The scarlet V: how women with dyspareunia negotiate postfeminist discourses of sexual agency

Young women must often contend with cultural scripts dictating neoliberal/postfeminist ideals of female sexual agency, including the ability to act in accord with one's personal sexual self-interest. The aim of this study was to explore how young women (n = 26) living with dyspareunia (pain experienced during penetrative sexual activity) negotiate these ideals. We found that in addition to discussing traditional discourses that assign value to women in accordance with their perceived sexual virtue, women judged themselves according to the degree to which their behaviour reflected sexual agency. Women perceived to be sexually agentic were, for the most part, lauded, while those perceived to lack sexual agency were either denigrated (in the case of high sexual activity) or seen as deficient (in the case of low sexual activity). The inability to be penetrated without pain significantly limited women's sexual repertoires. Contrasting their sexual agency with that of other women and of their past selves, women expressed feelings of disempowerment. Conceptualising agency as a spectrum rather than something that one has or lacks, as well as actively cultivating the potentialities of sexual 'transgression', may allow young women to resist heteronormative sexual hierarchies - including those rooted in a a postfeminist ethos.

Raising medical student awareness of compassionate care through reflection of annotated videotapes of clinical encounters

CONTEXT

With medical training focused on medical knowledge and skills, the nurturing of humanistic care can suffer.

OBJECTIVES

We designed and conducted an outpatient rheumatology patient-partner exercise that integrates the assessment of student compassionate care into an outpatient clinical skills training exercise.

METHODS

Eleven third-year medical students were videotaped performing a medical history on a patient volunteer. Students, the preceptor and a fourth-year medical student independently observed the videotape, tagged segments demonstrating observed or missed compassionate care opportunities and completed a compassionate care questionnaire. Students also participated in a focus group. Ten patients completed a comparable questionnaire and provided feedback on student encounters.

FINDINGS

Students recognized and reflected on opportunities for compassionate care. The preceptor's feedback was reinforced. Students' ratings of their demonstrations of compassionate care were lower after reviewing videotapes, and were also lower than preceptor ratings. Patients were satisfied with the exercise and highlighted student professionalism.

CONCLUSIONS

The exercise proved to be an effective format for promoting student reflection on and self-assessment of compassionate care. It demonstrated that nurturing compassionate care can be integrated into an outpatient clinical skills exercise.

The rising relative risk of mortality for singles: meta-analysis and meta-regression

Never-married persons (singles) constitute a growing demographic group; yet, the magnitude of the all-cause relative mortality risk for nonelderly singles is not known and important moderating factors have not been explored. The authors used meta-analysis to examine 641 risk estimates from 95 publications that provided data on more than 500 million persons. The comparison group consisted of currently married individuals. The mean hazard ratio for mortality was 1.24 (95% confidence interval: 1.19, 1.30) among multivariate-adjusted hazard ratios with a high subjective quality rating. Meta-regressions showed that hazard ratios have been modestly increasing over time for both genders, but have done so somewhat more rapidly for women. The results also showed that the hazard ratio decreased with age and that study quality has an important relation to hazard ratio magnitude.

Quantization of 2D hole gas in conductive hydrogenated diamond surfaces observed by electron field emission

Discrete jumps are observed in the emitted current density (J) versus extraction electric field (E) curves in electron field emission measurements from a conductive, hydrogen-terminated air-exposed diamond surface. These jumps are well reproduced by computations based on the assumption that a 2D nanoscale quantum system with discrete energy levels exists in the diamond near-surface layer. The present results confirm the formation of well-defined quantum states of holes in the 2D surface layer present on hydrogenated air-exposed diamond surfaces.

A preliminary dosimetric characterization of chemical vapor deposition diamond detector prototypes in photon and electron radiotherapy beams

Three radiation detectors based on polycrystalline diamond films with different thickness and resistivity, obtained by microwave chemical vapor deposition, were tested to assess their suitability for relative dosimetry of photon and electron beams supplied by clinical linear accelerators. All samples showed a linear response as a function of the absorbed dose. The sensitivity per unit of detector sensitive volume spanned between 7 and 43 nC Gy(-1) mm(-3) with an applied electric field of 40 kV/cm. The dose rate dependence was evaluated following the Fowler theory and delta coefficient values between 0.95 and 1.00 were found for the three samples when polarized at 40 kV/cm. Percentage depth dose curves, output factors, and normalized dose profiles were determined for 6 and 10 MV photon beams and for 6 and 15 MeV electron beams. The results obtained with the diamond detectors were in good agreement with those obtained by reference detector measurements [all the data were within the experimental uncertainty of 1% (1sigma)].

Frequency analysis of autoreactive T-helper 1 and 2 cells in bullous pemphigoid and pemphigus vulgaris by enzyme-linked immunospot assay

BACKGROUND

Bullous pemphigoid (BP) and pemphigus vulgaris (PV) are autoimmune bullous skin diseases mediated by autoantibodies against adhesion molecules of the skin. Previous studies have identified autoreactive T cells in patients with BP and PV, which may be critical in providing B-cell help for autoantibody production.

OBJECTIVES

To evaluate the frequency of autoreactive T-helper (Th) 1 and Th2 cells in patients with BP (n = 7) or PV (n = 1) and in healthy controls (n = 11).

METHODS

In an enzyme-linked immunospot (ELISPOT) assay, microtitre plates were coated with antihuman interleukin (IL)-5 IgG or antihuman interferon (IFN)-gamma IgG prior to culturing human peripheral blood lymphocytes (PBL) with BP180 or desmoglein (Dsg) 3 proteins for 7 days. Cytokine-producing autoreactive T cells were visualized as spot-forming units.

RESULTS

One BP patient with extensive blisters had 5.1 +/- 1.5 (mean +/- SD) BP180-reactive Th1 cells and 2.9 +/- 1.5 Th2 cells per 105 PBL. In contrast, PBL from six BP patients in remission or on immunosuppressive therapy did not form IFN-gamma- or IL-5-producing spots per </= 5 x 105 PBL. The patient with oral PV had 4.7 +/- 2.4 Th1 cells and 3.0 +/- 0.4 Th2 cells per 105 PBL and a vigorous PBL response to Dsg3. In addition, three of 10 controls had BP180-reactive Th1 (2.7-13.8 per 105 PBL) and Th2 (0.3-1.8 per 105 PBL) cells and one control had 9.0 +/- 0.7 Th1 cells and 1.1 +/- 0.8 Th2 cells per 105 PBL, with reactivity to Dsg3. ELISPOT reactivity correlated with 3H-thymidine incorporation in six of seven patients and controls with autoreactive T-cell responses.

CONCLUSIONS

The ELISPOT assay seems to be promising for the quantitative and qualitative analysis of autoreactive T-cell responses in BP and PV.

Comparison of PRA-STAT, sHLA-EIA, and anti-human globulin-panel reactive antibody to identify alloreactivity in pretransplantation sera of heart transplant recipients: correlation to rejection and posttransplantation coronary artery disease

BACKGROUND

Screening pretransplantation recipient sera for percent panel reactive antibodies (%PRA) by an anti-human globulin (AHG) assay may identify recipients who are at risk for graft rejection or development of posttransplantation coronary artery disease. However, the pretransplantation AHG-%PRA does not always correlate with the occurrence of graft rejection or coronary artery disease.

METHODS

We compared the predictive capacity of the AHG-%PRA with that of an enzyme-linked immunoassay (EIA)-based PRA assay that identifies immunoglobulin G bound to soluble human leukocyte antigen (sHLA) class I molecules from pooled platelets of 240 random donors (sHLA-EIA), and that of an EIA-based assay that detects immunoglobulin G anti-HLA class I antibodies bound to sHLA derived from individual HLA-typed cell cultures (PRA-STAT). The pretransplantation sera from 130 cardiac allograft recipients were comparatively tested and results evaluated.

RESULTS

Although AHG-%PRA- and sHLA-EIA-determined PRA results were comparable, neither assay discriminated potential recipients at risk for rejection or coronary artery disease. However, cardiac allograft recipients with pretransplantation PRA-STAT sera > 10% were at risk for (1) graft rejection (77% vs 56%, p < .05); (2) more rejections/recipient (1.9 vs 1.0, p < .02); (3) graft rejection within 30 days (92% vs 38%, p < .001); or (4) development of coronary artery disease (48% vs 23%, p < .05) than recipients with pretransplantation PRA-STAT sera < 10%.

CONCLUSIONS

PRA-STAT analysis of pretransplantation sera from potential cardiac allograft recipients may be more clinically informative about HLA alloimmunity and a better predictor of adverse clinical events than either AHG-%PRA- or sHLA-EIA-determined PRA.

Sensitization of mice to topically applied drugs: albuterol, chlorpheniramine, clonidine and nadolol

Allergic contact dermatitis from drugs is a significant obstacle to the development of transdermal drug delivery systems. Protocols for the sensitization of mice to drugs are needed to test methods for the prevention of allergic contact dermatitis. CBA/J female mice were sensitized to the drugs albuterol, chlorpheniramine, clonidine and nadolol by topical application. Sensitization was achieved by application of drug at 5% (w/v) to shaven dorsal skin for 5 days in a hydroxyethylcellulose vehicle. Contact sensitization was determined by measuring the ear swelling response to application of 1% drug in vehicle. Control mice treated by application of vehicle alone did not exhibit an ear swelling response to drug. Supplementation of the mice with vitamin A boosted the ear swelling response, as did application of drug to dorsal versus abdominal skin. Although plasma amounts of retinol were higher in vitamin A supplemented versus control mice, the rate of drug (albuterol and nadolol) permeation was not significantly different between vitamin A supplemented and control mice. Permeability of dorsal skin for nadolol was twice that of ventral skin, which may explain the differences in sensitization at these sites. This sensitization protocol should be useful in the development of hypoallergenic transdermal drug delivery systems.

Infrared emission from selected areas in ion-beam-irradiated diamond

The infrared emission properties of an electrically heated single resistive element produced by ion implantation of diamond is reported. It is found that good contrast can be obtained between the implanted and unimplanted regions of the diamond mainly because of the increased emissivity following implantation. The infrared output is stronger if the diamond is viewed with the implanted surface facing away from the detector. The possible utilization of diamond-based pixels in infrared scene generation is discussed.

Lyme disease

The clinical features of Lyme disease have been well documented since its description as a distinct clinical entity in 1975. A better understanding of the diversity of Borrelia strains and species that cause the disease as well as new insights into the immunology and pathogenesis of Lyme disease help explain some of the observed variations in clinical manifestations. The diagnosis of Lyme disease may be straightforward when patients in endemic areas present with typical clinical features; however, the diagnosis should be in doubt when the clinical picture is nonspecific or atypical, or a feasible exposure history cannot be obtained. Laboratory diagnosis is primarily based on serologic techniques, but interpretation of test results can be fraught with uncertainty. Treatment with appropriate antibiotics is successful in the majority of cases of Lyme disease. However, some patients may not respond, and in these cases multiple repeated courses are usually ineffective and unwarranted. More data are needed to determine the appropriate treatment of Lyme disease during pregnancy, and the appropriate management of ixodes tick bites. A suitable arthropod vector and a competent animal reservoir host are essential for perpetuating Lyme disease in a geographic location. The intricate ecologic forces at work are well understood in certain endemic areas but are poorly defined elsewhere, particularly where the disease is sporadic or its existence is in question. Prevention of Lyme disease is best achieved through education regarding avoidance of the tick vector. A vaccine using a recombinant form of the OspA protein of B. burgdorferi has been successful in animal models. Whether an effective human vaccine can be developed remains unknown.

Humana tries important entry into Chicago market

The proposed purchase of Chicago's Michael Reese Hospital and Medical Center by Humana Inc., is hailed as one of the first such takeovers driven by the value of an HMO plan rather than the value of the parent hospital. The author discusses the proposed $50 to $70 million Reese purchase and its impact on the market.

A polyclonal CD4+ and CD8+ lymphocytosis in a patient doubly infected with HTLV-I and HIV-1: a clinical and molecular analysis

HTLV-I is associated with adult T-cell leukemia/lymphoma (ATL) characterized by monoclonal expansions of CD4+ T-lymphocytes. In this report we describe a histologically benign, polyclonal HTLV-I infection in a patient exhibiting both an absolute CD4+ and CD8+ lymphocytosis. Three T-cell lines containing integrated HTLV-I proviral copies established from this patient were initially polyclonal, but with time all grew out the same two clones as determined by analysis of their T-cell antigen receptor beta chain gene rearrangements. The patient subsequently developed pulmonary and nasopharyngeal nodules containing HTLV-I infected cells. Restriction analysis of the patient's HTLV-I provirus revealed no differences from prototype HTLV-I and the tax gene was normally expressed in vivo and in vitro. The patient's T-lymphocytosis and HTLV-I+ pulmonary tract nodules were put into a complete clinical remission by treatment with alkylating agents and steroids. Subsequently, the patient developed a severe immunodeficiency state and expired. Retrospective serologic and gene amplification assays for HIV-1 demonstrated that he had been doubly infected from the time of presentation. Postmortem analysis by polymerase chain reaction revealed the presence of both HTLV-I and HIV-1 in lymphatic tissues and the testes; HIV-1 was also detected in brain tissue.

Enzymatic amplification of HTLV-I viral sequences from peripheral blood mononuclear cells and infected tissues

Human T-cell lymphotropic virus type I (HTLV-I) and human T-cell lymphotropic virus type II (HTLV-II) have been associated with adult T-cell leukemia/lymphoma (ATL) and a rare T-cell variant of hairy cell leukemia, respectively. Direct detection of viral nucleic acid in peripheral blood lymphocytes (PBLs) and infected tissues in carrier patients and those with chronic disease has proven refractory due to viral transcriptional dormancy and the small number of infected cells present. The investigators report here the successful application of the DNA amplification procedure, termed PCR, to the detection of these human oncoviruses. Judicious selection of specific oligonucleotides for primers and probes provides type-specific and simultaneous detection of these two retroviruses. The ability to amplify and detect highly conserved regions of these medically relevant viruses may facilitate the identification of, as yet, uncharacterized retroviruses.

In vitro function of granulocyte concentrates following passage through an electromechanical infusion pump

Six units of granulocytes stored for 18 hours at 20 to 24 degrees C without agitation were passed through an electromechanical infusion device pump system (test) (Abbott) and through a 170-micron filter (control). To determine the effect of needle gauge, a 19 or 23 gauge needle was attached to the end of the pump administration set. After passage through the pump, granulocytes were evaluated for signs of cytolysis and functional loss, red cells for hemolysis, platelets for release of beta-thromboglobulin, and plasma for C3a and C5a complement activation. There was no evidence (mean +/- 1 SD) of hemolysis (less than 1.0 vs. less than 1.0 mg/dl), loss of granulocytes (123 +/- 38 X 10(3)/microliters vs. 118 +/- 29 X 10(3)/microliters), changes in any of several tests of neutrophil function, increased release of beta-thromboglobulin (15.8 +/- 5.8 vs. 17.0 +/- 6.6%), or C3a complement activation (483 +/- 221 vs. 500 +/- 200 ng/ml) after passage through the pump system (p greater than 0.05). No significant differences were seen between the use of a 19 or 23 gauge needle. Based on these in vitro data, we conclude that this pump system is acceptable for use in clinical practice when control over rate and volume of granulocyte administration is important.

Adenocarcinoma of the distal esophagus and gastric cardia. Comparison of results of transhiatal esophagectomy and thoracoabdominal esophagogastrectomy

Between 1965 and 1984, 72 patients underwent operation for adenocarcinoma of the distal esophagus or gastric cardia. A standard transthoracic esophagogastrectomy and esophagogastrostomy was performed in 43 and a transhiatal esophagectomy without thoracotomy and partial proximal gastrectomy was performed in 29. There was no significant difference between the two groups in age, sex, or TNM tumor staging. The perioperative complication rate was 86% in the esophagogastrectomy patients and 48% in the transhiatal esophagectomy patients (p less than 0.05). Mortality was higher in the esophagogastrectomy group (14%) than in the transhiatal esophagectomy group (7%). Average operative blood loss was greater in the esophagogastrectomy patients (2,510 versus 1,187 ml). Average postoperative hospitalization was longer for the esophagogastrectomy patients (22.2 days versus 12.3 days). Both differences are statistically significant (p less than 0.05). Late results, as evaluated by life-table analysis, showed no significant difference in survival between the two groups of patients. Because the morbidity and mortality rates of transhiatal esophagectomy are as low as or lower than those for esophagogastrectomy, late survival is as good, and palliation is superior (less suture-line tumor recurrence and reflux esophagitis), we believe that transhiatal esophagectomy is the preferred operative approach in patients with adenocarcinoma of the distal esophagus or gastric cardia.

The effects of tumor facilitating factor of B16 melanoma on the macrophage

B16 cells produce a tumor facilitating factor (TFF) that increases B16 tumor incidence in mice injected with a small number of B16 cells. TFF was derived from serum-free culture supernatant concentrated on an Amicon PM10 membrane. One milliliter of concentrated material represented the product 10(8) B16 cells during a 6-h incubation. We report data that indicate TFF may act by altering macrophage function. In the nude mouse deficient in T cell, but not macrophage function, the injection of 0.8 ml of TFF facilitated tumor development. Subcutaneous injection of 0.7 ml of TFF induced mouse peritoneal macrophages to spread when removed and plated on glass coverslips. This effect peaked 3 days after injection of TFF and was abrogated by heating the TFF to 70 degrees C for 1 h. The injection of TFF was also able to induce macrophage spreading in nude mice. Injection of viable B16 cells induced spreading, as would be predicted if TFF is produced by B16 cells in vivo. In vitro incubation of peritoneal cells with TFF was also able to induce macrophage spreading. Finally, subcutaneous injection of TFF reduced by 80% the accumulation of peritoneal cells in response to intraperitoneal injection of phytohemagglutinin. We suggest that one mode by which TFF facilitates tumor growth is by reducing the numbers of macrophages chemotaxing to the tumor site.