University Coaching for Activity and Nutrition (UCAN): A weight-inclusive health coaching program

Background: Given the body image and disordered eating struggles prevalent in young adults, weight-inclusive anti-diet programs are needed on college campuses. Such programs replace weight loss advice with changes that center physical and mental well-being. Methods/Program Design: University health and wellness programs such as University Coaching for Activity and Nutrition (UCAN) is a novel weight-inclusive health and wellness coaching program designed to support university students and faculty/staff in their development and maintenance of self-care behaviors related to physical activity, nutrition, sleep, and stress management. Specifically, we describe the program's mechanisms for participant recruitment, health coach training, session protocol, program evaluation, and supervision so other campuses can replicate the program model at their respective universities. Discussion: This work can help campuses cultivate positive self-care habits that improve physical and mental health through the lens of a weight-inclusive paradigm while also creating research and service-learning experiences for pre-health professionals.

Qualitative Assessment of Access to Perinatal Mental Health Care: A Social-Ecological Framework of Barriers

Introduction

Psychological distress affects up to 25% of pregnant women and contributes to poor birth outcomes. Screening with appropriate referral or treatment is critical, yet many women do not access services. This project aimed to identify knowledge of and barriers to mental health services in the perinatal period.

Methods

Interviews with low-income pregnant or postpartum women, primary care providers (PCPs), and mental health care providers were conducted in Sedgwick County, Kansas. Interviews were transcribed, independently reviewed using grounded theory, and stratified using a social-ecological model framework.

Results

Thirty-three interviews were conducted with 12 (36%) pregnant or postpartum women, 15 (45%) PCPs, and 6 (18%) mental health care providers. Barriers were categorized into three levels: individual, social, and society. Individual level barriers, including cost or lack of insurance and transportation, were consistent across groups, however, women identified barriers only at this level. Provider groups identified barriers at all levels, including lack of support, poor communication between providers, and Medicaid limitations.

Conclusions

Multi-level interventions are needed to improve access to mental health care for low-income women in the perinatal period.

A-03 Ethnic/Racial Differences in Longitudinal Neurocognitive Change among People Living with HIV

HIV disproportionately affects Black and Latino people in the United States, but data on longitudinal neurocognitive patterns for these groups are scarce. This study evaluated the incidence and predictors of neurocognitive decline by ethnicity/race in a cohort of Black, Latino, and White people living with HIV (PLWH). Participants included 499 PLWH (43.5% White, 42.7% Black, 13.8% Latino; mean age at baseline = 43.5) from the six-site CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study. Participants completed comprehensive neurocognitive and neuromedical evaluations over 3-7 study visits for an average of 2.8 years (SD = 1.1). Interpertation of neurocognitive change was based on published methods using regression-based norms that correct for baseline performance and practice effects. Survival analyses investigated the relationship between ethnicity/race and neurocognitive change, and predictors of neurocognitive decline. In follow-up, 108 participants (21.6%) declined, 311 (62.3%) remained stable, and 80 (16.0%) improved. In Cox proportional hazard models, hazard ratios for neurocognitive decline were increased for Latinos compared to Whites (HR = 2.19, 95%CI = 1.32-3.63, p = .002) and Blacks (HR = 1.87, 95%CI = 1.14-3.04, p = .01). Including significant covariates (baseline nadir CD4, hepatitis C Virus, and VACS Index: a composite marker of physical health among PLWH)did not significantly decrease the elevated risk for decline among Latinos. We found that Latino PLWH appear to have higher risk of neurocognitive decline compared to White and Black PLWH. Traditional markers of HIV disease and physical health at baseline did not explain this elevated risk of neurocognitive decline. Future research examining economic, socio-environmental, and culturally-relevant biomedical factors may help to explain this observed ethnic/racial disparity in longitudinal neurocognitive function in HIV.

A State-Level Examination of School Nurses' Perceptions of Condom Availability Accompanied by Sex Education

School nurses are often sources of health-care support for teens with sexually transmitted infections (STIs) and unintended pregnancies. However, providing prevention (e.g., condoms) and teaching technical skills (e.g., condom use) needed to reduce high-risk sexual behavior may require a change in perceptions and policies. This study used a cross-sectional study design to assess nurses' perceptions of condom availability accompanied by sex education programs among high school nurses (n = 87) in Kansas. Results showed that school nurses in this study supported condom availability, were comfortable providing condoms, and felt condom availability was within the scope of their job but were less likely to provide condoms because of external barriers. Common barriers include administration, parents, cost, community support, and policies. School nurses, by virtue of their access to the majority of Kansas' adolescents, have the potential to provide sex education and tools such as condoms, so young people can prevent STIs and unintended pregnancies.

Effect of dose and route of immunisation on the immune response induced in cattle by heterologous Bacille Calmette-Guerin priming and recombinant adenoviral vector boosting

BCG is used experimentally as a vaccine against tuberculosis (TB), induced by Mycobacterium bovis, in cattle (bTB). However, the efficacy of BCG is variable in humans, cattle and guinea pigs. An adenoviral vector expressing Antigen 85A (Ad5Ag85A) has enhanced protection against TB in mice when used in combination with BCG for prime-boost experiments. However, the route of immunisation affects the degree of protection seen. This work examines the immunogenicity of a new vectored vaccine (Ad5-TBF) that expresses Ag85A, Rv0287, Rv0288 and Rv0251c to explore the effects of dose of adenoviral boost and route of inoculation on immunogenicity. We found that 2×10(9) infectious units (iu) delivered intradermally conferred the most consistent and strongest responses of the different regimes tested.

Preclinical trials in autosomal dominant AD: implementation of the DIAN-TU trial

The Dominantly Inherited Alzheimer's Network Trials Unit (DIAN-TU) was formed to direct the design and management of interventional therapeutic trials of international DIAN and autosomal dominant Alzheimer's disease (ADAD) participants. The goal of the DIAN-TU is to implement safe trials that have the highest likelihood of success while advancing scientific understanding of these diseases and clinical effects of proposed therapies. The DIAN-TU has launched a trial design that leverages the existing infrastructure of the ongoing DIAN observational study, takes advantage of a variety of drug targets, incorporates the latest results of biomarker and cognitive data collected during the observational study, and implements biomarkers measuring Alzheimer's disease (AD) biological processes to improve the efficiency of trial design. The DIAN-TU trial design is unique due to the sophisticated design of multiple drugs, multiple pharmaceutical partners, academics servings as sponsor, geographic distribution of a rare population and intensive safety and biomarker assessments. The implementation of the operational aspects such as home health research delivery, safety magnetic resonance imagings (MRIs) at remote locations, monitoring clinical and cognitive measures, and regulatory management involving multiple pharmaceutical sponsors of the complex DIAN-TU trial are described.

Neurocognitive impairment in HIV-infected individuals with previous syphilis

Cognitive impairment is common in HIV-infected individuals, as is syphilis. Treponema pallidum, the bacterium that causes syphilis, invades the central nervous system early in disease. We hypothesized that HIV-infected patients with a history of syphilis or neurosyphilis would have more cognitive impairment than HIV-infected individuals without these infections. Eighty-two of 1574 enrollees in CHARTER, a prospective, observational study, had reactive serum rapid plasma reagin (RPR) tests. They were matched to 84 controls with non-reactive RPR by age, gender, ethnicity and HIV risk factor. Participants underwent comprehensive neuropsychological (NP) evaluations. RPR results were confirmed and serum fluorescent treponemal antibody absorption (FTA-ABS) test reactivity determined at a central laboratory. Sera from 101 of 166 participants were FTA-ABS reactive, indicating past or current syphilis. Among the 136 individuals without confounding conditions, compared with patients who had never had syphilis, those with prior syphilis had a greater number of impaired NP test domains (1.90 SD [1.77] versus 1.25 [1.52], P = 0.03), a higher global deficit score (0.47 [0.46] versus 0.31 [0.33], P = 0.03), and more were impaired in the NP learning domain (36 [42.9%] of 84 versus 13 [25.0%] of 52, P = 0.04). These effects of prior syphilis remained after controlling for education and premorbid intelligence.

Association of self-reported painful symptoms with clinical and neurophysiologic signs in HIV-associated sensory neuropathy

Sensory neuropathy (HIV-SN) is a common cause of pain in HIV-infected people. Establishing a diagnosis of HIV-SN is important, especially when contemplating opioid use in high-risk populations. However physical findings of HIV-SN may be subtle, and sensitive diagnostic tools require specialized expertise. We investigated the association between self-report of distal neuropathic pain and/or paresthesias (DNPP) and objective signs of HIV-SN. Data were obtained from the Central Nervous System HIV Antiretroviral Therapy Effects Research (CHARTER) study. Out of 237 participants, 101 (43%) reported DNPP. Signs of HIV-SN were measured by a modified Total Neuropathy Score (TNS), composed of six objective sensory subscores (pin sensibility, vibration sensibility, deep tendon reflexes, quantitative sensory testing for cooling and vibration, and sural sensory amplitude). Self-report of DNPP was associated with all six TNS items in univariate analysis and with four TNS items in multivariate analysis. The sensitivity and specificity of self-report of DNPP in detecting the presence of a sensory abnormality were 52% and 92%, respectively with a PPV of 96% and a NPV of 34%. Increasing intensity of pain measured on a visual analog scale was associated with increasing severity of sensory abnormality. In summary, our results suggest that HIV-infected patients reporting symptoms consistent with HIV-SN, such as tingling, pins and needles, or aching or stabbing pain in the distal lower extremities, usually have objective evidence of HIV-SN on neurologic examination or with neurophysiologic testing. This finding holds true regardless of demographic factors, depression or substance use history.

Sheep category can be classified using machine learning techniques applied to fatty acid profiles derivatised as trimethylsilyl esters

Eruption of permanent incisors (dentition) is used as a proxy for age for defining meat quality in Australian sheep meat. However, this approach may not be reliable. While not presently available, an objective method could be used to determine sheep age, and thus sheep category, which would then potentially remove any inaccuracies that may occur in classifying sheep meat product. Statistical classification algorithms have been successfully used in bioinformatics. In this paper we review the performance of three algorithms (support vector machines, recursive partitioning and random forests) for determining sheep age. The algorithms were applied to the measured fatty acid profiles of fat samples from 533 carcasses; 254 lamb (<1 year old), 131 hogget (~1–2 years old) and 148 mutton (>2 years old) samples. Three data pretreatments (range transformation, column mean centering and range transformation with mean centering) were also examined to determine their impact on the performance of the algorithms. The random forests algorithm, when applied to mean-centred data, gave 100% predictive accuracy when classifying sheep category. This approach could be used for the development of an objective test for determining sheep age and category.

Acetyl-l-carnitine and nucleoside reverse transcriptase inhibitor-associated neuropathy in HIV infection

OBJECTIVES

Antiretroviral toxic neuropathy (ATN) is associated with dideoxynucleoside reverse transcriptase inhibitor use in patients infected with HIV, possibly as a result of mitochondrial toxicity. Acetyl-l-carnitine (ALC) has been linked to symptomatic improvement in ATN. We present an open-label single-arm pilot study to evaluate changes in intra-epidermal nerve fibre (IENF) density and mitochondrial DNA (mtDNA) copies/cell among subjects treated with 3000 mg ALC daily.

METHODS

Punch skin biopsies were examined at baseline and after 24 weeks of therapy. Participants reported neuropathic symptoms using the Gracely Pain Intensity Score. Neurological examinations were completed.

RESULTS

Twenty-one subjects completed the study. ALC was generally well tolerated. The IENF density did not change in cases completing 24 weeks of ALC therapy, with median (90% confidence interval) IENF changes of -1.70 (-3.50, infinity) (P=0.98) and 2.15 (-0.10, infinity) (P=0.11) for the distal leg and proximal thigh, respectively. Fat mtDNA copies/cell did not change with therapy. Improvements in neuropathic pain (P<0.01), paresthesias (P=0.01), and symptoms of numbness (P<0.01) were noted. Similarly, improvement was noted on the Gracely Pain Intensity Score.

CONCLUSIONS

ALC therapy coincided with improvements in subjective measures of pain in this open-label single-arm study. However, changes were not observed in objective measures of IENF density or mtDNA levels, providing little objective support for use of ALC in this setting.

Characterisation of experimental infections of domestic pigs with genotype 2.1 and 3.3 isolates of classical swine fever virus

The early identification of classical swine fever epizootics is hampered by difficulties in recognising early signs of infection, due to a lack of specific clinical signs. In addition many textbook descriptions of CSF are based on observations of disease caused by historic, mainly genotype 1, strains. Our objective was to improve our knowledge of the diverse range of signs that different CSFV strains can cause by characterising the experimental infection of domestic pigs with both a recent strain of CSFV and a divergent strain. Conventional pigs were inoculated with a genotype 2.1 isolate, that caused an outbreak in the UK in 2000, and a genotype 3.3 strain that is genetically divergent from European strains. This latter strain is also antigenically distinct as it is only poorly recognised by the CSFV-specific monoclonal antibody, WH303. Transmission was monitored by use of in-contact animals. Clinical, virological and haematological parameters were observed and an extended macro- and histopathological scoring system allowed detailed characterisation of pathological lesions. Infection with the genotype 2.1 isolate resulted in a similar outcome to other recent genotype 2 European strains, whereas the genotype 3.3 strain produced fewer and delayed clinical signs, notably with little fever. This strain would therefore be particularly difficult to detect in the early stages of infection and highlights the importance of encouraging early submission of samples for laboratory diagnosis. As representatives of recent and divergent CSFV isolates, these strains are good candidates to study the pathogenesis of current CSFV isolates and as challenge models for vaccine development.

Reactive uptake of ozone by chlorophyll at aqueous surfaces

We report the results of two complementary studies of the heterogeneous reaction between gas-phase ozone and aqueous chlorophyll. In the first experiment, the chlorophyll is present at the air-water interface and its concentration is measured as a function of time, using laser-induced fluorescence, to obtain the surface kinetics. Under most experimental conditions, these are well described using a Langmuir-Hinshelwood formalism. The second experiment was carried out in a wetted-wall flowtube apparatus and measured the uptake coefficient of ozone by the chlorophyll solution. The uptake coefficient decreases with increasing ozone concentration, consistent with the surface mechanism found in the fluorescence experiment. The two experiments agree that the uptake coefficient for ozone by such chlorophyll samples is approximately 2-5 x 10(-6) with unpolluted boundary layer ozone concentrations. At low wind speed, the reaction between ozone and chlorophyll at the sea surface may represent the driving force for ozone deposition at the ocean surface, significantly increasing its deposition velocity there.

Direct Experimental Evidence for a Heterogeneous Reaction of Ozone with Bromide at the Air−Aqueous Interface

Recent experimental and theoretical evidence has indicated an enhancement of the heavier halide ions at the air-aqueous interface, relative to their bulk concentrations. This, along with an order of magnitude discrepancy between measured and predicted Br2 production in the reaction of ozone with deliquesced NaBr aerosol, has led to the suggestion that an interface reaction occurs between ozone and bromide. We have used harmine, a beta-carboline alkaloid, as an interface-sensitive fluorescent pH probe in order to measure pH changes associated with the interfacial reaction of ozone and bromide. The rate of pH change depends upon the bulk bromide concentration in a way which is well described by a Langmuir-Hinshelwood kinetic model. In the presence of octanol at the interface, the rate of pH change tracks the octanol adsorption isotherm, as expected if octanol enhances the concentration of ozone at the surface.

Photochemical loss of nitric acid on organic films: a possible recycling mechanism for NO(x)

The films coating urban impervious surfaces have been found to be comprised of about 7% inorganic nitrate and approximately 10% organic compounds (by mass). A simple steady-state analysis of the lifetime of the nitrate in the film suggests the existence of a loss process(es) in addition to washout by rainfall. We show here that gas-phase nitric acid can be taken up in organic films and lower the film pH. Photolysis of nitrated films using actinic illumination causes loss both of protons and of nitrate anion. We argue that this is possibly due to a combination of direct and indirect (photosensitized) photochemistry involving nitrate ions, yielding gas-phase HONO and/or NO2.

Suppression of aqueous surface hydrolysis by monolayers of short chain organic amphiphiles

Aqueous aerosols and other water surfaces in the environment may be coated with organic films, which can give rise to significant effects on gas-solution transport and surface reactivity. We have used acridine as a molecular fluorescent pH probe to examine the hydration of nitric acid and ammonia at both the uncoated and the organic-coated air-water interface. For uncoated samples, a transient decrease in pH is observed at the interface upon introduction of nitric acid vapour, followed by a relaxation to a final pH which is lower than the initial value. This long-time final change in pH is also measured in bulk pH measurements. Solutions having monolayer and sub-monolayer films of 1-octanol do not display the transient, but do show the same long-time change in pH. The degree of suppression of the surface pH transient depends directly on the amount of octanol present at the surface. Hydrolysis of ammonia at the water surface is also indicated by a surface pH transient which is also suppressed when a monolayer of octanol is present at the surface. Monolayers of butanol and of uncompressed stearic acid at the surface show little difference from the clean interface. The results are related to the concentration of available water at the interface.

Influence of colostrum deprivation and concurrent Cryptosporidium parvum infection on the colonization and persistence of Escherichia coli O157 : H7 in young lambs

Escherichia coliO157 : H7 andCryptosporidium parvuminfections of man have been associated with direct contact with small ruminants. Colostrum protects neonates against gastrointestinal pathogens, and orphan lambs, which are common on petting farms, may be deprived of this protection. In a recent study, it was demonstrated that high shedding ofE. coliO157 : H7 by an 8-week-old goat kid was associated with coincidentalC. parvuminfection. Furthermore, both pathogens were co-located in the distal gastrointestinal tract. It was hypothesized that colostrum deprivation and pre-infection withC. parvumpredisposed young ruminants to colonization and increased shedding ofE. coliO157 : H7. To test this, 21 lambs 5 weeks of age were divided into four groups as follows: (A) colostrum-deprived and inoculated withE. coliO157 : H7, (B) colostrum-deprived and inoculated withC. parvumand thenE. coliO157 : H7, (C) conventionally reared and inoculated withE. coliO157 : H7, (D) conventionally reared and inoculated withC. parvumand thenE. coliO157 : H7.C. parvumwas detected between 8 and 12 days post-inoculation in most of the infected lambs. At 24 h post-inoculation withE. coliO157 : H7, all lambs were shedding between 5×104and 5×107 c.f.u.E. coliO157 : H7 per gram of faeces.E. coliO157 : H7 was shed in higher numbers in the groups pre-inoculated withC. parvum, whether conventionally reared or colostrum-deprived. Interestingly, for the colostrum-deprived lambs on day 3, a significant difference in shedding ofE. coliO157 : H7 was observed (P=0.038), with the lambs inoculated withE. colialone yielding higher counts than those pre-inoculated withC. parvum. From day 15 onwards, shedding ofE. coliO157 : H7 was highest from the colostrum-deprivedC. parvum-infected lambs, then (in descending order of shedding) the colostrum-deprived lambs, the conventionally reared lambs infected withC. parvum, and the conventionally reared animals. In total, four animals were euthanized, two at 24 h and two at 96 h post inoculation withE. coliO157 : H7 (two conventionally reared and two colostrum-deprived). All animals euthanized were from groups pre-inoculated withC. parvumprior to challenge withE. coliO157 : H7. On examination of tissues, in three of the four animals examined, multifocal attaching and effacing lesions were observed in the caecum, colon, rectum and at the recto-anal junction, and were confirmed by immunohistochemistry to be associated withE. coliO157 : H7.

Anti-sulfatide antibodies in HIV-infected individuals with sensory neuropathy

We used ELISA to estimate the prevalence of anti-sulfatide antibodies in HIV-infected individuals with distal sensory neuropathy (DSP) and compared the results with the prevalence in HIV-infected individuals without DSP and in individuals with neuropathy who are not infected with HIV. We found that 36% of HIV+/DSP+ individuals had immunoglobulin (Ig) G anti-sulfatide antibody titers greater than 1,500, whereas IgG anti-sulfatide antibodies were rarely found in HIV+/DSP- or HIV-/DSP+ patients.

Colonization of 8-week-old conventionally reared goats by Escherichia coli O157 : H7 after oral inoculation

Enterohaemorrhagic Escherichia coli O157 : H7 infections of man have been associated with consumption of unpasteurized goat's milk and direct contact with kid goats on petting farms, yet little is known about colonization of goats with this organism. To assess the contribution of flagella and intimin of E. coli O157 : H7 in colonization of the goat, 8-week-old conventionally reared goats were inoculated orally in separate experiments with 1×1010 c.f.u. of a non-verotoxigenic strain of E. coli O157 : H7 (strain NCTC 12900 Nalr), an aflagellate derivative (DMB1) and an intimin-deficient derivative (DMB2). At 24 h after inoculation, the three E. coli O157 : H7 strains were shed at approximately 5×104 c.f.u. (g faeces)−1 from all animals. Significantly fewer intimin-deficient bacteria were shed only on days 2 (P = 0.003) and 4 (P = 0.014), whereas from day 7 to 29 there were no differences. Tissues from three animals inoculated with wild-type E. coli O157 : H7 strain NCTC 12900 Nalr were sampled at 24, 48 and 96 h after inoculation and the organism was cultured from the large intestine of all three animals and from the duodenum and ileum of the animal examined at 96 h. Tissues were examined histologically but attaching-effacing (AE) lesions were not observed at any intestinal site of the animals examined at 24 or 48 h. However, the animal examined at 96 h, which had uniquely shed approximately 1×107 E. coli O157 : H7 (g faeces)−1 for the preceding 3 days, showed a heavy, diffuse infection with cryptosporidia and abundant, multifocal AE lesions in the distal colon, rectum and at the recto-anal junction. These AE lesions were confirmed by immunohistochemistry to be associated with E. coli O157 : H7.

Modulation of the bovine delayed-type hypersensitivity responses to defined mycobacterial antigens by a synthetic bacterial lipopeptide

The use of defined protein and peptide antigens can overcome specificity limitations of purified protein derivatives in the detection of bovine tuberculosis when the antigens are used in blood-based tests. Since the use of these specific antigens as skin test reagents could have practical advantages, we investigated the potential of Mycobacterium bovis-specific antigens to stimulate delayed-type hypersensitivity (DTH) responses in cattle experimentally infected with M. bovis. A cocktail of the recombinant antigens ESAT-6, MPB83, and MPB64 failed to stimulate in vivo DTH in cattle that had been experimentally infected with M. bovis despite the fact that the antigens were recognized in vitro by the same animals. However, it was possible to stimulate antigen-specific bovine DTH responses by using ESAT-6 in combination with a synthetic bacterial lipopeptide. This lipopeptide stimulated the release of the proinflammatory cytokine tumor necrosis factor alpha from monocyte-derived bovine dendritic cells in vitro, thereby providing a possible mechanism for its DTH-enhancing properties.

Lamotrigine for HIV-associated painful sensory neuropathies: a placebo-controlled trial

OBJECTIVE

To evaluate the efficacy and tolerability of lamotrigine (LTG) for the treatment of pain in HIV-associated sensory neuropathies.

METHODS

In a randomized, double-blind study, patients with HIV-associated distal sensory polyneuropathy (DSP) received LTG or placebo during a 7-week dose escalation phase followed by a 4-week maintenance phase. Randomization was stratified according to whether or not patients were currently using neurotoxic antiretroviral therapy (ART).

RESULTS

The number of patients randomized was 92 (62 LTG, 30 placebo) in the stratum receiving neurotoxic ART and 135 (88 LTG, 47 placebo) in the stratum not receiving neurotoxic ART. Mean change from baseline in Gracely Pain Scale score for average pain was not different between LTG and placebo at the end of the maintenance phase in either stratum, but the slope of the change in Gracely Pain Scale score for average pain reflected greater improvement with LTG than with placebo in the stratum receiving neurotoxic ART (p = 0.004), as did the mean change from baseline scores on the Visual Analogue Scale for Pain Intensity and the McGill Pain Assessment Scale and patient and clinician ratings of global impression of change in pain (p </= 0.02). The incidence of adverse events, including rash, was similar between LTG and placebo.

CONCLUSIONS

Lamotrigine was well-tolerated and effective for HIV-associated neuropathic pain in patients receiving neurotoxic antiretroviral therapy. Additional research is warranted to understand the differing response among patients receiving neurotoxic antiretroviral therapy compared with those not receiving neurotoxic antiretroviral therapy.

DNA injection in combination with electroporation: a novel method for vaccination of farmed ruminants

Injection of plasmid DNA encoding antigens into rodents followed by electroporation improved the immune response when compared with injection without electroporation (Widera et al. J Immunol 2000;164:4635-40; Zucchelli et al. J Virol 2000;74:11598-607; Kadowaki et al. Vaccine 2000;18:2779-88). The present study describes the extension of this technology to farm animals, by injecting plasmid DNA encoding mycobacterial antigens (MPB70, Ag85B and Hsp65) into the muscles of goats and cattle using two different types of electrodes, both allowing DNA delivery at the site of electroporation. The animals were vaccinated under local anaesthesia without any observed immediate or long-term distress or discomfort, or any behavioural signs of muscle damage or pathological changes after the electroporation. DNA-injected and electroporated goats showed increased humoral response after the primary vaccination when compared with nonelectroporated animals. Improved T-cell responses following electroporation were observed in hsp65 DNA-vaccinated cattle. DNA injection with or without electroporation did not compromise the specificity of the tuberculin skin test. In conclusion, a protocol applying in vivo electroporation free of side effects to farmed ruminants was established. In addition, we show that DNA vaccination in combination with electroporation can improve the primary immune responses to the encoded antigens.

HIV-1 reverse transcriptase sequence in plasma and cerebrospinal fluid of patients with AIDS dementia complex treated with Abacavir

OBJECTIVE

To assess HIV-1 RNA levels and the relationship between HIV-1 reverse transcriptase (RT) genotype from plasma and cerebrospinal fluid (CSF) during treatment with abacavir (Ziagen, ABC) or placebo in combination with stable background therapy (SBG) in subjects with AIDS dementia complex (ADC) (study CNA3001).

DESIGN

One-hundred and five HIV-1 infected adults with ADC were randomized to receive either ABC (600 mg twice daily) or ABC-matched placebo (twice daily) in addition to SBG for 12 weeks.

METHODS

Plasma and CSF were collected for population sequencing at baseline and week 12 (CSF optional). Sequences were analyzed for mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI).

RESULTS

Sixty out of sixty-seven subjects with baseline plasma HIV-RT sequence data harbored virus with > or = 1 NRTI-associated mutations; 50 out of 67 had the M184V mutation. At week 12, more subjects in the ABC group had plasma HIV-1 RNA < or = 400 copies/ml than the SBG group (46% versus 13%, P = 0.002). Non-response to ABC was associated with multiple baseline zidovudine (ZDV)/stavudine (d4T)-associated mutations. Baseline RT mutation patterns differed in 14 out of 21 (67%) paired samples from plasma and CSF. Four subjects experienced > 1 log10 copies/ml reductions in CSF HIV-1 RNA, two in the absence of reductions in plasma HIV-1 RNA and two with undetectable plasma HIV-1 RNA at baseline.

CONCLUSIONS

Substantial decreases in plasma and CSF HIV-1 RNA following addition of ABC were not precluded by baseline HIV-1 NRTI-associated mutations, including the M184V mutation, but non-responders commonly harbored multiple ZDV/d4T-associated mutations. HIV-1 RNA responses and RT genotype appear to be discordant between CSF and plasma in some subjects.

Effective DNA vaccination of cattle with the mycobacterial antigens MPB83 and MPB70 does not compromise the specificity of the comparative intradermal tuberculin skin test

The current tuberculin test and slaughter strategy for the control of bovine tuberculosis in cattle has failed to prevent a sharp rise in cases over recent years, especially in the south-west of England. A recent scientific review has concluded that the development of a cattle vaccine holds the best prospect for tuberculosis control in British herds. In order to continue with test and slaughter-based control strategies, the development of TB vaccines that do not compromise the specificity of the tuberculin skin test are required. This report describes results of cattle vaccination experiments with TB DNA vaccines expressing the mycobacterial antigens MPB70, MPB83, and Ag85A and constitutes the first published vaccination study with DNA vaccines undertaken in a target host species. All calves vaccinated with the MPB83 expressing plasmid demonstrated potent cellular immune responses, characterised by CD4(+) T cells producing interferon-gamma as well as humoral immunity characterised by IgG1 biased specific antibodies. Vaccination with MPB70 was less effective with immune responses only observed in half of the vaccinated animals, while vaccination with Ag85A did not result in vaccine-induced immune responses. Intramuscular vaccination was found to stimulate stronger cellular responses than intradermal immunisation. Significantly, the specificity of tuberculin skin testing was not compromised by DNA vaccination since none of the vaccinated calves showed positive skin test reactivity.

Group interventions for anger in people with intellectual disabilities

This paper describes an evaluation of a group intervention for reducing inappropriately expressed anger (as aggression) in people with intellectual disabilities. Group intervention was compared to a treatment as usual group consisting of people referred to the group but who had to wait to participate. The intervention used was based on the work of Novaco (1976; 1978) and Benson (1994). However, further modifications to the group that emphasized the contextual perspective of anger, such as the participants being accompanied by a support worker and more collaborative recording procedures, were devised. A reduction in expressed anger and measured levels of depression occurred after group treatment. Reductions in expressed anger were maintained at 6 and 12 months follow up. However, scores on the depression scale tended to increase on follow up. While caution must be expressed when considering these results, this type of intervention shows promise for reducing inappropriately expressed anger in people with intellectual disabilities Suggestions are made for future research and clinical practice.

Psychosexual awareness in everyday nursing

Using real life examples, this article shows how nurses, midwives and other professional carers can help patients to communicate about the way sexual feelings are affected by illness, childbirth and hospitalisation. Nurses need to special knowledge, the author argues, but need to develop confidence in their own ability to listen and respond.

Failure of cytarabine in progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection. AIDS Clinical Trials Group 243 Team

BACKGROUND

Progressive multifocal leukoencephalopathy affects about 4 percent of patients with the acquired immunodeficiency syndrome (AIDS), and survival after the diagnosis of leukoencephalopathy averages only about three months. There have been anecdotal reports of improvement but no controlled trials of therapy with antiretroviral treatment plus intravenous or intrathecal cytarabine.

METHODS

In this multicenter trial, 57 patients with human immunodeficiency virus (HIV) infection and biopsy-confirmed progressive multifocal leukoencephalopathy were randomly assigned to receive one of three treatments: antiretroviral therapy alone, antiretroviral therapy plus intravenous cytarabine, or antiretroviral therapy plus intrathecal cytarabine. After a lead-in period of 1 to 2 weeks, active treatment was given for 24 weeks. For most patients, antiretroviral therapy consisted of zidovudine plus either didanosine or stavudine.

RESULTS

At the time of the last analysis, 14 patients in each treatment group had died, and there were no significant differences in survival among the three groups (P=0.85 by the log-rank test). The median survival times (11, 8, and 15 weeks, respectively) were similar to those in previous studies. Only seven patients completed the 24 weeks of treatment. Anemia and thrombocytopenia were more frequent in patients who received antiretroviral therapy in combination with intravenous cytarabine than in the other groups.

CONCLUSIONS

Cytarabine administered either intravenously or intrathecally does not improve the prognosis of HIV-infected patients with progressive multifocal leukoencephalopathy who are treated with the antiretroviral agents we used, nor does high-dose antiretroviral therapy alone appear to improve survival over that reported in untreated patients.

Cerebellar degeneration associated with human immunodeficiency virus infection

Cerebellar disorders associated with HIV infection are typically the result of discrete cerebellar lesions resulting from opportunistic infections such as toxoplasmosis and progressive multifocal leukoencephalopathy or primary CNS lymphoma. Clinical symptoms and pathologic abnormalities related to the cerebellum may also be observed with HIV dementia. A primary cerebellar degeneration with HIV has not previously been reported. Ten patients were identified over an 8-year period at five medical centers. All patients had clinical, laboratory, and radiologic evaluations, and three had neuropathologic examinations. Patients presented with progressively unsteady gait, slurred speech, and limb clumsiness. Examination revealed gait ataxia, impaired limb coordination, dysarthria, and abnormal eye movements. Cognition, strength, and sensory function remained normal. CD4 lymphocyte counts varied between 10 and 437 cells/mm3. Neuroimaging studies showed prominent cerebellar atrophy. Neuropathology showed focal degeneration of the cerebellar granular cell layer and unusual focal axonal swellings in the brainstem and spinal cord. Cultures, histopathology, and immunochemical studies showed no conclusive evidence of infection. We report a syndrome of unexplained degeneration of the cerebellum occurring in association with HIV infection.

Erythropoietin response in anaemic patients with multiple myeloma and other lymphoid malignancies infiltrating the bone marrow

Immunoreactive erythropoietin levels were measured in 42 patients with lymphoid malignancies with anaemia and bone marrow involvement. Results were compared to a control group of 16 patients suffering from anaemia due to other causes. Significant inverse correlations between serum erythropoietin level and haemoglobin concentration were shown for the patients with lymphoid malignancies and also for the control subjects. Overall, the erythropoietin levels of patients with lymphoid malignancies with bone marrow infiltration and with normal renal function did not differ significantly from erythropoietin levels of the anaemic controls. We conclude that anaemia in patients with lymphoproliferative disorders with bone marrow infiltration and normal renal function is caused primarily by a diminished/inadequate response to erythropoietin at the level of the target cell.

Plasma vitamin E levels in a chronically hemolyzing group of dialysis patients

Plasma vitamin E levels and the ascorbate cyanide test were assessed in 15 chronic hemodialysis (HD) patients (group A) exposed to persistently elevated chloramine levels in the dialysis water. The vitamin E levels in these patients, who had evidence of oxidant induced hemolytic anemia, were compared to 15 chronic HD patients exposed to low chloramine levels (group B) and 17 controls (group C). Vitamin E levels were found to be significantly lower in group A than in either groups B or C (p less than 0.001). Within group A, levels were lower in those patients who had a positive ascorbate cyanide test (p less than 0.05). Upon removal of chloramines from the dialysis water, vitamin E levels in group A were no longer significantly different from those found in groups B or C.

A one-year report on rights violations under Michigan's new protection system

A total of 1034 complaints were received in the first 11 months after the implementation of Michigan's new system to safeguard the rights of recipients of services from state institutions. Twenty-eight per cent of the complaints resolved during that period were substantiated as violations of statutorily protected rights. Both the volume of complaints and the number of substantiated violations were far higher in hospitals for the mentally ill than in facilities for the mentally retarded; however, facilities for the retarded had twice the percentage of substantiated complaints. There were significant differences in the numbers and categories of complaints and substantiated violations both between the two types of institutions and between large and small institutions. The findings sugtest directions for further action by the institutions and by the state office of recipient rights, which was established to oversee the system.