxide (NO) from NG and its action on vascular smooth muscle (in 1977). Robert Furchgott and John Zawadski recognized the importance of the endothelium in acetylcholine-induced vasorelaxation (in 1980) and Louis Ignarro and Salvador Moncada identified endothelial-derived relaxing factor (EDRF) as NO (in 1987). 9. Glycerol trinitrate remains the treatment of choice for relieving angina; other organic esters and inorganic nitrates are also used, but the rapid action of NG and its established efficacy make it the mainstay of angina pectoris relief.

Sequence variants of DLC1 in colorectal and ovarian tumours

Loss of heterozygosity occurs frequently on the short arm of chromosome 8 in many neoplasms, including colorectal and ovarian cancer. Monochromosome transfer experiments into colorectal tumour cell lines have provided functional evidence for a tumour suppressor gene located at 8p22-23. One of the genes from this region that is expressed by our suppressed hybrids is a candidate tumour suppressor gene, DLC1 (deleted in liver cancer), which has homology to rat RhoGAP. We have delineated the structure of the DLC1 gene and used single-stranded conformation polymorphism analysis (SSCP) to look for sequence variants in 126 colorectal and 33 ovarian primary tumours and cell lines. One exonic missense mutation and three intronic insertions/deletions were identified in primary colorectal tumours, as well as many polymorphisms present in germline DNAs. The rarity of exonic missense mutations, and the absence of protein-truncating mutations, indicates that DLC1 is not the target of 8p LOH in colorectal or ovarian tumours. The delineation of the gene structure allows mutation analysis of DLC1 in other tumour types for which it remains a candidate tumour suppressor gene based on its location and homology to rhoGAP.

The creation of a global telemedical information society

Healthcare is a major candidate for improvement in any vision of the kinds of "information highways" and "information societies" that are now being visualized. The medical information management market is one of the largest and fastest growing segments of the healthcare device industry. The expected revenue by the year 2000 is US$21 billion. Telemedicine currently accounts for only a small segment but is expanding rapidly. In the United States more than 60% of federal telemedicine projects were initiated in the last two years. The concept of telemedicine captures much of what is developing in terms of technology implementations, especially if it is combined with the growth of the Internet and World Wide Web (WWW). It is foreseen that the World Wide Web (WWW) will become the most important communication medium of any future information society. If the development of such a society is to be on a global scale it should not be allowed to develop in an ad hoc manner. The Euromed Project has identified 20 building blocks resulting in 39 steps requiring multi-disciplinary collaborations. Since, the organization of information is therefore critical especially when concerning healthcare the Euromed Project has also introduced a new (global) standard called "Virtual Medical Worlds" which provides the potential to organize existing medical information and provide the foundations for its integration into future forms of medical information systems. Virtual Medical Worlds, based on 3D reconstructed medical models, utilizes the WWW as a navigational medium to remotely access multimedia medical information systems. The visualisation and manipulation of hyper-graphical 3D "body/organ" templates and patient-specific 3D/4D/and VR models is an attempt to define an information infrastructure in an emerging WWW-based telemedical information society.

The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care

OBJECTIVE

To determine the effect of an early intervention program in an acute care setting on the length of stay in hospital of elderly patients with proximal femoral fractures.

SETTING

Acute orthopaedic ward of a large teaching hospital.

DESIGN AND PARTICIPANTS

A randomised controlled trial comparing 38 Intervention patients with 33 Standard Care patients.

INTERVENTION

Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a multidisciplinary approach versus routine hospital management.

MAIN OUTCOME MEASURES

Length of stay (LOS); deaths; level of independent functioning.

RESULTS

Mean LOS was shorter in the Intervention group than in the Standard Care group (21 days v. 32.5 days; P < 0.01). After adjusting for other factors that could affect LOS (eg, age, sex, pre-trauma functional levels, pre-trauma comorbidity and postsurgical complications), the Intervention program was significantly predictive of shorter LOS (P = 0.01). The Intervention group did not experience greater numbers of deaths, deterioration in function or need for social support than the Standard Care group.

CONCLUSION

This early intervention program in an acute care setting results in significantly shorter length of hospital stay for elderly patients with femoral fractures.

The Creation of a global telemedical information society

Healthcare is a major candidate for improvement in any vision of the kinds of 'information highways' and 'information societies' that are now being visualized. The medical information management market is one of the largest and fastest growing segments of the healthcare device industry. The expected revenue by the year 2000 is US$21 billion. Telemedicine currently accounts for only a small segment but is expanding rapidly. In the USA more than 60% of federal telemedicine projects were initiated in the last 2 years. The concept of telemedicine captures much of what is developing in terms of technology implementations, especially if it is combined with the growth of the Internet and World Wide Web (WWW). It is foreseen that the World Wide Web (WWW) will become the most important communication medium of any future information society. If the development of such a society is to be on a global scale it should not be allowed to develop in an ad hoc manner. For this reason, the Euromed Project has identified 20 building blocks resulting in 39 steps requiring multi-disciplinary collaborations. Since, the organization of information is therefore critical especially when concerning healthcare the Euromed Project has also introduced a new (global) standard called 'Virtual Medical Worlds' which provides the potential to organize existing medical information and provide the foundations for its integration into future forms of medical information systems. Virtual Medical Worlds, based on 3D reconstructed medical models, utilizes the WWW as a navigational medium to remotely access multi-media medical information systems. The visualization and manipulation of hyper-graphical 3D 'body/organ' templates and patient-specific 3D/4D/and VR models is an attempt to define an information infrastructure in an emerging WWW-based telemedical information society.

Knowledge-based modeling of a bacterial dichloromethane dehalogenase

A three-dimensional structural model of the dichloromethane dehalogenase (DCMD) from Methylophilus sp. DM11 is constructed based on sequence similarities to the glutathione S-transferases (GSTs). To maximize sequence identity and minimize gaps in the alignment, a hybrid approach is used that takes advantage of the increased homology found between DM11 and domain I of the sheep blowfly theta class GST (residues 1-79) and domain II of the human alpha class GST (residues 81-222). The resulting structure has C alpha root mean square deviations of 1.16 A in domain I and 1.83 A in domain II from the template GSTs, which compare well to those seen in other GST inter-class comparisons. The model is further applied to explore the structural basis for substrate binding and catalysis. A conserved network of hydrogen bonds is described that binds glutathione to the G site, placing the thiol group in a suitable location for nucleophilic attack of dichloromethane. A mechanism is proposed that involves activation through a hydrogen bond interaction between Ser12 and glutathione, similar to that found in the theta-GSTs. The model also demonstrates how aromatic residues in the hydrophobic site (H site) could play a role in promoting catalysis: His116 and Trp117 are ideally situated to accept a growing negative charge on a chlorine of dichloromethane, stabilizing displacement. This scheme is consistent with experimental results of single-point mutations and comparisons with other GST structures and mechanisms.

Evaluation in the Substance Abuse and Mental Health Services Administration

The evaluation policy of the Substance Abuse and Mental Health Services Administration (SAMHSA) is described in this article. Three studies are presented that exemplify SAMHSA's evaluations. These include evaluations of a program to prevent substance abuse among pregnant and postpartum women and their infants; a Job Corps treatment enrichment program; and the McKinney program for homeless persons with severe mental illnesses. Each of these evaluations demonstrated the effectiveness of the programs in reducing substance abuse or homelessness and in improving the health and well-being of the consumers served. SAMHSA will use the results of these and similar evaluations to guide policy and program development. Through its evaluations, SAMHSA must identify effective approaches to prevention, treatment, and rehabilitation. By using its evaluation results to guide policy and program development, SAMHSA aims to improve the quality of the public system of substance abuse and mental health services.

Sarcocystis falcatula from passerine and psittacine birds: synonymy with Sarcocystis neurona, agent of equine protozoal myeloencephalitis

Equine protozoal myeloencephalitis (EPM) is a neurologic disease of horses caused by Sarcocystis neurona. The horse is a dead-end host for S. neurona and the definitive and intermediate hosts have not previously been identified. We hypothesized that S. neurona is actually Sarcocystis falcatula, a parasite that cycles in nature between Virginia opossums (Didelphis virginiana) and any of a variety of avian intermediate hosts. We extracted DNA from S. falcatula sarcocysts in the muscle of a brown-headed cowbird (Molothrus ater) and from schizonts in a fixed specimen of lung from a Moluccan cockatoo (Cacatua moluccensis). Three segments of the small subunit ribosomal RNA (SSURNA) gene, containing a total of 742 nucleotides, were amplified by the polymerase chain reaction, sequenced, and compared with the SSURNA sequence from two isolates of S. neurona. The S. falcatula sequence was identical to the sequence of the S. neurona isolate UCD-1 and differed in only 3 positions from isolate SN5. Recent evidence, also based on SSURNA sequences, implicates the opossum as the definitive host of S. neurona. Based on the SSURNA gene sequences S. falcatula and S. neurona are synonymous, thus the parasite cycles between opossums and birds maintaining a reservoir of the organism from which horses can be infected.

Radioimmunoassay of drugs of abuse in hair. Part 2: The determination of methadone in the hair of known drug users

This communication addresses the analytical problems associated with the analysis of hair specimens from known users and misusers of the synthetic opioid methadone. An adapted radioimmunoassay and a previously developed preanalytical decontamination procedure have been applied to samples from known drug users. The removal of drugs from the hair surface by washing and the effect of proprietary hair treatments on methadone entrapped in the hair have also been investigated. Pre-analytical washing reduced methadone levels by up to 29%, whilst hair colouration and peroxide bleaching were found to reduce levels by up to 21% and 50% respectively. Methadone assay of extracts from dated hair segments were shown to provide long-term histories of methadone intake, under controlled and non-controlled conditions. Evidence that a dose relationship between hair drug levels and intake may exist is presented. Results of hair analysis, expressed as ng methadone/mg hair, from drug users (range 0.20-10.63) are compared to a pre-determined cut-off of 0.1 ng methadone/mg hair, obtained from the analysis of a known drug free population (n = 23).

Radioimmunoassay of drugs of abuse in hair. Part 1: Methadone in human hair, method adaptation and the evaluation of decontamination procedures

A method suitable for the determination of methadone in human hair is presented. Adaptation and evaluation of a solid-phase I125 radioimmunoassay, designed for the quantitative measurement of methadone in urine, and development of a pre-analytical wash procedure has enabled a specific, sensitive and accurate analytical procedure to be developed. The specificity of the antiserum towards other drugs or biologically active compounds is evaluated up to a concentration of 100,000 ng ml-1 and accuracy covering a range of 0-450 ng ml-1 is found to be within 6% of expected methadone concentrations prepared in both drug free hair extract and urine. Inter-assay relative standard deviation (RSD) at concentrations of 5.1, 76.0 and 247 ng ml-1 methadone are 5.5, 2.5 and 3.6% respectively (n = 10) and intra-assay RSD at concentrations 2.3, 25.2 and 217 ng ml-1 are 5.3, 3.6 and 6.8% (n = 5). The limit of detection is 0.5 ng ml-1. Extraction of control drug free hair samples spiked with methadone at concentrations of 100, 250 and 400 ng ml-1 achieved recoveries of 86, 80 and 89%, respectively. Control hair samples contaminated with methadone are examined under differing wash procedures to assess their effectiveness in the removal of methadone contaminant. A suitable pre-analytical wash regime is proposed for removal of contaminant derived from external or environmental sources. The mechanics of the wash action and contaminant application to the hair is discussed. It is concluded that the adapted radioimmunoassay and developed pre-analytical decontamination procedure is a suitable technique to employ for the measurement of methadone in human hair, be it prescribed or abused, with concentrations expressed as ng methadone per mg hair.

A bridge too near? Injecting drug users' sexual behaviour

One-hundred-and-fifty injecting drug users were interviewed about their sexual behaviour, and types of sexual relationships and partners in the past year. The aims of the study were to assess the extent of changes in sexual HIV-risk behaviour patterns and to understand aspects of respondents' sexual relationships, as well as HIV/AIDS knowledge. We found few changes in sexual behaviour. The ability to assess personal HIV-risk varied widely across the sample and intoxication during sexual activity was widely reported. Whilst the use of condoms was infrequent, young respondents were more likely to use condoms, but have more sexual partners, hence a likely erosion of any net gain may have occurred. Over half of the respondents were in sexually monogamous relationships and there were no significant gender-related differences in respect of regular partners' IDU-status. Estimated rates of seroprevalence in Perth are low and with the effectiveness of deterrence dependent on visible negative outcomes, it may be difficult to ensure safer-sex messages are heeded. These concerns are raised and facilitation of safer-sex among IDUs are discussed. Further areas of research are recommended.

Challenging declarations of abstinence by the determination of morphine in hair by radioimmunoassay

Morphine extracted from dated hair segments and analysed by adaptation of a specific solid-phase 125I radioimmunoassay for the measurement of morphine in urine has provided long term histories of the heroin usage of individual patients. Results expressed as ng morphine/mg hair are compared with a pre-determined cut-off level of 0.3 ng morphine/mg hair, from a known drug-free population (n = 21). Morphine concentrations in hair samples from known heroin abusers are found to be above the cut-off limit (range 0.6-9.4 ng morphine/mg hair), and suggest a possible correlation between heroin intake and concentration of morphine in hair. Intra-assay relative standard deviation (RSD), at morphine levels of 9.27 and 1.12 ng morphine/mg hair are 2.4 and 5.5%, respectively, and acceptable recoveries from drug-free hair spiked with morphine are also achieved. The developed segmental hair analysis regime has been used successfully to challenge a self-declaration of heroin abstinence. Routine cumulative urine screening was unable to provide such evidence. The potential for hair drug analysis is discussed.

Isolation of calicivirus from the joint of a kitten with arthritis

Calicivirus was isolated from the joint of a kitten that had pyrexia, upper respiratory tract disease, and severe shifting-limb lameness. Marked mononuclear inflammation was found in the synovial fluid. Calicivirus infection or live-virus vaccination previously had been associated with arthropathy, but virus had not been recovered from affected joints. Calicivirus infection should be considered as a diagnosis in kittens with fever and arthralgia, especially if there is a history of recent vaccination or upper respiratory tract disease. Lameness associated with calicivirus infection may be severe, but appears to be self-limiting and is associated with an excellent prognosis for recovery.

A conceptual validation study of the texture response on the Rorschach

This study addresses the Rorschach texture response (T). The authors proposed a developmental line incorporating tactile self-soothing functions and tactile aspects of interpersonal closeness and related it to T. It was hypothesized that T would be linearly related to one's reliance on tactile cues cognitively by categorizing objects according to texture and behaviorally by touching and stroking. Subjects were 81 women, between the ages of 18 and 30. The results confirm the notion that T is related to both cognitive and behavioral reliance on tactile cues. It was also hypothesized that high T subjects, more than others, would increase their use of tactile cues and touching when stressed, but this hypothesis was not supported. The results were considered to be consistent with the proposed developmental line but not for differential regression along the line. They also supported T as being related to a tactile mode of information processing.

Coffee shops and clinics: the give and take of doing HIV/AIDS research with injecting drug users

We discuss recruiting and interviewing injecting drug users and using research as health promotion in the context of collecting information related to human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) from a convenience sample of 200 injecting drug users, half in treatment and half not, in 1989 and 1990 in Perth, Western Australia. A variety of recruiting methods were used including advertising, referral by agency staff, 'snowballing' and approaches to personal contacts and others known to inject by the interviewer. Snowballing and personal contacts were the most successful means of recruiting those not in treatment, while advertising was comparatively unsuccessful with this group because of the importance of establishing the credibility of the study and the interviewer among injecting drug users before they will volunteer to be involved. The promotion of behavioural risk reduction among respondents during the interview is detailed. We argue that the traditionally rigid separation between research and intervention is inappropriate in the HIV/AIDS context. When lives are potentially at stake, any contact with injecting drug users, especially those not in treatment (where may receive HIV/AIDS education), must be used as an HIV/AIDS prevention opportunity, and the interview is an ideal opportunity. The employment of research as community intervention is also discussed.

Ribosomal DNA probe for differentiation of Babesia microti and B. gibsoni isolates

The objective of this study was to determine whether different isolates of Babesia microti could be distinguished from morphologically similar isolates of B. gibsoni by using a ribosomal DNA (rDNA) probe. A Babesia-specific rDNA probe was obtained by polymerase chain reaction amplification of sequences from B. microti DNA using universal primers directed against highly conserved portions of the eukaryotic 16S-like rRNA gene. The chemiluminescent rDNA probe hybridized to Southern blots of restriction endonuclease-digested DNA preparations of different isolates of B. gibsoni from infected dogs and B. microti from infected humans and white-footed mice. Restriction fragment length polymorphisms served to differentiate these species. Although the hybridization patterns seen with DNAs from six B. microti isolates did not vary, those of the five B. gibsoni isolates did indicate genotypic variation. We concluded that isolates of B. microti and B. gibsoni can be differentiated on the basis of restriction fragment length polymorphism detected with a chemiluminescent rDNA probe.

Age and injecting drug use in Perth, Western Australia: the Australian national AIDS and injecting drug use study

Young injecting drug users (IDUs) in Australia are a group about whom little is known. It is suggested, however, that their drug using behaviours and life styles put them at particular risk for HIV/AIDS. Data collected in Perth from 195 respondents in the Australian National AIDS and Injecting Drug Use Study was analyzed with emphasis on the distinctions between young and older injecting drug users. It was found that, relative to those aged 23 or over, IDUs under 23 used more stimulants and LSD and fewer opiates and benzodiazepines; were more likely to inject all or most of their drugs; were less likely to have been in treatment; had more sex partners; were less likely to have changed their drug taking behaviour because of AIDS; were less likely to use alone; shared needles less frequently but shared at least some of the time; and had less knowledge of AIDS and were more pessimistic about the long term outcomes of AIDS. Such characteristics need to be taken into account if effective intervention and prevention strategies for this group are planned.

The haemodynamic effects of bronchoscopy. Comparison of propofol and thiopentone with and without alfentanil pretreatment

The haemodynamic response to bronchoscopy under general anaesthesia was investigated. Forty patients were allocated at random to receive either thiopentone or propofol; half the patients in each group received in addition 18 micrograms/kg of alfentanil one minute before induction of anaesthesia. The heart rate, noninvasive blood pressure and Holter ECG was monitored in all patients. Significant increases in heart rate (p less than 0.05), systolic and diastolic arterial pressures (p less than 0.01) occurred in the thiopentone only group, following bronchoscopy. Systolic and diastolic arterial pressure decreased in patients receiving thiopentone plus alfentanil, following induction of anaesthesia and laryngoscopy (p less than 0.05). No significant haemodynamic changes were seen in either of the groups which received propofol. ST segment changes on subsequent Holter analysis were seen in four patients, but there were no significant differences between the groups. Anaesthesia with propofol alone provides adequate haemodynamic stability for bronchoscopy and the addition is superfluous.