Transforming Latinx HIV Care: Mixed-Methods Evaluation of a Patient-Centered HIV Practice Transformation

We conducted a mixed-method longitudinal evaluation of an HIV primary care practice transformation project in Washington, D.C. The project aimed to enhance organizational capacity to deliver culturally appropriate and patient-centered care for Latinxs living with HIV. Quantitative and qualitative data were simultaneously collected to capture the complex interactions among care providers, staff, and patients as well as to monitor practice changes that occurred as a result of the project implementation. The practice transformation intervention consisted of core competency workforce training, workflow redesign, and data-driven quality improvement strategies utilized to guide the intervention and to gather data from providers and patients. The mixed-methods approach facilitated meaningful change within the clinic that resulted in improved patient outcomes, patient experiences of care, and increases in staff's perceived level of knowledge of patient-centered care and improved efficiencies in HIV health care service delivery.

Use of a State Registry to Compare Practices of Physicians and Nurse Practitioners in Completing Physician Orders for Life-Sustaining Treatment Forms

Background: Understanding the role of nonphysicians in Physician Orders for Life-Sustaining Treatment (POLST) completion is limited. Objectives: To examine the role that nurse practitioners (NPs) play in POLST completion and differences between NPs and physicians in POLST orders. Design: Retrospective observational study. Setting/Subjects: A total of 3829 POLST forms submitted to the West Virginia (WV) e-Directive Registry between July 1, 2018 and June 30, 2019, which was completed by 98 NPs and 511 physicians. Measurements: POLST forms completed and orders in POLST Section A and Section B by all physicians and NPs according to practice (primary care, palliative care, hospital, and nursing home) and by palliative care physicians and NPs only. Results: NPs completed almost twice as many forms on average as physicians (9.54 ± 20.82 vs. 5.66 ± 17.18, p = 0.0064). NPs constituted 16.10% (98/609) of the clinicians writing POLST forms but completed 24.40% (935/3829) of the forms (p < 0.001). Compared with physicians' orders, a greater percentage of NP's orders was for do-not-resuscitate in Section A (87.20% vs. 72.60%, p < 0.001) and comfort measures in Section B (42.90% vs. 33.10%, p < 0.001). There was a greater percentage of NPs in palliative care practice than physicians (23.50% vs. 6.07%, p < 0.001), and palliative care NPs completed 64.20% (600/935) of the forms submitted by NPs compared with palliative care physicians who completed 17.90% (517/2894) of the forms submitted by physicians (p < 0.001). Conclusions: In WV, physician and NP POLST completion differs based on practice. NPs completed significantly more POLST forms on average and more often ordered comfort measures. NPs can play a significant role in POLST completion.

Required Sexual Orientation and Gender Identity Reporting by US Health Centers: First-Year Data

Objectives. To assess the performance of US health centers during the first year of required sexual orientation and gender identity (SOGI) data reporting and to estimate the baseline proportion of lesbian, gay, bisexual, and transgender patients accessing health centers. Methods. We conducted a secondary analysis of SOGI data from 2016. These data were reported by 1367 US health centers caring for 25 860 296 patients in the United States and territories. Results. SOGI data were missing for 77.1% and 62.8% of patients, respectively. Among patients with data, 3.7% identified as lesbian, gay, bisexual, or something else; 0.4% identified as transgender male or female; 27.5% did not disclose their sexual orientation; and 9.3% did not disclose their gender identity. Conclusions. Although health centers had a high percentage of missing SOGI data in the first year of reporting, among those with data, the percentages of lesbian, gay, bisexual, and transgender people were similar to national estimates, and disclosure was more than 70%. Future data collection efforts would benefit from increased training for health centers and improved messaging on the clinical benefits of SOGI data collection and reporting.

Development and Implementation of an HIV Health Care Practice Transformation Model for Latinos

A Latino Community Health Center in Washington, D.C. implemented and evaluated a practice transformative model to optimize human resources and improve quality health outcomes in HIV service delivery for Latino patients. We conducted a qualitative formative assessment through interviews and focus groups with clinic staff and patients living with HIV/AIDS in order to inform implementation. The formative assessment identified specific training and practice facilitation needs and provided valuable insight for choosing evaluation metrics. Incorporating staff input fostered staff engagement in laying the foundation of the transformation and helped build a sense of ownership of the transformative process. Through the formative assessment process we gained insight into the organization's HIV practice and improved our ability to align practice transformation goals with evaluation metrics to better measure changes resulting from the model implementation. The formative assessment process also highlighted challenges in conducting health systems research with Latino communities in the U.S.

Effects of prazosin and doxazosin on yohimbine-induced reinstatement of alcohol seeking in rats

RATIONALE AND OBJECTIVES

Alpha-1 adrenoceptor antagonists, such as prazosin, show promise in treating alcoholism. In rats, prazosin reduces alcohol self-administration and relapse induced by footshock stress and the alpha-2 antagonist yohimbine, but the processes involved in these effects of prazosin are not known. Here, we present studies on the central mechanisms underlying the effects of prazosin on yohimbine-induced reinstatement of alcohol seeking.

METHODS

In experiment 1, we trained rats to self-administer alcohol (12 % w/v, 1 h/day), extinguished their responding, and tested the effects of prazosin, administered ICV (2 and 6 nmol) or systemically (1 mg/kg) on yohimbine (1.25 mg/kg)-induced reinstatement. In experiment 2, we determined potential central sites of action by analyzing effects of prazosin (1 mg/kg) on yohimbine (1.25 mg/kg)-induced Fos expression. In experiment 3, we determined the effects of doxazosin (1.25, 2.5, and 5 mg/kg), an alpha-1 antagonist with a longer half-life on yohimbine-induced reinstatement.

RESULTS

Yohimbine-induced reinstatement of alcohol seeking was reduced significantly by ICV and systemic prazosin (50 and 69 % decreases, respectively). Systemic prazosin reduced yohimbine-induced Fos expression in the prefrontal cortex, accumbens shell, ventral bed nucleus of the stria terminalis, and basolateral amygdala (46-67 % decreases). Doxazosin reduced yohimbine-induced reinstatement of alcohol seeking (78 % decrease).

CONCLUSIONS

Prazosin acts centrally to reduce yohimbine-induced alcohol seeking. The Fos mapping study suggests candidate sites where it may act. Doxazosin is also effective in reducing yohimbine-induced reinstatement. These data provide information on the mechanisms of alpha-1 antagonists on yohimbine-induced alcohol seeking and indicate their further investigation for the treatment of alcoholism.

Effects of varenicline on operant self-administration of alcohol and/or nicotine in a rat model of co-abuse

Alcohol and nicotine (in the form of tobacco) are often taken together, with increased negative health consequences. Co-use may modify intake of one or both of the drugs, or the effects of drugs used to treat nicotine or alcohol addiction. Varenicline is commonly prescribed as an aid to enhance quitting smoking. More recently it has been shown to reduce alcohol intake in humans and laboratory animals. There is little work investigating the role of co-exposure to alcohol and nicotine in the effects of varenicline. In pilot clinical studies, it has been reported that smoking enhances varenicline's effectiveness as a treatment for alcohol misuse, but this relationship has not been systematically investigated. To help resolve this, we examined if the effects of varenicline on alcohol and nicotine self-administration (SA) in rats are modified when the two drugs are taken together. Rats were trained on alcohol SA, and some were implanted with i.v. catheters for nicotine SA. Groups of animals then lever pressed for alcohol or nicotine alone, and another group lever pressed for alcohol and nicotine, using a two lever choice procedure. Varenicline did not affect alcohol SA. Varenicline reduced nicotine SA modestly. Access to both alcohol and nicotine reduced self-administration of either drug, but did not change the effects of varenicline. We found that in rats with a history of alcohol SA, varenicline reduced reinstatement of extinguished alcohol seeking induced by exposure to an alcohol prime combined with cues previously associated with alcohol.

[Usefulness of lactate dehydrogenase concentration in thoracic and abdominal fluid of dogs]

The aims of this study were to investigate the usefulness of LDH measurement in effusions in dogs to classify the fluid as exudate or transudate and to classify the fluid based on the pathophysiological mechanism. In thoracic (n = 107) and abdominal (n = 199) fluid of dogs cell count, protein and LDH concentrations were measured. The fluid was retrospectively categorized into exudate (group A), protein-poor (B) or protein-rich transudate (C) as well as based on pathophysiology into the following five groups (group 1 - 5): hemorrhagic, chylous, inflammatory, oncotic and congestive. In thoracic and abdominal fluid LDH concentrations were significantly higher in group A compared to group B and C. There was a significant difference of LDH concentration between the groups 1 to 5 in both thoracic and abdominal fluid, however there was a large overlap between the five groups. While fluid LDH measurement in dogs is helpful to distinguish exudate from transudate it is only of little help to elucidate the pathophysiological cause.

Increased vulnerability to nicotine self-administration and relapse in alcohol-naive offspring of rats selectively bred for high alcohol intake

The prevalence of smoking in human alcoholics is substantially higher than in the general population, and results from twin studies suggest that a shared genetic vulnerability underlies alcohol and nicotine addiction. Here, we directly tested this hypothesis by examining nicotine-taking behavior in alcohol-naive offspring of alcohol-preferring (P) rats and alcohol-nonpreferring (NP) rats that had been selectively bred for high and low alcohol intake. The self-administration of intravenous nicotine (0.015-0.060 mg/kg per infusion) in P rats was more than twice than that of NP rats. Nicotine seeking induced by reexposure to nicotine cues in extinction tests was also substantially greater in P rats than in NP rats. In a subsequent relapse test, priming nicotine injections reinstated drug seeking in P rats but not NP rats. P rats also self-administered higher amounts of oral sucrose (1-20%) than NP rats, a finding consistent with previous reports. In contrast, self-administration of intravenous cocaine (0.1875-1.125 mg/kg per infusion) was remarkably similar in the P and NP rats; however, P-NP differences in cocaine seeking emerged in subsequent extinction and cocaine priming-induced reinstatement tests. In both cases, lever responding was higher in P rats than in NP rats. Thus, alcohol-naive offspring of rats genetically selected for high alcohol intake are highly susceptible to nicotine self-administration and relapse, and this susceptibility is not likely caused by general reward deficits in NP rats. The present findings provide experimental evidence for the hypothesis that a shared genetic determinant accounts for the co-abuse of nicotine and alcohol.

Effects of environmental and pharmacological stressors on c-fos and corticotropin-releasing factor mRNA in rat brain: Relationship to the reinstatement of alcohol seeking

We have observed marked heterogeneity among different stressors in their ability to reinstate alcohol seeking in rats. Of the stressors we have tested, only the environmental stressor footshock and the pharmacological stressor yohimbine induce reinstatement. The reasons for such differences among stressors are not known. The purpose of the experiments presented here is to determine the neuroanatomical substrates that underlie these behavioral differences. To this end, we assessed whether stressors effective in inducing reinstatement of alcohol seeking activate a different set of neuronal pathways than do those that are ineffective, using the technique of in situ hybridization of the mRNAs for c-fos, a marker of neuronal activation, and corticotropin-releasing factor (CRF), a stress-related peptide we have shown to be critical to footshock-induced reinstatement of alcohol seeking. Exposure of rats to the environmental stressors footshock, restraint or social defeat, or the pharmacological stressors yohimbine or FG-7142 increased levels of the mRNAs for c-fos and CRF in the brain in a number of areas previously shown to be responsive to stressors. We found regionally specific effects of the stressors on c-fos and CRF mRNA in brain regions associated with the rewarding effects of alcohol and other abused drugs. The two stressors we have previously shown to be effective in inducing reinstatement of alcohol seeking, footshock and yohimbine, induced c-fos mRNA in the shell of the nucleus accumbens, and the basolateral and central amygdalar nuclei. These two stressors also induced CRF mRNA in the dorsal region of the bed nucleus of the stria terminalis. Taken together, these results provide evidence that activity in these regions may be involved in the reinstatement of alcohol seeking induced by these stressors. These results are also in keeping with the previously demonstrated role of CRF neurons in the dorsal bed nucleus of the stria terminalis in the reinstatement of alcohol seeking induced by stress.

Effects of unconditioned and conditioned social defeat on alcohol self-administration and reinstatement of alcohol seeking in rats

RATIONALE AND OBJECTIVES

We and others have shown that a stressor commonly used in laboratory studies, intermittent footshock, reinstates alcohol seeking in a rat relapse model. The effects of more ethologically relevant stressors on reinstatement have not been examined. Here, we characterized the effects of social defeat (a naturalistic stressor) or a cue associated with the defeat experience on reinstatement of alcohol seeking. We also examined the effect of unconditioned and conditioned social defeat on alcohol self-administration.

METHODS

Rats were trained to self-administer alcohol (12% w/v, 1 h day(-1)), and after stable responding, one group of animals received five exposures to social defeat paired with peppermint odor prior to daily self-administration sessions. After three more self-administration sessions, these rats were tested for the effects of the peppermint odor cue on self-administration. In another group of rats, the effects of three daily exposures to social defeat paired with peppermint odor on extinction of responding were examined. After further extinction sessions, the effect of the odor cue on reinstatement was tested in these animals. The acute effect of social defeat on reinstatement was examined in another group of animals.

RESULTS

Acute exposure to social defeat decreased alcohol self-administration, reduced rates of responding during extinction, and did not reinstate alcohol seeking. Exposure to a discrete odor cue previously paired with social defeat decreased alcohol self-administration but induced modest reinstatement of alcohol seeking.

CONCLUSIONS

Results provide the first demonstration of reinstatement of alcohol seeking by a cue paired with social defeat and are also in agreement with previous findings on the suppressive effect of social defeat stress on alcohol self-administration.

Effects of injections of 8-hydroxy-2-(di-n-propylamino)tetralin or muscimol in the median raphe nucleus on c-fos mRNA in the rat brain

Inhibition of the median raphe nucleus (MRN) by the local injection of 5-HT(1A) or GABA(A) receptor agonists produces strong activational effects on feeding, drinking and locomotor activity. Using an animal model of relapse, we have shown that intra-MRN injection of the 5-HT(1A) autoreceptor agonist 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT) reinstates alcohol seeking in rats. The circuitry underlying the behavioral effects of intra-MRN injection of these drugs is not known. In order to identify the brain areas that may be involved, we measured levels of mRNA of the immediate early gene c-fos in discrete nuclei of the rat brain following intra-MRN infusions of these drugs. Male Wistar rats received intra-MRN infusions of 8-OH-DPAT (1 mug), muscimol (25 ng) or saline vehicle immediately prior to placement in locomotor activity chambers. Thirty minutes later, they were decapitated, and their brains processed for in situ hybridization of c-fos mRNA. In agreement with previous reports, injections of 8-OH-DPAT or muscimol into the MRN resulted in large increases in locomotor activity. Intra-MRN injections of these drugs increased c-fos in a number of brain nuclei previously shown to be involved in the rewarding effects of drugs of abuse in a regionally specific manner. Both drugs significantly increased the expression of c-fos mRNA in the medial frontal cortex, nucleus accumbens, lateral septum, dorsal bed nucleus of the stria terminalis and ventral tegmental area. In the ventral hippocampus, only 8-OH-DPAT increased c-fos, while in the basolateral nucleus of the amygdala and locus coeruleus, it was increased only by muscimol. These results are discussed in terms of the projections of the MRN and the pathways involved in relapse to alcohol and drug seeking.

Role of alpha-2 adrenoceptors in stress-induced reinstatement of alcohol seeking and alcohol self-administration in rats

RATIONALE AND OBJECTIVES

Alpha-2 adrenoceptors are known to be involved in stress-induced reinstatement of heroin and cocaine seeking in laboratory animals. Here, we studied the involvement of these receptors in stress-induced reinstatement of alcohol seeking by using an agonist (lofexidine) and an antagonist (yohimbine) of these receptors, which inhibit and activate, respectively, noradrenaline transmission. We also tested the effect of lofexidine and yohimbine on alcohol self-administration. Lofexidine is used clinically for treating opiate withdrawal symptoms and yohimbine induces stress-like responses in humans and non-humans.

METHODS

Rats were trained to self-administer alcohol (12% w/v, 1 h/day) and after extinction of the alcohol-reinforced behavior, they were tested for the effect of lofexidine (0, 0.05 and 0.1 mg/kg, IP) on reinstatement of alcohol seeking induced by intermittent footshock stress (10 min, 0.8 mA) or for the effect of yohimbine (0, 1.25 and 2.5 mg/kg, IP) on reinstatement of alcohol seeking. Other rats were trained to self-administer alcohol, and after stable responding, the effects of lofexidine and yohimbine on alcohol self-administration were determined.

RESULTS

Pretreatment with lofexidine (0.05 mg/kg and 0.1 mg/kg) attenuated stress-induced reinstatement of alcohol seeking and also decreased alcohol self-administration. In contrast, yohimbine pretreatment potently reinstated alcohol seeking after extinction and also induced a profound increase in alcohol self-administration.

CONCLUSIONS

Results indicate that activation of alpha-2 adrencoceptors is involved in both stress-induced reinstatement of alcohol seeking and alcohol self-administration. To the degree that the present results are relevant to human alcoholism, alpha-2 adrencoceptor agonists should be considered in the treatment of alcohol dependence.

Influence of stressors on the rewarding effects of alcohol in Wistar rats: studies with alcohol deprivation and place conditioning

RATIONALE AND OBJECTIVES

Studies on laboratory animals have provided conflicting results regarding the actions of stressors on the rewarding effects of alcohol. In the present study, we first examined the effects of footshock or social defeat, given during deprivation, on the alcohol deprivation effect (ADE). We then tested the effects of stressors on place conditioning to alcohol, another technique used to measure drug reward.

METHODS

Male Wistar rats were trained to drink 10% alcohol in a 24 h access, free-choice design and received intermittent footshock or defeat 5 times during a 2-week alcohol deprivation period, followed by 2 weeks of free access to alcohol. There were three such cycles. In the place conditioning studies, animals received footshock, defeat, or no stress immediately prior to conditioning sessions where they received alcohol (0.6 or 1.0 g/kg, i.p.) or vehicle injections.

RESULTS

Alcohol intake of footshock-treated animals was significantly higher than that of controls following the first and second, but not the third period of alcohol deprivation and stress exposure. Defeat caused a smaller increase in alcohol intake that was significant only after the first deprivation and stress cycle. In the place conditioning studies, we found that either stressor blocked the place aversion induced by 1.0 g/kg alcohol.

CONCLUSIONS

These results demonstrate that stressors can modify the rewarding and aversive properties of alcohol, measured using two different paradigms. Footshock and defeat produced transient, but significant increases in the magnitude of ADE, while exposure to either stressor reduced the aversive effects of a high dose of alcohol measured using the place conditioning paradigm.

Effects of chronic cocaine exposure on corticotropin-releasing hormone binding protein in the central nucleus of the amygdala and bed nucleus of the stria terminalis

The neuropeptide, corticotropin-releasing hormone (CRH), has been shown to play a role in behavioral and neurobiological effects of drugs of abuse. An important modulator of CRH, the CRH binding protein (CRH-BP), has not, on the other hand, been assessed for its role in drug-associated effects. The primary objective of the present experiment was to assess whether prior, chronic exposure to cocaine modulates expression of CRH-BP, and to compare expression of the BP with that of the peptide itself. We assessed CRH-BP and CRH mRNA expression in two brain regions where CRH is known to affect responses to drugs of abuse; namely, the central nucleus of the amygdala (CeA) and bed nucleus of the stria terminalis (BNST). Male Long-Evans rats were given 14 daily injections of cocaine (30 mg/kg, i.p.) or saline. One, 3, 10, 28, or 42 days post-treatment, animals were killed and adjacent brain sections through the CeA and BNST were processed for CRH-BP and CRH by in situ hybridization. In the CeA, cocaine pre-exposure increased both CRH and CRH-BP mRNA expression 1 day post-treatment. In the dorsal BNST, cocaine pre-exposure elevated levels of CRH-BP, but not CRH, mRNA 3 days post-treatment. Taken together, the results suggest that withdrawal-induced changes in the expression of the CRH-BP, and CRH itself, are relatively short-lived and that a dysregulation in basal expression of either gene is not likely responsible for long-lasting behavioral effects noted with cocaine and other drugs of abuse.

Effect of blockade of corticotropin-releasing factor receptors in the median raphe nucleus on stress-induced c-fos mRNA in the rat brain

Using a rat relapse model, we have shown that infusion of a corticotropin-releasing factor (CRF) receptor antagonist into the median raphe nucleus (MRN) blocks footshock stress-induced reinstatement of alcohol seeking in rats. The goal of the present study was to begin identifying brain sites potentially involved in this effect. For this purpose, we measured levels of c-fos mRNA in discrete nuclei of the rat brain following exposure to intermittent footshock, which was preceded by intra-MRN infusions of a CRF receptor antagonist, d-Phe CRF (0 or 50 ng). Exposure to intermittent footshock increased the expression of c-fos mRNA in a number of brain regions previously shown to be responsive to stressful stimuli. Pretreatment with d-Phe CRF in the MRN selectively attenuated the increases in c-fos mRNA induced by footshock in the central nucleus of the amygdala (CeA). These findings are consistent with previous data on the important role for the CeA in stress-induced reinstatement of drug seeking. These results also suggest that inhibition of CeA activity may contribute to the blockade of alcohol-seeking induced by footshock that we have observed following injections of d-Phe into the MRN.

[The use of disposable instruments of a high performance polymer for tonsillectomy and adenoidectomy]

Cases of the new variant Creutzfeldt-Jakob disease (vCJD) in human beings have to be anticipated in Germany. In subclinical vCJD, the accumulation of prions in lymphoid tissue has been identified prior to their manifestation in cerebral tissue. The remarkable resistance of prions to standard methods of sterilisation questions the safety of reusing metallic surgical instruments. The transmission of vCJD via such reusable surgical instruments in tonsillectomies and adenoidectomies cannot be excluded. In this study, 96 tonsillectomies and adenoidectomies were performed with disposable instruments made of a high performance polymer (Aesculap, Tuttlingen). No increase in the number of intra- or postoperative complications was evident. These disposable instruments may represent an alternative to reusable metallic surgical instruments in potentially infected patients or in patients desiring the use of disposable instruments during their operation for safety reasons.

Development of a branching submaximal treadmill test for predicting VO2max

This study determined the reliability and validity of a branching treadmill protocol in predicting VO2max. Thirty-seven, apparently healthy individuals (19 women and 18 men); volunteered to participate. On 2 separate testing days, each subject underwent maximal exercise testing using the protocol developed. Stepwise regression analysis indicated that the percentage of age-predicted maximum heart rate (APMHR) achieved at stage 3, speed and grade at stage 3, and APMHR accounted for 89% of the variance in VO2max. The 4 predictor variables were statistically significant (p < 0.01), and the standard error of the estimate was 4.56 ml x kg(-1) min(-1). Results indicate that health and fitness professionals can incorporate this protocol into their practices for the purpose of predicting VO2max for their clients outside the laboratory environment. Furthermore, our results indicate that using the proposed regression model is reliable and has received preliminary construct validity support.

Two-year trends of peripherally inserted central catheter-line complications at a tertiary-care hospital: role of nursing expertise

We found reductions in peripherally inserted central catheter (PICC) complication rates over 2 years of observation (20.4 vs 13.8/1,000 line-days; relative risk, 0.5-0.9). This difference represents a cost saving due to reduced line reinsertions and reduced use of thrombolytic agents. The presence of a dedicated PICC insertion nursing team and education of ward nurses in PICC maintenance is a plausible explanation for the observed differences.

Efficacy of moist heat pack application over static stretching on hamstring flexibility

Inadequate flexibility is a contributing factor to muscle injury, especially with respect to the hamstring muscle group. Simple therapeutic regimens capable of increasing hamstring flexibility may reduce the injury potential of athletes with below-average hamstring flexibility or history of injury. This study compared 30 seconds of static stretching with 20 minutes of heat application on hamstring flexibility. A secondary purpose was to determine the relationship between the subjects attitude toward each treatment and the efficacy of treatment. Thirty undergraduate student athletes who were current members of a Midwestern collegiate football team participated in a 2 (treatment: heat vs. stretching) by 2 (coun-terbalanced order: heat first vs. stretching first) repeated-measures design. Results indicated that significant benefits to increase hamstring flexibility could be gained by using moist heat packs in comparison with static stretching despite a perceived attitudinal bias in favor of stretching. These findings may have implications for orthopedic fitness as well as injury prevention for an athlete with prior hamstring injury or inadequate flexibility.

Enhanced fos expression within the primary olfactory and limbic pathways induced by an aversive conditioned odor stimulus

A central question in olfactory learning is how animals become tuned to odor stimuli that gain significance through conditioning. A leading view is that tuning to conditioned odor stimuli involves functional modifications within the primary olfactory pathways, themselves.(7) Here we studied this idea further by investigating responses within the olfactory system to an odor that had previously been paired with footshock in classical fear-conditioning trials in adult rats. Using the transcription factor Fos as a marker of odor-induced neuronal activation,(1,14) we found that in rats that had received forward pairings of odor and footshock during training, presentation of the conditioned odor stimulus, alone, produced an enhanced increase in levels of Fos in the main and accessory olfactory bulbs and anterior olfactory nucleus compared with that found in animals that had received backward presentations of the stimuli or of odor alone. These results demonstrate that Fos responses to an odor within the primary olfactory pathways can be modified through aversive conditioning, and are consistent with other evidence that olfactory conditioning can lead to functional changes within these pathways.(7)

Circadian modulation of fos responses to odor of the red fox, a rodent predator, in the rat olfactory system

We have previously shown that neuronal responses to a biologically neutral odor, cedar wood oil, in the olfactory system are greater in the subjective night compared to subjective day. In the present study, we confirm these results and extend them to a biologically relevant odor, the urine of the red fox, a rodent predator. Fos induced by exposure of rats to fox urine or a neutral odor, mineral oil, was markedly enhanced during the subjective night compared to subjective day in the main olfactory bulb, primary olfactory cortex, and other structures related to olfaction. These results show that neuronal responses to an ethologically relevant odor follow a circadian rhythm similar to biologically neutral odors. Fos responses induced by fox urine were observed to be of greater magnitude than a neutral odor in brain areas involved in fear responses, suggesting that fox urine activates fear circuitry.

Education of paramedics regarding aspirin use

OBJECTIVE

Paramedics (EMT-Ps) often care for patients having an acute myocardial infarction (AMI). The benefit of early administration of aspirin in AMI is well established. This study was undertaken to determine whether EMT-Ps are able to retain information regarding the use of aspirin in AMI after a standard didactic session.

METHODS

The EMT-Ps from a suburban EMS system with an annual call volume of 4,000 were given a 12-question test regarding the out-of-hospital use of aspirin in AMI. They then received a 30-minute lecture about the use of aspirin in the out-of-hospital venue. Aspirin was then put into the treatment protocols for AMI. Three months after the educational session, a follow-up test was administered. A paired, two-tailed t-test was used to compare pretest and posttest scores with a p < or = 0.05 for statistical significance.

RESULTS

The study was completed by 22 of 25 EMT-Ps. The scores on the pretest ranged from 50% to 100% correct, with an average score of 83%. The posttest scores ranged from 83% to 100%, with an average score of 94% (p = 0.002). The questions missed on the posttest were regarding: 1) the length of the effects of aspirin, 2) the bronchospastic effects of aspirin, and 3) the recently instituted indications for its out-of-hospital use. All paramedics correctly identified the contraindications to aspirin use.

CONCLUSION

These results suggest that EMT-Ps can retain information regarding the out-of-hospital use of aspirin for AMI after a standard didactic session. Further study is needed to determine how this information is clinically applicable.

Conditioned fear attenuates light-induced suppression of melatonin release in rats

Male rats were given 5 min of intermittent footshock, or were not shocked, for 3 or 5 consecutive days in a novel context at the midpoint of the dark phase of a 12:12-h light:dark cycle. Six days later, animals were reexposed to the context without footshock and received either a 5-min light pulse or were not disturbed. Reexposure to the context significantly increased plasma corticosterone in animals previously shocked there. Prior context-shock pairings significantly attenuated the suppression of melatonin by light, but did not affect basal levels of melatonin. These results suggest that the circuitry underlying the suppression of melatonin by light can be modified by changes in emotional state produced by aversive conditioning.

De novo synthesis of 4,5-dimethoxycatechol and 2, 5-dimethoxyhydroquinone by the brown rot fungus Gloeophyllum trabeum

The new dimethoxycatechol 4,5-dimethoxy-1,2-benzenediol (DMC) and the new dimethoxyhydroquinone 2,5-dimethoxy-1,4-benzenediol (DMH) were isolated from stationary cultures of the brown rot fungus Gloeophyllum trabeum growing on a glucose mineral medium protected from light. The structure was elucidated by gas chromatography-mass spectrometry through comparison to a synthetic standard. Further confirmation was obtained by forming a dimethoxyoxazole derivative by condensation of DMC with methylene chloride and through examination of methylated derivatives. DMC and DMH may serve as ferric chelators, oxygen-reducing agents, and redox-cycling molecules, which would include functioning as electron transport carriers to Fenton's reactions. Thus, they appear to be important components of the brown rot decay system of the fungus.

Role of central dopaminergic and 5-hydroxytryptaminergic projections in the behavioral responses elicited by thyrotropin-releasing hormone in rats

The systemic administration of thyrotropin-releasing hormone (TRH) to rats elicits locomotor activation, wet dog shakes, jaw movements, paw licking and tail rattle. Central dopamine (DA) and 5-hydroxytryptamine (5-HT) systems and peripheral vagal afferents have been implicated in these responses. To define this circuitry further, the effects of lesions of these pathways on the behavioral responses elicited by intraperitoneal (IP) injections of TRH were assessed in rats. Lesions of the DAergic innervation of the nucleus accumbens did not affect the locomotor activation, wet dog shakes, paw licking, jaw movements or tail rattle elicited by TRH. This is consistent with our in vivo microdialysis finding that TRH did not affect the release of DA in the nucleus accumbens at a dose that strongly increased locomotor activity. Depletion of spinal 5-HT significantly decreased the wet dog shakes induced by TRH, while depletion of forebrain 5-HT had no effect on any behavior. Bilateral vagotomy did not affect the locomotor response to TRH or any of the other behaviors measured. Taken together these results suggest that the DAergic mesolimbic, the 5-HTergic projections to the forebrain and vagal afferent systems are not mediators of the behavioral responses to systemic TRH. In contrast, the raphe-spinal 5-HTergic projection system may serve to modulate the wet dog shakes elicited by this peptide.

Corticotropin-releasing factor, but not corticosterone, is involved in stress-induced relapse to heroin-seeking in rats

We showed previously that brief footshock stress and priming injections of heroin reinstate heroin-seeking after prolonged drug-free periods. Here, we examined whether the adrenal hormone, corticosterone, and brain corticotropin-releasing factor (CRF) were involved in such reinstatement. We tested the effects of adrenalectomy, chronic exposure to the corticosterone synthesis inhibitor metyrapone (100 mg/kg, s.c., twice daily), acute exposure to metyrapone, acute intracerebroventricular injections of CRF (0.3 and 1.0 microgram), and intracerebroventricular injections of the CRF antagonist alpha-helical CRF (3 and 10 micrograms). Rats were trained to self-administer heroin (100 micrograms/kg/infusion, i.v.) for 12-14 d. Extinction sessions were given for 4-8 d (saline substituted for heroin). Tests for reinstatement were given after priming injections of saline and of heroin (0.25 mg/kg, s.c.), and after intermittent footshock (15 or 30 min, 0.5 mA). Adrenalectomy (performed after training) did not affect reinstatement by heroin but appeared to potentiate the reinstatement by footshock. Chronic exposure to metyrapone (from the beginning of extinction) or an acute injection of metyrapone (3 hr before testing) did not alter the reinstatement of heroin-seeking induced by footshock or heroin. Acute exposure to metyrapone alone potently reinstated heroin-seeking. In addition, acute exposure to CRF reinstated heroin-seeking, and the CRF antagonist alpha-helical CRF attenuated stress-induced relapse. The effect of the CRF antagonist on reinstatement by heroin was less consistent. These results suggest that CRF, a major brain peptide involved in stress, contributes to relapse to heroin-seeking induced by stressors.

Blockers of nitric oxide synthase inhibit stress activation of c-fos expression in neurons of the hypothalamic paraventricular nucleus in the rat

The cellular transcription factor Fos, product of the immediate early gene c-fos, is induced in secretory neurons of the hypothalamic paraventricular nucleus in response to stress. Recent evidence indicates that the paracrine-acting messenger molecule nitric oxide may be involved in the activation or regulation of c-fos expression in neurons, and many neurons in the paraventricular nucleus contain the enzyme nitric oxide synthase. Furthermore, nitric oxide has been implicated in the regulation of corticotropin-releasing factor and arginine vasopressin release from neurons of the paraventricular nucleus. To study whether nitric oxide is involved in stress activation of c-fos expression in the paraventricular nucleus, we assessed the effect of treatment with competitive nitric oxide synthase blockers on expression of Fos protein in neurons of the paraventricular nucleus of rats subjected to immobilization stress. We found that such treatment blocks stress-induced Fos expression in the paraventricular nucleus. Furthermore, using double staining for Fos and the nitric oxide synthase histochemical marker, nicotinamide adenine dinucleotide phosphatediaphorase, we found that many neurons in the paraventricular nucleus that express Fos in response to immobilization stress also contain nitric oxide synthase. These results indicate that nitric oxide is involved in the regulation of Fos expression in stress-activated cells of the paraventricular nucleus.

Role of catecholamines in the frontal cortex in the modulation of basal and stress-induced autonomic output in rats

Exposure of animals to noxious or stressful stimuli increases heart rate (HR) and blood pressure through activation of the autonomic nervous system (ANS) and elicits the release of the catecholamines noradrenaline (NA) and dopamine (DA) in the frontal cortex. Subregions of the frontal cortex, such as the medial frontal cortex (MFC) and agranular insular cortex (AIC) project directly to brainstem nuclei involved in autonomic control. It may be hypothesized that catecholamines in the frontal cortex could influence autonomic output through actions on these descending pathways. To evaluate this hypothesis, the effects of intracortical microinjections of drugs acting at NAergic and DAergic receptors were assessed on an autonomically mediated response, the increase in HR induced by tail pinch, in rats anesthetized with urethane. Intra-MFC or AIC injections of an antagonist of beta-adrenoceptors reduced the magnitude of the HR response to pinch. Injections of an agonist of beta-adrenoceptors into these regions increased basal HR but did not affect the pinch response. Injections of drugs acting at alpha-adrenoceptors were without effect. When injected alone, drugs acting at DAergic receptors did not effect basal HR or the response to pinch, but intra-AIC injections of a combination of a D2 antagonist and an agonist of beta-adrenoceptors increased the magnitude of the pinch response. These results suggest that catecholamines, especially NA, released in the frontal cortex are important modulators of the basal and stress-induced output of the ANS.

The effects of lesions of the habenular nuclei on the development of sensitization to the behavioral activational effects of repeatedly administered morphine in the rat

The effects of lesions of the habenular nuclei on the development of sensitization to the behavioral activational effects of morphine (MOR), administered repeatedly either systemically or directly into the ventral tegmental area (VTA) were examined. Lesions of the habenular nuclei blocked the early-appearing sedative effects and enhanced the later-appearing locomotor activational effects seen after systemic injections of MOR (10 mg/kg, i.p.). Habenular lesions did not potentiate the development of sensitization to the locomotor-activational effects seen with the repeated, systemic administration of MOR. The bilateral injection of MOR (5.0 micrograms/0.5 microliter/side) directly into the VTA of animals with habenular lesions resulted in the performance of stereotyped behaviors that appeared as early as the second MOR exposure and remained at high levels with repeated MOR treatment. The stereotyped behavior shown by lesioned animals did not appear to interfere with the acute locomotor activational effects of intra-VTA MOR nor the development of sensitization to these effects when it was administered repeatedly. These results are in agreement with previous research suggesting that by disinhibiting the dopamine (DA) systems, habenular lesions enhance the acute behavioral activational effects of MOR. The results also suggest that the habenular nuclei do not control the changes in the response of the DA systems underlying the development of sensitization to the locomotor-activating effects of MOR when administered repeatedly.

Effect of procaine HCLl on ATP: calcium-dependent alterations in red cell shape and deformability

Procaine hydrochloric acid, a cationic anesthetic, although unable to prevent the effect of calcium ionophore A23187 on erythrocytes, inhibited the discocyte--echinocyte transformation, increased viscosity, and decreased filterability of red cells undergoing ATP depletion. The effects were abolished by washing ATP-depleted, procaine HCl-treated red cells prior to these determinations. Procaine HCl had no effects on volume, incubated osmotic fragility, or monovalent cation composition of ATP-depleted red cells. The drug increased 45Ca uptake by ATP-depleted red cells but did not change the fraction of membrane-bound calcium. Sodium dodecyl sulfate acrylamide gel electrophoresis of membrane proteins from ATP-depleted red cells revealed formation of high molecular weight protein complexes, which were not formed when biconcave shape and ATP content were maintained by incubation with adenine (0.54 mM) and inosine (12.7 mM); Formation of these complexes was not prevented when the biconcave shape was maintained by procaine HCl. It was concluded that the maintenance of the biconcave shape and normal deformability during ATP depletion by procaine HCl was not related to a displacement of membrane-bound calcium and inhibition of ATP-dependent rearrangement of red cell membrane proteins.

Rheumatoid arthritis of the cricoarytenoid joints: an airway hazard

The anesthesiologist must maintain a high index of suspicion for the presence of cricoarytenoid arthritis and vocal-cord fixation in the rheumatoid arthritic. He must be prepared to intubate the trachea blindly, attempting to minimize trauma by using a smaller endotracheal tube. Indirect laryngoscopy, or direct laryngoscopy using a fiberoptic laryngoscope, may be indicated as part of the preanesthetic evaluation. In some instances, preanesthetic tracheostomy or an alternative regional anesthetic technic may be appropriate. Unusually close vigilance in the postoperative period may be required to detect signs of postextubation airway obstruction.

Hemoglobin olympia ( 20 valine leads to methionine): an electrophoretically silent variant associated with high oxygen affinity and erythrocytosis

In a family with erythrocytosis, electrophoretic and chromatographic studies failed to demonstrate a hemoglobin variant. However, the oxygen dissociation curves of affected individuals were shifted to the left of normal and this shift persisted when oxygen equilibria were studied in 2.3-diphosphoglycerate-stripped hemolysates. A mutant hemoglobin was evidently present in the red blood cells of the affected persons and was responsible for the increased oxygen affinity and erythrocytosis. Specific staining of tryptic peptide maps of beta-chains from the propositus showed that peptide betaT(3) was positive for a sulfur-containing amino acid. Amino acid analysis yielded a composition identical to that of normal betaT(3), except that there were 2.6 residues of valine and 0.4 residues of methionine (normal composition: Val = 3.0, Met = 0). This suggested that the beta-chains of affected individuals consisted of a mixture of two kinds of chains, 40% of which had a methionyl residue in betaT(3). Structural studies of isolated cyanogen bromide fragments demonstrated unequivocally that, in the abnormal beta-chains, valine in position 20 is replaced by methionine. The new hemoglobin mutant is designated hemoglobin Olympia (beta20 (B2) valine --> methionine).