STUDY OBJECTIVE: To describe the reasons for the HIV testing of HIV-positive women and their clinical presentation and to make specific laboratory comparisons between women intravenous drug users (IVDUs) and non-IVDUs who were heterosexually infected (HTs). DESIGN: Consecutive case series. SETTING: Four primary care sites associated with the Brown University AIDS Program. PARTICIPANTS: 140 consecutive HIV-seropositive women. RESULTS: The most common reason for HIV testing in both groups was self-perception of risk. Presenting T-helper lymphocyte counts, leukocyte counts, and hematocrits did not differ significantly between the groups. Intravenous drug users were significantly more likely than HTs to have evidence of hepatitis B virus exposure (p less than 0.0001) and to report the history of a sexually transmitted disease (p = 0.005). Twenty percent of HTs versus 10% of IVDUs were tested only after they had HIV-related symptoms. The most frequent clinical presentation for both groups was Centers for Disease Control Group IV/A constitutional symptoms. CONCLUSIONS: Many HIV-seropositive women do not enter the health care system until they are symptomatic, but those infected heterosexually and those using parenteral drugs have similar laboratory indices at presentation. AIDS education strategies toward all women at risk must include information about manifestations of HIV disease in women, as well as preventive measures, to ensure early access to the health care system.

AIDS Serodiagnosis↗

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Cocaine-associated dissection of the thoracic aorta.

Patients present to emergency departments with a variety of complications related to cocaine abuse. Emergency physicians must be aware of the life- and limb-threatening complications to avoid undue mortality and morbidity. We present the case of a patient with aortic dissection who developed the acute onset of abdominal pain 5 minutes after subcutaneous cocaine use. Four previous reports of cocaine-associated aortic dissection are reported in the literature. These cases and other reports of intra-abdominal vascular injuries related to cocaine use are reviewed. Cocaine's mechanism of action as it relates to aortic dissection and some of the pharmacologic agents available for treatment are discussed.

Acute Disease↗

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Effects of muscarinic and adrenergic agonism on auditory P300 in the macaque.

Homologs of human endogenous evoked potentials are known in several species of nonhuman primates, but the neurotransmitter substrates of these potentials remain uncertain. In particular, the role of central cholinergic and adrenergic systems is not yet clearly defined. We recorded cognitive evoked potentials from the scalp in four adult bonnet macaque monkeys during a passive version of the auditory oddball paradigm with unique novel stimuli under saline control conditions. In two subjects each, cognitive evoked potentials were also recorded following intramuscular administration of the m1 muscarinic agonist AF102B or of the alpha-2A noradrenergic agonist guanfacine. On saline, large positivities resembling the human P300 were recorded over midline sites in response to rare or novel auditory stimuli in all four monkeys. The amplitude of these positivities was sensitive to the delivery of fruit-juice reward in association with rare stimuli in three monkeys tested. At cognition-enhancing doses, AF102B enlarged the amplitude of P300-like positivities in both monkeys tested; guanfacine enlarged the amplitude of P300-like positivities in one of two monkeys tested. These results add to existing evidence of human-like endogenous late positivities in monkeys that are influenced by the cholinergic and adrenergic systems, and suggest a possible role of m1 muscarinic and alpha-2A noradrenergic receptor subtypes.

Acoustic Stimulation↗

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A celebration of cultures in a long-term care facility. A day of cultural awareness may help staff and residents forge stronger relationships through greater understanding.

Cultural interaction is older than the spice route. Groups of people require little encouragement to share "how we do things back home," as well as favorite foods, customs, and beliefs. This interchange is important in decreasing myths and stereotypes that occur between cultures. Identification of differences is an essential as the discovery of how people are alike. The acknowledgement of sameness promotes unity, but recognition of differences promotes cooperative effort. There is enormous strength in cultures working together, supplementing the limitations and talents of each other. This celebration of cultures was our attempt to encourage staff-resident interactions and strengthen relationships among staff, residents, and all departments. Although several years have passed, staff still speak of Cultural Awareness Day as having been a positive force in promoting good relationships. The day provided entertainment and valuable lessons for all.

Aged↗

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The effects of the acetylcholinesterase inhibitor ENA713 and the M1 agonist AF150(S) on apolipoprotein E deficient mice.

Apolipoprotein E (apoE)-deficient and control mice were treated chronically with either the acetylcholinesterase (AChE) inhibitor ENA713, or the M1 muscarinic agonist AF150(S). Both treatments reversed the spatial working memory impairment of apoE-deficient mice but they differed in their effects on the levels of brain AChE activity. AF150(S) enhanced the brain AChE activity of apoE-deficient mice and rendered it similar to that of the untreated controls, whereas ENA713 reduced the brain AChE activity of control mice but had no effect on that of apoE-deficient mice. These findings suggest that AChE inhibition and M1 muscarinic activation have similar beneficial cognitive effects on apoE-deficient mice, but that the cellular and molecular mechanisms underlying these effects differ.

Animals↗

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Novel m1 muscarinic agonists in treatment and delaying the progression of Alzheimer's disease: an unifying hypothesis.

M1 selective agonists from the AF series (e.g. AF102B, AF150(S)), via m1 muscarinic receptors, activate distinct signal transductions, enhance amyloid precursors proteins secretion from transfected cells and primary cell cultures, show neurotrophic effects and are beneficial in a variety of animal models for Alzheimer's disease. Such m1 agonists may be effective in the treatment and therapy of Alzheimer's disease.

Alzheimer Disease↗

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How hospitals cut operating costs by cutting utility, fuel bills and have the utility pay for the savings!

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Electricity↗

PubMedDate not supplied

Oxygen availability during hypothermic cardiopulmonary bypass.

Oxygen availability during cardiopulmonary bypass was assessed in 22 patients under hypothermic and relatively normothermic conditions. The patients were divided into two groups, 17 of whom received ACD blood and 5, CPD blood. The mean P50 for all patients fell from a preoperative value of 25.9 +/- 2.4 (SD) to 15.6 +/- 2.1 during hypothermia confirming a leftward shift of the oxyhemoglobin dissociation curve. Oxygen uptake, calculated from a-v oxygen content differences (avDO2) and flow, was significantly lower during hypothermic bypass (65 +/- 27 ml/min) than during rewarming (121 +/- 41 ml/min). The increase in oxygen affinity during hypothermia was influenced also by changes in acid base and 2,3-DPG concentrations, the changes being similar in both the ACD and CPD groups of patients. During rewarming, however, oxygen availability was increased in the CPD group presumably from significantly increased 2,3-DPG concentrations. A "functional" value of hemoglobin, based upon the effects of the shift of the oxyhemoglobin dissociation curve and, therefore, reflecting the true capacity of hemoglobin to unload oxygen at the tissue level, was calculated. During the hypothermic phase of bypass, this functional hemoglobin was only 4.2 g/100 ml blood, suggesting that, in spite of reduced metabolic demands, oxygenation reserves are minimal.

Adult↗

PubMedDate not supplied

Giant intracranial aneurysms with skull base erosion and extracranial masses: CT and MR findings.

OBJECTIVE: To present the CT and MR findings of three patients with giant intracranial aneurysms (GIAs), each of which eroded the skull base and had an extracranial mass component. A literature review of GIAs was also performed. MATERIALS AND METHODS: In the past year the imaging studies of three patients with these unusual GIAs were collected at our institutions. All three patients had had CT, and one patient had had MR on a 1.5 T GE unit. RESULTS: One patient had a 5 cm GIA in the left petrocavernous region, filling the middle cranial fossa and extending into the left sphenoid sinus and the left posterior ethmoid complex. The aneurysm had heterogeneous high attenuation and extensive rim calcification. The second patient had a 5 cm GIA that filled most of the left middle cranial fossa, eroding the floor and lateral wall and extending into the infratemporal fossa and parapharyngeal space. The aneurysm was partially thrombosed and had minimal rim calcification. The third patient had a 4 cm left cavernous GIA that eroded the floor of the middle cranial fossa and extended into the subjacent parapharyngeal space. The lesion was partially thrombosed and had an enhancing lumen. The rim had low signal intensity on MR. None of these patients had a history of trauma. CONCLUSION: Giant intracranial aneurysms can cause significant skull base erosion and extend into the paranasal sinuses, parapharyngeal space, and infratemporal fossa. The CT and MR findings can lead to an accurate diagnosis.

Aged↗

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The temporalis tendon: CT and MR appearance.

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Cadaver↗

PubMedDate not supplied

Idiopathic scoliosis and the central nervous system: a motor control problem. The Harrington lecture, 1983. Scoliosis Research Society.

An etiologic concept linking an impaired axial motor control system to the structural deformity of idiopathic scoliosis (ISc) is proposed. Postural studies reveal that during quiet stance, adaptation is marked in conditions associated with visual control of sway, particularly of lateral sway; during imposed perturbations of the body, destabilized postural reactions are pronounced in tests requiring visual-vestibular coupling. Observations of visual and/or vestibular generated eye movements indicate ocular instability among a high proportion of the ISc. Previously, the authors argued that a direct relationship exists between visual and/or vestibular functioning and a disordered axial motor system. This was attributed to an aberrant brain stem mechanism. In this presentation, however, we propose that a higher level CNS disturbance may be responsible for reports of EEG abnormalities, visuo-spatial impairment, motor adaptation, and learning deficits. Among the wide range of visual-vestibular variables studied, those representing processing of vestibular signals within the CNS yield the highest degree of correlation with the magnitude of the curve. Moreover, differences in vestibular processing between two subsets of ISc, namely ISc with (70%) and without (30%) normal academic achievement are significant. Variables referable to both vestibular and visual processing correctly classify 87% of the ISc with normal academic achievement and 100% of the ISc with a history of academic problems. The association between learning deficits, altered processing of vestibular information, and ISc suggest a unique syndrome complex, and an important role of cortical structures in the etiology of this disorder. The presence of a visuo-spatial perceptual impairment may be the common feature of ISc. In an attempt to restore perceptual dysfunction (by rearrangement), the ISc adopts a new axial and vestibular motor control strategy based upon recalibration or reinterpretation of proprioceptive signals arising from the axial musculature.

Adaptation, Physiological↗

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A control-free ventilator alarm.

An alarm for use with positive-pressure lung ventilators is described. The device gives audible warning if the pressure in the patient circuit fails either to exceed or to fall below 15 cmH2O within a period of 20 seconds or if the batteries are running low. No external controls are provided and the alarm is activated when a probe connected to the breathing circuit is inserted into the alarm. The probe whistles if incorrectly connected during intermittent positive pressure ventilation. Battery life in clinical practice is longer than 6 months.

Positive-Pressure Respiration↗

PubMedDate not supplied

Creating a culture of patient-focused care through a learner-centered philosophy.

This paper will discuss the teaching-learning process used in the Patient-Focused Care Course at a major teaching hospital in Canada that is transforming nursing practice from a provider driven to a patient-focused approach. The experiential and reflective nature of the course offers opportunities for nurses to link theory with practice, to think critically and reflectively about their own values and beliefs and to translate that meaning into practice. The learning process reflects principles of adult learning based on Knowles andragogical model which differs from the traditional pedagogical model of teaching. The essence of andragogy is a constant unfolding process of discovery based on dialogue. Utilization of adult learning principles that support critical thinking and foster transformational change present an alternative to traditional ways of teaching and learning the art and science of nursing practice.

Adult↗